Frailty and health service use in rural South Australia

Highlights

• This study investigated frailty in a rural South Australian community (n = 1501).

• Frailty was operationalized using the Frailty Index.

• Frail adults were more likely to visit specific health service providers.

• They were also more likely to report severe difficulties accessing health care.

Abstract

Background

Frailty is a common geriatric condition, well known to contribute to morbidity and mortality. What is not yet well articulated in the literature is the health service use of frail older people in rural areas. This study investigated the impact of frailty on health service use in rural South Australia.

Methods

This secondary cross-sectional analysis included people aged ≥65 years from the LINKIN health census in Port Lincoln. Frailty was classified using a Frailty Index (FI) score ≥0.25. Health service use was determined by patient questionnaire. All regression analyses controlled for age, gender and education level.

Results

1501 people [mean (SD) age = 75.9 (7.9)] years were included. Frailty prevalence was 25%, with this prevalence higher in females (29%) than in males (21%). Compared with their non-frail peers, frail adults were more likely to have consulted health providers, including: general practitioners (GPs) (odds ratio (OR), 95% confidence interval (CI = 2.09, 1.24–3.53); physiotherapists (OR, CI = 2.42, 1.80–3.25); mental health providers (OR, CI = 2.88, 1.42–5.85); community nurses (OR, CI = 2.57, 1.73–3.82); and dieticians (OR, CI = 2.77, 1.77–4.48). They were also more likely to have visited a health professional prior to a problem occurring (OR, CI = 1.51, 1.08–2.11), travelled to the city for a specialist appointment (OR, CI = 1.53, 1.11–2.11), and to have been hospitalised in the previous 12 months (OR, CI = 2.39, 1.74–3.29).

Conclusion

Frail older adults were more likely to use several health services, yet often had unmet needs in their health care.

Introduction

Life expectancy is increasing globally, however these additional lifespan years are not necessarily lived in good health (Rodriguez-Manas & Fried, 2015). An older person may develop frailty, which can detract significantly from health, mobility and quality of life (QOL) (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013). Frailty is recognised as multidimensional geriatric condition characterised by a decreased reserve of physiological systems, and is associated increased risk of adverse outcomes when encountering minor stressors (Clegg et al., 2013; Rodriguez-Manas & Fried, 2015). Frailty is common, with an estimated 4–59% of the population aged over 65 years identified as frail, depending on the definition of frailty used (Collard, Boter, Schoevers, & Oude Voshaar, 2012).

Understanding health service use patterns by frail older people is integral to guiding clinical practice and health care policy for older people. Frail older people tend to be frequent users of the health care system (Gobbens and van Assen, 2012; Gobbens, van Assen, Luijkx, & Schols, 2012; Rochat et al., 2010), at least in urban-based settings. Very little is known about frailty and health service use in rural communities. Rural communities face enormous difficulties when accessing health care services: there is often a shortage of health care professionals (Moore, Sutton, & Maybery, 2010), specialist health care services are located faraway (Piper, Iedema, & Bower, 2014), and there tends to be a lack of communication between health care providers (Piper et al., 2014). To compound these issues, people in rural communities tend to have higher levels of both disability (Pham et al., 2013) and frailty (Yu et al., 2012) than their city-dwelling peers.

A better insight of frailty and its impact on health care services will have wide-scale implications for health care policy and practice in rural dwelling populations. This study aims to investigate specific health service provision among frail older people in the rural community of Port Lincoln, South Australia. Use of primary care services and allied health practitioners was investigated, as was access to other health care services.