The impact of frailty on care intensity in older people with intellectual disabilities

Frailty appears to develop earlier and is more severe in people with intellectual disabilities compared to the general population. The high prevalence of frailty may lead to an increase in care intensity and associated health care costs. Therefore a longitudinal observational study was conducted to determine the effect of frailty on care intensity. The association between frailty and care intensity at baseline and follow-up (3 years later) was assessed. Furthermore, the ability of the frailty index to predict an increase in care intensity after 3 years was evaluated. This study was part of the Dutch 'Healthy aging and intellectual disabilities' (HA-ID) study. Frailty was measured at baseline with a frailty index that included 51 health-and age-related deficits. For all participants information on care intensity in seven steps was available, based on long term care indications under the Act on Exceptional Medical Expenses (AWBZ) - a law that finances specialized long-term care. 676 participants (50 years and over) with ID were included in the final analysis. In 26% of the participants, care intensity had increased during the follow-up period. Increased care during the follow-up was related to a high frailty index score at baseline, independent of gender, age, level of ID and the presence of Down syndrome (p = 0.003). After exclusion of ADL and IADL items, the frailty index remained significantly related with increasing care intensity during follow-up (p = 0.007). Our results underline that screening instruments for early detection of frailty and effective interventions are required to limit the burden of frailty for individuals and caregivers, but also to limit health care utilization.