Frailty in Late Midlife to Old Age and Its Relationship to Medical Imaging Use and Imaging-related Costs: A Longitudinal Study

Published Online:https://doi.org/10.1148/radiol.230283

In the Helsinki Birth Cohort Study, frailty in late midlife and its rapid progression into old age were associated with increased imaging service use and imaging-related costs.

Background

Frailty, defined as an increased vulnerability to and impaired recovery from stressors, is common in individuals in late midlife to old age. While frailty predisposes individuals to adverse health outcomes and increased health care utilization, how it impacts imaging service use and related costs remains unclear.

Purpose

To determine whether frailty is associated with greater use of imaging services and higher imaging-related costs.

Materials and Methods

This longitudinal study included a subset of participants from the Helsinki Birth Cohort Study who were clinically assessed up to three times from late midlife to old age between August 2001 and September 2018. A frailty index (FI) based on 41 variables was calculated, and an FI of 0.25 or more indicated frailty. Associations of baseline frailty and its rate of change during the study with medical imaging service use and imaging-related costs were assessed using covariate-adjusted negative binomial and other generalized linear models.

Results

Of the 1995 participants (mean age, 61.5 years ± 2.9 [SD]; 1074 female participants) included in this study, 569 (28.5%) were identified as frail at baseline, and these participants underwent 10 677 (42.4%) of the 25 172 medical imaging examinations among the participants. Compared to participants who were not frail at baseline, participants who were frail at baseline showed increased use of all imaging modalities (incidence rate ratio [IRR], 2.28 [95% CI: 1.97, 2.64]; P < .001) and higher imaging costs (log annual cost, 3.26 [95% CI: 2.36, 4.50]; P < .001). Compared to participants with stable or slow change in frailty (<0.0010 FI units per year), participants with a rapid increase in frailty (>0.0064 FI units per year) from late midlife to old age showed greater use of all medical imaging services, independent of FI at baseline (IRR, 1.82 [95% CI: 1.53, 2.17]; P < .001) and had higher imaging costs (log annual cost, 1.62 [95% CI: 1.30, 2.01)]; P < .001).

Conclusion

The presence of frailty and its progression rate are associated with increased use of imaging services and higher imaging-related costs.

© RSNA, 2023

Supplemental material is available for this article.

