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Fogg C, England T, Zhu S, Jones J, de Lusignan S, Fraser SDS, Roderick P, Clegg A, Harris S, Brailsford S, Barkham A, Patel HP, Walsh B. Primary and secondary care service use and costs associated with frailty in an ageing population: longitudinal analysis of an English primary care cohort of adults aged 50 and over, 2006-2017. Age Ageing 2024; 53:afae010. [PMID: 38337044 PMCID: PMC10857897 DOI: 10.1093/ageing/afae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/23/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Frailty becomes more prevalent and healthcare needs increase with age. Information on the impact of frailty on population level use of health services and associated costs is needed to plan for ageing populations. AIM To describe primary and secondary care service use and associated costs by electronic Frailty Index (eFI) category. DESIGN AND SETTING Retrospective cohort using electronic health records. Participants aged ≥50 registered in primary care practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre, 2006-2017. METHODS Primary and secondary care use (totals and means) were stratified by eFI category and age group. Standardised 2017 costs were used to calculate primary, secondary and overall costs. Generalised linear models explored associations between frailty, sociodemographic characteristics. Adjusted mean costs and cost ratios were produced. RESULTS Individual mean annual use of primary and secondary care services increased with increasing frailty severity. Overall cohort care costs for were highest in mild frailty in all 12 years, followed by moderate and severe, although the proportion of the population with severe frailty can be expected to increase over time. After adjusting for sociodemographic factors, compared to the fit category, individual annual costs doubled in mild frailty, tripled in moderate and quadrupled in severe. CONCLUSIONS Increasing levels of frailty are associated with an additional burden of individual service use. However, individuals with mild and moderate frailty contribute to higher overall costs. Earlier intervention may have the most potential to reduce service use and costs at population level.
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Affiliation(s)
- Carole Fogg
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Tracey England
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Shihua Zhu
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jeremy Jones
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon D S Fraser
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Roderick
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andy Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Scott Harris
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, UK
| | - Abigail Barkham
- Southern Health NHS Foundation Trust, Unit 1 Wessex Way, Colden Common, Winchester SO21 1WP, UK
| | - Harnish P Patel
- University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton, UK
| | - Bronagh Walsh
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Ren W, He R, Tarimo CS, Sun L, Wu J, Zhang L. Willingness and influencing factors of old-age care mode selection among middle-aged and older adults in Henan Province, China. BMC Geriatr 2024; 24:72. [PMID: 38238651 PMCID: PMC10797948 DOI: 10.1186/s12877-023-04559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/02/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The choice of old-age care methods or places plays an important role in improving the quality of life and well-being of older adults. This study aimed to analyze the choices of various old-age care modes (OCMs) among middle-aged and older adults (MOA) aged 40 years and older in Henan Province, China, and to explore the influence of personal health status, perspectives on old-age (POA) and external support received on their choices. METHODS This study analyzed the data from the previous survey which included 911 MOA. The mean comparison method was used to analyze the evaluation of MOA prior to selecting OCMs, and the effect of individual characteristics, external support received, and personal health status on the choice of OCM for MOA was assessed by Logistic regression (LR) and Concentration Index. The Mediation Effect Model was used to explore effect manner and scope of MOA' POA in their choice of OCM. RESULTS The overall scores for MOA on the choice of the home-based, community-family, retirement village, nursing homes OCM were 4.06 ± 0.81, 3.70 ± 0.88, 3.72 ± 0.90, 3.49 ± 0.97, respectively. The LR model indicated that education level, number of children, relationship between family members and the relationship with neighbors affected the choice of OCM for MOA (P < 0.05). Difference in OCM selection was relatively the largest based on the individual's POA (Concentration index = -0.0895 ~ -0.0606), and it was shown to play a mediating role in other factors influencing the choice of OCM for MOA (Mediation effect = -0.002 ~ 0.013). CONCLUSIONS The evaluation of MOA on choosing a non-home OCM was generally, and the number of children and external support received were shown to have a relatively substantial impact on the choice of OCM among MOA, however, their power was affected by MOA' POA. Policy makers could encourage the MOA' selection of non-home OCM by improving the relationship among MOA persons while positively transforming their POA.
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Affiliation(s)
- Weicun Ren
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
- Wuhan University Health Governance Research Centre, Wuhan University, Wuhan, China
| | - Ruibo He
- School of Political Science and Public Administration, Wuhan University, Wuhan, China.
- School of Finance and Public Administration, Hubei University of Economics, 8 Yangqiaohu Avenue, Jiangxia District, Wuhan City, Hubei Province, China.
| | - Clifford Silver Tarimo
- Department of Science and Laboratory Technology, Dares Salaam Institute of Technology, Dares Salaam, Tanzania
| | - Lei Sun
- Department of Health Management, Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Jvxiao Wu
- School of Communication and Journalism, Wuhan University, Wuhan, China
| | - Liang Zhang
- School of Political Science and Public Administration, Wuhan University, Wuhan, China.
- Wuhan University Health Governance Research Centre, Wuhan University, Wuhan, China.
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