Cirrhosis Burden Expected to Climb in this Frail Population
New research shows that older Americans with cirrhosis have
significantly worse health status and greater functional disability
compared to those without this potentially deadly disease. In fact,
findings now published in Hepatology,
a peer-reviewed journal of the American Association for the Study of
Liver Diseases, show that elderly patients with cirrhosis require twice
the amount of informal caregiving and contribute added strain on the
health care system. Given the increase in obesity and aging of those
with hepatitis C (HCV), researchers expect the prevalence of cirrhosis
to climb in this frail population.
Cirrhosis is a chronic condition that causes the liver to slowly
deteriorate, with scar tissue replacing healthy tissue and impairing
liver function. 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% of the general
population and found in 75% of obese individuals. The Action Plan for
Liver Disease Research estimates that 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,” said Dr. Mina Rakoski with
the University of Michigan Medical School in Ann Arbor. “Therefore,
understanding the health and economic burden on older cirrhotic
patients, their caregivers, and the health system is extremely
important.” In the present study Dr. Rakoski and colleagues identified
317 patients with cirrhosis and 951 age-matched individuals without the
disease from the Health and Retirement Study (HRS) and Medicare claims
files. Researchers assessed patients’ health status which included
comorbidities, healthcare utilization and functional disability.
Informal caregiving, measured by hours of care and associated cost, was
also examined.
Study results reveal that patients with cirrhosis were more likely to be
Hispanic, have less education, and have lower net worth. Older cirrhotic
patients had worse self-reported health status and more medical
comorbidities compared to those without the disease. Utilization of
health care services, including physician visits, nursing home stays and
hospitalizations, was more than double in those with cirrhosis compared
to non-cirrhotic peers.
Greater functional disability was also significant among those with
cirrhosis as measured by activities of daily living (ADL) and
instrumental activities of daily living (IADL). Overall, 14% of
cirrhotic patients could perform only one to two ADLs, such as dressing
oneself, while 10% could perform none or only one IADL, such as
housework. Given their inability to perform common everyday tasks, it is
not surprising that informal caregiving was much higher in individuals
with cirrhosis—twice the number of informal caregiving hours per week 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,” concludes Dr. 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 authors recommend that future studies
should investigate the impact of functional disability on outcomes such
as hospital readmission and mortality in older patients with cirrhosis.
