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Frailty transitions predict healthcare use and Medicare payments in older Mexican Americans: a longitudinal cohort study.

ABSTRACT: BACKGROUND:Little is known regarding the impact of transitions in frailty on healthcare use and payment in older Mexican Americans. We address this gap in knowledge by investigating the effect of early transitions in physical frailty on the use of healthcare services and Medicare payments involving older Mexican Americans. METHODS:Longitudinal analyses were conducted using the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey data from five Southwest states linked to the Medicare claims files from the Centers for Medicare and Medicaid Services. Seven hundred and eighty-eight community-dwelling Mexican Americans 72?years and older in 2000/01 were studied. We used a modified Frailty Phenotype (unintentional weight loss, weakness, self-reported exhaustion and slow walking speed) to classify frailty status (non-frail, pre-frail or frail). Each participant was placed into one of 5 frailty transition groups: 1) remain non-frail, 2) remain pre-frail, 3) remain frail, 4) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail) and 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail). The outcomes for the one-year follow-up period (2000-2001) were: (a) healthcare use (hospitalization, emergency room [ER] admission and physician visit); and (b) Medicare payments (total payment and outpatient payment). RESULTS:Mean age was 78.8 (SD?=?5.1) years and 60.3% were female in 1998/99. Males who remained pre-frail (Odds Ratio [OR]?=?3.49, 1.13-10.8, remained frail OR?=?6.92, 1.61-29.7) and transitioned to worse frail status (OR?=?4.49, 1.74-11.6) had significantly higher hospitalization risk compared to individuals who remained non-frail. Males in the 'worsened' groups, and females in the 'improved' groups, had significantly higher Medicare payments than individuals who remained non-frail (Cost Ratio [CR]?=?2.00, 1.30-3.09; CR?=?1.53, 1.12-2.09, respectively]. CONCLUSIONS:Healthcare use and Medicare payments differed by frailty transition status. The differences varied by sex. Research is necessary to elucidate the relationship between frailty transitions and outcomes, sex difference and Medicare payment for older Mexican Americans living in the community.

SUBMITTER: Li CY

PROVIDER: S-EPMC7268381 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Frailty transitions predict healthcare use and Medicare payments in older Mexican Americans: a longitudinal cohort study.

Li Chih-Ying CY Al Snih Soham S Chou Lin-Na LN Karmarkar Amol A Kuo Yong-Fang YF Markides Kyriakos S KS Ottenbacher Kenneth J KJ

BMC geriatrics 20200601 1

<h4>Background</h4>Little is known regarding the impact of transitions in frailty on healthcare use and payment in older Mexican Americans. We address this gap in knowledge by investigating the effect of early transitions in physical frailty on the use of healthcare services and Medicare payments involving older Mexican Americans.<h4>Methods</h4>Longitudinal analyses were conducted using the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey dat ...[more]

PMID: 32487037

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Project description:ObjectivesDevelop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies.DesignExpert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure.SettingFive southwestern states.ParticipantsA total of 1833 community-dwelling Mexican Americans aged 67 years or older.MeasurementsFrailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing "low physical activity" with "limitations in walking half a mile"). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13).ResultsThe original and modified frailty phenotype measures had a strong correlation (r = .89; P < .000) and agreement (κ = .84; 95% confidence interval [CI] = .81-.86; weighted κ = .86; 95% CI = .84-.88; bootstrap κ = .84; 95% CI = .81-.86; bootstrap-weighted κ = .86; 95% CI = .84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants.Conclusion"Limitations in walking half a mile" can be used as a substitute criterion for "low physical activity" in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans. J Am Geriatr Soc 67:2393-2397, 2019.

Dataset Information

Frailty transitions predict healthcare use and Medicare payments in older Mexican Americans: a longitudinal cohort study.

Publications

Frailty transitions predict healthcare use and Medicare payments in older Mexican Americans: a longitudinal cohort study.

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