Kristine E Ensrud1,2,3, Li-Yung Lui4, Lisa Langsetmo2, Tien N Vo2, Brent C Taylor1,2,3, Peggy M Cawthon4,5, Meredith L Kilgore6, Charles E McCulloch5, Jane A Cauley7, Marcia L Stefanick8, Kristine Yaffe9,10,11, Eric S Orwoll12, John T Schousboe13,14. 1. Department of Medicine, University of Minnesota, Minneapolis. 2. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis. 3. Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota. 4. California Pacific Medical Center Research Institute, San Francisco. 5. Department of Epidemiology and Biostatistics, University of California, San Francisco. 6. Department of Health Care Organization and Policy, University of Alabama at Birmingham. 7. Department of Epidemiology, University of Pittsburgh, Pennsylvania. 8. Department of Medicine, Stanford University, California. 9. Department of Psychiatry, University of California, San Francisco. 10. Department of Neurology, University of California, San Francisco. 11. Department of Epidemiology, University of California, San Francisco. 12. Bone and Mineral Unit, Oregon Health and Science University, Portland. 13. HealthPartners Institute, Bloomington, Minnesota. 14. Division of Health Policy and Management, University of Minnesota, Minneapolis.
Abstract
Background: This study examines effects of mobility and multimorbidity on hospitalization and inpatient and postacute care (PAC) facility days among older men. Methods: Prospective study of 1,701 men (mean age 79.3 years) participating in Osteoporotic Fractures in Men (MrOS) Study Year 7 (Y7) examination (2007-2008) linked with their Medicare claims. At Y7, mobility ascertained by usual gait speed and categorized as poor, intermediate, or good. Multimorbidity quantified by applying Elixhauser algorithm to inpatient and outpatient claims and categorized as none, mild-moderate, or high. Hospitalizations and PAC facility stays ascertained during 12 months following Y7. Results: Reduced mobility and greater multimorbidity burden were independently associated with a higher risk of inpatient and PAC facility utilization, after accounting for each other and traditional indicators. Adjusted mean total facility days per year were 1.13 (95% confidence interval [CI] = 0.74-1.40) among men with good mobility increasing to 2.43 (95% CI = 1.17-3.84) among men with poor mobility, and 0.67 (95% CI = 0.38-0.91) among men without multimorbidity increasing to 2.70 (95% CI = 1.58-3.77) among men with high multimorbidity. Men with poor mobility and high multimorbidity had a ninefold increase in mean total facility days per year (5.50, 95% CI = 2.78-10.87) compared with men with good mobility without multimorbidity (0.59, 95% CI = 0.37-0.95). Conclusions: Among older men, mobility limitations and multimorbidity were independent predictors of higher inpatient and PAC utilization after considering each other and conventional predictors. Marked combined effects of reduced mobility and multimorbidity burden may be important to consider in clinical decision-making and planning health care delivery strategies for the growing aged population.
Background: This study examines effects of mobility and multimorbidity on hospitalization and inpatient and postacute care (PAC) facility days among older men. Methods: Prospective study of 1,701 men (mean age 79.3 years) participating in Osteoporotic Fractures in Men (MrOS) Study Year 7 (Y7) examination (2007-2008) linked with their Medicare claims. At Y7, mobility ascertained by usual gait speed and categorized as poor, intermediate, or good. Multimorbidity quantified by applying Elixhauser algorithm to inpatient and outpatient claims and categorized as none, mild-moderate, or high. Hospitalizations and PAC facility stays ascertained during 12 months following Y7. Results: Reduced mobility and greater multimorbidity burden were independently associated with a higher risk of inpatient and PAC facility utilization, after accounting for each other and traditional indicators. Adjusted mean total facility days per year were 1.13 (95% confidence interval [CI] = 0.74-1.40) among men with good mobility increasing to 2.43 (95% CI = 1.17-3.84) among men with poor mobility, and 0.67 (95% CI = 0.38-0.91) among men without multimorbidity increasing to 2.70 (95% CI = 1.58-3.77) among men with high multimorbidity. Men with poor mobility and high multimorbidity had a ninefold increase in mean total facility days per year (5.50, 95% CI = 2.78-10.87) compared with men with good mobility without multimorbidity (0.59, 95% CI = 0.37-0.95). Conclusions: Among older men, mobility limitations and multimorbidity were independent predictors of higher inpatient and PAC utilization after considering each other and conventional predictors. Marked combined effects of reduced mobility and multimorbidity burden may be important to consider in clinical decision-making and planning health care delivery strategies for the growing aged population.
