Restricted activity among community-living older persons: incidence, precipitants, and health care utilization.
ABSTRACT 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.
SourceAvailable from: Heather G AlloreAnnals of internal medicine 01/2012; 156(2):131. DOI:10.7326/0003-4819-156-2-201201170-00009 · 16.10 Impact Factor
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ABSTRACT: Objectives To evaluate the relationship between intervening illnesses and injuries leading to hospitalization and restricted activity, respectively, and prolongation of disability in four essential activities of daily living in newly disabled older persons.DesignProspective cohort study.SettingGreater New Haven, Connecticut.ParticipantsCommunity-living persons aged 70 and older who had at least one episode of disability from March 1998 to June 2013 (N = 632).MeasurementsDisability and exposure to intervening illesses and injuries leading to hospitalization and restricted activity, respectively, were assessed every month. Prolongation of disability was operationalized in two complementary ways: as a dichotomous outcome, based on the persistence of any disability, and as a count of the number of disabled activities.ResultsDuring a median follow-up of 114 months, the 632 participants experienced 2,764 disability episodes. The mean exposure rates for hospitalization and restricted activity were 80.7 (95% confidence interval (CI) = 73.7–88.4) and 173.6 (95% CI = 162.5–185.5), respectively, per 1,000 person-months. After adjustment for multiple disability risk factors, the likelihood of disability prolongation was 2.5 times as great (odds ratio (OR) 2.54, 95% CI = 2.05–3.15) for hospitalization and 1.2 times as great (1.21, 95% CI = 1.06–1.40) for restricted activity as for no hospitalization or restricted activity, and the mean number of disabilities was 35% (risk ratio (RR) = 1.35, 95% CI = 1.30–1.39) greater in the setting of hospitalization and 7% (1.07, 95% CI = 1.05–1.09) greater in the setting of restricted activity.Conclusion Intervening illnesses and injuries leading to hospitalization and restricted activity, respectively, are strongly associated with prolongation of disability in newly disabled older adults. Efforts to prevent and more-aggressively manage these intervening events have the potential to break the cycle of disability in older persons.Journal of the American Geriatrics Society 03/2015; DOI:10.1111/jgs.13319 · 4.22 Impact Factor
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ABSTRACT: Background/Study Context: The potential of cluster analysis (CA) as a baseline predictor of multivariate gerontologic outcomes over a long period of time has not been previously demonstrated. Methods: Restricting candidate variables to a small group of established predictors of deleterious gerontologic outcomes, various CA methods were applied to baseline values from 754 nondisabled, community-living persons, aged 70 years or older. The best cluster solution yielded at baseline was subsequently used as a fixed explanatory variable in time-to-event models of the first occurrence of the following outcomes: any disability in four activities of daily living, any disability in four mobility measures, and death. Each outcome was recorded through a maximum of 129 months or death. Associations between baseline ordinal cluster level and first occurrence of all three outcomes were modeled over a 10-year period with proportional hazards regression and compared with the associations yielded by the analogous latent class analysis (LCA) solution. Results: The final cluster-defining variables were continuous measures of cognitive status and depressive symptoms, and dichotomous indicators of slow gait and exhaustion. The best solution yielded by baseline values of these variables was obtained with a K-means algorithm and cosine similarity and consisted of three clusters representing increasing levels of impairment. After adjustment for age, sex, ethnic group, and number of chronic conditions, baseline ordinal cluster level demonstrated significantly positive associations with all three outcomes over a 10-year period that were equivalent to those from the corresponding LCA solution. Conclusion: These findings suggest that baseline clusters based on previously established explanatory variables have potential to predict multivariate gerontologic outcomes over a long period of time.Experimental Aging Research 03/2015; 41(2):177-192. DOI:10.1080/0361073X.2015.1001655 · 1.10 Impact Factor