Restricted activity among community-living older persons: Incidence, precipitants, and health care utilization

Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504, USA.
Annals of internal medicine (Impact Factor: 17.81). 09/2001; 135(5):313-21. DOI: 10.7326/0003-4819-135-5-200109040-00007
Source: PubMed


Restricted activity is a potentially important indicator of health and functional status. Yet, relatively little is known about the incidence, precipitants, or health care utilization associated with restricted activity among older persons.
To more accurately estimate the rate of restricted activity among community-living older persons, to identify the health-related and non-health-related problems that lead to restricted activity, and to determine whether restricted activity is associated with increased health care utilization.
Prospective cohort study.
New Haven, Connecticut.
754 nondisabled members of a large health plan, 70 years of age or older, who were categorized according to their risk for disability (low, intermediate, or high).
Occurrence of restricted activity (defined as having stayed in bed for at least half a day or having cut down on one's usual activities because of an illness, injury, or another problem), problems leading to restricted activity, and health care utilization were ascertained during monthly telephone interviews for up to 2 years.
In median follow-up of 15 months, 76.6% of participants reported restricted activity during at least 1 month and 39.3% reported restricted activity during 2 consecutive months. The rates of restricted activity per 100 person-months were 19.0 episodes for all participants and 16.9, 27.3, and 22.7 episodes for participants at low, intermediate, and high risk for disability, respectively. Of the 24 prespecified health-related and non-health-related problems, the rates per 100 person-months of restricted activity ranged from 0.1 episode for "problem with alcohol" to 65.5 episodes for "been fatigued." On average, participants identified 4.5 different problems as a cause for their restricted activity. Health care utilization was substantially greater during months with restricted activity than months without restricted activity. The corresponding rates per 100 person-months were 63.8 and 45.1 for physician office visits, 12.5 and 1.0 for emergency department visits, 14.1 and 0.3 for hospital admissions, and 67.6 and 45.1 for any health care utilization (P < 0.001 for each pairwise comparison).
Restricted activity is common among community-living older persons, regardless of risk for disability, and it is usually attributable to several concurrent health-related problems. Although restricted activity is associated with a substantial increase in health care utilization, older persons with restricted activity often do not seek medical attention.

Download full-text


Available from: Thomas Gill, Aug 13, 2015
  • Source
    • "Fatigue is strongly associated with poor physical performance (Vestergaard et al., 2009), independently of age (Mänty et al., 2014), and with multiple negative outcomes in the elderly, including hospitalizations, increased use of healthcare services, incident disability, and mortality (Avlund et al., 2001; Hardy and Studenski, 2008a; Hardy and Studenski, 2008b; Schultz-Larsen and Avlund, 2007). Furthermore, fatigue is one of the main factors associated with reduced capacity to conduct regular physical activities among community-living older adults (Gill et al., 2001). Daily "
    [Show abstract] [Hide abstract]
    ABSTRACT: Frailty has been identified as a promising condition for distinguishing different degrees of vulnerability among older persons. Several operational definitions have proposed fatigue as one of the features characterizing the frailty syndrome. However, such a subjective symptom is still not yet sufficiently explored and understood. Fatigue is a common and distressing self-reported symptom perceived by the person while performing usual mental and physical activities, highly prevalent in older people, and strongly associated to negative health-related events. The understanding of fatigue is hampered by several issues, including the difficulty at objectively operationalizing, the controversial estimates of its prevalence, and the complex pathophysiological mechanisms underlying its manifestation. Despite such barriers, the study of fatigue is important and might be encouraged. Fatigue may be the marker of the depletion of the body's homeostatic reserves to a threshold leading to its psycho-physical functional impairment, mirroring the concept of frailty. Its subjective and symptomatic nature resembles that of other conditions (e.g., pain, depression), which equally affect the individual's quality of life, expose to negative outcomes, and severely burden healthcare expenditures. In the present paper, we present an overview of the current knowledge on fatigue in older persons in order to increase awareness about its clinical and research relevance. Future research on this topic should be encouraged and developed because it could potentially lead to novel interventions against this symptom as well as against frailty and age-related conditions. Copyright © 2015. Published by Elsevier Inc.
    Experimental Gerontology 07/2015; 70. DOI:10.1016/j.exger.2015.07.011 · 3.49 Impact Factor
  • Source
    • "These criteria were met by 231 individuals. At baseline, the mean age was 76 years (standard deviation [SD] = 4.2), years of education were 12.5 (SD = 2.7), number of chronic conditions (Gill et al., 2001 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To examine whether the age stereotypes of older individuals would become more negative or else show resiliency following stressful events and to examine whether age-stereotype negativity would increase the likelihood of experiencing a stressful event (i.e., hospitalization). Method: Age stereotypes of 231 participants, 70 years and older, were assessed across 10 years, before and after the occurrence of hospitalizations and bereavements. Results: Age-stereotype negativity was resilient despite encountering stressful events. In contrast, more negative age stereotypes were associated with a 50% greater likelihood of experiencing a hospitalization. Discussion: The robustness of negative age stereotypes was expressed in their capacity to resist change as well as generate it.
    The Journals of Gerontology Series B Psychological Sciences and Social Sciences 07/2014; 70(6). DOI:10.1093/geronb/gbu082 · 3.21 Impact Factor
  • Source
    • "Individuals were 70 years and older at the study’s inception (mean age = 78.4, SD = 5.3) [8,9]. The Yale-PEP survey contains longitudinal data of 754 community-dwelling, English-speaking, non-disabled persons who were not terminally ill. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The frailty index (FI) is used to measure the health status of ageing individuals. An FI is constructed as the proportion of deficits present in an individual out of the total number of age-related health variables considered. The purpose of this study was to systematically assess whether dichotomizing deficits included in an FI affects the information value of the whole index. Secondary analysis of three population-based longitudinal studies of community dwelling individuals: Nova Scotia Health Survey (NSHS, n = 3227 aged 18+), Survey of Health, Ageing and Retirement in Europe (SHARE, n = 37546 aged 50+), and Yale Precipitating Events Project (Yale-PEP, n = 754 aged 70+). For each dataset, we constructed two FIs from baseline data using the deficit accumulation approach. In each dataset, both FIs included the same variables (23 in NSHS, 70 in SHARE, 33 in Yale-PEP). One FI was constructed with only dichotomous values (marking presence or absence of a deficit); in the other FI, as many variables as possible were coded as ordinal (graded severity of a deficit). Participants in each study were followed for different durations (NSHS: 10 years, SHARE: 5 years, Yale PEP: 12 years). Within each dataset, the difference in mean scores between the ordinal and dichotomous-only FIs ranged from 0 to 1.5 deficits. Their ability to predict mortality was identical; their absolute difference in area under the ROC curve ranged from 0.00 to 0.02, and their absolute difference between Cox Hazard Ratios ranged from 0.001 to 0.009. Analyses from three diverse datasets suggest that variables included in an FI can be coded either as dichotomous or ordinal, with negligible impact on the performance of the index in predicting mortality.
    BMC Geriatrics 02/2014; 14(1):25. DOI:10.1186/1471-2318-14-25 · 1.68 Impact Factor
Show more