Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea
Abstract Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortali...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-12-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-48403-y |
| _version_ | 1797415234507374592 |
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| author | Fatima Nari Eun-Cheol Park Chung- Mo Nam Sung-In Jang |
| author_facet | Fatima Nari Eun-Cheol Park Chung- Mo Nam Sung-In Jang |
| author_sort | Fatima Nari |
| collection | DOAJ |
| description | Abstract Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008–2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37–1.69) and severe risk group (HR: 3.10, 95% CI: 2.55–3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0–35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults. |
| first_indexed | 2024-03-09T05:44:52Z |
| format | Article |
| id | doaj.art-2e5712a28efc4e68af83ba547dd1c0fa |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-09T05:44:52Z |
| publishDate | 2023-12-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-2e5712a28efc4e68af83ba547dd1c0fa2023-12-03T12:21:37ZengNature PortfolioScientific Reports2045-23222023-12-0113111010.1038/s41598-023-48403-yImpact of frailty on mortality and healthcare costs and utilization among older adults in South KoreaFatima Nari0Eun-Cheol Park1Chung- Mo Nam2Sung-In Jang3National Cancer Control Institute, National Cancer CenterInstitute of Health Services Research, Yonsei UniversityDepartment of Preventive Medicine, Yonsei University College of MedicineInstitute of Health Services Research, Yonsei UniversityAbstract Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008–2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37–1.69) and severe risk group (HR: 3.10, 95% CI: 2.55–3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0–35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults.https://doi.org/10.1038/s41598-023-48403-y |
| spellingShingle | Fatima Nari Eun-Cheol Park Chung- Mo Nam Sung-In Jang Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea Scientific Reports |
| title | Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea |
| title_full | Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea |
| title_fullStr | Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea |
| title_full_unstemmed | Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea |
| title_short | Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea |
| title_sort | impact of frailty on mortality and healthcare costs and utilization among older adults in south korea |
| url | https://doi.org/10.1038/s41598-023-48403-y |
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