Conditions

Elderly Cirrhosis Patients Strain Health System

Older patients with cirrhosis have significant functional disability, require twice the amount of informal caregiving, and contribute added strain to the health care system, according to a new study.

Researchers from the University of Michigan published their findings in the journal Hepatology.

Cirrhosis is a chronic condition that causes the liver to slowly deteriorate, with scar tissue replacing healthy tissue and impairing liver function, researchers said.

They expect the prevalence of cirrhosis to climb among older Americans given the increase in obesity and aging of those with hepatitis C.

Researchers noted that studies have shown that “non-alcoholic fatty liver disease (NAFLD) ranging in severity from fatty liver to nonalcoholic steatohepatitis (NASH) to cirrhosis has become the most prevalent cause of chronic liver disease worldwide, affecting up to 30 percent of the general population and found in 75 percent of obese individuals.”

According to the Action Plan for Liver Disease Research, 5.5 million Americans have chronic liver disease or cirrhosis, which is one of the most expensive digestive diseases costing $1.6 billion annually in healthcare costs and lost work days.

"With the obesity epidemic contributing to a rise in NAFLD cases along with the aging HCV patient population, cirrhosis among the elderly is expected to become increasingly prevalent," says Mina Rakoski, M.D., a transplant hepatology fellow in the University of Michigan Medical School's Division of Gastroenterology and Hepatology and lead author of the study.

"Therefore, understanding the health and economic burden on older cirrhotic patients, their caregivers, and the health system is extremely important." 

In reviewing 317 patients with cirrhosis and 951 age-matched individuals without the disease from the Health and Retirement Study and Medicare claims files the researchers found that patients with cirrhosis were more likely to be Hispanic, have less education, and have lower net worth.

They also found that older patients with the disease had worse self-reported health status and more medical co-morbidities compared to those without the disease.

The authors said that utilization of health care services, including physician visits, nursing home stays, hospitalizations, and disability was more than double in those with cirrhosis compared to non-cirrhotic peers.

Fees for informal caregiving were much higher in individuals with cirrhosis at an annual cost of $4,700 per person compared to their elderly counterparts without the disease.

"Our population-based study confirms that cirrhosis in the elderly poses a significant burden to patients and their caregivers in terms of health-related and economic costs," says Rakoski. 

"A greater focus on comprehensive delivery of patient care by involving caregivers and improving care coordination will help to optimize disease management for older cirrhotic patients." 

The researchers suggest that future studies investigate the impact of functional disability on outcomes such as hospital readmission and mortality in older patients with cirrhosis.

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