Restricted Activity among Older People Living in the Community

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The summary below is from the full report titled "Restricted Activity among Community-Living Older Persons: Incidence, Precipitants, and Health Care Utilization." It is in the 4 September 2001 issue of Annals of Internal Medicine (volume 135, pages 313-321). The authors are TM Gill, MM Desai, EA Gahbauer, TR Holford, and CS Williams.

What is the problem and what is known about it so far?

Older people sometimes restrict their activities because of health problems. Little is known, however, about how frequently this happens or what causes it to happen, or whether decreased activity is associated with an increase in the use of health care services.

Why did the researchers do this particular study?

To understand better how frequently older people decrease their usual activities because of health problems, and which health problems cause this to happen.

Who was studied?

The study included 754 members of a large health plan in Connecticut who were 70 years of age or older and able to care for themselves without assistance (no disability).

How was the study done?

At the beginning of the study, nurses collected information from study patients about age, medical problems, mental abilities, and walking speed. Using this information, the researchers decided whether people were at low, medium, or high risk for future disability. The researchers then called patients monthly for an average of 15 months and asked them two questions: 1) "Since we last talked, have you stayed in bed for at least half a day due to illness, injury, or other problem?" and 2) "Since we last talked, have you cut down on your usual activities due to an illness, injury, or other problem?" If patients answered "yes" to either question, the researchers asked whether they had experienced any of 24 specific problems since the last interview and whether any of these problems caused the decreased activity.

What did the researchers find?

Over three quarters of the study patients reported either having to stay in bed or cut down on usual activities during at least one month of the study. Not surprisingly, rates of restricted activity were lowest in people at low risk and highest in those at high risk for disability, but even those at low risk reported some activity restrictions. On average, patients identified 4 to 5 different problems as causes of each episode of restricted activity, most commonly fatigue, joint or back stiffness, dizziness, cold or flu symptoms, difficulty breathing, and being afraid of falling. Health care use was higher during periods of restricted activity than periods of usual activity, but many older people with restricted activity did not seek care.

What were the limitations of the study?

This study does not tell us the frequency of these health problems among people whose activity did not decrease.

What are the implications of the study?

Older people living in the community frequently decrease their usual activities regardless of their risk for disability, and they usually report several health-related problems as the reason. Further research should evaluate the consequences of activity restrictions and ways to reduce the frequency of such restrictions.