Functional Impairments, Phenotypic Frailty, and Sector-Specific Incremental Healthcare Costs in Older Adults.

Kristine E Ensrud, John T Schousboe, Allyson M Kats, Brent C Taylor, Wei Duan-Porter, Kerry M Sheets, Cynthia M Boyd, Peggy M Cawthon, Lisa Langsetmo
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Abstract

Background: This study quantifies incremental healthcare expenditures of functional impairments and phenotypic frailty in specific healthcare sectors.

Methods: Pooled 2023 analysis of 4 prospective cohort studies linked with Medicare claims including 4 318 women and 3 847 men attending an index examination (2002-2011). Annualized inpatient, skilled nursing facility (SNF), home healthcare (HHC), and outpatient costs (2023 dollars) ascertained for 36 months following index examination. Functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Weighted multimorbidity index including demographics derived from claims.

Results: Mean age at index examination was 79.2 years. After accounting for multimorbidity and each other, average annualized incremental costs of 3-4 functional impairments versus no impairment in women (men) were $2 838 ($5 516) in inpatient, $1 572 ($1 446) in SNF, and $1 349 ($1 060) in HHC sectors; average incremental costs of phenotypic frailty versus robust in women (men) was $4 100 (not significant for men) in inpatient, $1 579 ($1 254) in SNF, and $645 ($526) in HHC sectors. Incremental inpatient costs were primarily due to a higher hospitalization risk, while incremental SNF and HHC costs were related to both increased risks of utilization and higher costs among individuals with utilization. Neither geriatric domain was associated with outpatient costs.

Conclusions: In this study of community-dwelling beneficiaries, functional impairments were independently associated with higher subsequent expenditures in inpatient, SNF, and HHC sectors among both sexes. Phenotypic frailty was independently associated with higher subsequent inpatient costs in women, and higher SNF and HHC costs in both sexes.

老年人的功能障碍、表型虚弱和特定部门的医疗成本递增。
背景:本研究量化了特定医疗行业中功能障碍和表型虚弱的医疗支出增量:本研究量化了特定医疗保健部门因功能障碍和表型虚弱而增加的医疗保健支出:方法:对与医疗保险理赔相关联的 4 项前瞻性队列研究进行 2023 年汇总分析,其中包括参加指数检查的 4318 名女性和 3847 名男性(2002-2011 年)。确定指标检查后 36 个月内的住院、专业护理机构 (SNF)、家庭保健 (HHC) 和门诊年化费用(2023 年美元)。从队列数据中得出功能障碍(进行 4 项日常生活活动有困难)和虚弱表型(使用 5 个组件进行操作)。加权多病指数包括从索赔中获得的人口统计数据:指标检查时的平均年龄为 79.2 岁。在考虑了多病症和其他因素后,女性(男性)3-4 种功能障碍与无障碍的平均年化增量成本分别为:住院 2838 美元(5516 美元)、SNF 1572 美元(1446 美元)和 HHC 1349 美元(1060 美元);女性(男性)表型虚弱与体格健壮的平均增量成本分别为:住院 4100 美元(男性不显著)、SNF 1579 美元(1254 美元)和 HHC 645 美元(526 美元)。住院病人费用的增加主要是由于住院风险的增加,而非住院医疗机构和 HHC 费用的增加则与使用风险的增加和使用个人费用的增加有关。两个老年医学领域都与门诊费用无关:在这项针对居住在社区的受益人进行的研究中,男女受益人的功能障碍均与住院、社区护理机构和高等保健机构的后续支出较高有关。表型虚弱与女性后续住院费用的增加以及男女性SNF和HHC费用的增加密切相关。
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