Effects of Mobility and Multimorbidity on Inpatient and Postacute Health Care Utilization

Kristine E. Ensrud, Li Yung Lui, Lisa Langsetmo, Tien N. Vo, Brent C. Taylor, Peggy M. Cawthon, Meredith L. Kilgore, Charles E. McCulloch, Jane A. Cauley, Marcia L. Stefanick, Kristine Yaffe, Eric Orwoll, John T. Schousboe

Research output: Contribution to journalReview article

4 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1343-1349
Number of pages7
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume73
Issue number10
DOIs
StatePublished - Sep 11 2018

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Subacute Care
Patient Acceptance of Health Care
Comorbidity
Inpatients
Confidence Intervals
Hospitalization
Mobility Limitation
Osteoporotic Fractures
Medicare

Keywords

  • Gait speed
  • Hospitalization
  • Multimorbidity
  • Older men
  • Postacute care

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology

Cite this

Ensrud, K. E., Lui, L. Y., Langsetmo, L., Vo, T. N., Taylor, B. C., Cawthon, P. M., ... Schousboe, J. T. (2018). Effects of Mobility and Multimorbidity on Inpatient and Postacute Health Care Utilization. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 73(10), 1343-1349. https://doi.org/10.1093/gerona/glx128

Effects of Mobility and Multimorbidity on Inpatient and Postacute Health Care Utilization. / Ensrud, Kristine E.; Lui, Li Yung; Langsetmo, Lisa; Vo, Tien N.; Taylor, Brent C.; Cawthon, Peggy M.; Kilgore, Meredith L.; McCulloch, Charles E.; Cauley, Jane A.; Stefanick, Marcia L.; Yaffe, Kristine; Orwoll, Eric; Schousboe, John T.

In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, Vol. 73, No. 10, 11.09.2018, p. 1343-1349.

Research output: Contribution to journalReview article

Ensrud, KE, Lui, LY, Langsetmo, L, Vo, TN, Taylor, BC, Cawthon, PM, Kilgore, ML, McCulloch, CE, Cauley, JA, Stefanick, ML, Yaffe, K, Orwoll, E & Schousboe, JT 2018, 'Effects of Mobility and Multimorbidity on Inpatient and Postacute Health Care Utilization', Journals of Gerontology - Series A Biological Sciences and Medical Sciences, vol. 73, no. 10, pp. 1343-1349. https://doi.org/10.1093/gerona/glx128
Ensrud, Kristine E. ; Lui, Li Yung ; Langsetmo, Lisa ; Vo, Tien N. ; Taylor, Brent C. ; Cawthon, Peggy M. ; Kilgore, Meredith L. ; McCulloch, Charles E. ; Cauley, Jane A. ; Stefanick, Marcia L. ; Yaffe, Kristine ; Orwoll, Eric ; Schousboe, John T. / Effects of Mobility and Multimorbidity on Inpatient and Postacute Health Care Utilization. In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2018 ; Vol. 73, No. 10. pp. 1343-1349.
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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.",
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AU - Ensrud, Kristine E.

AU - Lui, Li Yung

AU - Langsetmo, Lisa

AU - Vo, Tien N.

AU - Taylor, Brent C.

AU - Cawthon, Peggy M.

AU - Kilgore, Meredith L.

AU - McCulloch, Charles E.

AU - Cauley, Jane A.

AU - Stefanick, Marcia L.

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AU - Schousboe, John T.

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N2 - 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.

AB - 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.

KW - Gait speed

KW - Hospitalization

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KW - Postacute care

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