title: The increase in healthcare costs associated with frailty in older people discharged to a post-acute transition care program.
abstract: BACKGROUND
  older people are high users of healthcare resources. The frailty index can predict negative health outcomes; however, the amount of extra resources required has not been quantified.
  
  
  OBJECTIVE
  to quantify the impact of frailty on healthcare expenditure and resource utilisation in a patient cohort who entered a community-based post-acute program and compare this to a cohort entering residential care.
  
  
  METHODS
  the interRAI home care assessment was used to construct a frailty index in three frailty levels. Costs and resource use were collected alongside a prospective observational cohort study of patients. A generalized linear model was constructed to estimate the additional cost of frailty and the cost of alternative residential care for those with high frailty.
  
  
  RESULTS
  participants (n = 272) had an average age of 79, frailty levels were low in 20%, intermediate in 50% and high in 30% of the cohort. Having an intermediate or high level of frailty increased the likelihood of re-hospitalisation and was associated with 22 and 43% higher healthcare costs over 6 months compared with low frailty. It was less costly to remain living at home than enter residential care unless >62% of subsequent hospitalisations in 6 months could be prevented.
  
  
  CONCLUSIONS
  the frailty index can potentially be used as a tool to estimate the increase in healthcare resources required for different levels of frailty. This information may be useful for quantifying the amount to invest in programs to reduce frailty in the community.
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive Meadowbrook, Brisbane, Queensland 4131, Australia Metro North Hospital and Health Service District-Allied Health, The Prince Charles Hospital Rode Road Chermside, Brisbane, Queensland 4032, Australia.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Comans
authors.affiliation: Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland 4102, Australia.
authors.forename: Nancye M
authors.initials: NM
authors.lastname: Peel
authors.affiliation: Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland 4102, Australia The University of Queensland School of Medicine-Geriatric Medicine, Woolloongabba, Queensland, Australia.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Hubbard
authors.affiliation: Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland 4102, Australia.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Mulligan
authors.affiliation: Centre for Research in Geriatric Medicine, University of Queensland, Woolloongabba, Queensland, Australia.
authors.forename: Leonard C
authors.initials: LC
authors.lastname: Gray
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive Meadowbrook, Brisbane, Queensland 4131, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging; D001315:Australia; D005260:Female; D016330:Frail Elderly; D017048:Health Care Costs; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000191:economics*; D006801:Humans; D016014:Linear Models; D008297:Male; D018803:Models, Economic; D010351:Patient Discharge / Q000191:economics*; D011446:Prospective Studies; D000069341:Transitional Care / Q000191:economics*
keywords: community care; cost; frailty; older people