Research paper
Physical frailty predicts medical expenses in community-dwelling, elderly patients: Three-year prospective findings from living profiles of older people surveys in Korea

https://doi.org/10.1016/j.eurger.2015.05.003Get rights and content

Abstract

Background

With an aging population, medical expenses for elderly patients are increasing rapidly. Frailty is currently considered an important issue in geriatrics. The purpose of this study was to investigate the effect of frailty on medical expenses in elderly Korean patients.

Material and methods

Data were gathered from the 2008 and 2011 living profiles of older people surveys (from August 11, 2008 to February 20, 2012) and included 5303 community-living Korean men and women, aged 65 years or older. The five-item frailty index was comprised of items on weight loss, exhaustion, weak grip strength, slow walking speed, and low physical activity. Frailty data were extracted from the 2008 living profiles of older people survey, and out-of-pocket medical expenses data were extracted from the 2011 living profiles of older people survey. A generalized linear model was used to analyze the correlation between frailty and medical expenses after adjusting for sociodemographics, health behavior, and health status factors.

Results

Baseline frailty assessments grouped patients as robust (43.3%), prefrail (49.3%), and frail (7.4%). After adjusting for sociodemographics, health behavior, and health status variables, frailty was found to increase out-of-pocket medical expenses (robust: ref., prefrail: β = 0.087 and P < 0.001, frail: β = 0.143 and P < 0.001).

Conclusion

Our findings suggested that frailty is an independent predictor of increasing medical expenses in community-dwelling elderly patients.

Introduction

The population of Korea is aging very rapidly. People aged 65 years or over accounted for 10.8% of the South Korean population in 2010, a figure which is expected to reach 14.3% in 2018 and exceed 20.8% in 2026, at which point Korea will be a post-aged society. Following this aging trend, the number of community-dwelling seniors in Korea and the associated expenses for the care of elderly patients are expected to rapidly increase. Specifically, in 2009, people older than 65 years received 12,391 trillion KRW in health insurance reimbursements, representing 30.5% of total national medical expenses; this figure is also rapidly increasing.

As the elderly population increases, the number of studies examining the health of elderly patients is also increasing, as is interest in “frailty” (a major factor that threatens the health of elderly people). Frailty is defined as a state in which, due to aging, the physiological reserve needed to maintain biological homeostasis is decreased, overall functionality has deteriorated, the risk associated with various diseases is increased, and the probability of disability or hospitalization is increased as responses to external stimuli are diminished [1], [2], [3]. Therefore, frailty is not an intermediate stage in the health of elderly patients but is rather a precursor state, characterized by reversibility and a high probability of resultant disability [4]. Because recovery from such disability is difficult (although reversal is possible) [5], it is important to identify and manage the frail elderly in order to control increasing health care costs.

Among previous studies examining the correlation between frailty as a pre-disability stage and medical expenses, Liu et al. [6] found that frailty is associated with increased use of health care expenditure, and Robinson et al. [7] found that frailty among patients with colorectal cancer is associated with increased medical expenses six months after surgical treatment. However, no prospective study has demonstrated that frailty in community-dwelling seniors is associated with increased medical expenses.

Using data from the living profiles of older people survey, a representative national-scale survey, we conducted a comparative analysis of medical expenses of patients aged 65 years or over who were not medical aid beneficiaries and classified them according to frailty level. We also investigated the effect of frailty on medical expenses relative to household income.

Section snippets

Subjects

Data were extracted from the 2008 living profiles of Older People Survey (comprising 15,146 elderly participants aged 60 years or older) and the 2011 Living Profiles of older people Survey (comprising 10,003 elderly participants aged 60 years or older). The living profiles of older people survey is conducted every three years to establish evidence-based policies for the aging population according to the Welfare of the Aged Act and includes various indicators to monitor trends in the health,

Baseline characteristics

Table 1 presents the results of each group according to frailty criteria and baseline characteristics of the study participants. Among the 5303 participants, 2295 were determined to be robust (43.3%), 2617 to be prefrail (49.3%), and 391 to be frail (7.4%). The mean age of the robust group was 74.0 years, prefrail group was 75.7 years, and frail group was 77.9 years. Age tended to increase among the more frail elderly patients. Regarding gender distribution, 43.7% of respondents were male, and

Discussion

Using data from the 2008 and 2011 living profiles of older people surveys, we found that out-of-pocket medical expenses increase as elderly patients become more frail and the result was persistent even after controlling socio-economic factors, health behaviors, and health status.

As it is difficult to identify extant domestic or international research examining the longitudinal association of frailty with medical expenses in a population representative of community dwelling elderly, our results

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

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