International depiction of the cost of functional independence limitations among older adults living in the community: a systematic review and cost-of-impairment study

Ryan S Falck; Alexis G Percival; Daria Tai; Jennifer C Davis

doi:10.1186/s12877-022-03466-w

International depiction of the cost of functional independence limitations among older adults living in the community: a systematic review and cost-of-impairment study

BMC Geriatr. 2022 Oct 22;22(1):815. doi: 10.1186/s12877-022-03466-w.

Authors

Ryan S Falck^#^{1

2

3}, Alexis G Percival^#⁴, Daria Tai^{1

2

3}, Jennifer C Davis^{5

6

7}

Affiliations

¹ University of British Columbia, Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada.
² University of British Columbia, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.
³ Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Applied Health Economics Laboratory, Faculty of Management, University of British Columbia - Okanagan, 1137 Alumni Avenue, Kelowna, BC, V1V 1V7, Canada.
⁵ University of British Columbia, Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada. jennifer.davis@ubc.ca.
⁶ Applied Health Economics Laboratory, Faculty of Management, University of British Columbia - Okanagan, 1137 Alumni Avenue, Kelowna, BC, V1V 1V7, Canada. jennifer.davis@ubc.ca.
⁷ Social & Economic Change Laboratory, Faculty of Management, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada. jennifer.davis@ubc.ca.

^# Contributed equally.

Abstract

Background: Functional independence limitations restrict older adult self-sufficiency and can reduce quality of life. This systematic review and cost of impairment study examined the costs of functional independence limitations among community dwelling older adults to society, the health care system, and the person.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines this systematic review included community dwelling older adults aged 60 years and older with functional independence limitations. Databases (Cochrane Database of Systematic Reviews, EconLit, NHS EED, Embase, CINAHL, AgeLine, and MEDLINE) were searched between 1990 and June 2020. Two reviewers extracted information on study characteristics and cost outcomes including mean annual costs of functional independence limitations per person for each cost perspective (2020 US prices). Quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

Results: 85 studies were included. The mean annual total costs per person (2020 US prices) were: $27,380.74 (95% CI: [$4075.53, $50,685.96]) for societal, $24,195.52 (95% CI: [$9679.77, $38,711.27]) for health care system, and $7455.49 (95% CI: [$2271.45, $12,639.53]) for personal. Individuals with cognitive markers of functional independence limitations accounts for the largest mean costs per person across all perspectives. Variations across studies included: cost perspective, measures quantifying functional independence limitations, cost items reported, and time horizon.

Conclusions: This study sheds light on the importance of targeting cognitive markers of functional independence limitations as they accounted for the greatest costs across all economic perspectives.

Keywords: Cost-of-impairment; Functional independence limitations; Older adults; Systematic review.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cost-Benefit Analysis
Functional Status*
Humans
Independent Living
Middle Aged
Quality of Life*