Volume 66, Issue 7 p. 1276-1283
Clinical Investigation

Frailty Phenotype and Healthcare Costs and Utilization in Older Women

Kristine E. Ensrud MD, MPH

Corresponding Author

Kristine E. Ensrud MD, MPH

Department of Medicine, University of Minnesota, Minneapolis, Minnesota

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota

Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota

Address correspondence to Kristine E. Ensrud, MD, MPH, One Veterans Drive (111–0), Minneapolis, MN 55417. E-mail: [email protected]Search for more papers by this author
Allyson M. Kats MS

Allyson M. Kats MS

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota

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John T. Schousboe MD, PhD

John T. Schousboe MD, PhD

HealthPartners Institute, Bloomington, Minnesota

Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota

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Brent C. Taylor PhD, MPH

Brent C. Taylor PhD, MPH

Department of Medicine, University of Minnesota, Minneapolis, Minnesota

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota

Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota

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Peggy M. Cawthon PhD

Peggy M. Cawthon PhD

California Pacific Medical Center Research Institute, San Francisco, California

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California

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Teresa A. Hillier MD, MS

Teresa A. Hillier MD, MS

Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon

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Kristine Yaffe MD

Kristine Yaffe MD

Department of Psychiatry, University of California, San Francisco, San Francisco, California

Department of Neurology, University of California, San Francisco, San Francisco, California

Department of Epidemiology, University of California, San Francisco, San Francisco, California

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Steve R. Cummings MD

Steve R. Cummings MD

California Pacific Medical Center Research Institute, San Francisco, California

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Jane A. Cauley DrPH

Jane A. Cauley DrPH

Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania

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Lisa Langsetmo PhD

Lisa Langsetmo PhD

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota

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for the Study of Osteoporotic Fractures

Study of Osteoporotic Fractures

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First published: 23 April 2018
Citations: 70

Abstract

Objectives

To determine the association of the frailty phenotype with subsequent healthcare costs and utilization.

Design

Prospective cohort study (Study of Osteoporotic Fractures (SOF)).

Setting

Four U.S. sites.

Participants

Community-dwelling women (mean age 80.2) participating in SOF Year 10 (Y10) examination linked with their Medicare claims data (N=2,150).

Measurements

At Y10, frailty phenotype defined using criteria similar to those used in the Cardiovascular Health Study frailty phenotype and categorized as robust, intermediate stage, or frail. Participant multimorbidity burden ascertained using claims data. Functional limitations assessed by asking about difficulty performing instrumental activities of daily living. Total direct healthcare costs and utilization ascertained during 12 months after Y10.

Results

Mean total annualized cost±standard deviation (2014 dollars) was $3,781±6,920 for robust women, $6,632±12,452 for intermediate stage women, and $10,755 ± 16,589 for frail women. After adjustment for age, site, multimorbidity burden, and cognition, frail women had greater mean total (cost ratio (CR)=1.91, 95% confidence interval (CI)=1.59–2.31) and outpatient (CR=1.55, 95% CI=1.36–1.78) costs than robust women and greater odds of hospitalization (odds ratio (OR)=2.05, 95% CI=1.47–2.87) and a skilled nursing facility stay (OR=3.85, 95% CI=1.88–7.88). There were smaller but significant effects of the intermediate stage category on these outcomes. Individual frailty components (shrinking, poor energy, slowness, low physical activity) were also each associated with higher total costs. Functional limitations partially mediated the association between the frailty phenotype and total costs (CR further adjusted for self-reported limitations=1.32, 95% CI=1.07–1.63 for frail vs robust; CR=1.35, 95% CI=1.18–1.55 for intermediate stage vs robust women).

Conclusion

Intermediate stage and frail older community-dwelling women had higher subsequent total healthcare costs and utilization after accounting for multimorbidity and functional limitations. Frailty phenotype assessment may improve identification of older adults likely to require costly, extensive care.