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Cited by 39Frailty in Older AdultsDementia and Cognitive Impairment ResearchChronic Disease Management Strategies

The Incremental Health Care Costs of Frailty Among Home Care Recipients With and Without Dementia in Ontario, Canada: A Cohort Study

Mondor, Luke, Maxwell, Colleen J., Hogan, David B., Bronskill, Susan E., Campitelli, Michael A., Seitz, Dallas P., Wodchis, Walter P.·2019·Medical Care
DOI 10.1097/mlr.0000000000001139
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Abstract

OBJECTIVE: In this study, we investigated the incremental 1-year direct costs of health care associated with frailty among home care recipients in Ontario with and without dementia. METHODS: We conducted a cohort study of 159,570 home care clients aged 50 years and older in Ontario, Canada in 2014/2015. At index home care assessment, we ascertained dementia status using a validated algorithm and frailty level (robust, prefrail, frail) based on the proportion of accumulated to potential health deficits. Clients were followed for 1-year during which we obtained direct overall and sector-specific publicly-funded health care costs (in 2015 Canadian dollars). We estimated the incremental effect of frailty level on costs using a 3-part survival- and covariate-adjusted estimator. All analyses were stratified by dementia status. RESULTS: Among those with dementia (n=42,828), frailty prevalence was 32.1% and the average 1-year cost was $30,472. The incremental cost of frailty (vs. robust) was $10,845 [95% confidence interval (CI): $10,112-$11,698]. Among those without dementia (n=116,742), frailty prevalence was 25.6% and the average 1-year cost was $28,969. Here, the incremental cost of frailty (vs. robust) was $12,360 (95% CI: $11,849-$12,981). Large differences in survival between frailty levels reduced incremental cost estimates, particularly for the dementia group (survival effect: -$2742; 95% CI: -$2914 to -$2554). CONCLUSIONS: Frailty was associated with greater 1-year health care costs for persons with and without dementia. This difference was driven by a greater intensity of health care utilization among frail clients. Mortality differences across the frailty levels mitigated the association especially among those with dementia.

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  • Differences observed between dementia populations and those without dementia are likely attributable to differences in dementia severity as well as other important risk factors such as frailty.

    “Differences observed between dementia populations and those without dementia are likely attributable to differences in dementia severity as well as other important risk factors such as frailty.27–29”

    From Trajectories of health system use and survival for community-dwelling persons with dementia: a cohort study (2020) · cites this paper as [28]

  • Compared to community dwellers without dementia, those with dementia are more likely to use home care support services over time.

    “Compared to community dwellers without dementia, those with dementia are more likely to use home care support services over time [5,6].”

    From Towards defining quality in home care for persons living with dementia (2022) · cites this paper as [6]

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Authors
Mondor, L., Maxwell, C. J., Hogan, D. B., Bronskill, S. E., Campitelli, M. A., Seitz, D. P., & Wodchis, W. P.
Affiliations
  • ICES
  • University of Waterloo (CA)
  • University of Calgary (CA)
  • University of Toronto (CA)
  • Queen's University (CA)
Corresponding author
  • Mondor, Luke
  • Maxwell, Colleen J.
  • Bronskill, Susan E.
  • Campitelli, Michael A.
  • Wodchis, Walter P.
ORCID
Venue
Medical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-07
Volume
57
Issue
7
Pages
512-520
ISSN
0025-7079 (ISSN-L)
DOI
10.1097/mlr.0000000000001139
OpenAlex
W2946740003
Cited by
39
References
48
Citations by year
2026: 5 · 2025: 3 · 2024: 9 · 2023: 8 · 2022: 4 · 2021: 7 · 2020: 1 · 2019: 2
FWCI
1.84
Type
journal article
Language
en
Open access
closed
Locations
  • Medical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
frailty, dementia, home care recipients, health care costs, incremental cost, pre-frailty, health care utilization, mortality, older adults, Ontario
MeSH terms
Aged, Aged, 80 and over, Dementia, Female, Home Care Services, Humans, Male, Middle Aged, Ontario, Retrospective Studies, Geriatric Assessment, Frail Elderly, Health Care Costs

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