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 4318 women and 3847 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) was $2838 ($5516) in inpatient, $1572 ($1446) in SNF and $1349 ($1060) in HHC sectors; average incremental costs of phenotypic frailty versus robust in women (men) was $4100 (not significant for men) in inpatient, $1579 ($1254) 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.

中文翻译：

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老年人的功能障碍、表型衰弱和特定行业的增量医疗保健成本


背景 本研究量化了特定医疗保健部门中功能障碍和表型虚弱的增量医疗保健支出。方法 汇总了 2023 年对 4 项与 Medicare 索赔相关的前瞻性队列研究的分析，其中包括 4318 名女性和 3847 名男性参加指数检查 （2002-2011）。指数检查后 36 个月确定的年化住院、专业护理机构 （SNF）、家庭医疗保健 （HHC） 和门诊费用（2023 美元）。从队列数据中得出的功能障碍（难以进行 4 项日常生活活动）和虚弱表型（使用 5 个组成部分进行操作）。加权多病共存指数，包括来自索赔的人口统计数据。结果 指数检查的平均年龄为 79.2 岁。在考虑多病共存和彼此之后，女性（男性）3-4 种功能障碍与无功能障碍的平均年化增量成本为 2838 美元（5516 美元），SNF 为 1572 美元（1446 美元），HHC 部门为 1349 美元（1060 美元）;女性（男性）表型衰弱与健壮的平均增量成本为住院 4100 美元（对男性不重要），SNF 为 1579 美元（1254 美元），HHC 部门为 645 美元（526 美元）。增加的住院费用主要是由于更高的住院风险，而增加的 SNF 和 HHC 成本与使用风险的增加和利用个体的成本增加有关。两个老年领域均与门诊费用无关。结论 在这项针对社区居民受益人的研究中，功能性障碍与男女住院、SNF 和 HHC 部门较高的后续支出独立相关。 表型衰弱与女性较高的后续住院费用以及男女较高的 SNF 和 HHC 费用独立相关。