Frailty and healthcare costs-longitudinal results of a prospective cohort study
Frailty and healthcare costs-longitudinal results of a prospective cohort study
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DOI：
10.1093/ageing/afx157
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发表时间：
2018-03-01
期刊：
影响因子：
6.7
通讯作者：
Koenig, Hans-Helmut
中科院分区：
文献类型：
--
作者：
Hajek, Andre;Bock, Jens-Oliver;Koenig, Hans-Helmut
目的：探讨衰弱和衰弱症状对老年人医疗费用的纵向影响。方法：数据收集自德国萨尔州的一项前瞻性队列研究（两波，间隔3年，n = 1,636，基线年龄为57-84岁）。虚弱是通过五个弗里德虚弱标准来评估的。虚弱被定义为至少有三个标准，存在1-2个标准为“虚弱前期”。根据住院治疗、门诊治疗、专业护理和非正式护理部门的自我报告医疗保健使用情况以及提供药品、医疗用品和牙科假体，对医疗保健费用进行了量化。结果：虽然在调整了包括共病在内的潜在混杂因素后，虚弱前期的发病并没有增加（log）总医疗费用，但从非虚弱到虚弱的进展与总医疗费用的增加有关（例如，如果出现3种症状和4种或5种症状，费用分别增加54%和101%）。在住院部门和非正式护理中，这种虚弱发作与医疗费用增加的关系尤其明显。在虚弱症状中，疲劳的发作与总医疗费用的增加有关，而行动迟缓、虚弱、体重减轻和低体力活动的变化与总医疗费用的增加没有显著相关。结论：我们的数据强调了晚年虚弱的经济相关性。为了降低医疗成本，推迟或减少身体虚弱可能是有益的。
Objective: to investigate how frailty and frailty symptoms affect healthcare costs in older age longitudinally.Methods: data were gathered from a prospective cohort study in Saarland, Germany (two waves with 3-year interval, n = 1,636 aged 57-84 years at baseline). Frailty was assessed by the five Fried frailty criteria. Frailty was defined as having at least three criteria, the presence of 1-2 criteria as 'pre-frail'. Healthcare costs were quantified based on self-reported healthcare use in the sectors of inpatient treatment, outpatient treatment, professional nursing care and informal care as well as the provision of pharmaceuticals, medical supplies and dental prostheses.Results: while the onset of pre-frailty did not increase (log) total healthcare costs after adjusting for potential confounders including comorbidity, progression from non-frailty to frailty was associated with an increase in total healthcare costs (for example, costs increased by similar to 54 and 101% if 3 and 4 or 5 symptoms were present, respectively). This association of frailty onset with increased healthcare costs was in particular observed in the inpatient sector and for informal nursing care. Among the frailty symptoms, the onset of exhaustion was associated with an increase in total healthcare costs, whereas changes in slowness, weakness, weight loss and low-physical activity were not significantly associated with an increase in total healthcare costs.Conclusions: our data stress the economic relevance of frailty in late life. Postponing or reducing frailty might be fruitful in order to reduce healthcare costs.