The relationship between different settings of medical service and incident frailty

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Background:Some studies have reported a potential association between usual source of health care and disability, but no one has explored the association with frailty, a state of early and potential reversible disability. We therefore aimed to explore the association between older persons' self-reported usual source of health care at baseline and the onset of frailty.Methods:Information regarding usual source of health care was captured through self-report and categorized as 1) private doctor's office, 2) public clinic, 3) Health Maintenance Organization (HMO), or 4) hospital clinic/emergency department (ED). Frailty was defined using the Study of Osteoporotic Fracture (SOF) index as the presence of at least two of the following criteria: (i) weight loss ≥5% between baseline and any subsequent follow-up visit; (ii) inability to do five chair stands; and (iii) low energy level according to the SOF definition. Multivariable Cox's regression analyses, calculating hazard ratios (HRs) with 95% confidence intervals (CIs), were undertaken.Results:Of the 4292 participants (mean age: 61.3), 58.7% were female. During the 8-year follow-up, 348 subjects (8.1% of the baseline population) developed frailty. Cox's regression analysis, adjusting for 14 potential confounders showed that, compared to those using a private doctor's office, people using a public clinic for their care had a significantly higher risk of developing frailty (HR=1.56; 95%CI: 1.07–2.70), similar to those using HMO (HR=1.48; 95%CI: 1.03–2.24) and those using a hospital/ED (HR=1.76; 95%CI: 1.03–3.02).Conclusion:Participants receiving health care from sources other than private doctors are at increased risk of frailty, highlighting the need for screening for frailty in these health settings.HIGHLIGHTSNo study is available regarding usual source of health care and frailty.People using a public clinic for their care had a higher risk of developing frailty.People using ED/hospital had an increased risk of frailty.Primary source of health care may indicate a potential target for the early identification of frailty.

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