Frailty and Healthcare Utilisation Across Care Settings Among Community-Dwelling Older Adults in Singapore

Abstract Background Frailty is frequently found to be associated with increased healthcare utilisation in western countries, but little is known in Asian population. This study was conducted to investigate the association between frailty and healthcare utilisation by care setting among community-dwelling older adults in Singapore.Methods We conducted a six-month look-back and six-month post-baseline analysis of healthcare utilisation. Data from a longitudinal population-based survey were linked with healthcare utilisation data obtained from an administrative database. Baseline frailty status was measured using the five-item FRAIL scale, which is categorised into three groups: robust (0), pre-frail (1–2), and frail (3–5). Healthcare utilisation included government primary care clinic visits, specialised outpatient clinic visits, emergency department visits, day surgery and hospitalisations. Multivariable logistic and negative binomial regression were applied to examine the associations between frailty with healthcare utilisation, controlling for other confounding variables. Results In our sample of 701 older adults, 64.8% were of robust health, 27.7% belonged to the pre-frail category, and 7.6% were frail. Compared to the non-frail group, frail individuals had a higher rate of specialised outpatient clinic visits (incidence rate ratio (IRR): 2.8, 95% confidence interval (CI): 1.2-6.5), emergency department visits (IRR: 3.1, 95%CI: 1.1-8.1), day surgeries done (IRR: 6.4, 95%CI: 1.3-30.9), and hospitalisations (IRR: 6.7, 95%CI: 2.1-21.1) in the six-months before the baseline and in subsequent six months (IRR: 3.3, 95%CI: 1.6-7.1; 6.4, 2.4-17.2; 5.8, 1.3-25.8; 13.1, 4.9-35.0; respectively). Frailty was also significantly associated with an increased in the number of specialised outpatient clinic visits, emergency department visits and hospitalisations in 6 months before and after baseline, with controlling for covariates. Conclusions Among community-dwelling adults, frailty was positively associated with the likelihood and the number of specialised outpatient clinic visits, emergency department visits, day surgeries and hospitalisations but no significant associations were observed with primary care utilization. The positive association was significant at 6-month before and after the baseline. As frailty is a potentially reversible health state with early screening and intervention, providing preventive activities that delay the onset or progression of frailty should have the potential effect on delaying secondary and tertiary care needs.