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Background Cognitive frailty (CF) in older adults is a potentially reversible syndrome that may benefit from lifestyle-based multidomain interventions. This study assessed the AGELESS intervention’s impact on cognitive, physical, vascular, dietary, and psychosocial outcomes, along with its cost-effectiveness, in a Low-Middle-Income Country (LMIC). Methods The AGELESS randomized controlled trial recruited 106 older adults (above 60 years) from Klang Valley, Malaysia, with (pre)-CF (≥ 1 Fried’s criteria and Clinical Dementia Rating scale = 0.5). Participants were randomly assigned to a 24-month multidomain intervention (physical activity, cognitive training, nutritional and psychological counselling, cardiovascular care) or control group (educational module). Primary outcomes, assessed at baseline, 12 and 24 months, included the modified Neuropsychological Tests Battery (mNTB) and physical performance measures. Intervention costs were calculated to determine Incremental Cost-Effectiveness Ratios (ICERs). An intention-to-treat analysis was conducted to account for attrition. Results The trial occurred during the COVID-19 pandemic. Despite a 50% dropout rate, adherence among remaining participants was over 50% for all intervention components (range 53%-91%). The intervention led to significant improvements in selected parameters of cognitive function, physical performance, anthropometry, and dietary patterns (for all parameters, p < 0.05 for interaction time*group in repeat-measures ANOVA). The cost per participant was RM 1592.74 (≈USD 355.05) in the multidomain arm, and RM 488.21 (≈USD 108.83) in the control arm. The ICER computation indicated the 2-min step test as the most cost-effective measure (ICER RM 149.19 ≈USD33.26). Conclusion The AGELESS trial demonstrates that a multidomain, lifestyle-based intervention can improve cognitive and physical function in older adults with (pre)-CF. This cost-effective approach highlights CF as a modifiable health condition and supports its potential inclusion in health policy to promote healthy aging and reduce health risks in LMICs, where there is a larger prevention potential due to prevalent lifestyle-related risk factors.

Background Frailty in older adults is associated with increased healthcare utilization and costs, yet evidence on the clinical effectiveness and cost-effectiveness of frailty management programs in primary care remains limited, particularly in Asian settings. This pilot randomized controlled trial (RCT) evaluated a structured, primary care–based frailty intervention in Korea to assess its feasibility, clinical impact, and economic outcomes. Methods We conducted a 6-month pilot RCT involving community-dwelling older adults recruited from four urban primary care clinics. Participants were randomized to either the intervention group, which received frailty screening with the validated Korean Frailty Index for Primary Care (KFI-PC) and monthly health coaching delivered by trained nurses and health coaches, or the control group receiving usual care. Outcomes included changes in frailty index scores and total healthcare costs. Between-group comparisons were assessed using independent t-tests, chi-squared tests, and cost-effectiveness analysis from a healthcare system perspective. Results A total of 84 participants were analyzed (intervention, n  = 39; control, n  = 45). At 3 months, the intervention showed a greater reduction in the frailty index than usual care, but the between-group difference was not statistically significant (mean difference − 0.03, 95% CI − 0.064 to 0.004); at 6 months the difference remained non-significant. However, the Group × Time interaction was significant (F = 4.99, p  = 0.009). Total 6-month costs were lower in the intervention group, indicating economic dominance. Conclusions This pilot RCT provides preliminary clinical evidence and demonstrates economic dominance of a structured, primary care–based frailty management program, supporting feasibility and the need for larger, longer trials. By integrating KFI-PC–based screening with telephone-based health coaching, the intervention reduced physician burden while addressing multidimensional needs of frail older adults. These findings support the feasibility of scaling frailty management in primary care, although further research is required to confirm long-term effectiveness and sustainability. Trial registration CRIS (KCT0005922), registered on February 22, 2021.

The increasing burden of chronic diseases associated with the ageing of the European population constitutes one of the main challenges for the welfare systems in developed western countries, especially through its impact on the use of hospital services and the cost of care. This study aims at evaluating the cost of hospital care for older adults living in the Lazio Region, Italy, according to their level of frailty. Since 2014 a longitudinal randomized cohort study has been carried out on a sample consisting of 1280 older adults aged over 64 years resident in the Lazio region (Italy), with their being evaluated for multidimensional frailty. Accesses to Hospital Services (acute care and Day Hospital care admissions and Emergency Room accesses) during the first year after enrolment, as well as the related costs have been recorded through a regional database. Costs have been stratified on the basis of the state of frailty. The analysis of hospital services and costs highlights the role played by pre-frail individuals who generated 49.3% of the hospital care cumulative costs. Hospital Admission (HA) costs arising from robust and pre-frail subjects are 70% of the total HA costs. Pre-frail individuals also showed the highest average HA cost per person/year (7062.89 Euros). The main determinant of the highest HA costs was given by the number of HAs during the follow-up (multivariate linear regression, ß coefficient = 0.319; p<0.001), which was higher among pre-frail individuals than in any other group of patients. Pre-frail individuals generated the highest cost for hospital care in a sample of representative subjects living in an Italian Region with a low rate of community care services, as is the case in the Lazio region. Assessment of the multidimensional frailty of older adults permits a better definition of the important target of the pre-frail population as the main category within which interventions to prevent or mitigate frailty should be carried out.