References

  • 1. Smith-Bindman R, Kwan ML, Marlow EC, et al. Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000-2016. JAMA 2019;322(9):843–856. Crossref, MedlineGoogle Scholar
  • 2. Lysdahl KB, Hofmann BM. What causes increasing and unnecessary use of radiological investigations? A survey of radiologists’ perceptions. BMC Health Serv Res 2009;9(1):155. Crossref, MedlineGoogle Scholar
  • 3. Wang L, Nie JX, Tracy CS, Moineddin R, Upshur RE. Utilization patterns of diagnostic imaging across the late life course: a population-based study in Ontario, Canada. Int J Technol Assess Health Care 2008;24(4):384–390. Crossref, MedlineGoogle Scholar
  • 4. United Nations Population Division. World population ageing 2019: highlights. ST/ESA/SER.A/430. New York, NY: United Nations, 2019. https://digitallibrary.un.org/record/3846855?ln=en. Accessed January 15, 2023. Google Scholar
  • 5. Kalseth J, Halvorsen T. Health and care service utilisation and cost over the life-span: a descriptive analysis of population data. BMC Health Serv Res 2020;20(1):435. Crossref, MedlineGoogle Scholar
  • 6. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56(3):M146–M156. Crossref, MedlineGoogle Scholar
  • 7. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet 2019;394(10206):1365–1375. Crossref, MedlineGoogle Scholar
  • 8. Ikonen JN, Eriksson JG, Salonen MK, Kajantie E, Arponen O, Haapanen MJ. The utilization of specialized healthcare services among frail older adults in the Helsinki Birth Cohort Study. Ann Med 2021;53(1):1875–1884. Crossref, MedlineGoogle Scholar
  • 9. Ikonen JN, Eriksson JG, von Bonsdorff MB, Kajantie E, Arponen O, Haapanen MJ. The utilization of primary healthcare services among frail older adults—findings from the Helsinki Birth Cohort Study. BMC Geriatr 2022;22(1):79. Crossref, MedlineGoogle Scholar
  • 10. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal 2001;1:323–336. Crossref, MedlineGoogle Scholar
  • 11. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr 2008;8(1):24. Crossref, MedlineGoogle Scholar
  • 12. Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 2007;62(7):738–743. Crossref, MedlineGoogle Scholar
  • 13. Hwang AC, Lee WJ, Huang N, et al. Longitudinal changes of frailty in 8 years: comparisons between physical frailty and frailty index. BMC Geriatr 2021;21(1):726. Crossref, MedlineGoogle Scholar
  • 14. Barker DJP, Osmond C, Forsén TJ, Kajantie E, Eriksson JG. Trajectories of growth among children who have coronary events as adults. N Engl J Med 2005;353(17):1802–1809. Crossref, MedlineGoogle Scholar
  • 15. Haapanen MJ, Mikkola TM, Kortelainen L, et al. Body composition in late midlife as a predictor of accelerated age-associated deficit-accumulation from late midlife into old age: a longitudinal birth cohort study. J Gerontol A Biol Sci Med Sci 2023;78(6):980–987. Crossref, MedlineGoogle Scholar
  • 16. Haapanen MJ, Jylhävä J, Kortelainen L, et al. Early-life factors as predictors of age-associated deficit accumulation across 17 years from midlife into old age. J Gerontol A Biol Sci Med Sci 2022;77(11):2281–2287. Crossref, MedlineGoogle Scholar
  • 17. Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 2008;56(5):898–903. Crossref, MedlineGoogle Scholar
  • 18. Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 2010;58(4):681–687. Crossref, MedlineGoogle Scholar
  • 19. Radiologinen tutkimus- ja toimenpideluokitus. Association of Finnish Local and Regional Authorities (Kuntaliitto). https://www.kuntaliitto.fi/sosiaali-ja-terveysasiat/radiologinen-tutkimus-ja-toimenpideluokitus. Accessed January 11, 2023. Google Scholar
  • 20. Diagnostic center price catalogue for the Hospital District of Helsinki and Uusimaa and Member Municipalities for the year 2022 [in Finnish]. Hospital District of Helsinki and Uusimaa. https://www.hus.fi/en/about-us/administration-and-decision-making/finances/pricing. Accessed January 10, 2023. Google Scholar
  • 21. Classification of socio-economic groups 1989. Statistics Finland. https://www.stat.fi/en/luokitukset/sosioekon_asema/. Accessed January 11, 2023. Google Scholar
  • 22. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381(9868):752–762. Crossref, MedlineGoogle Scholar
  • 23. Han L, Clegg A, Doran T, Fraser L. The impact of frailty on healthcare resource use: a longitudinal analysis using the Clinical Practice Research Datalink in England. Age Ageing 2019;48(5):665–671. Crossref, MedlineGoogle Scholar
  • 24. Howlett SE, Rutenberg AD, Rockwood K. The degree of frailty as a translational measure of health in aging. Nat Aging 2021;1(8):651–665. Crossref, MedlineGoogle Scholar
  • 25. Blodgett JM, Rockwood K, Theou O. Changes in the severity and lethality of age-related health deficit accumulation in the USA between 1999 and 2018: a population-based cohort study. Lancet Healthy Longev 2021;2(2):e96–e104. Crossref, MedlineGoogle Scholar

Article History

Received: Feb 9 2023
Revision requested: Mar 16 2023
Revision received: Sept 25 2023
Accepted: Oct 18 2023
Published online: Nov 21 2023