Frailty, hospital use and mortality in the older population: findings from the Newcastle 85+ study

Abstract Background Frailty is a significant determinant of health care utilisation and associated costs, both of which also increase with proximity to death. What is not known is how the relationships between frailty, proximity to death, hospital use and costs develop in a population aged 85 years and over. Methods This study used data from a prospective observational cohort, the Newcastle 85+ Study, linked with hospital episode statistics and death registrations. Using the Rockwood frailty index (cut off <0.25), we analysed the relationship between frailty and mortality, proximity to death, hospital use and hospital costs over 2, 5 and 7 years using descriptive statistics, Kaplan–Meier survival curves, Cox’s proportional hazards and negative binomial regression models. Results Baseline frailty was associated with a more than two-fold increased risk of mortality after 7 years, compared to people who were non-frail. Participants classified as frail spent more time in hospital over 7 years than the non-frail, but this difference declined over time. Baseline frailty was not associated with increased time spent in hospital during the last 90 days of life. Conclusion Evidence continues to accrue on the impact of frailty on emergency health care use. Hospital and community services need to adapt to meet the challenge of introducing new proactive and preventative approaches, designed to achieve benefits in clinical and/or cost effectiveness of frailty management.

Download Full-text

Predicting the Use of Outpatient Mental Health Services: Do Modeling Approaches Make a Difference?

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.5034/inquiryjrnl_39.2.168 ◽

2002 ◽

Vol 39 (2) ◽

pp. 168-183 ◽

Cited By ~ 12

Author(s):

Yuhua Bao

Keyword(s):

Mental Health ◽

Health Care ◽

Negative Binomial ◽

Household Survey ◽

Ordinary Least Squares ◽

Health Care Use ◽

Health Coverage ◽

Outpatient Services ◽

Modeling Approaches ◽

The Impact

Studies attempting to project the impact of providing health coverage to the uninsured population have demonstrated considerable variation in the estimated costs of mental health care. Different modeling approaches to project health care use and costs have been shown to address some data characteristics well, but not all of them. Using data from Health Care for Communities, a recent national household survey, this paper attempts to estimate and predict the use of mental health outpatient services if insurance coverage were extended to the uninsured. The study employs two-part models, with the second part based on an ordinary least squares (OLS) approach and a generalized linear model (GLM), and a zero-inflated negative binomial model (ZINB). Estimates and predictions are not sensitive to the modeling approaches chosen, although the ZINB model outperforms the two-part models in terms of out-of-sample prediction.

Download Full-text

756 The Moderating Influence of Depression on Insomnia and Suicidal Ideation in a Military Sample

SLEEP ◽

10.1093/sleep/zsab072.753 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A294-A295

Author(s):

Emma Palermo ◽

Jennifer Goldschmied ◽

Elaine Boland ◽

Elizabeth A Klingaman ◽

Philip Gehrman ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Research University ◽

Negative Binomial ◽

Suicide Attempts ◽

Risk And Resilience ◽

Depression Severity ◽

Significant Interaction Effect ◽

Increased Risk ◽

The Impact

Abstract Introduction Military personnel are at an increased risk for suicide compared to the general population, making it important to develop a deeper understanding of which factors contribute to this elevated risk. Given that suicidal ideation (SI) is one of the strongest predictors of suicide attempts, understanding factors that underlie SI may improve prevention efforts. Insomnia and depression both serve as independent risk factors for SI, and therefore the aim of this study was to examine the extent to which depressive symptoms moderate the association between insomnia and SI. Methods Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Soldiers (n=21,450) completed questions related to suicidal ideation (5 items), depressive symptoms (9 items), and insomnia (5 items) based on symptom presence in the past 30 days. Items in each domain were summed to create a total severity score. GEE models using a negative binomial linking function were conducted to examine the impact of depression, insomnia, and their interaction on SI. Results Both depression (χ2 =117.56, p<0.001) and insomnia (χ2=11.79, p=0.0006) were found to have significant main effects on SI, and there was a significant interaction effect (χ2=4.52, p=0.0335). Follow up simple effects revealed that insomnia was no longer significantly associated with SI when depression severity was low, but was associated with SI in the presence of greater depression severity (χ2=2.91, p=0.0882). Conclusion In a large sample of Army soldiers, depression significantly moderated the association between SI and insomnia, such that insomnia seems to amplify the effects of depression on SI. These findings highlight the importance of addressing insomnia severity as a mean of reducing SI in those with depression, potentially allowing for intervention prior to a suicide attempt. Support (if any) Perlis: K24AG055602 & R01AG041783. This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan- http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

Download Full-text

Adolescent, Pregnant, and HIV-Infected: Risk of Adverse Pregnancy and Perinatal Outcomes in Young Women from Southern Mozambique

Journal of Clinical Medicine ◽

10.3390/jcm10081564 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1564

Author(s):

Clara Pons-Duran ◽

Aina Casellas ◽

Azucena Bardají ◽

Anifa Valá ◽

Esperança Sevene ◽

...

