Association between intrinsic capacities limitations and annual healthcare costs in Nursing Home residents.

Abstract

Background: The aim of this study is to analyse the associations of annual Intrinsic Capacities (IC) impairment evolution with the annual cost of care in Nursing Home (NH) residents. This was a prospective, longitudinal and multicenter study. NH residents in the Occitanie region (south of France), 60 years and older with moderate level of dependency were included in the study and were followed during 12 months.

Methods: IC was assessed for four of the six IC domains (Cognitive, locomotion, vitality and psychological). Longitudinal IC impairment trajectories of residents were built using the K-means Longitudinal method. Costs were assessed from the healthcare payer's perspective and include direct medical and non-medical costs. Descriptive analyses of costs and characteristics as well as general linear models were carried out.

Results: Three hundred forty-five residents (86 years old on average and mostly women) were included. Mild, moderate and severe impairment profiles were clustered. For the cognitive domain, we observe a total cost decrease of 1552€ between the most severe impairment profile and the less severe profile, led by medication costs. For the locomotion, psychological and vitality domains we observed a total cost increase of 1,672€, 3,869 € and 1,709€ for the most severe impairment profile in comparison with the less severe profile, respectively. This cost increase was driven by hospitalisation for the psychological and the vitality domains and by physiotherapist costs for the locomotion domain. Medication costs decrease with the severity of impairment whatever the IC domain considered.

Conclusions: Our study is the first aiming to estimate the association between impairment on IC domains and healthcare costs in NH. The implementation of clusterization highlight resident's profiles using data driven process, which may facilitate the implementation of personalized health strategies.