Authors: B W Penninx; L Ferrucci; S G Leveille; T Rantanen; M Pahor; J M Guralnik Journal: J Gerontol A Biol Sci Med Sci Date: 2000-11 Impact factor: 6.053
Authors: Robert S Wilson; Kumar B Rajan; Lisa L Barnes; Liesi E Hebert; Carlos F Mendes de Leon; Denis A Evans Journal: J Gerontol A Biol Sci Med Sci Date: 2013-10-10 Impact factor: 6.053
Authors: Eric Orwoll; Janet Babich Blank; Elizabeth Barrett-Connor; Jane Cauley; Steven Cummings; Kristine Ensrud; Cora Lewis; Peggy M Cawthon; Robert Marcus; Lynn M Marshall; Joan McGowan; Kathy Phipps; Sherry Sherman; Marcia L Stefanick; Katie Stone Journal: Contemp Clin Trials Date: 2005-10 Impact factor: 2.226
Authors: Heather E Whitson; Kimberly S Johnson; Richard Sloane; Christine T Cigolle; Carl F Pieper; Lawrence Landerman; Susan N Hastings Journal: J Am Geriatr Soc Date: 2016-06-16 Impact factor: 5.562
Authors: G Abellan van Kan; Y Rolland; S Andrieu; J Bauer; O Beauchet; M Bonnefoy; M Cesari; L M Donini; S Gillette Guyonnet; M Inzitari; F Nourhashemi; G Onder; P Ritz; A Salva; M Visser; B Vellas Journal: J Nutr Health Aging Date: 2009-12 Impact factor: 4.075
Authors: Anne-Marie Hill; Angela Jacques; A Michelle Chandler; Phyllis A Richey; Lorraine C Mion; Ronald I Shorr Journal: Jt Comm J Qual Patient Saf Date: 2018-09-28
Authors: Anne-Marie Hill; Steven M McPhail; Terry P Haines; Meg E Morris; Christopher Etherton-Beer; Ronald Shorr; Leon Flicker; Max Bulsara; Nicholas Waldron; Den-Ching A Lee; Jacqueline Francis-Coad; Amanda Boudville Journal: J Gerontol A Biol Sci Med Sci Date: 2019-08-16 Impact factor: 6.053
Authors: A Calderón-Larrañaga; D L Vetrano; L Ferrucci; S W Mercer; A Marengoni; G Onder; M Eriksdotter; L Fratiglioni Journal: J Intern Med Date: 2018-11-22 Impact factor: 8.989
Authors: Lisa Langsetmo; Allyson M Kats; Peggy M Cawthon; Jane A Cauley; Tien N Vo; Brent C Taylor; Marcia L Stefanick; Nancy E Lane; Katie L Stone; Eric S Orwoll; John T Schousboe; Kristine E Ensrud Journal: J Gerontol A Biol Sci Med Sci Date: 2019-05-16 Impact factor: 6.053
Authors: Javier de la Fuente; Francisco Félix Caballero; Albert Sánchez-Niubó; Demosthenes B Panagiotakos; A Matthew Prina; Holger Arndt; Josep Maria Haro; Somnath Chatterji; José Luis Ayuso-Mateos Journal: J Gerontol A Biol Sci Med Sci Date: 2018-10-08 Impact factor: 6.053