Cognitive Frailty and Health Care Utilization and Costs Among Middle-Aged and Older Adults: Findings from Four Longitudinal Cohort Studies

Health care systems need better strategies to identify older adults at risk for costly care to select target populations for interventions to reduce health care burden. Cognitive impairment and frailty are among the two most common geriatric syndromes. We examined the association between cognitive frailty and health care utilization and costs. Participants aged 50 and over were drawn from four prospective cohorts of aging, including the China Health and Retirement Longitudinal Study (CHARLS), the Korean Longitudinal Study of Aging (KLoSA), the Mexican Health and Aging Study (MHAS), and the Survey of Health, Ageing and Retirement in Europe (SHARE). We classified participants according to their cognitive impairment and frailty status into the following groups: none, only cognitive impairment, only frailty and cognitive frailty. We used negative binomial regression models and sample selection models to explore the association between cognitive frailty and health care utilization and costs. Compared to participants without cognitive impairment and frailty, participants in the only frailty or cognitive frailty groups had higher average annual outpatient visits and inpatient admissions. Only cognitive impairment was significantly negatively associated with the probability of outpatient visits or out-of-pocket (OOP) costs. Only frailty was significantly associated with a higher probability of outpatient visits or more OOP costs. The association between cognitive frailty and outpatient visits varied by cohort. In KLoSA, cognitive frailty was associated with a lower probability of outpatient visits, whereas the other three cohorts show the opposite. Cognitive frailty was associated with higher outpatient costs in CHARLS, KLoSA and MHAS. Only frailty and cognitive frailty were associated with a higher likelihood of inpatient admission in each cohort, and they were also linked to higher inpatient costs in both KLoSA and SHARE. But cognitive frailty was associated with lower inpatient costs in MHAS. This study highlights the significant positive association between cognitive frailty and health care utilization and OOP costs in most countries. By recognizing the multifaceted nature of cognitive impairment and frailty, healthcare providers and policymakers can work towards more effective interventions and support systems that address the needs of middle-aged and older adults, ultimately improving their quality of life and reducing health care costs.