Keyword(s):

Hiv Infection ◽

Maternal Morbidity ◽

Low Birthweight ◽

Negative Binomial ◽

Perinatal Outcomes ◽

Sub Saharan Africa ◽

P Value ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Impact

Sub-Saharan Africa concentrates the burden of HIV and the highest adolescent fertility rates. However, there is limited information about the impact of the interaction between adolescence and HIV infection on maternal health in the region. Data collected prospectively from three clinical trials conducted between 2003 and 2014 were analysed to evaluate the association between age, HIV infection, and their interaction, with the risk of maternal morbidity and adverse pregnancy and perinatal outcomes in women from southern Mozambique. Logistic regression and negative binomial models were used. A total of 2352 women were included in the analyses; 31% were adolescents (≤19 years) and 29% HIV-infected women. The effect of age on maternal morbidity and pregnancy and perinatal adverse outcomes was not modified by HIV status. Adolescence was associated with an increased incidence of hospital admissions (IRR 0.55, 95%CI 0.37–0.80 for women 20–24 years; IRR 0.60, 95%CI 0.42–0.85 for women >25 years compared to adolescents; p-value < 0.01) and outpatient visits (IRR 0.86, 95%CI 0.71–1.04; IRR 0.76, 95%CI 0.63–0.92; p-value = 0.02), and an increased likelihood of having a small-for-gestational age newborn (OR 0.50, 95%CI 0.38–0.65; OR 0.43, 95%CI 0.34–0.56; p-value < 0.001), a low birthweight (OR 0.40, 95%CI 0.27–0.59; OR 0.37, 95%CI 0.26–0.53; p-value <0.001) and a premature birth (OR 0.42, 95%CI 0.24–0.72; OR 0.51, 95%CI 0.32–0.82; p-value < 0.01). Adolescence was associated with an increased risk of poor morbidity, pregnancy and perinatal outcomes, irrespective of HIV infection. In addition to provision of a specific maternity care package for this vulnerable group interventions are imperative to prevent adolescent pregnancy.

Download Full-text

P070: Mixed effectiveness of emergency department diversion strategies: a systematic review

CJEM ◽

10.1017/cem.2017.272 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S102

Author(s):

S.W. Kirkland ◽

A. Soleimani ◽

B.H. Rowe ◽

A.S. Newton

Keyword(s):

Systematic Review ◽

Health Care ◽

Emergency Department ◽

Health Care Services ◽

Grey Literature ◽

Study Data ◽

Care Utilization ◽

Alternative Source ◽

Increased Risk ◽

The Impact

Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.

Download Full-text

Increased risk of morbidities and health‐care utilisation in children born following preterm labour compared with full‐term labour: A population‐based study

Journal of Paediatrics and Child Health ◽

10.1111/jpc.14225 ◽

2018 ◽

Vol 55 (4) ◽

pp. 446-453 ◽

Cited By ~ 2

Author(s):

Eline Houben ◽

Elisabeth Smits ◽

Jeanne M Pimenta ◽

Libby K Black ◽

Irene D Bezemer ◽

...

Keyword(s):

Health Care ◽

Preterm Labour ◽

Population Based ◽

Health Care Utilisation ◽

Full Term ◽

Population Based Study ◽

Care Utilisation ◽

Increased Risk ◽

Term Labour

Download Full-text

32 Quantifying the Prevalence of Frailty in Drug Trials and the Relationship with Serious Adverse Events

Age and Ageing ◽

10.1093/ageing/afab029.11 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i7-i11

Author(s):

P Hanlon ◽

E Butterly ◽

J Lewsey ◽

S Siebert ◽

F S Mair ◽

...

Keyword(s):

