Skip to main content

Impact of frailty status on the cost of drugs and dietary supplements prescribed to nursing home residents: the SENIOR cohort

Abstract

Background

The financial impact associated with drug consumption has been poorly investigated among frail subjects and, specifically, in nursing home settings.

Aims

To determine the association of the average monthly cost of the drugs and dietary supplements consumed by nursing home residents with their frailty status.

Methods

This is an analysis of the first follow-up year of the SENIOR cohort. All participants were classified into “frail” or “non-frail” categories according to Fried’s criteria at baseline. Monthly bills from the pharmacy were analysed to determine the association between the average monthly cost of the drugs and dietary supplements consumed and frailty status.

Results

A sample of 87 residents (83.8 ± 9.33 years and 75.9% women) from the SENIOR cohort was included. The prevalence of frailty was 28%. The median number of medications consumed each day was 9 (6–12) (no difference between frail and non-frail subjects; p = 0.15). The overall median monthly cost was € 109.6, of which 49% was covered by Belgian social security and the remaining balance was paid by the patient. When comparing the drug expenses of the frail subjects and the non-frail subjects, the overall average monthly cost did not differ between the 2 groups (p = 0.057). Nevertheless, the expenditure remaining to be paid by the residents, after the Belgian social security intervention, was significantly higher among the frail residents (€ 65.7) than among the non-frail residents (€ 47.6; p = 0.017).

Conclusions

Frailty status has an impact on the expenditures related to the consumption of drugs.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Hazra NC, Rudisill C, Gulliford MC (2018) Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death? Eur J Health Econ 19:831–842

    Article  PubMed  Google Scholar 

  2. 2.

    Rivers PA, Hall NG, Frimpong J (2006) Prescription drug spending: contribution to health care spending and cost containment strategies. J Health Care Finance 32:8–19

    PubMed  Google Scholar 

  3. 3.

    Kamboj S et al (1999) Cost of medications for elderly in a nursing home. J La State Med Soc 151:470–472

    CAS  PubMed  Google Scholar 

  4. 4.

    Stevenson DG, Huskamp HA, Newhouse JP (2008) Medicare part D and the nursing home setting. Gerontologist 48:432–441

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Stuart B et al (2006) Coverage and use of prescription drugs in nursing homes: implications for the medicare modernization act. Med Care 44:243–249

    Article  PubMed  Google Scholar 

  6. 6.

    Onder G et al (2012) Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci 67:698–704

    Article  PubMed  Google Scholar 

  7. 7.

    Ensrud KE et al (2018) Frailty phenotype and healthcare costs and utilization in older women. J Am Geriatr Soc 66:1276–1283

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Gnjidic D et al (2012) High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther 91:521–528

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Herr M et al (2015) Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 24:637–646

    Article  PubMed  Google Scholar 

  10. 10.

    Buckinx F et al (2016) Relationship between frailty, physical performance and quality of life among nursing home residents: the SENIOR cohort. Aging Clin Exp Res 28:1149–1157

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Fried LP et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  CAS  Google Scholar 

  12. 12.

    World Health Organization (2013) Introduction to drug utilization research, Oslo, Norway

  13. 13.

    Chen L et al (2012) Predicting Anatomical Therapeutic Chemical (ATC) classification of drugs by integrating chemical-chemical interactions and similarities. PLoS One 7:e35254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Wertheimer AI (1986) The defined daily dose system (DDD) for drug utilization review. Hosp Pharm 21:233–234, 239–41, 258

    Google Scholar 

  15. 15.

    Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Katz S et al (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185914–919

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Gordon AL et al (2014) Health status of UK care home residents: a cohort study. Age Ageing 43:97–103

    Article  PubMed  Google Scholar 

  18. 18.

    Vossius C et al (2018) Mortality in nursing home residents: a longitudinal study over three years. PLoS One 13:e0203480

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    von Gunten A, Mosimann UP, Antonietti JP (2013) A longitudinal study on delirium in nursing homes. Am J Geriatr Psychiatry 21:963–972

    Article  Google Scholar 

  20. 20.

    Matusik P et al (2012) Severe frailty and cognitive impairment are related to higher mortality in 12-month follow-up of nursing home residents. Arch Gerontol Geriatr 55:22–24

    Article  PubMed  Google Scholar 

  21. 21.

    Freiheit EA et al (2011) Operationalizing frailty among older residents of assisted living facilities. BMC Geriatr 11:23

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Gonzalez-Vaca J et al (2014) Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: rationale, design, methodology, prevalence and attributes. Maturitas 77:78–84

    Article  PubMed  Google Scholar 

  23. 23.

    Castell MV et al (2013) Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care. BMC Fam Pract 14:86

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Buckinx F et al (2015) Burden of frailty in the elderly population: perspectives for a public health challenge. Arch Public Health 73:19

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Collard RM et al (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 60:1487–1492

    Article  PubMed  Google Scholar 

  26. 26.

    Wagner JL, McCarthy E (2004) International differences in drug prices. Annu Rev Public Health 25:475–495

    Article  PubMed  Google Scholar 

  27. 27.

    Tamura BK et al (2012) Outcomes of polypharmacy in nursing home residents. Clin Geriatr Med 28:217–236

    Article  PubMed  Google Scholar 

  28. 28.

    Kojima T et al (2012) Polypharmacy as a risk for fall occurrence in geriatric outpatients. Geriatr Gerontol Int 12:425–430

    Article  PubMed  Google Scholar 

  29. 29.

    Gutierrez-Valencia M et al (2018) Relationship between frailty, polypharmacy, and underprescription in older adults living in nursing homes. Eur J Clin Pharmacol 74:961–970

    Article  PubMed  Google Scholar 

  30. 30.

    Clegg A et al (2013) Frailty in elderly people. Lancet 381:752–762

    Article  Google Scholar 

  31. 31.

    Di Sabatino A et al (2018) Frailty and the gut. Dig Liver Dis 50:533–541

    Article  PubMed  Google Scholar 

  32. 32.

    Kojima G, Iliffe S, Walters K (2018) Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing 47:193–200

    Article  PubMed  Google Scholar 

  33. 33.

    Tabue-Teguo M et al (2015) Frailty index and mortality in nursing home residents in France: results from the INCUR study. J Am Med Dir Assoc 16:603–606

    Article  PubMed  Google Scholar 

  34. 34.

    Clague F et al (2017) Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data. Age Ageing 46:33–39

    PubMed  Google Scholar 

  35. 35.

    Simoni-Wastila L, Stuart BC, Shaffer T (2006) Over-the-counter drug use by medicare beneficiaries in nursing homes: implications for practice and policy. J Am Geriatr Soc 54:1543–1549

    Article  PubMed  Google Scholar 

  36. 36.

    Qato DM et al (2008) Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA 300:2867–2878

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to F. Buckinx.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Statement of human and animal rights

All procedures were approved by the Ethics Committee of the University of Liège.

Informed consent

All participants provided informed written consent after having received information on nature, goal, procedures and risks associated with the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Buckinx, F., Charles, A., Quabron, A. et al. Impact of frailty status on the cost of drugs and dietary supplements prescribed to nursing home residents: the SENIOR cohort. Aging Clin Exp Res 31, 875–880 (2019). https://doi.org/10.1007/s40520-019-01162-1

Download citation

Keywords

  • Frailty
  • Drugs
  • Dietary supplements
  • Cost
  • Nursing home