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The incremental healthcare costs of frailty among home care recipients with and without dementia in Ontario, Canada: a cohort study


Objective — In this study, we investigated the incremental 1-year direct costs of healthcare 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 healthcare 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 healthcare costs for persons with and without dementia. This difference was driven by a greater intensity of healthcare utilization among frail clients. Mortality differences across the frailty levels mitigated the association especially among those with dementia.



Mondor L, Maxwell CJ, Hogan DB, Bronskill SE, Campitelli MA, Seitz DP, Wodchis WP. Med. Care. 2019; 57(7):512-20. Epub 2019 May 15.

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