title: Formal and informal care costs of hospitalized older people at risk of poor functioning: A prospective cohort study.
abstract: Hospitalized older people are at risk of poor functioning after hospital discharge. We aimed to relate formal and informal care costs to level of risk for low functioning of hospitalized older people up to one year after admission. We studied 460 patients 65 years or older who were admitted to a 450-bed hospital in the Netherlands between June 2010 and October 2010. Participants were classified into five risk groups at hospital admission using the Identification Seniors At Risk-Hospitalized Patients (ISAR-HP). Patients were interviewed at hospital admission and at three and twelve months after admission using validated questionnaires to measure health care utilization. Informal caregivers were interviewed by mailed paper questionnaires at the same time as patients. We estimated costs per unit from hospital information systems and nationally representative research. Mean healthcare costs were €30k euro per person per year, with one third for initial hospital stay (€9,8k), one third for formal healthcare costs between hospital discharge and twelve month follow up (€10,3k), and one third for informal healthcare costs between hospital discharge and twelve month follow up (€9,5k). Informal and formal healthcare costs were almost double for people with the highest risk score compared to people not at risk (p<0.001). Older patients with high risk scores at hospital admission have substantially higher formal and informal care costs in the year after initial hospital admission than people with low risk scores. This implies that substantial investments may be made in preventive interventions for at-risk hospitalized older people.
authors.affiliation: Erasmus University Medical Centre, Department of Public Health, Rotterdam, the Netherlands. Electronic address: k.asmus@erasmusmc.nl.
authors.forename: Kirsten J E
authors.initials: KJ
authors.lastname: Asmus-Szepesi
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Koopmanschap
authors.affiliation: Erasmus University Medical Centre, Department of Public Health, Rotterdam, the Netherlands.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Flinterman
authors.affiliation: Stichting Wetenschap Balans (SWB), Rotterdam, the Netherlands.
authors.forename: Ton J E M
authors.initials: TJ
authors.lastname: Bakker
authors.affiliation: Erasmus University Medical Centre, Department of Public Health, Rotterdam, the Netherlands.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.affiliation: Erasmus University Medical Centre, Department of Public Health, Rotterdam, the Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D009426:Netherlands; D010351:Patient Discharge; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires
keywords: Healthcare costs; Older hospitalized people; Risk of poor functioning