Restricted activity among community-living older persons: Incidence, precipitants, and health care utilization

Background: Restricted activity is a potentially important indicator of hea lth and functional status. Yet, relatively little is known about the incide nce, precipitants, or health care utilization associated with restricted ac tivity among older persons. Objective: To more accurately estimate the rate of restricted activity amon g community-living older persons, to identify the health-related and non-he alth-related problems that lead to restricted activity, and to determine wh ether restricted activity is associated with increased health care utilizat ion. Design: Prospective cohort study. Setting: New Haven, Connecticut. Participants: 754 nondisabled members of a large health plan, 70 years of a ge or older, who were categorized according to their risk for disability (l ow, intermediate, or high). Measurements: Occurrence of restricted activity (defined as having stayed i n 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 res tricted activity, and health care utilization were ascertained during month ly telephone interviews for up to 2 years. Results: In median follow-up of 15 months, 76.6% of participants reported r estricted activity during at least 1 month and 39.3% reported restricted ac tivity during 2 consecutive months. The rates of restricted activity per 10 0 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 dis ability, respectively. Of the 24 prespecified health-related and non-health -related problems, the rates per 100 person-months of restricted activity r anged from 0.1 episode for "problem with alcohol" to 65.5 episodes for "bee n fatigued." On average, participants identified 4.5 different problems as a cause for their restricted activity, Health care utilization was substant ially greater during months with restricted activity than months without re stricted 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 he alth care utilization (P<0.001 for each pairwise comparison). Conclusions: Restricted activity is common among community-living older per sons, 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.