SUPPORTING OLDER PEOPLE TO AGE IN PLACE IN IRELAND: FRAILTY-RELATED HEALTH CARE USE AND OUTCOMES

Background: Frail older people have both “depth and breadth” in their healthcare needs and require an integrated approach to service delivery but often experience poor service coordination in practice. Reforming service delivery models is a priority for this group, but the process is hindered by a dearth of evidence, particularly of current service utilisation patterns. This project aims to identify diverse service-utilisation patterns among frail older people, to examine these patterns over time and to ascertain their effect on key individual and service outcomes. Methodology: Data were taken from The Irish Longitudinal Study on Ageing (TILDA), a prospective cohort study representing the Irish community-dwelling population aged ≥50 years. We sampled adults aged ≥65 years (n=3,507) in wave one (2009/11) who were classified as frail (n=745) on the Frailty Index (FI). FI scores of ≥0.25 indicated that participants were frail. Latent class analysis determined service-utilisation profiles across hospital, primary and community service indicator variables. Repeated measures cross-sectional analyses mapped transitions between service-utilisation profiles and mixed effects models determined the impact of transitions in service-utilisation profiles on health outcomes and social indicators. Results: 24% (95% CI 23,26) of the Irish older population were frail at baseline. This group utilised 26–87% of services delivered by the Irish healthcare system. However, four heterogeneous service-utilisation profiles were identified; Non users (52%), Hospital users (20%), Community users (26%) and Community and Hospital users (2%). Conclusions: These initial results illustrate quite diverse management strategies for frailty which occurs in the Irish healthcare system and warrants further investigation.