IntroductionThe provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysisIn a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and disseminationApproved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.Trial registration number NCT03180606.

Background Frailty is a multidimensional geriatric syndrome associated with functional loss. The Senior Chef (SC, nutrition) and SAYGO (strength and balance exercise) programmes are well accepted among older adults but the impact of each, or a combination of both, on the frailty syndrome in pre-frail older adults is unknown. Aims To determine the effectiveness and cost-effectiveness of a complex intervention consisting of the SC and/or SAYGO programmes to prevent progression of frailty in pre-frail older adults. Methods A multi-centre randomised controlled assessor-blinded study. The four intervention groups are SC, an 8-week nutrition education and cooking class; SAYGO, a 10-week strength and balance exercise class; SC plus SAYGO, and a social group (Control). Community-dwelling adults aged 75+ (60 + Māori and Pasifika) in New Zealand are recruited through health providers. Participants are not terminally ill or with advanced dementia, and have a score of 1 or 2 on the FRAIL questionnaire. Baseline assessments are completed using standardised questionnaires prior to randomisation. Four follow-up assessments are completed: immediately after intervention, 6, 12 and 24 months post-intervention. The primary outcome is frailty score, secondary outcomes are falls, physical function, quality of life, food intake, physical activity, and sustainability of the strategy. Study outcomes will be analysed using intention-to-treat approach. Cost analyses will be completed to determine if interventions are cost effective relative to the control group. Discussion This trial is designed to be a real world rigorous assessment of whether the two intervention strategies can prevent progression of frailty in older people. If successful, this will generate valuable information about effectiveness of this nutrition and exercise strategy, and provide insights for their implementation. Trial registration Australian and New Zealand Clinical Trials Registry number—ACTRN12614000827639.

Sarcopenia and muscle weakness are responsible for considerable health care expenditure but little is known about these costs in the UK. To address this, we estimated the excess economic burden for individuals with muscle weakness regarding the provision of health and social care among 442 men and women (aged 71–80 years) who participated in the Hertfordshire Cohort Study (UK). Muscle weakness, characterised by low grip strength, was defined according to the Foundation for the National Institutes of Health criteria (men < 26 kg, women < 16 kg). Costs associated with primary care consultations and visits, outpatient and inpatient secondary care, medications, and formal (paid) as well as informal care for each participant were calculated. Mean total costs per person and their corresponding components were compared between groups with and without muscle weakness. Prevalence of muscle weakness in the sample was 11%. Mean total annual costs for participants with muscle weakness were £4592 (CI £2962–£6221), with informal care, inpatient secondary care and primary care accounting for the majority of total costs (38%, 23% and 19%, respectively). For participants without muscle weakness, total annual costs were £1885 (CI £1542–£2228) and their three highest cost categories were informal care (26%), primary care (23%) and formal care (20%). Total excess costs associated with muscle weakness were £2707 per person per year, with informal care costs accounting for 46% of this difference. This results in an estimated annual excess cost in the UK of £2.5 billion.

Low neighborhood socioeconomic status is associated with adverse health outcomes, but its association with health care costs in older adults is uncertain. To estimate the association of neighborhood Area Deprivation Index (ADI) with total, inpatient, outpatient, skilled nursing facility (SNF), and home health care (HHC) costs among older community-dwelling Medicare beneficiaries, and determine whether these associations are explained by multimorbidity, phenotypic frailty, or functional impairments. Four prospective cohort studies linked with each other and with Medicare claims. In total, 8165 community-dwelling fee-for-service beneficiaries (mean age 79.2 years, 52.9% female). ADI of participant residence census tract, Hierarchical Conditions Category multimorbidity score, self-reported functional impairments (difficulty performing four activities of daily living), and frailty phenotype. Total, inpatient, outpatient, post-acute SNF, and HHC costs (US 2020 dollars) for 36 months after the index examination. Mean incremental annualized total health care costs adjusted for age, race/ethnicity, and sex increased with ADI ($3317 [95% CI 1274 to 5360] for the most deprived vs least deprived ADI quintile, and overall p-value for ADI variable 0.009). The incremental cost for the most deprived vs least deprived ADI quintile was increasingly attenuated after separate adjustment for multimorbidity ($2407 [95% CI 416 to 4398], overall ADI p-value 0.066), frailty phenotype ($1962 [95% CI 11 to 3913], overall ADI p-value 0.22), or functional impairments ($1246 [95% CI -706 to 3198], overall ADI p-value 0.29). Total health care costs are higher for older community-dwelling Medicare beneficiaries residing in the most socioeconomically deprived areas compared to the least deprived areas. This association was not significant after accounting for the higher prevalence of phenotypic frailty and functional impairments among residents of socioeconomically deprived neighborhoods.

