Restricted Activity among Community-Living Older Persons: Incidence, Precipitants, and Health Care Utilization

  1. Thomas M. Gill, MD;
  2. Mayur M. Desai, PhD;
  3. Evelyne A. Gahbauer, MD, MPH;
  4. Theodore R. Holford, PhD; and
  5. Christianna S. Williams, MPH
  1. From Yale University School of Medicine, New Haven, and Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.

    Abstract

    Background: 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.

    Objective: 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.

    Design: Prospective cohort study.

    Setting: New Haven, Connecticut.

    Participants: 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).

    Measurements: 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.

    Results: 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).

    Conclusions: 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.

    Article and Author Information

    • Acknowledgments: The authors thank Susan E. Hardy, MD, and Mary E. Tinetti, MD, for review of an earlier draft of this manuscript; Denise Shepard, BSN, MBA, Bernice Hebert, RN, Shirley Hannan, RN, Martha Oravetz, RN, Alice Kossack, Barbara Foster, and Shari Lani for assistance with data collection; Wanda Carr and Geraldine Hawthorne for assistance with data entry and management; Peter Charpentier, MPH, for development of the participant tracking system; Joanne McGloin, MDiv, MBA, for leadership and advice as the project director; and the physicians and staff of the former CHC Physicians, who provided us with access to our study population.

    • Grant Support: In part by grants from the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the National Institute on Aging (1R01AG17560-01A1). Dr. Gill is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar and the recipient of Academic Award K23AG00759 from the National Institute on Aging; during the course of this study, he was also a Paul Beeson Physician Faculty Scholar in Aging Research.

    • Requests for Single Reprints: Thomas M. Gill, MD, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504.

    • Current Author Addresses: Dr. Gill: Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504.

    • Dr. Desai: Veterans Affairs Connecticut Health Care Systems, 950 Campbell Avenue, West Haven, CT 06516.

    • Dr. Gahbauer and Ms. Williams: Yale Program on Aging, 1 Church Street, 7th Floor, New Haven, CT 06510-3330.

    • Dr. Holford: Yale University School of Medicine, Laboratory of Epidemiology and Public Health, 60 College Street, New Haven, CT 06510-3210.

    • Author Contributions: Conception and design: T.M. Gill, M.M. Desai, C.S. Williams.

    • Analysis and interpretation of the data: T.M. Gill, M.M. Desai, E.A. Gahbauer, T.R. Holford, C.S. Williams.

    • Drafting of the article: T.M. Gill, M.M. Desai, C.S. Williams.

    • Critical revision of the article for important intellectual content: T.M. Gill, M.M. Desai, E.A. Gahbauer, T.R. Holford, C.S. Williams.

    • Final approval of the article: T.M. Gill, M.M. Desai, E.A. Gahbauer, T.R. Holford, C.S. Williams.

    • Statistical expertise: M.M. Desai, T.R. Holford, C.S. Williams.

    • Obtaining of funding: T.M. Gill.

    • Administrative, technical, or logistic support: E.A. Gahbauer.

    • Collection and assembly of data: T.M. Gill.

    Summary for Patients

    • Summaries for Patients:Restricted Activity among Older People Living in the Community Ann Intern Med September 4, 2001 135:S33
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    1. Ann Intern Med September 4, 2001 vol. 135 no. 5 313-321
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