Impact of frailty in older people on health care demand: simulation modelling of population dynamics to inform service planning

• Published in: Health and social care delivery research 2024-10, Vol.12 (44), p.1-140
• Main Authors: Walsh, Bronagh, Fogg, Carole, England, Tracey, Brailsford, Sally, Roderick, Paul, Harris, Scott, Fraser, Simon, Clegg, Andrew, de Lusignan, Simon, Zhu, Shihua, Lambert, Francesca, Barkham, Abigail, Patel, Harnish, Windle, Vivienne
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; ageing population; cohort study; computer simulation modelling; England - epidemiology; Female; Frail Elderly - statistics & numerical data; frailty; Frailty - epidemiology; health; Health Services Needs and Demand; Humans; Incidence; Male; older people; Population Dynamics; Prevalence; Retrospective Studies; service costs; service use; system dynamics; transitions; Wales - epidemiology
• ISSN: 2755-0079; 2755-0079
• DOI: 10.3310/LKJF3976

As populations age, frailty and the associated demand for health care increase. Evidence needed to inform planning and commissioning of services for older people living with frailty is scarce. Accurate information on incidence and prevalence of different levels of frailty and the consequences for health outcomes, service use and costs at population level is needed. To explore the incidence, prevalence, progression and impact of frailty within an ageing general practice population and model the dynamics of frailty-related healthcare demand, outcomes and costs, to inform the development of guidelines and tools to facilitate commissioning and service development. A retrospective observational study with statistical modelling to inform simulation (system dynamics) modelling using routine data from primary and secondary health care in England and Wales. Modelling was informed by stakeholder engagement events conducted in Hampshire, England. Data sources included the Royal College of General Practitioners Research and Surveillance Centre databank, and the Secure Anonymised Information Linkage Databank. Population prevalence, incidence and progression of frailty within an ageing cohort were estimated using the electronic Frailty Index tool, and associated service use and costs were calculated. Association of frailty with outcomes, service use and costs was explored with multistate and generalised linear models. Results informed development of a prototype system dynamics simulation model, exploring population impact of frailty and future scenarios over a 10-year time frame. Simulation model population projections were externally validated against retrospective data from Secure Anonymised Information Linkage. The Royal College of General Practitioners Research and Surveillance Centre sample comprised an open cohort of the primary care population aged 50 + between 2006 and 2017 (approx. 2.1 million people). Data were linked to Hospital Episode Statistics data and Office for National Statistics death data. A comparable validation data set from Secure Anonymised Information Linkage was generated. Electronic Frailty Index score calculated annually and stratified into Fit, Mild, Moderate and Severe frailty categories. Other variables included age, sex, Index of Multiple Deprivation score, ethnicity and Urban/rural. Frailty transitions, mortality, hospitalisations, emergency department attendances, general practitioner visits and costs. Frailty is already present in peop