Frail Patients Use More Imaging Services, Especially Those in Rapid Decline

RSNA News highlights the role radiology plays in supporting the imaging needs of the aging population. This is the third in a series of stories. Read the first and second story.  

Aging patients who are characterized as frail may utilize medical imaging services at a rate double that of their peers—and may incur three times the cost, according to a Finnish longitudinal study.

Nearly 2,000 patients, a subset of participants in the Helsinki Birth Cohort Study, were assessed in late midlife and followed up for almost two decades to old age.

“We noted that those patients who were characterized as frail used approximately two times more imaging services, and their imaging-related costs were threefold higher, in comparison to the non-frail participants,” said Otso Arponen, MD, PhD, a resident physician and postdoctoral researcher at the Department of Radiology at Tampere University Hospital in Finland.

Dr. Arponen and the team investigated contributing factors to the utilization of radiologic services. The team’s work, published in Radiology, examined the association between frailty and the use of radiologic tests.

Frailty Can Affect Imaging Use

“We had a systematic approach when selecting variables for our frailty index in accordance with the standard procedure described in the BMC Geriatrics journal by Searle and colleagues,” Dr. Arponen said.

The researchers considered all available variables that were linked to “frail” status, including chronic diseases, functioning, laboratory results and medications. These variables typically showed an increasing prevalence across older ages and were common enough to be relevant for the study population.

“Additionally, it was important that the variable was not correlated too strongly with other variables and that it had low missingness—less than 10%,” Dr. Arponen explained.

The team found that, compared with participants who had a slow or stable change in frailty as they aged, patients who demonstrated a rapid increase in frailty used medical imaging services at a rate 1.82 times higher, regardless of their frailty score at baseline. Their costs were also 1.62 times higher.

“The patients who experienced a rapid increase in frailty were often older, female, and less frail at baseline,” Dr. Arponen said. “However, there were no socioeconomic differences between the groups.”