Frailty and health services use among Quebec seniors with non-hip fractures: a population-based study using adminsitrative databases
Frailty and health services use among Quebec seniors with non-hip fractures: a population-based study using adminsitrative databases
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DOI：
10.1186/s12913-019-3865-z
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发表时间：
2019-01-25
影响因子：
2.8
通讯作者：
Jean, Sonia
中科院分区：
文献类型：
--
作者：
Fillion, Vanessa;Sirois, Marie-Josee;Jean, Sonia
背景随着世界人口老龄化的加速，年老体弱的人数将会增加。由于体弱多病的老年人有跌倒、住院和残疾的危险，他们将需要更多的保健和服务。使用健康管理数据库评估虚弱患病率，检查虚弱与医疗服务使用之间的关系，并测量社区居住老年人在非髋部骨折后过度使用医疗服务的情况。方法从魁北克慢性疾病综合监测系统中建立了一项基于人群的队列研究，包括65岁的男性和女性，在骨折前一年未住院。虚弱程度采用长者风险评估（ERA）指数进行测量。在调整协变量时，使用多元广义估计方程模型来检验脆弱水平与卫生服务之间的关系。还估计了急诊部（ED）和初级保健医生（PCP）以及住院人数的过剩。结果纳入178304例骨折病例。体弱多病老年人占13.6%，体弱多病老年人占5.2%。在骨折后的一年中，体弱多病的老年人ED就诊、PCP就诊和住院的风险明显高于非体弱多病的老年人：ED就诊的调整相对风险(RR)=2.69 [95% CI: 2.50-2.90]， PCP就诊的调整相对风险(RR)= 1.28 [95% CI: 1.23-1.32]，住院的调整相对风险(RR)= 2.34 [95% CI: 2.14-2.55]。结论本研究结果表明，利用卫生管理数据库可以在人口水平上表征老年人的虚弱状态。此外，本研究表明，非机构体弱老年人在意外骨折后需要更多的卫生服务。老年人体弱多病筛查应成为临床管理的一部分，以便确定那些需要保健服务的风险较高的人。
BackgroundThe number of frail elderly will increase as the world population ageing accelerates. Since frail elders are at risk of falls, hospitalizations and disabilities, they will require more health care and services. To assess frailty prevalence using health administrative databases, to examine the association between frailty and the use of medical services and to measure the excess use of health services following a non-hip fracture across frailty levels among community-dwelling seniors.MethodsA population-based cohort study was built from the Quebec Integrated Chronic Disease Surveillance System, including men and women 65years old, non-institutionalized in the pre-fracture year. Frailty was measured using the Elders Risk Assessment (ERA) index. Multivariate Generalized Estimating Equation models were used to examine the relationship between frailty levels and health services while adjusting for covariates. The excess numbers of visits to Emergency Departments (ED) and to Primary Care Practitioners (PCP) as well as hospitalizations were also estimated.ResultsThe cohort included 178,304 fractures. There were 13.6 and 5.2% frail and robust seniors, respectively. In the post-fracture year, the risks of ED visits, PCP visits and hospitalizations, were significantly higher in frail vs. non-frail seniors: adjusted relative risk (RR)=2.69 [95% CI: 2.50-2.90] for ED visits, RR=1.28 [95% CI: 1.23-1.32] for PCP visits and RR=2.34 [95% CI: 2.14-2.55] for hospitalizations.ConclusionOur results suggest that it is possible to characterize seniors' frailty status at a population level using health administrative databases. Furthermore, this study shows that non-institutionalized frail seniors require more health services after an incident fracture. Screening for frailty in seniors should be part of clinical management in order to identify those at a higher risk of needing health services.