{"doi":"10.7326/m22-2626","title":"Incremental Health Care Costs of Self-Reported Functional Impairments and Phenotypic Frailty in Community-Dwelling Older Adults","abstract":"BACKGROUND: Health care systems need better strategies to identify older adults at risk for costly care to select target populations for interventions to reduce health care burden. OBJECTIVE: To determine whether self-reported functional impairments and phenotypic frailty are associated with incremental health care costs after accounting for claims-based predictors. DESIGN: Prospective cohort study. SETTING: Index examinations (2002 to 2011) of 4 prospective cohort studies linked with Medicare claims. PARTICIPANTS: 8165 community-dwelling fee-for-service beneficiaries (4318 women, 3847 men). MEASUREMENTS: Weighted (Centers for Medicare & Medicaid Services Hierarchical Condition Category index) and unweighted (count of conditions) multimorbidity and frailty indicators derived from claims. Self-reported functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Health care costs ascertained for 36 months after index examinations. RESULTS: Average annualized costs (2020 U.S. dollars) were $13 906 among women and $14 598 among men. After accounting for claims-based indicators, average incremental costs of functional impairments versus no impairment in women (men) were $3328 ($2354) for 1 impairment increasing to $7330 ($11 760) for 4 impairments; average incremental costs of phenotypic frailty versus robust in women (men) were $8532 ($6172). Mean predicted costs adjusted for claims-based indicators in women (men) varied by both functional impairments and the frailty phenotype ranging from $8124 ($11 831) among robust persons without impairments to $18 792 ($24 713) among frail persons with 4 impairments. Compared with the model with claims-derived indicators alone, this model resulted in more accurate cost prediction for persons with multiple impairments or phenotypic frailty. LIMITATION: Cost data limited to participants enrolled in the Medicare fee-for-service program. CONCLUSION: Self-reported functional impairments and phenotypic frailty are associated with higher subsequent health care expenditures in community-dwelling beneficiaries after accounting for several claims-based indicators of costs. PRIMARY FUNDING SOURCE: National Institutes of Health.","journal":"Annals of Internal Medicine","year":2023,"id":328583,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":22,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9393,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":361151,"name":"John T. Schousboe","orcid":"0000-0002-9329-0750","position":1,"is_corresponding":false},{"id":362761,"name":"Allyson M. Kats","orcid":null,"position":2,"is_corresponding":false},{"id":361154,"name":"Brent C Taylor","orcid":"0000-0002-2140-8377","position":3,"is_corresponding":false},{"id":270278,"name":"Cynthia M. Boyd","orcid":"0000-0001-5642-9015","position":4,"is_corresponding":false},{"id":361152,"name":"Lisa Langsetmo","orcid":"0000-0003-2245-1657","position":5,"is_corresponding":false},{"id":242503,"name":"Kristine E. Ensrud","orcid":"0000-0002-9069-3036","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-19T01:08:56.940647Z","pmid":"37011386","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}