Authors' objectives: As populations age, frailty and the associated demand for health care increase. Evidence needed to inform planning and commissioning of services for older people living with frailty is scarce. Accurate information on incidence and prevalence of different levels of frailty and the consequences for health outcomes, service use and costs at population level is needed. To explore the incidence, prevalence, progression and impact of frailty within an ageing general practice population and model the dynamics of frailty-related healthcare demand, outcomes and costs, to inform the development of guidelines and tools to facilitate commissioning and service development. As the population ages, prevalence of frailty and associated demand for health care in both primary and secondary care settings will rise. Identification and clinical management of frailty are a priority, but capacity and resources for delivery remain limited. There is an evidence gap in relation to the planning, commissioning and delivery of services for older people living with frailty and questions remain about the incidence and prevalence of different levels of frailty and the consequences for health outcomes, service use and costs. The overarching aim of this study was to explore the incidence, prevalence, progression and impact of frailty within the ageing population. The specific study objectives were to: identify incidence and prevalence of frailty states in an ageing population; identify frailty trajectories and transitions in severity in the older population over time; explore drivers of progression of frailty, including clinical, socio-economic and demographic factors; examine the impact of frailty on service use, costs and pathways of care; explore the relationship between frailty status, socioeconomic factors, practice factors and service use and outcomes (mortality, unplanned admissions, residential care use); and predict trends in frailty, modelling of health and care demand and costs over time and in different service contexts. The final aim of these analyses was to inform the development of guidelines and tools to facilitate commissioning and service development, thus providing an evidence-based approach to planning primary and secondary care services for patients aged 50 and over with different levels of frailty.

Authors' results and conclusions: Simulation modelling indicates that frailty prevalence and associated service use and costs will continue to rise in the future. Scenario analysis indicates reduction of incidence and slowing of progression, particularly before the age of 65, has potential to substantially reduce future service use and costs, but reducing unplanned admissions in frail older people has a more modest impact. Study outputs will be collated into a commissioning toolkit, comprising guidance on drivers of frailty-related demand and simulation model outputs. This study provides new and robust evidence on incidence, prevalence and progression of frailty in an ageing population, in particular highlighting that frailty is already present in those aged 50–64 and that healthcare use and costs related to older people with frailty are substantial. The statistical modelling suggests that age, sex, deprivation, ethnicity and urban/rural location are all independently associated with frailty onset and progression and costs. The large increases in individual costs with more severe frailty need to be considered together with overall population prevalence of frailty categories, and the larger overall total costs of care for people with mild or moderate frailty need to be taken into account when deciding which services would be most cost-effective. The simulation model provides projections of frailty prevalence and associated service use and costs over 10 years. Frailty prevalence, service use and costs will continue to rise in the future due in part to the ageing population. Scenario analyses indicate that reduction of incidence and slowing of progression, particularly before the age of 65, has potential to reduce future service demand in both primary and secondary care settings. For example, in relation to primary care, reducing frailty incidence in all age groups could result in reduced GP consultations and home visits as well as fewer medicines used. In secondary care settings, there could also be reductions in ED attendances, hospital admissions and outpatient appointments. Reducing unplanned hospitalisations in older people with frailty would have a more modest impact on costs. The outputs and findings from each element of the study will be collated into a commissioning toolkit, comprising guidance on drivers of frailty-related demand and simulation model outputs that can be used for prediction of future demand and exploration of different service scenarios.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/16/116/43

Year Published: 2024

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/LKJF3976

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: United Kingdom

DOI: 10.3310/LKJF3976

Organisation Name: NIHR Health and Social Care Delivery Program

Contact Name: Rhiannon Miller

Contact Email: rhiannon.m@prepress-projects.co.uk