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Frailty and Dementia: Differences in Health Care Utilization and Costs
Stephanie Denise M. Sison, Gahee Oh, Sandra Shi, Brianne L. Olivieri‐Mui, Ellen P. McCarthy, Dae Hyun Kim. Innovation in Aging, 2021-12-01
Topic: Risk, prevention and care in population studies
Abstract Frailty and dementia are associated with poor health outcomes and increased health care utilization. A more nuanced understanding of this dynamic may be useful in improving care and developing policies. This retrospective cohort study was conducted using 5% random sample of Medicare fee-for-service beneficiaries (n=1,132,367; mean age 76.2 years; 57.9% female) in 2014-2016. We compared average 1-year home time (number of days alive outside of the hospital and SNF), mean total cost per beneficiary, and number of incident ICU stays per 100 person-years (PY) across four groups: frailty and dementia, dementia alone, frailty alone or neither. Frailty and dementia were identified using validated claims-based algorithms. We also determined differences in costs per group across different regions within the United States. Beneficiaries with both frailty and dementia had a high 1-year mortality rate of 21.9% (vs. dementia alone [9.7%], frailty alone [9.4%] or neither [2.1%]), while having less home time (306 days; difference of 36 days, 31 days, and 53 days, respectively), and more incident ICU stays per 100 PY (29.9 vs 9.5, 25.8, and 5.6, respectively). Mean total costs for beneficiaries with both was $26,030 compared to other groups ($12,096, $24,693, and $9,029, respectively). Across the United States, range of costs varied the most for beneficiaries with both frailty and dementia ($13,244-31,987 vs $4,621-15,364, $20,090-30,965, and $7,672-10,450, respectively). Increase in health care utilization and wide geographic variation in costs associated with patients with frailty and dementia suggests room for improvement in health care delivery to improve outcomes of this group.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Sison, S. D. M., Oh, G., Shi, S., Olivieri‐Mui, B. L., McCarthy, E. P., & Kim, D. H. (2021). Frailty and Dementia: Differences in Health Care Utilization and Costs. Innovation in Aging. https://doi.org/10.1093/geroni/igab046.2996
Vancouver
Sison SDM, Oh G, Shi S, Olivieri‐Mui BL, McCarthy EP, Kim DH. Frailty and Dementia: Differences in Health Care Utilization and Costs. Innovation in Aging. 2021. doi:10.1093/geroni/igab046.2996.
BibTeX
@article{sison2021-d624e259,
author = {Sison, Stephanie Denise M. and Oh, Gahee and Shi, Sandra and Olivieri‐Mui, Brianne L. and McCarthy, Ellen P. and Kim, Dae Hyun},
title = {{Frailty and Dementia: Differences in Health Care Utilization and Costs}},
journal = {Innovation in Aging},
year = {2021},
doi = {10.1093/geroni/igab046.2996},
url = {https://doi.org/10.1093/geroni/igab046.2996}
}
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Key findings
- Abstract Frailty and dementia are associated with poor health outcomes and increased health care utilization.
- Mean total costs for beneficiaries with both was $26,030 compared to other groups ($12,096, $24,693, and $9,029, respectively).
- Increase in health care utilization and wide geographic variation in costs associated with patients with frailty and dementia suggests room for improvement in health care delivery to improve outcomes of this group.
Why it matters
This study shows that Medicare beneficiaries with both frailty and dementia had higher mortality, less time at home, more ICU stays, and higher costs than those with either condition alone. It suggests that improving health care delivery for this group could improve outcomes, but it does not test any treatment, cure, or prevention.
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Study details
- Study designcohort study
- Participants1,132,367
- Effect size57.9%; 21.9%; 9.7%
- Evidence strengthModerate
How this study scored 49/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Innovation in Aging) |
| Journal's citation record | 0 / 4 | Innovation in Aging: journal h-index 48 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 1,132,367 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Dae Hyun Kim: h-index 55 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 49 / 100 | — |
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