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High rates of disability and health care use found in older Americans with cirrhosis

Cirrhosis burden expected to climb in this frail population

Older patients with cirrhosis have significant functional disability, require twice the amount of informal caregiving, and contribute added strain on the health care system, according to U-M research published in Hepatology.

Given the increase in obesity and aging of those with hepatitis C (HCV), researchers expect the prevalence of cirrhosis to climb among older Americans.

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 percent of the general population and found in 75 percent 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," 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."

Rakoski and U-M colleagues identified 317 patients with cirrhosis and 951 age-matched individuals without the disease from the Health and Retirement Study and Medicare claims files. Researchers assessed patients' health status and informal caregiving, measured by hours of care and associated cost.

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 co-morbidities 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 and instrumental activities of daily living. 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," 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 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.

Hepatology is the official journal of the American Association for the Study of Liver Diseases.

Additional authors: All from University of Michigan. Ryan J. McCammon, John D. Piette, Theodore J. Iwashyna, Jorge A. Marrero, Anna S. Lok, Kenneth M. Langa and Michael L. Volk.

Journal citation: DOI: 10.1002/hep.24616

This study is published in Hepatology. Media wishing to receive a PDF of this article may contact

About U-M's Division of Gastroenterology: U-M is one of the largest gastroenterology practices in the country and is a leader in the prevention, diagnosis, and treatment of diseases of the gastrointestinal tract and liver. Our 50-plus physicians are experts in the diagnosis and treatment of all diseases of the gastrointestinal system, from simple to complex, including those of the esophagus, stomach, small intestine, colon, rectum, liver, gallbladder, pancreas and biliary tract.

Mary F. Masson | EurekAlert!
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