Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 1;53(2):afae010.
doi: 10.1093/ageing/afae010.

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

Carole Fogg  1 , Tracey England  1 , Shihua Zhu  2 , Jeremy Jones  1 , Simon de Lusignan  3 , Simon D S Fraser  2 , Paul Roderick  2 , Andy Clegg  4 , Scott Harris  2 , Sally Brailsford  5 , Abigail Barkham  6 , Harnish P Patel  7   8 , Bronagh Walsh  1
Affiliations

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

Carole Fogg et al. Age Ageing. .

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.

Keywords: frailty; health care costs; older people; primary health care; secondary health care.

PubMed Disclaimer

Conflict of interest statement

HP has received lecture fees or sponsorship from Abbott, Pfizer, HC-UK conferences and UCB pharma outside of the submitted work and is supported by the NIHR Southampton Biomedical Research Centre, Nutrition, and the University of Southampton. S de L has research funding through his University from AstraZeneca, GSK, Moderna, MSD, Sanofi, Seqirus and Takeda. He has been a member of advisory boards for AstraZeneca, GSK, Sanofi and Seqirus, with funding paid to his University. AC is part-funded by the National Institute for Health Research Applied Research Collaboration Yorkshire & Humber, the NIHR Leeds BRC and Health Data Research UK, an initiative funded by UK Research and Innovation Councils, NIHR and the UK devolved administrations and leading medical research charities.

References

    1. Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–57. - PubMed
    1. NHS England . NHS Standard General Medical Services Contract 2017/18, 2018.
    1. Ensrud KE, Schousboe JT, Kats AM, Taylor BC, Boyd CM, Langsetmo L. Incremental health care costs of self-reported functional impairments and phenotypic frailty in community-dwelling older adults: a prospective cohort study. Ann Intern Med 2023; 176: 463–71. - PMC - PubMed
    1. Jin HY, Liu X, Xue QL, Chen S, Wu C. The association between frailty and healthcare expenditure among Chinese older adults. J Am Med Dir Assoc 2020; 21: 780–5. - PubMed
    1. Ikonen JN, Eriksson JG, von BonsdorffMB, Kajantie E, Arponen O, Haapanen MJ. The utilization of primary healthcare services among frail older adults – findings from the Helsinki birth cohort study. BMC Geriatr 2022; 22: 79. - PMC - PubMed

Publication types