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J Gerontol A Biol Sci Med Sci. 2018 Sep 11;73(10):1343-1349. doi: 10.1093/gerona/glx128.

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

Author information

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.

PMID:
28645202
PMCID:
PMC6132118
[Available on 2019-09-11]
DOI:
10.1093/gerona/glx128

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