The utilization of primary healthcare services among frail older adults - findings from the Helsinki Birth Cohort Study

Background The impact of frailty on primary healthcare service use, especially general practice office visits and remote contacts, is currently unknown. Further, little is known about the association of frailty with physiotherapy contacts. Methods We examined the utilization of primary healthcare services among 1064 participants from the Helsinki Birth Cohort Study between the years 2013 and 2017. Frailty was assessed based on Fried's frailty criteria at mean age of 71.0 (2.7 SD) years in clinical examinations between the years 2011 and 2013. General practice office visits and remote contacts, the total number of general practice contacts, physiotherapy contacts, and the total number of primary healthcare contacts were extracted from a national Finnish register. We analyzed the data with negative binomial regression models. Results Of the 1064 participants, 37 were frail (3.5%) and 427 pre-frail (40.1%); 600 non-frail (56.4%) served as a reference group. Frailty was associated with general practice office visits (IRR 1.31, 95% CI=1.01-1.69), physiotherapy contacts (IRR 2.97, 95% CI=1.49-5.91) and the total number of primary healthcare contacts (IRR 1.41, 95% CI=1.07-1.85). Pre-frailty predicted the use of general practice remote contacts (IRR 1.39, 95% CI=1.22-1.57) and the total number of general practice contacts (IRR 1.25, 95% CI=1.12-1.40). Conclusions Frailty increases the overall primary healthcare service use whereas pre-frailty is associated with the use of general practice services, especially remote contacts. Primary healthcare needs measures to adapt healthcare services based on the needs of rapidly increasing number of pre-frail and frail older adults and should consider preventative interventions against frailty.Peer reviewe

The utilization of specialized healthcare services among frail older adults in the Helsinki Birth Cohort Study

Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Background: The association between frailty and specialized healthcare utilization is not well studied. We, therefore, examined the utilization of specialized healthcare services among frail Finnish older adults. Methods: A sub-sample of 1060 participants of the Helsinki Birth Cohort Study were followed prospectively for specialized healthcare utilization from nationwide registers between the years 2013 and 2017. The participants’ frailty status was assessed according to Fried’s criteria at a mean age of 71.0 (2.7 SD) years between the years 2011 and 2013. A negative binomial regression model was used to examine the association between frailty and the total number of visits, emergency visits, outpatient appointments separating the first outpatient appointments and the follow-up appointments, inpatient care including elective and non-elective hospital admissions and the total number of hospital days. We also calculated average length of stay (ALOS) and used the Kruskal–Wallis test to examine the differences between the groups. Results: After adjusting for covariates, frailty was significantly associated with the number of specialized healthcare visits (IRR 1.50, 95% CI = 1.04–2.15) and all subgroups of visits apart from follow-up outpatient appointments. Frailty was particularly strongly associated with the number of hospital days (IRR 5.24, 95% CI = 2.35–11.7) and notably with emergency visits (IRR = 2.26, 95% CI = 1.45–3.51) and hospital admissions (IRR 2.23, 95% CI = 1.39–3.56). Frail older adults had also higher ALOS compared to non-frail participants (p =.009). Conclusions: Frailty increases the use of most specialized healthcare services. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.KEY MESSAGE Frailty is associated with the utilization of most specialized healthcare services, the most expensive part of the healthcare in most high-income countries. The association of frailty with inpatient care is particularly strong. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.Peer reviewe

Effects of military training on plasma amino acid concentrations and their associations with overreaching

Amino acids are thought to have a key role in the processes contributing to overreaching development through their metabolic properties and neuronal functions. In the present study, the effects of 10-week military training on the concentrations of 19 amino acids were investigated. Plasma amino acid concentrations were measured at rest from 53 healthy male conscripts on weeks 1, 4, 7, and 9 of their military service. Conscripts were classified as overreached and non-overreached. Overreaching classification was based on fulfilling at least three of five criteria: greater than 5% decrease in maximal oxygen uptake, increased rating perceived exertion (RPE), and decreased lactate-RPE ratio in submaximal marching test, admitting feeling overloaded and both increased scores in fatigue and decreased scores in vigor in the Profile of Mood States Adolescents. Eight conscripts (15%) were classified as overreached; their glutamine–glutamate ratio and alanine and arginine levels were significantly lower (P < 0.05) and glutamate concentration significantly higher (P < 0.05) in comparison to their non-overreached counterparts. The levels of arginine increased (P < 0.05) and tryptophan (P < 0.001) decreased in both groups throughout the study. The tyrosine concentration increased in non-overreached but, in contrast, remained at the same level in overreached individuals (P < 0.05). The results suggest that alterations in the levels of three metabolically important amino acids, alanine, glutamate and arginine, and the possibly neuroactive tyrosine and tryptophan might explain some of the physical and psychological symptoms of overreaching. The present study also confirms the potential use of glutamine–glutamate ratio as a tool for detecting overreaching.peerReviewe