Background The self-reported FRAIL scale is suitable for frailty assessment in the busy primary care practice setting. Aim To estimate the association between phenotypic frailty assessed by FRAIL and subsequent health care costs in older men and women. Methods Prospective study of 7947 community-dwelling adults (mean age 79.2 years, 52.6% female) enrolled in 4 cohort studies of older adults linked to U.S. Medicare claims. The primary predictor was the FRAIL scale categorized into 3 levels (robust, pre-frail, and frail). A multimorbidity index (Hierarchical Conditions Category score) and the Kim frailty indicator (approximating the deficit accumulation index) were derived from U.S. Medicare claims. Annualized total and sector-specific health care costs (U.S. 2023 dollars) for 36 months after the index examination were ascertained from claims. Generalized linear models with gamma variance and log link functions were used to estimate the association of FRAIL category with subsequent health care costs. Results After accounting for claims-based indicators of multimorbidity and frailty, estimated annualized mean total health care costs for individuals categorized as robust were $9742 in women and $13,319 in men. Compared with robust individuals, adjusted mean annualized incremental costs for prefrailty were $4104 (95% C.I. 604–5604) in women and $1955 (95% C.I. 102–3808) in men and for frailty were $9028 (95% C.I. 6653–11402) in women and $6604 (95% C.I. 3168–11039) in men. Discussion and conclusion Pre-frailty and frailty assessed using the self-reported FRAIL scale are associated with higher subsequent total health care costs, even after accounting for claims-based indicators of multimorbidity and frailty.

PurposeTo validate the Hospital Frailty Risk Score (HFRS) in Chinese hospital settings, describing how patients are allocated to frailty risk groups and how frailty risk is associated with length of stay (LoS) and hospital costs.DesignRetrospective observational study.SettingForty-eight hospitals in Lvliang City, Shanxi Province, China.SubjectsPatients aged 75 years or older hospitalised between 1 January 2022 and 31 December 2023 (n = 34,731).MethodsA logistic regression model examined the association between long length of stay (LoS) and frailty risk. A generalised linear model assessed the association between hospital costs and frailty risk. Subgroup analyses of age group, sex, and hospital tiers were conducted.Results22.2% of patients were categorised as having zero risk, 62.4% as low risk, 15.3% as intermediate risk, and 0.08% as high risk. Compared to the zero risk group: for those with low risk, the probability of long LoS was 1.92 (95% CI 1.79–2.06) times higher and hospital costs were ¥1926 (95% CI 1655–2197) higher; for those with intermediate risk, the probability of long LoS was 2.7 (95% CI 2.49–2.96) times higher and hospital costs were ¥4284 (95% CI 3916–4653) higher; and for those with high risk, the probability of long LoS was 6.7 (95% CI 3.06–14.43) times higher and hospital costs were ¥16,613 (95% CI 12,827–20,399) higher. The explanatory power of the HFRS held across subgroups.ConclusionsCompared to patients aged 75 + elsewhere, those in China had lower frailty risk scores, likely reflecting a younger age structure and recording of fewer diagnosis codes. Even so, the HFRS is a powerful predictor of long length of stay and hospital costs in China.AimTo validate the Hospital Frailty Risk Score (HFRS) in Chinese hospital settingsFindingsRelatively few older people hospitalised in China are categorised using the HFRS as having high frailty risk.The HFRS predicts long length of stay and hospital costs among hospitalised older patients in China.MessageThe HFRS has potential for widespread use in both developed and developing countries that use ICD-10 codes.

Background Frailty is expected to increase in prevalence internationally. With many older adults experiencing progressive functional decline and limitations in activities of daily living, family caregivers’ contributions to support frail older adults is likely to be substantial. Hence, this study aims to quantify the societal cost of caring for a community-based frail population by frailty status and to examine factors related to societal cost in a frail population. Methods Our sample included 199 community-dwelling frail older adults. Data were collected as part of a mixed methods evaluation study for a frailty management programme in Singapore. All participants received a comprehensive geriatric assessment and were categorised using the Clinical Frailty Scale (CFS) as CFS4 (very mildly frail), CFS5 (mildly frail) and CFS6-7 (moderate to severely frail). Sociodemographic variables were collected at baseline. Participant self-reported cost data included direct healthcare, direct non-healthcare and informal caregiver resource use 6-months post-enrolment. Descriptive statistics, the Kruskal Wallis test and generalised linear modelling (GLM) was conducted. Results The average societal cost per participant was £4,468, with direct healthcare, direct non-healthcare and informal caregiving costs accounting for 19.8%, 6.9% and 73.3% of the average total societal cost respectively. As CFS increased, there was an increase in the proportion of total societal cost due to informal caregiving cost, and a corresponding decline attributable to direct healthcare cost. The GLM results suggest that participants with CFS5 and CFS6-7 spent 61% to 272% more than participants with CFS4. Ethnicity and higher SES (housing type) were also predictive of total societal cost. Conclusion This study highlights the total societal cost associated with frailty and the importance of informal caregivers (both family and Migrant Domestic Workers) in caring for frail older adults. Frailty prevention and management, as well as greater support for informal caregivers are recommended.