University of Oulu

Jenni N. Ikonen, Johan G. Eriksson, Minna K. Salonen, Eero Kajantie, Otso Arponen & Markus J. Haapanen (2021) The utilization of specialized healthcare services among frail older adults in the Helsinki Birth Cohort Study, Annals of Medicine, 53:1, 1875-1884, DOI:

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

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Author: Ikonen, Jenni N.1,2; Eriksson, Johan G.1,2,3,4; Salonen, Minna K.2,5;
Organizations: 1Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
2Folkhälsan Research Center, Helsinki, Finland
3Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
4Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore
5Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
6Department of Public Health Solutions, THL Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
7PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
8Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
9Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
10Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
11Department of Radiology, Tampere University Hospital, Tampere, Finland
12Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.7 MB)
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Language: English
Published: Informa, 2021
Publish Date: 2021-12-10


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.

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Series: Annals of medicine
ISSN: 0785-3890
ISSN-E: 1365-2060
ISSN-L: 0785-3890
Volume: 53
Issue: 1
Pages: 1875 - 1884
DOI: 10.1080/07853890.2021.1941232
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3142 Public health care science, environmental and occupational health
Funding: The Helsinki Birth Cohort Study was supported by Finnish Foundation for Cardiovascular Research, Finnish Foundation for Diabetes Research, Juho Vainio Foundation, Academy of Finland, Novo Nordisk Foundation, Signe and Ane Gyllenberg Foundation, Samfundet Folkhälsan, Finska Läkaresällskapet, Liv och Hälsa, European Commission FP7 (DORIAN) under Grant Agreement [No. 278603] and EU H2020-PHC-2014-DynaHealth under Grant [No. 633595] and EU Horizon 2020 Award 733206 LIFECYCLE.
EU Grant Number: (633595) DYNAHEALTH - Understanding the dynamic determinants of glucose homeostasis and social capability to promote Healthy and active aging
(733206) LIFECYCLE - Early-life stressors and LifeCycle health
Copyright information: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.