Physical and mental functioning trajectory classes among older adults and their association with specialized healthcare use

BackgroundSex-specific physical and mental functioning trajectory classification could offer a way of understanding the differences in healthcare use at older age.MethodsUsing latent growth mixture models, sex-specific physical and mental functioning trajectory classes were formed for 1991 participants (mean age 61.5 years) of the Helsinki Birth Cohort Study. Physical and mental functioning were evaluated with the SF-36 survey conducted in clinical examinations in 2001-2004, 2011-2013, and 2017-2018. First and follow-up outpatient visits, emergency visits, and hospital days were extracted from a national register between the first clinical examination and the year 2017. We used regression models to examine the associations between healthcare use and trajectory classes.ResultsTwo physical and mental functioning trajectory classes, high and intermediate, were observed for both sexes. The intermediate physical functioning trajectory class was associated with higher utilization rates of all examined specialized healthcare services (fully-adjusted IRRs varying 1.36-1.58; 95% CI = 1.03-1.79, 95% CI = 1.21-2.05) compared to the high trajectory class. Relative to the high trajectory class, the intermediate mental trajectory class was associated with the use of first outpatient visits (fully-adjusted IRRs 1.17, 95% CI = 1.03-1.33 for men, and 1.16, 95% CI = 1.04-1.30 for women). The findings were similar among both sexes.ConclusionsCompared to the high trajectory class, the intermediate physical functioning trajectory class was associated with greater specialized healthcare use and the intermediate mental trajectory class with first outpatient visits. Public health interventions should be considered to support functioning with aging.Peer reviewe

The utilization of specialized healthcare services among frail older adults in the Helsinki Birth Cohort Study

Abstract Background: The association between frailty and specialized healthcare utilization is not well studied. We, therefore, examined the utilization of specialized healthcare services among frail Finnish older adults. Methods: A sub-sample of 1060 participants of the Helsinki Birth Cohort Study were followed prospectively for specialized healthcare utilization from nationwide registers between the years 2013 and 2017. The participants’ frailty status was assessed according to Fried’s criteria at a mean age of 71.0 (2.7 SD) years between the years 2011 and 2013. A negative binomial regression model was used to examine the association between frailty and the total number of visits, emergency visits, outpatient appointments separating the first outpatient appointments and the follow-up appointments, inpatient care including elective and non-elective hospital admissions and the total number of hospital days. We also calculated average length of stay (ALOS) and used the Kruskal–Wallis test to examine the differences between the groups. Results: After adjusting for covariates, frailty was significantly associated with the number of specialized healthcare visits (IRR 1.50, 95% CI = 1.04–2.15) and all subgroups of visits apart from follow-up outpatient appointments. Frailty was particularly strongly associated with the number of hospital days (IRR 5.24, 95% CI = 2.35–11.7) and notably with emergency visits (IRR = 2.26, 95% CI = 1.45–3.51) and hospital admissions (IRR 2.23, 95% CI = 1.39–3.56). Frail older adults had also higher ALOS compared to non-frail participants (p = .009). Conclusions: Frailty increases the use of most specialized healthcare services. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems

The utilization of primary healthcare services among frail older adults:findings from the Helsinki Birth Cohort Study

Abstract Background: The impact of frailty on primary healthcare service use, especially general practice office visits and remote contacts, is currently unknown. Further, little is known about the association of frailty with physiotherapy contacts. Methods: We examined the utilization of primary healthcare services among 1064 participants from the Helsinki Birth Cohort Study between the years 2013 and 2017. Frailty was assessed based on Fried’s frailty criteria at mean age of 71.0 (2.7 SD) years in clinical examinations between the years 2011 and 2013. General practice office visits and remote contacts, the total number of general practice contacts, physiotherapy contacts, and the total number of primary healthcare contacts were extracted from a national Finnish register. We analyzed the data with negative binomial regression models. Results: Of the 1064 participants, 37 were frail (3.5%) and 427 pre-frail (40.1%); 600 non-frail (56.4%) served as a reference group. Frailty was associated with general practice office visits (IRR 1.31, 95% CI=1.01–1.69), physiotherapy contacts (IRR 2.97, 95% CI=1.49–5.91) and the total number of primary healthcare contacts (IRR 1.41, 95% CI=1.07–1.85). Pre-frailty predicted the use of general practice remote contacts (IRR 1.39, 95% CI=1.22–1.57) and the total number of general practice contacts (IRR 1.25, 95% CI=1.12–1.40). Conclusions: Frailty increases the overall primary healthcare service use whereas pre-frailty is associated with the use of general practice services, especially remote contacts. Primary healthcare needs measures to adapt healthcare services based on the needs of rapidly increasing number of pre-frail and frail older adults and should consider preventative interventions against frailty