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. 2019 Jan 25;19(1):70.
doi: 10.1186/s12913-019-3865-z.

Frailty and health services use among Quebec seniors with non-hip fractures: a population-based study using adminsitrative databases

Vanessa Fillion  1   2   3   4 , Marie-Josée Sirois  5   6   7   8   9 , Philippe Gamache  10 , Jason Robert Guertin  6   8   11 , Suzanne N Morin  12   13 , Sonia Jean  10   8
Affiliations

Frailty and health services use among Quebec seniors with non-hip fractures: a population-based study using adminsitrative databases

Vanessa Fillion et al. BMC Health Serv Res. .

Abstract

Background: The number of frail elderly will increase as the world population ageing accelerates. Since frail elders are at risk of falls, hospitalizations and disabilities, they will require more health care and services. To assess frailty prevalence using health administrative databases, to examine the association between frailty and the use of medical services and to measure the excess use of health services following a non-hip fracture across frailty levels among community-dwelling seniors.

Methods: A population-based cohort study was built from the Quebec Integrated Chronic Disease Surveillance System, including men and women ≥65 years old, non-institutionalized in the pre-fracture year. Frailty was measured using the Elders Risk Assessment (ERA) index. Multivariate Generalized Estimating Equation models were used to examine the relationship between frailty levels and health services while adjusting for covariates. The excess numbers of visits to Emergency Departments (ED) and to Primary Care Practitioners (PCP) as well as hospitalizations were also estimated.

Results: The cohort included 178,304 fractures. There were 13.6 and 5.2% frail and robust seniors, respectively. In the post-fracture year, the risks of ED visits, PCP visits and hospitalizations, were significantly higher in frail vs. non-frail seniors: adjusted relative risk (RR) = 2.69 [95% CI: 2.50-2.90] for ED visits, RR = 1.28 [95% CI: 1.23-1.32] for PCP visits and RR = 2.34 [95% CI: 2.14-2.55] for hospitalizations.

Conclusion: Our results suggest that it is possible to characterize seniors' frailty status at a population level using health administrative databases. Furthermore, this study shows that non-institutionalized frail seniors require more health services after an incident fracture. Screening for frailty in seniors should be part of clinical management in order to identify those at a higher risk of needing health services.

Keywords: Elderly; Fracture; Frailty; Health administrative database.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval and participant consent was not necessary as this study involved the use of a previously-published de-identified database according to the Public Health Ethics Board and by the “Commission d’accès à l’information”.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of the study
Fig. 2
Fig. 2
a Distribution of the study population according to frailty levels. b Distribution of admissions in long-term care (LTC) and death in the year post- fracture according to frailty levels
See this image and copyright information in PMC

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