Preventing mobility disability in Europe: a health economics perspective from the SPRINTT study

Abstract

In a global context of population aging, gaining better knowledge of the mechanisms leading to loss of autonomy has become a major objective, notably with the aim of implementing effective preventive health policies. The concept of frailty, originally introduced in gerontology and geriatrics as a precursor state to functional dependency, appears as a useful tool in this specific context. The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) project will provide a unique opportunity to explore health economics issues associated with frailty. In terms of health economics, the loss of autonomy approach retained here focuses on the economic and social causes and consequences of the onset of frailty in older adults, and examines the challenges not only in terms of health system efficiency but also in terms of social protection.

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Different approaches to frailty emerged in medical science over the past twenty years. All offer a multidimensional measure of frailty, based on a combination of criteria selected and weighted “by expert opinion”. In this context, it is worth acknowledging Fried’s approach made some effort to ensure consistency among several elements that contribute to the loss of functional autonomy process [11]. The theoretical model is deliberately restricted to the physiological aspects; the phenotype is distinct from cognitive problems and has no explicit social dimension; so it is very specific. This is the main feature that allows considering frailty according to Fried as an innovative element of the analysis.

For the sake of comparison, the main alternative frailty model proposed by Rockwood et al. [12] takes various health measures into account, including chronic diseases and functional limitations, so that the contribution of this frailty health expenditure index indeterminately aggregates the effect of the usual health variables with the specific effects of an hitherto “overlooked” health dimension. More recently, models combining health and social dimensions have emerged, explicitly conferring a social dimension to frailty. Previous work had shown that the Fried frailty phenotype, though it resorted exclusively to health variables, was strongly correlated with social and economic measures [13]. The use of such general measurements of "vulnerability" in health spending patterns mix the respective contributions of the different components of health and of the economic and social dimension, thereby making it impossible to separate the need for care from dimensions more often associated with access to and use of the health care system.

The Fried phenotype allows, however, conceptually separating frailty from other health problems usually taken into account to measure the need for care. Frailty is defined by the presence of at least three criteria, including: unintentional weight loss, reported fatigue, low physical activity, slow walking speed and muscle weakness. Individuals with one or two of these criteria are called pre-frail. This is the concept of frailty as Fried understood it that is considered in this study. Under this classification, 43.6% of the population aged 65 and over living in private households in France are pre-frail, and about 15% frail [14].