Abstract
Objectives
Frailty, a multidimensional syndrome characterized by vulnerability to stressors,
is an emerging public health priority with high prevalence in older adults. Frailty
has been identified to predictive negative health outcomes, yet quantified evidence
regarding its effect on health care systems is scarce. This study examines how frailty
affects health care utilization, and explores whether these associations varied by
gender.
Design
Cohort study with a 2-year follow-up.
Setting
and Participants: Data were derived from 2 waves (2011 and 2013) of the China Health
and Retirement Longitudinal Study, and 3119 community-dwelling participants aged ≥60 years
were analyzed.
Methods
Frailty was assessed by a validated frailty phenotype scale, and measures for health
care utilization were self-reported. Panel data approach of mixed-effects regression
models was used to examine the associations.
Results
Longitudinal results demonstrated that compared with robustness, prefrailty and frailty
were both significantly associated with increased likelihood of outpatient visit,
inpatient visit, and inpatient length of stay, even after adjusting for multimorbidity
in multivariate analyses (all P < .05). Every 1-component increase in frailty was also found to significantly increase
the risk for health care utilization [any outpatient visit: adjusted odds ratio (OR)
1.30, 95% confidence interval (CI) 1.14–1.48; number of outpatient visits: adjusted
incident rate ratio (IRR) 1.34, 95% CI 1.18–1.53; any inpatient visit: adjusted OR
1.44, 95% CI 1.22–1.71; number of inpatient visits: adjusted IRR 1.40, 95% CI 1.20–1.62;
inpatient length of stay: adjusted IRR 1.50, 95% CI 1.18–1.92]. The preceding associations
were similarly observed irrespective of gender.
Conclusions and Implications
Frailty is a significant predictor for increased health care utilization among community-dwelling
older adults. These findings have important implications for routine clinical practice
and public health investment. Early screening and intervention for potentially modifiable
frailty could translate into considerable savings for households and health care systems.
Keywords
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Article info
Publication history
Published online: March 01, 2021
Footnotes
The authors declare no conflicts of interest.
This work was supported by the Natural Science Foundation of China (NSFC 71704192), the Fundamental Research Funds for the Central Universities (2242020R40105, 2242020R10007), and the Zhishan Youth Scholar Program of Southeast University (2019–2021). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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