Societal cost of frailty in Singapore: an overview to the cost of healthcare and informal caregiving for frail older adults by frailty status, a cross-sectional study

Frailty is expected to increase in prevalence internationally. With many older adults experiencing progressive functional decline and limitations in activities of daily living, family caregivers’ contributions to support frail older adults is likely to be substantial. Hence, this study aims to quantify the societal cost of caring for a community-based frail population by frailty status and to examine factors related to societal cost in a frail population. Our sample included 199 community-dwelling frail older adults. Data were collected as part of a mixed methods evaluation study for a frailty management programme in Singapore. All participants received a comprehensive geriatric assessment and were categorised using the Clinical Frailty Scale (CFS) as CFS4 (very mildly frail), CFS5 (mildly frail) and CFS6-7 (moderate to severely frail). Sociodemographic variables were collected at baseline. Participant self-reported cost data included direct healthcare, direct non-healthcare and informal caregiver resource use 6-months post-enrolment. Descriptive statistics, the Kruskal Wallis test and generalised linear modelling (GLM) was conducted. The average societal cost per participant was £4,468, with direct healthcare, direct non-healthcare and informal caregiving costs accounting for 19.8%, 6.9% and 73.3% of the average total societal cost respectively. As CFS increased, there was an increase in the proportion of total societal cost due to informal caregiving cost, and a corresponding decline attributable to direct healthcare cost. The GLM results suggest that participants with CFS5 and CFS6-7 spent 61% to 272% more than participants with CFS4. Ethnicity and higher SES (housing type) were also predictive of total societal cost. This study highlights the total societal cost associated with frailty and the importance of informal caregivers (both family and Migrant Domestic Workers) in caring for frail older adults. Frailty prevention and management, as well as greater support for informal caregivers are recommended.