The association between frailty, care receipt and unmet need for care with the risk of hospital admissions

Asri Maharani; David R. Sinclair; Andrew Clegg; Barbara Hanratty; James Nazroo; Gindo Tampubolon; Chris Todd; Raphael Wittenberg; Terence W. O’Neill; Fiona E. Matthews

doi:10.1371/journal.pone.0306858

Peer Review History

Original SubmissionFebruary 9, 2024
23 May 2024 Decision Letter - Pasquale Abete, Editor Transfer Alert This paper was transferred from another journal. As a result, its full editorial history (including decision letters, peer reviews and author responses) may not be present. PONE-D-24-05107The association between frailty, care receipt and unmet need for care with the risk of hospital admissionsPLOS ONE Dear Dr. Maharani, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jul 06 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: “This research was funded through the National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty (funding reference PR-PRU-1217-2150). As of 01.01.24, the unit has been renamed to the NIHR Policy Research Unit in Healthy Ageing (funding reference NIHR206119). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: According to Reviewers' decision, the manuscript needs a minor revision. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA, waves 6-8). Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalization due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. Conclusions: Care receipt increases risk of hospitalization substantially, suggesting this is a group worthy of prevention intervention focus. The manuscript is interesting. However, I have a couple of questions about the frailty measurements. In Frailty index used in the present study, sarcopenia and nutritional status do not seem to be considered. It should be a limitation of the study. In frailty evaluation, both parameters are frequently included in the frailty assessment tool. Please see and discuss Abete P et al. The Italian version of the "frailty index" based on deficits in health: a validation study. Aging Clin Exp Res. 2017 Oct;29(5):913-926. Reviewer #2: This study aimed to evaluate how care receipt and unmet need for care among older people with different frailty status are associated with the risk of unplanned admission to the hospital for any cause and for conditions associated with frailty, specifically falls and fractures. This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6-8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalization due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. The study is based on a large sample size and information derived from the study are relevant for English health system. The continuity of care should be ensured by community care intervention, and I’m absolutely agree that intervention should be based on several factors such as comorbidity, frailty status and social support. [Mazzella, F., Cacciatore, F., Galizia, G., Della-Morte, D., Rossetti, M., Abbruzzese, R., et al. (2010). Social support and long-term mortality in the elderly: role of comorbidity. ARCHIVES OF GERONTOLOGY AND GERIATRICS, 51(3), 323-328] The unmet need (social and medical) is probably one of the main determinants on quality of life and appropriate health services use. I found the study of interest. Tables should be improved and simplified. I suggest that it might be beneficial to consider adding more information to the figure legend. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: cacciatore francesco ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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Revision 1
12 Jun 2024 Author Response Comments from Editor 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf [journals.plos.org] and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf [journals.plos.org] Authors’ response Thank you for the comments. We have ensured that our manuscript meets PLOS ONE’s style requirements. Comments from Editor 2. Thank you for stating the following financial disclosure: “This research was funded through the National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty (funding reference PR-PRU-1217-2150). As of 01.01.24, the unit has been renamed to the NIHR Policy Research Unit in Healthy Ageing (funding reference NIHR206119). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Authors’ response We have included the Role of Funder statement in the Cover Letter: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." Comments from Editor 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information [journals.plos.org]. Authors’ response We have included the captions of the Supporting Information at the end of our manuscript and ensure the in-text citation to match accordingly. Comments from Editor 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Authors’ response We have reviewed our references list to ensure that it is complete and correct. We have included the additional reference in the Cover Letter and the Response to Reviewer document. Comments from Reviewer #1 This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA, waves 6-8). Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalization due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. Conclusions: Care receipt increases risk of hospitalization substantially, suggesting this is a group worthy of prevention intervention focus. The manuscript is interesting. However, I have a couple of questions about the frailty measurements. In Frailty index used in the present study, sarcopenia and nutritional status do not seem to be considered. It should be a limitation of the study. In frailty evaluation, both parameters are frequently included in the frailty assessment tool. Please see and discuss Abete P et al. The Italian version of the "frailty index" based on deficits in health: a validation study. Aging Clin Exp Res. 2017 Oct;29(5):913-926. Authors’ response Thank you for the input. We have included the exclusion of sarcopenia and nutritional status in constructing the frailty index in this manuscript in the Limitation section: Finally, the frailty index constructed in this study did not include the diagnosis of sarcopenia and nutritional status due to the unavailability of the information in ELSA. The Italian frailty index, for instance, includes the nutritional index and provides good reliability and validity in predicting mortality, disability and hospitalisation [48]. Future research may include sarcopenia, nutritional status, and other geriatric assessments in constructing a frailty index to allow for a more comprehensive assessment of an older adult’s health. We further added a reference in our reference list: 48. Abete P, Basile C, Bulli G, Curcio F, Liguori I, Della-Morte D, et al. The Italian version of the “frailty index” based on deficits in health: a validation study. Aging Clinical And Experimental Research. 2017;29:913-926. doi: 10.1007/s40520-017-0793-9. Comments from Reviewer #2 Reviewer #2: This study aimed to evaluate how care receipt and unmet need for care among older people with different frailty status are associated with the risk of unplanned admission to the hospital for any cause and for conditions associated with frailty, specifically falls and fractures. This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6-8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalization due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. The study is based on a large sample size and information derived from the study are relevant for English health system. The continuity of care should be ensured by community care intervention, and I’m absolutely agree that intervention should be based on several factors such as comorbidity, frailty status and social support. [Mazzella, F., Cacciatore, F., Galizia, G., Della-Morte, D., Rossetti, M., Abbruzzese, R., et al. (2010). Social support and long-term mortality in the elderly: role of comorbidity. ARCHIVES OF GERONTOLOGY AND GERIATRICS, 51(3), 323-328] The unmet need (social and medical) is probably one of the main determinants on quality of life and appropriate health services use. I found the study of interest. Tables should be improved and simplified. I suggest that it might be beneficial to consider adding more information to the figure legend. Authors’ response Thank you for the input. We have added the discussion and reference to support our statement that intervention should be based on several factors, such as comorbidity, frailty status and social support: Prior study shows that low social support is associated with long-term mortality among older people [50]. 50. Mazzella F, Cacciatore F, Galizia G, Della-Morte D, Rossetti M, Abbruzzese R, et al. Social support and long-term mortality in the elderly: role of comorbidity. Archives of Gerontology and Geriatrics. 2010;51(3):323-328. doi: 10.1016/j.archger.2010.01.011. We have further improved and simplified Tables 1 and 2. https://doi.org/10.1371/journal.pone.0306858.r002
26 Jun 2024 Decision Letter - Pasquale Abete, Editor The association between frailty, care receipt and unmet need for care with the risk of hospital admissions PONE-D-24-05107R1 Dear Dr. MAHARANI, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Manuscript has been improved. The revisions have enhanced the overall clarity of the work and strengthened the discussion of the topic. Reviewer #2: The manuscript is improved and all queries were discussed.I found the manuscript suitable for publication ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0306858.r003
Formally Accepted
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