The utilization of specialized healthcare services among frail older adults in the Helsinki Birth Cohort Study

Jenni N Ikonen; Johan G Eriksson; Minna K Salonen; Eero Kajantie; Otso Arponen; Markus J Haapanen

doi:10.1080/07853890.2021.1941232

The utilization of specialized healthcare services among frail older adults in the Helsinki Birth Cohort Study

Ann Med. 2021 Dec;53(1):1875-1884. doi: 10.1080/07853890.2021.1941232.

Authors

Jenni N Ikonen^{1

2}, Johan G Eriksson^{1

2

3

4}, Minna K Salonen^{2

5}, Eero Kajantie^{6

7

8

9}, Otso Arponen^{10

11}, Markus J Haapanen^{1

2

12}

Affiliations

¹ Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
² Folkhälsan Research Center, Helsinki, Finland.
³ Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴ Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore.
⁵ Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
⁶ Department of Public Health Solutions, THL Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland.
⁷ PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
⁸ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
⁹ Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
¹⁰ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
¹¹ Department of Radiology, Tampere University Hospital, Tampere, Finland.
¹² Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.

Abstract

Background: The association between frailty and specialized healthcare utilization is not well studied. We, therefore, examined the utilization of specialized healthcare services among frail Finnish older adults.

Methods: A sub-sample of 1060 participants of the Helsinki Birth Cohort Study were followed prospectively for specialized healthcare utilization from nationwide registers between the years 2013 and 2017. The participants' frailty status was assessed according to Fried's criteria at a mean age of 71.0 (2.7 SD) years between the years 2011 and 2013. A negative binomial regression model was used to examine the association between frailty and the total number of visits, emergency visits, outpatient appointments separating the first outpatient appointments and the follow-up appointments, inpatient care including elective and non-elective hospital admissions and the total number of hospital days. We also calculated average length of stay (ALOS) and used the Kruskal-Wallis test to examine the differences between the groups.

Results: After adjusting for covariates, frailty was significantly associated with the number of specialized healthcare visits (IRR 1.50, 95% CI = 1.04-2.15) and all subgroups of visits apart from follow-up outpatient appointments. Frailty was particularly strongly associated with the number of hospital days (IRR 5.24, 95% CI = 2.35-11.7) and notably with emergency visits (IRR = 2.26, 95% CI = 1.45-3.51) and hospital admissions (IRR 2.23, 95% CI = 1.39-3.56). Frail older adults had also higher ALOS compared to non-frail participants (p = .009).

Conclusions: Frailty increases the use of most specialized healthcare services. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.KEY MESSAGEFrailty is associated with the utilization of most specialized healthcare services, the most expensive part of the healthcare in most high-income countries.The association of frailty with inpatient care is particularly strong.Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.

Keywords: Frailty; hospital services; inpatient care; length of stay; outpatient care; specialized healthcare.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Birth Cohort
Cohort Studies
Female
Frail Elderly*
Frailty* / epidemiology
Humans
Male
Patient Acceptance of Health Care*

Grants and funding

The Helsinki Birth Cohort Study was supported by Finnish Foundation for Cardiovascular Research, Finnish Foundation for Diabetes Research, Juho Vainio Foundation, Academy of Finland, Novo Nordisk Foundation, Signe and Ane Gyllenberg Foundation, Samfundet Folkhälsan, Finska Läkaresällskapet, Liv och Hälsa, European Commission FP7 (DORIAN) under Grant Agreement [No. 278603] and EU H2020-PHC-2014-DynaHealth under Grant [No. 633595] and EU Horizon 2020 Award 733206 LIFECYCLE.