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Walsh B, Fogg C, England T, Brailsford S, Roderick P, Harris S, Fraser S, Clegg A, de Lusignan S, Zhu S, Lambert F, Barkham A, Patel H, Windle V. Impact of frailty in older people on health care demand: simulation modelling of population dynamics to inform service planning. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-140. [PMID: 39487824 DOI: 10.3310/lkjf3976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2024]
Abstract
Background As populations age, frailty and the associated demand for health care increase. Evidence needed to inform planning and commissioning of services for older people living with frailty is scarce. Accurate information on incidence and prevalence of different levels of frailty and the consequences for health outcomes, service use and costs at population level is needed. Objectives To explore the incidence, prevalence, progression and impact of frailty within an ageing general practice population and model the dynamics of frailty-related healthcare demand, outcomes and costs, to inform the development of guidelines and tools to facilitate commissioning and service development. Study design and methods A retrospective observational study with statistical modelling to inform simulation (system dynamics) modelling using routine data from primary and secondary health care in England and Wales. Modelling was informed by stakeholder engagement events conducted in Hampshire, England. Data sources included the Royal College of General Practitioners Research and Surveillance Centre databank, and the Secure Anonymised Information Linkage Databank. Population prevalence, incidence and progression of frailty within an ageing cohort were estimated using the electronic Frailty Index tool, and associated service use and costs were calculated. Association of frailty with outcomes, service use and costs was explored with multistate and generalised linear models. Results informed development of a prototype system dynamics simulation model, exploring population impact of frailty and future scenarios over a 10-year time frame. Simulation model population projections were externally validated against retrospective data from Secure Anonymised Information Linkage. Study population The Royal College of General Practitioners Research and Surveillance Centre sample comprised an open cohort of the primary care population aged 50 + between 2006 and 2017 (approx. 2.1 million people). Data were linked to Hospital Episode Statistics data and Office for National Statistics death data. A comparable validation data set from Secure Anonymised Information Linkage was generated. Baseline measures Electronic Frailty Index score calculated annually and stratified into Fit, Mild, Moderate and Severe frailty categories. Other variables included age, sex, Index of Multiple Deprivation score, ethnicity and Urban/rural. Outcomes Frailty transitions, mortality, hospitalisations, emergency department attendances, general practitioner visits and costs. Findings Frailty is already present in people aged 50-64. Frailty incidence was 47 cases per 1000 person-years. Frailty prevalence increased from 26.5% (2006) to 38.9% (2017). Older age, higher deprivation, female sex, Asian ethnicity and urban location independently predict frailty onset and progression; 4.8% of 'fit' people aged 50-64 years experienced a transition to a higher frailty state in a year, compared to 21.4% aged 75-84. Individual healthcare use rises with frailty severity, but Mild and Moderate frailty groups have higher overall costs due to larger population numbers. Simulation projections indicate frailty will increase by 7.1%, from 41.5% to 48.7% between 2017 and 2027, and associated costs will rise by £5.8 billion (in England) over an 11-year period. Conclusions Simulation modelling indicates that frailty prevalence and associated service use and costs will continue to rise in the future. Scenario analysis indicates reduction of incidence and slowing of progression, particularly before the age of 65, has potential to substantially reduce future service use and costs, but reducing unplanned admissions in frail older people has a more modest impact. Study outputs will be collated into a commissioning toolkit, comprising guidance on drivers of frailty-related demand and simulation model outputs. Study registration This study is registered as NCT04139278 www.clinicaltrials.gov. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/116/43) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 44. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Bronagh Walsh
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Carole Fogg
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Tracey England
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, UK
| | - Paul Roderick
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Scott Harris
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon Fraser
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Shihua Zhu
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Francesca Lambert
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Harnish Patel
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
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Selenius JS, Silveira PP, Haapanen MJ, von Bonsdorff M, Lahti J, Eriksson JG, Wasenius NS. The brain insulin receptor gene network and associations with frailty index. Age Ageing 2024; 53:afae091. [PMID: 38752921 PMCID: PMC11097905 DOI: 10.1093/ageing/afae091] [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: 10/31/2023] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To investigate longitudinal associations between variations in the co-expression-based brain insulin receptor polygenic risk score and frailty, as well as change in frailty across follow-up. METHODS This longitudinal study included 1605 participants from the Helsinki Birth Cohort Study. Biologically informed expression-based polygenic risk scores for the insulin receptor gene network, which measure genetic variation in the function of the insulin receptor, were calculated for the hippocampal (hePRS-IR) and the mesocorticolimbic (mePRS-IR) regions. Frailty was assessed in at baseline in 2001-2004, 2011-2013 and 2017-2018 by applying a deficit accumulation-based frailty index. Analyses were carried out by applying linear mixed models and logistical regression models adjusted for adult socioeconomic status, birthweight, smoking and their interactions with age. RESULTS The FI levels of women were 1.19%-points (95% CI 0.12-2.26, P = 0.029) higher than in men. Both categorical and continuous hePRS-IR in women were associated with higher FI levels than in men at baseline (P < 0.05). In women with high hePRS-IR, the rate of change was steeper with increasing age compared to those with low or moderate hePRS-IR (P < 0.05). No associations were detected between mePRS-IR and frailty at baseline, nor between mePRS-IR and the increase in mean FI levels per year in either sex (P > 0.43). CONCLUSIONS Higher variation in the function of the insulin receptor gene network in the hippocampus is associated with increasing frailty in women. This could potentially offer novel targets for future drug development aimed at frailty and ageing.
