The objective of this scoping review was to map and describe the available evidence reporting out-of-pocket expenses related to aging in place for older people with frailty and their caregivers.
As the global population ages, there has been increasing attention on supporting older people to live at home in the community as they experience health and functional changes. Older people with frailty often require a variety of supports and services to live in the community, yet the out-of-pockets costs associated with these resources are often not accounted for in health and social care literature.
Sources that reported on the financial expenses incurred by older people with frailty living in the community or their caregivers were eligible for inclusion in the review.
We searched for published and unpublished (ie, policy papers, theses, and dissertations) studies written in English or French between 2001 and 2019 located in databases including MEDLINE (Ovid), CINAHL (EBSCO), and Elsevier. JBI scoping review methodology was used, and we consulted with a patient and family advisory group to support the relevance of the review.
A total of 42 sources were included in the review, including two policy papers and 40 research papers. The majority of the papers were from the US (n = 18), with others from Canada (n = 6), the United Kingdom (n = 3), Japan (n = 2), Australia (n = 1), Brazil (n = 1), China (n = 1), Denmark (n = 1), Israel (n = 1), Italy (n = 1), The Netherlands (n = 1), Poland (n = 1), Portugal (n = 1), Singapore (n = 1), South Korea (n = 1), Taiwan (n = 1), and Turkey (n = 1). The included research studies used various research designs, including cross-sectional (n = 18), qualitative (n = 15), randomized control trials (n = 2), longitudinal (n = 2), cost effectiveness (n = 1), quasi-experimental (n = 1), and mixed methods (n = 1).
The included sources used the term “frailty” inconsistently and used various methods to demonstrate frailty. Categories of out-of-pocket expenses found in the literature included home care, medication, cleaning and laundry, food, transportation, medical equipment, respite, assistive devices, home modifications, and insurance. Five sources reported on out-of-pocket expenses associated with people who were frail and had dementia, and seven reported on the out-of-pocket expenses for caregivers of people with frailty. While seven articles reported on specific programs, there was very little consistency in how out-of-pocket expenses were used as outcome measures. Several studies used measures of combined out-of-pocket expenses, but there was no standard approach to reporting aggregate out-of-pocket expenses.
Contextual factors are important to the experiences of out-of-pocket spending for older people with frailty. There is a need to develop a standardized approach to measuring out-of-pocket expenses in order to support further synthesis of the literature. We suggest a measure of out-of-pocket spending as a percentage of family income. The review supports education for health care providers to assess the out-of-pocket spending of community-dwelling older people with frailty and their caregivers, as well as to be aware of the local policies and resources to support older people with frailty address out-of-pocket spending.
Correspondence: Elaine Moody, Elaine.Moody@dal.ca
The authors declare no conflict of interest.
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