title: Frailty: a costly phenomenon in caring for elders with cognitive impairment.
abstract: OBJECTIVE
  Dementia draws on a variety of public and private resources. There is increasing pressure to define the cost components in this area to improve resource allocation and accountability. The aim of this study was to characterize frailty in a group of cognitively impaired community-dwelling elders and evaluate its relationship with cost and resource utilization.
  
  
  METHODS
  We assessed a cross-sectional, convenient sample of 115 cognitively impaired patients of age >55 years who attended the National Memory Clinic in St James' University Hospital, a Trinity College-affiliated hospital in Dublin, Ireland. Participants had a clinical diagnosis of possible Alzheimer's disease or mild cognitive impairment. Frailty was measured using the biological syndrome model. Formal health and social care costs and daily informal caregiving costs were collected and the total costs of care estimated by applying the appropriate unit cost estimate for each resource activity. Stepwise regression models were constructed to establish the factors associated with increased care costs.
  
  
  RESULTS
  Patient dependence, frailty and number of co-morbid illnesses explained 43.3% of the variance in observed daily informal care costs in dementia and cognitively impaired patients. Dependence was the sole factor retained in an optimal model explaining 19% of the variance in formal health and social care costs.
  
  
  CONCLUSIONS
  Frailty retained a strong association with daily informal care costs even in the context of other known risk factors for increasing care costs. Interventions that reduce frailty as well as patient dependence on others may be associated with cost savings.
authors.affiliation: St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland.
authors.forename: Aine
authors.initials: A
authors.lastname: Butler
authors.affiliation: St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland.
authors.forename: Damien
authors.initials: D
authors.lastname: Gallagher
authors.affiliation: School of Business and Economics, National University of Ireland Galway, Galway, Ireland.
authors.forename: Paddy
authors.initials: P
authors.lastname: Gillespie
authors.affiliation: St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Crosby
authors.affiliation: St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Ryan
authors.affiliation: Janssen Alzheimer Immunotherapy, Dublin, Ireland.
authors.forename: Loretto
authors.initials: L
authors.lastname: Lacey
authors.affiliation: St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland.
authors.forename: Robert
authors.initials: R
authors.lastname: Coen
authors.affiliation: Irish Centre for Social Gerontology, National University of Ireland Galway, Galway, Ireland.
authors.forename: Eamon
authors.initials: E
authors.lastname: O'Shea
authors.affiliation: St James's Hospital, Mercer's Institute for Research on Ageing, Dublin, Ireland.
authors.forename: Brian
authors.initials: B
authors.lastname: Lawlor
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D017028:Caregivers / Q000191:economics; D003072:Cognition Disorders / Q000191:economics*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland
keywords: cognitive impairment; frailty; healthcare costs