OBJECTIVES: To use multivariate analyses to i] examine factors that affect functionality, use of services, and costs of care, and ii] assess whether a SIB would be a feasible financing instrument for a preventive intervention that aims to maintain the functionality of the elderly.

METHODS: The study was part of functional capacity of the elderly SIB project. PICOSTEPS (Patients-Intervention-Comparator-Outcomes-Setting-Time-Effects-Perspective-Sensitivity) framework was applied. Data from two regions of Finland (Pohjanmaa, Etelä-Savo) consisting of 1,107 elderly people using assisted living services was managed, instrumented, and analysed.

The dependent variables in the models were the amount of used services, the expected annually cumulative costs during years 2019-2024, and the expected yearly costs. The models included multilevel linear and Poisson regressions and generalized estimating equations. The costs were presented in year 2019 real value without discounting.

RESULTS: First, mobility and health challenges, social challenges, poverty and losses, technological challenges, and cognitive impairment significantly increased whereas informal care decreased the amount of services used and care costs.

Second, SIBs might be suitable financial instruments for preventive interventions that aim to maintain the functionality of the elderly especially, if the intervention focuses on mobility, health, or social challenges. However, the SIB approach requires careful planning, predictive analyses, implementation, and assessment. In general, when the SIB is applied, indicators, outcomes, patient perspectives, potential for cost savings and other health economic value is essential for the knowledge management of SIB-based services.

CONCLUSIONS: We assessed factors and feasibility of a SIB and found important drivers of resources and costs. We recommend tying SIB-associated costs and outcomes to a general functionality meter. A topic for follow-up research is prediction of costs of care with a functionality meter, including determining the natural regression of functionality over time and estimation of the changes in costs of care due to changes in functionality.