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Self-Reported Frailty and Health Care Utilization in Community-Dwelling Middle-Aged and Older Adults in the United States

Published:December 27, 2022DOI:https://doi.org/10.1016/j.jamda.2022.12.007
      Frailty, a dynamic state, is a consequence of cumulative deficits in multiple physiological systems accompanied by an increased vulnerability to stressor events.
      • Hoogendijk E.O.
      • Afilalo J.
      • Ensrud K.E.
      • Kowal P.
      • Onder G.
      • Fried L.P.
      Frailty: implications for clinical practice and public health.
      The aging of the population has increased the prevalence of frailty substantially, especially among the costliest patients
      • Kojima G.
      Increased healthcare costs associated with frailty among community-dwelling older people: a systematic review and meta-analysis.
      ; however, the current health care response to frailty is mainly reactive and acute care–based. Some have proposed primary care approaches to frailty management in community settings.
      • Turner G.
      • Clegg A.
      British Geriatrics Society, Age UK, Royal College of General Practioners
      Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report.
      Although frailty occurs more often in the older population, it can occur at any time in a person’s life.
      • Hoogendijk E.O.
      • Afilalo J.
      • Ensrud K.E.
      • Kowal P.
      • Onder G.
      • Fried L.P.
      Frailty: implications for clinical practice and public health.
      Thus, identifying frailty earlier is advantageous for its reversal or control. However, previous studies on frailty have mainly been conducted in people 65 years and older. It is well known that frailty in older adults is independently associated with health care burden across acute and post-acute care, and outpatient sectors.
      • Ensrud K.E.
      • Kats A.M.
      • Schousboe J.T.
      • et al.
      Frailty phenotype and healthcare costs and utilization in older women.
      There is a knowledge gap in understanding the association between frailty and health care utilization in community-dwelling middle-aged adults. With a few exceptions,
      • Bandeen-Roche K.
      • Seplaki C.L.
      • Huang J.
      • et al.
      Frailty in older adults: a nationally representative profile in the United States.
      ,
      • Kurnat-Thoma E.L.
      • Murray M.T.
      • Juneau P.
      Frailty and determinants of health among older adults in the United States 2011-2016.
      most prior studies of frailty used nonrepresentative samples. With a nationally representative sample, we describe the prevalence of frailty in the United States and evaluate the associations between frailty and health care utilization in community-dwelling middle-aged and older adults. These results are discussed to inform policymaking and quality improvements in primary care settings.
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