Kerry M Sheets1,2,3, Allyson M Kats4, Lisa Langsetmo4, Dawn Mackey5, Howard A Fink2,3,4,6, Susan J Diem2,3,4, Wei Duan-Porter2,3, Peggy M Cawthon7, John T Schousboe8,9, Kristine E Ensrud2,3,4. 1. Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA. 2. Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota, USA. 3. Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA. 4. Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA. 5. Aging and Population Health Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada. 6. Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, Minnesota, USA. 7. Research Institute, California Pacific Medical Center, San Francisco, California, USA. 8. HealthPartners Institute, Bloomington, Minnesota, USA. 9. Division of Health Policy & Management, University of Minnesota, Minneapolis, Minnesota, USA.
Abstract
OBJECTIVES: To determine the association of life-space score with subsequent healthcare costs and utilization. DESIGN: Prospective cohort study (Osteoporotic Fracture in Men [MrOS]). SETTING: Six U.S. sites. PARTICIPANTS: A total of 1555 community-dwelling men (mean age 79.3 years; 91.5% white, non-Hispanic) participating in the MrOS Year 7 (Y7) examination linked with their Medicare claims data. MEASUREMENTS: Life-space during the past month was assessed as 0 (daily restriction to one's bedroom) to 120 (daily trips outside one's town without assistance) and categorized (0-40, 41-60, 61-80, 81-100, 101-120). Total annualized direct healthcare costs and utilization were ascertained during 36 months after the Y7 examination. RESULTS: Mean total annualized costs (2020 U.S. dollars) steadily increased across category of life-space score, from $7954 (standard deviation [SD] 16,576) among men with life-space scores of 101-120 to $26,430 (SD 28,433) among men with life-space scores of 0-40 (p < 0.001). After adjustment for demographics, men with a life-space score of 0-40 versus men with a life-space score of 101-120 had greater mean total costs (cost ratio [CR] = 2.52; 95% confidence interval [CI] = 1.84-3.45) and greater risk of subsequent hospitalization (odds ratio [OR] 4.72, 95% CI 2.61-8.53) and skilled nursing facility (SNF) stay (OR 7.32, 95% CI 3.65-14.66). Life-space score was no longer significantly associated with total healthcare costs (CR for 0-40 vs 101-120 1.29; 95% CI 0.91-1.84) and hospitalization (OR 1.76, 95% CI 0.89-3.51) after simultaneous consideration of demographics, medical factors, self-reported health and function, and the frailty phenotype; the association of life-space with SNF stay remained significant (OR 2.86, 95% CI 1.26-6.49). CONCLUSION: Our results highlight the importance of function and mobility in predicting future healthcare costs and suggest the simple and convenient life-space score may in part capture risks from major geriatric domains and improve identification of older, community-dwelling men likely to require costly care.
OBJECTIVES: To determine the association of life-space score with subsequent healthcare costs and utilization. DESIGN: Prospective cohort study (Osteoporotic Fracture in Men [MrOS]). SETTING: Six U.S. sites. PARTICIPANTS: A total of 1555 community-dwelling men (mean age 79.3 years; 91.5% white, non-Hispanic) participating in the MrOS Year 7 (Y7) examination linked with their Medicare claims data. MEASUREMENTS: Life-space during the past month was assessed as 0 (daily restriction to one's bedroom) to 120 (daily trips outside one's town without assistance) and categorized (0-40, 41-60, 61-80, 81-100, 101-120). Total annualized direct healthcare costs and utilization were ascertained during 36 months after the Y7 examination. RESULTS: Mean total annualized costs (2020 U.S. dollars) steadily increased across category of life-space score, from $7954 (standard deviation [SD] 16,576) among men with life-space scores of 101-120 to $26,430 (SD 28,433) among men with life-space scores of 0-40 (p < 0.001). After adjustment for demographics, men with a life-space score of 0-40 versus men with a life-space score of 101-120 had greater mean total costs (cost ratio [CR] = 2.52; 95% confidence interval [CI] = 1.84-3.45) and greater risk of subsequent hospitalization (odds ratio [OR] 4.72, 95% CI 2.61-8.53) and skilled nursing facility (SNF) stay (OR 7.32, 95% CI 3.65-14.66). Life-space score was no longer significantly associated with total healthcare costs (CR for 0-40 vs 101-120 1.29; 95% CI 0.91-1.84) and hospitalization (OR 1.76, 95% CI 0.89-3.51) after simultaneous consideration of demographics, medical factors, self-reported health and function, and the frailty phenotype; the association of life-space with SNF stay remained significant (OR 2.86, 95% CI 1.26-6.49). CONCLUSION: Our results highlight the importance of function and mobility in predicting future healthcare costs and suggest the simple and convenient life-space score may in part capture risks from major geriatric domains and improve identification of older, community-dwelling men likely to require costly care.
Authors: Richard E Kennedy; Courtney P Williams; Patricia Sawyer; Alexander X Lo; Kay Connelly; Ariann Nassel; Cynthia J Brown Journal: J Aging Health Date: 2017-09-14
Authors: John T Schousboe; Misti L Paudel; Brent C Taylor; Lih-Wen Mau; Beth A Virnig; Kristine E Ensrud; Bryan E Dowd Journal: Health Serv Res Date: 2014-01-24 Impact factor: 3.402