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. 2024 Nov 1;79(11):glae245.
doi: 10.1093/gerona/glae245.

Functional Impairments, Phenotypic Frailty, and Sector-Specific Incremental Healthcare Costs in Older Adults

Kristine E Ensrud  1   2 , John T Schousboe  3   4 , Allyson M Kats  1 , Brent C Taylor  2   5 , Wei Duan-Porter  2   5 , Kerry M Sheets  2   6 , Cynthia M Boyd  7 , Peggy M Cawthon  8 , Lisa Langsetmo  2   3
Affiliations

Functional Impairments, Phenotypic Frailty, and Sector-Specific Incremental Healthcare Costs in Older Adults

Kristine E Ensrud et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: This study quantifies incremental healthcare expenditures of functional impairments and phenotypic frailty in specific healthcare sectors.

Methods: Pooled 2023 analysis of 4 prospective cohort studies linked with Medicare claims including 4 318 women and 3 847 men attending an index examination (2002-2011). Annualized inpatient, skilled nursing facility (SNF), home healthcare (HHC), and outpatient costs (2023 dollars) ascertained for 36 months following index examination. Functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Weighted multimorbidity index including demographics derived from claims.

Results: Mean age at index examination was 79.2 years. After accounting for multimorbidity and each other, average annualized incremental costs of 3-4 functional impairments versus no impairment in women (men) were $2 838 ($5 516) in inpatient, $1 572 ($1 446) in SNF, and $1 349 ($1 060) in HHC sectors; average incremental costs of phenotypic frailty versus robust in women (men) was $4 100 (not significant for men) in inpatient, $1 579 ($1 254) in SNF, and $645 ($526) in HHC sectors. Incremental inpatient costs were primarily due to a higher hospitalization risk, while incremental SNF and HHC costs were related to both increased risks of utilization and higher costs among individuals with utilization. Neither geriatric domain was associated with outpatient costs.

Conclusions: In this study of community-dwelling beneficiaries, functional impairments were independently associated with higher subsequent expenditures in inpatient, SNF, and HHC sectors among both sexes. Phenotypic frailty was independently associated with higher subsequent inpatient costs in women, and higher SNF and HHC costs in both sexes.

Keywords: Frail; Functional status; Health services; Medicare claims data.

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Conflict of interest statement

C.M.B. reports honoraria from UpToDate and DynaMed. The other authors disclose no conflict.

Figures

Figure 1.
Figure 1.
Mean annualized predicted total healthcare expenditures and costs in specific healthcare sectors in women and men by number of functional impairments (A) and category of frailty phenotype (B). Independent variables in models include geographic region, CMS-HCC score, functional impairments, and frailty phenotype. CMS-HCC = Centers for Medicare & Medicaid Services Hierarchical Conditions Categories; HHC = home healthcare; SNF = skilled nursing facility.
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