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

Yale University, New Haven, Connecticut, United States
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.

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Available from: Thomas Gill, Aug 13, 2015
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    • "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 "
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    • "This improvement in muscle fatigue properties with age seems to be at odds with what is more commonly observed during everyday living, namely that older adults often fatigue more quickly than younger adults during functional physical activities[16]. Similarly, the perception of fatigue is a significant complaint in older adults171819and predicts functional deficits over time including gait speed and physical performance[20].Avin and Frey Law (2011)found that the age-related fatigue advantage observed with static tasks was not present for dynamic tasks (effect size=0.05)[8]. However, this still does not explain the greater fatigue observed in older populations during functional tasks. "

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