Life-space mobility and healthcare costs and utilization in older men

Kerry M. Sheets, Allyson M. Kats, Lisa Langsetmo, Dawn Mackey, Howard A. Fink, Susan J. Diem, Wei Duan-Porter, Peggy M. Cawthon, John T. Schousboe, Kristine E. Ensrud

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To determine the association of life-space score with subsequent healthcare costs and utilization. Design: Prospective cohort study (Osteoporotic Fracture in Men [MrOS]). Setting: Six U.S. sites. Participants: A total of 1555 community-dwelling men (mean age 79.3 years; 91.5% white, non-Hispanic) participating in the MrOS Year 7 (Y7) examination linked with their Medicare claims data. Measurements: Life-space during the past month was assessed as 0 (daily restriction to one's bedroom) to 120 (daily trips outside one's town without assistance) and categorized (0–40, 41–60, 61–80, 81–100, 101–120). Total annualized direct healthcare costs and utilization were ascertained during 36 months after the Y7 examination. Results: Mean total annualized costs (2020 U.S. dollars) steadily increased across category of life-space score, from $7954 (standard deviation [SD] 16,576) among men with life-space scores of 101–120 to $26,430 (SD 28,433) among men with life-space scores of 0–40 (p < 0.001). After adjustment for demographics, men with a life-space score of 0–40 versus men with a life-space score of 101–120 had greater mean total costs (cost ratio [CR] = 2.52; 95% confidence interval [CI] = 1.84–3.45) and greater risk of subsequent hospitalization (odds ratio [OR] 4.72, 95% CI 2.61–8.53) and skilled nursing facility (SNF) stay (OR 7.32, 95% CI 3.65–14.66). Life-space score was no longer significantly associated with total healthcare costs (CR for 0–40 vs 101–120 1.29; 95% CI 0.91–1.84) and hospitalization (OR 1.76, 95% CI 0.89–3.51) after simultaneous consideration of demographics, medical factors, self-reported health and function, and the frailty phenotype; the association of life-space with SNF stay remained significant (OR 2.86, 95% CI 1.26–6.49). Conclusion: Our results highlight the importance of function and mobility in predicting future healthcare costs and suggest the simple and convenient life-space score may in part capture risks from major geriatric domains and improve identification of older, community-dwelling men likely to require costly care.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - 2021

Bibliographical note

Funding Information:
This manuscript was supported by the National Institute on Aging (NIA) under grant numbers R56 AG057498 and R01 AG067973. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health (NIH) funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. This manuscript is also the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System.

Funding Information:
National Institute of Arthritis and Musculoskeletal and Skin Diseases, Grant/Award Number: U01 AR066160; National Institute on Aging, Grant/Award Numbers: R01 AG067973, R56 AG057498, U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168; NIH Roadmap for Medical Research; National Center for Advancing Translational Sciences; National Institutes of Health Funding information

Publisher Copyright:
© 2021 The American Geriatrics Society.

Keywords

  • healthcare costs
  • healthcare utilization
  • mobility

PubMed: MeSH publication types

  • Journal Article

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