Study: Elderly with cirrhosis present growing burden on healthcare system

Older Americans with cirrhosis have significantly worse health status, greater functional disability and require twice the amount of informal caregiving compared to those without the disease, according to findings published in Hepatology, a journal of the American Association for the Study of Liver Diseases.

The study shows that elderly patients with cirrhosis contribute added strain on the healthcare system. Given the increase in obesity and aging of those with hepatitis C, the researchers expect the prevalence of cirrhosis to climb in this population.

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

Researchers with the University of Michigan Medical School in Ann Arbor identified 317 patients with cirrhosis and 951 age-matched individuals without the disease from the Health and Retirement Study and Medicare claims files.

Study results revealed that older cirrhotic patients had worse self-reported health status and more medical comorbidities compared to those without the disease. Utilization of healthcare services, including 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 and instrumental activities of daily living. Overall, 14 percent of cirrhotic patients could perform only one to two ADLs, such as dressing oneself.

“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,” researchers said. “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 recommended that future studies should investigate the impact of functional disability on outcomes such as hospital readmission and mortality in older patients with cirrhosis.