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Affiliation(s)
- Jannica S Selenius
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patricia P Silveira
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Verdun QCH4H1R3, Canada
- Ludmer Centre for Neuroinformatic and Mental Health, Douglas Mental Health University Institute, McGill University, Verdun QCH4H1R3, Canada
| | - Markus J Haapanen
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikaela von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari Lahti
- Folkhälsan Research Center, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Haartmaninkatu 8, 00014 Helsinki, Finland
- Turku Institute for Advanced Studies, University of Turku, 20014 Turku, Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics & Gynecology and Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore
| | - Niko S Wasenius
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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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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Arponen O, Ikonen JN, Kajantie E, Eriksson JG, Haapanen MJ. Frailty in Late Midlife to Old Age and Its Relationship to Medical Imaging Use and Imaging-related Costs: A Longitudinal Study. Radiology 2023; 309:e230283. [PMID: 37987666 DOI: 10.1148/radiol.230283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Frailty, defined as an increased vulnerability to and impaired recovery from stressors, is common in individuals in late midlife to old age. While frailty predisposes individuals to adverse health outcomes and increased health care utilization, how it impacts imaging service use and related costs remains unclear. Purpose To determine whether frailty is associated with greater use of imaging services and higher imaging-related costs. Materials and Methods This longitudinal study included a subset of participants from the Helsinki Birth Cohort Study who were clinically assessed up to three times from late midlife to old age between August 2001 and September 2018. A frailty index (FI) based on 41 variables was calculated, and an FI of 0.25 or more indicated frailty. Associations of baseline frailty and its rate of change during the study with medical imaging service use and imaging-related costs were assessed using covariate-adjusted negative binomial and other generalized linear models. Results Of the 1995 participants (mean age, 61.5 years ± 2.9 [SD]; 1074 female participants) included in this study, 569 (28.5%) were identified as frail at baseline, and these participants underwent 10 677 (42.4%) of the 25 172 medical imaging examinations among the participants. Compared to participants who were not frail at baseline, participants who were frail at baseline showed increased use of all imaging modalities (incidence rate ratio [IRR], 2.28 [95% CI: 1.97, 2.64]; P < .001) and higher imaging costs (log annual cost, 3.26 [95% CI: 2.36, 4.50]; P < .001). Compared to participants with stable or slow change in frailty (<0.0010 FI units per year), participants with a rapid increase in frailty (>0.0064 FI units per year) from late midlife to old age showed greater use of all medical imaging services, independent of FI at baseline (IRR, 1.82 [95% CI: 1.53, 2.17]; P < .001) and had higher imaging costs (log annual cost, 1.62 [95% CI: 1.30, 2.01)]; P < .001). Conclusion The presence of frailty and its progression rate are associated with increased use of imaging services and higher imaging-related costs. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Otso Arponen
- From the Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland (O.A.); Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (O.A.); Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Folkhälsan Research Center, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland (J.N.I., E.K.); Clinical Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland (E.K.); Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway (E.K.); Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.G.E.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (J.G.E.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (M.J.H.)
| | - Jenni N Ikonen
- From the Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland (O.A.); Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (O.A.); Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Folkhälsan Research Center, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland (J.N.I., E.K.); Clinical Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland (E.K.); Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway (E.K.); Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.G.E.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (J.G.E.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (M.J.H.)
| | - Eero Kajantie
- From the Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland (O.A.); Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (O.A.); Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Folkhälsan Research Center, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland (J.N.I., E.K.); Clinical Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland (E.K.); Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway (E.K.); Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.G.E.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (J.G.E.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (M.J.H.)
| | - Johan G Eriksson
- From the Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland (O.A.); Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (O.A.); Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Folkhälsan Research Center, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland (J.N.I., E.K.); Clinical Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland (E.K.); Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway (E.K.); Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.G.E.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (J.G.E.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (M.J.H.)
| | - Markus J Haapanen
- From the Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland (O.A.); Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (O.A.); Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Folkhälsan Research Center, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland (J.N.I., E.K.); Clinical Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland (E.K.); Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway (E.K.); Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.G.E.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (J.G.E.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (M.J.H.)
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