• Family practice · Feb 2023

    Effective primary care attenuates the association between frailty and hospital admission in old age: the ELSI-Brazil.

    • SilvaSilvia L ASLA0000-0002-2323-2029Departmento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil., James Macinko, Maria Fernanda Lima-Costa, and Juliana L Torres.
    • Departmento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.
    • Fam Pract. 2023 Feb 9; 40 (1): 475447-54.

    BackgroundFrailty is a multidimensional syndrome leading to a higher hospitalization. However, few studies explicitly analyze whether measures of effective primary care modify the relationship between frailty and hospital admission.MethodsThis cross-sectional study included data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative community-based study with older adults aged 50 years and over, conducted in 2019-2021. Self-reported hospital admission in the past 12 months was the outcome. Frailty included the 5 phenotypic criteria: weight loss, exhaustion, low physical activity, weakness, and slowness. The effective primary care index included 12 attributes indicators, continuously. Statistical analyzes comprised logistic regression.ResultsAmong the 7,436 study participants, frailty (odds ratio [OR] 2.17; 95% confidence intervals [95% CI] 1.31-3.62) and effective primary care index (OR 1.10; 95% CI 1.03-1.16) were positively associated with higher hospitalization. Interaction revealed that while effective primary care was positively associated with hospitalization, this association was different among frail older adults (OR 0.80; 95% CI 0.65-0.99). After stratification by frailty status, positive association with hospitalization remained only among prefrail and nonfrail individuals. The predicted probability of hospitalization tended to decrease along with higher primary care index values among frail older adults and became similar to prefrail/nonfrail at the highest end of the scale.ConclusionsEffective primary care decreases the likelihood of hospital admission among frail older adults. Interventions for delaying frailty should be initiated in primary care along with policies to strengthen primary care's organizational and provider/team-level attributes.© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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