Clinical Trials ◽

Adverse Events ◽

Disease Severity ◽

Negative Binomial ◽

Frailty Index ◽

Chronic Obstructive ◽

Drug Trials ◽

Phase 3 ◽

Serious Adverse Events ◽

Increased Risk

Abstract Introduction Frailty is common in clinical practice, but trials rarely report on participant frailty. Consequently, clinicians and guideline-developers assume frailty is largely absent from trials and have questioned the relevance of trial findings to frail people. Therefore, we examined frailty in phase 3/4 industry-sponsored clinical trials of pharmacological interventions for three exemplar conditions: type 2 diabetes mellitus (T2DM), rheumatoid arthritis (RA), and chronic obstructive pulmonary disease (COPD). Methods We constructed a 40-item frailty index (FI) in 19 clinical trials (7 T2DM, 8 RA, 4 COPD, mean age 42–65 years) using individual-level participant data. Participants with a FI >0.24 were considered “frail”. Baseline disease severity was assessed using HbA1c for T2DM, Disease Activity Score-28 (DAS28) for RA, and % predicted FEV1 for COPD. Using generalised gamma regression, we modelled FI on age, sex and disease severity. In negative binomial regression we modelled serious adverse event rates on FI, and combined results for each index condition in a random-effects meta-analysis. Results All trials included frail participants: prevalence 7–21% in T2DM trials, 33–73% in RA trials, and 15–22% in COPD trials. Increased disease severity and female sex were associated with higher FI in all trials. Frailty was associated with age in T2DM and RA trials, but not in COPD. Across all trials, and after adjusting for age, sex, and disease severity, higher FI predicted increased risk of serious adverse events; the pooled incidence rate ratios (per 0.1-point increase in FI scale) were 1.46 (95% CI 1.21–1.75), 1.45 (1.13–1.87) and 1.99 (1.43–2.76) for T2DM, RA and COPD, respectively. Conclusion Frailty is identifiable and prevalent among middle aged and older participants in phase 3/4 drug trials and has clinically important safety implications. Trial data may be harnessed to better understand chronic disease management in people living with frailty.

Download Full-text

The Impact of Population-Based Disease Management Services on Health Care Utilisation and Costs: Results of the CAPICHe Trial

Journal of General Internal Medicine ◽

10.1007/s11606-018-4682-5 ◽

2018 ◽

Vol 34 (1) ◽

pp. 41-48 ◽

Cited By ~ 2

Author(s):

Paul A. Scuffham ◽

Joshua M. Byrnes ◽

Christine Pollicino ◽

David Cross ◽

Stan Goldstein ◽

...

Keyword(s):

Health Care ◽

Disease Management ◽

Population Based ◽

Health Care Utilisation ◽

Care Utilisation ◽

The Impact ◽

Management Services

Download Full-text

The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0219731 ◽

2019 ◽

Vol 14 (8) ◽

pp. e0219731 ◽

Cited By ~ 9

Author(s):

Darius Erlangga ◽

Marc Suhrcke ◽

Shehzad Ali ◽

Karen Bloor

Keyword(s):

Public Health ◽

Systematic Review ◽

Health Care ◽

Health Care Utilisation ◽

Public Health Insurance ◽

Financial Protection ◽

Middle Income ◽

Middle Income Countries ◽

Care Utilisation ◽

The Impact

Download Full-text

Impact of Pressure Injury Prevention Protocol in Home Care Services on the Prevalence of Pressure Injuries in the Dubai Community

Dubai Medical Journal ◽

10.1159/000511226 ◽

2020 ◽

Vol 3 (3) ◽

pp. 99-104

Author(s):

Sajitha Prasad ◽

Nazneen Hussain ◽

Sangeeta Sharma ◽

Somy Chandy ◽

Jessy Kurien

Keyword(s):

Health Care ◽

Home Care ◽

Care Delivery ◽

Assessment Tools ◽

Care Plan ◽

Significant Drop ◽

Braden Scale ◽

Increased Risk ◽

Prevention Protocol ◽

The Impact

Background: Pressure injuries (PIs) in the community have emerged as a health care burden in the past few years, leading to high rates of morbidity and mortality among the elderly population. There is evidence that simple risk assessment tools and protocols have reduced the prevalence of PIs considerably by shifting the focus to timely prevention and adequate management. The prevalence of PIs is high in home care setting and utilizes a major share of the organizational resources for its treatment and prevention. Aim: This study aims to assess the impact of the newly developed PI prevention protocol for home care patients in Dubai. The objectives are to evaluate effective implementation of the proposed protocol and its impact on the prevalence of PIs in the community to identify the gaps for improvement in the future. Methods: This retrospective observational was conducted in 13 primary health care centers in Dubai, UAE. Data were collected from 249 patients’ records at an average age of 75.5 ± 14.5 years old with compromised mobility (bedbound/chairbound) from January to July 2019. The PI prevalence was assessed before and after 6 months of implementing the PI prevention protocol and comparison was done using a standardized skin assessment scale (Braden Scale). Internationally validated tools from the Agency for Healthcare Research and Quality and National Institute for Health and Care Excellence were used to ensure the reliable use of the Braden Scale and PI protocol compliance. The prevalence was calculated from the existing key performance indicators in the home care office and considering the significant improvement at p value of <0.05. Results: The findings in the first quarter revealed a significant drop in both prevalence (9.0%) and incidence rate (6.0%) to approximately 2.0%. Overall PIs prevalence declined significantly after implementing the protocol (p < 0.0001) among both genders. Also, a significant improvement was detected in the use of Braden Scale and multidisciplinary care plan (p < 0.0001). Conclusion: This study indicates that standardization of care delivery reduces the increased risk and incidence of PIs with a potentially positive outcome on PI prevalence.

Download Full-text