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Braga F, Milani M, Fachetti A, Espinosa G, Moraes G, Milani JGPO, Mourilhe-Rocha R. Peak oxygen uptake after the 80s as a survival predictor. Eur Geriatr Med 2024; 15:807-815. [PMID: 38421586 DOI: 10.1007/s41999-024-00949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Peak oxygen uptake (VO2peak) is a crucial health marker, extensively studied in adults for its prognostic value. However, its significance in the older persons, especially octogenarians, remains underexplored due to limited representation in research. This study aims to assess the predictive power of VO2peak for survival in individuals aged 80 and above. METHODS We included individuals aged 80 or older who underwent cardiopulmonary exercise tests at a single center. Mortality rates were compared based on VO2peak relative to 80% of predicted values (%VO2peak). We employed three multivariate Cox regression models: Model 1 (unadjusted), Model 2 (adjusted for age) and Model 3 (adjusted for age and stroke). RESULTS Among 188 participants (mean age 83.3 ± 3 years, 68.9% male), 22 (11.7%) passed away during a median follow-up of 494 days. Non-survivors tended to be older with lower VO2peak and %VO2peak. All models demonstrated associations between %VO2peak ≤ 80% and mortality: HR = 3.19 (95% CI: 1.30-7.86, p = 0.011) for M1; HR = 3.12 (95% CI: 1.26-7.74, p = 0.013) for M2 and HR = 2.80 (95% CI: 1.11-7.06, p = 0.028) for M3. CONCLUSION In the context of an aging population, this study underscores the enduring significance of VO2peak as a survival predictor among the older person, including octogenarians. These findings carry profound implications for tailoring healthcare strategies to address the evolving demographic landscape.
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Affiliation(s)
- Fabricio Braga
- Laboratório de Performance Humana, Largo do Ibam, no1-2o floor-Humaitá, Rio de Janeiro, RJ, 22271-070, Brazil.
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Mauricio Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Science, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Ana Fachetti
- Laboratório de Performance Humana, Largo do Ibam, no1-2o floor-Humaitá, Rio de Janeiro, RJ, 22271-070, Brazil
- Instituto Nacional de Cardiologia de Laranjeira, Rio de Janeiro, RJ, Brazil
| | - Gabriel Espinosa
- Laboratório de Performance Humana, Largo do Ibam, no1-2o floor-Humaitá, Rio de Janeiro, RJ, 22271-070, Brazil
- Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Gabriel Moraes
- Laboratório de Performance Humana, Largo do Ibam, no1-2o floor-Humaitá, Rio de Janeiro, RJ, 22271-070, Brazil
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Juliana Goulart Prata Oliveira Milani
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Science, Hasselt University, Hasselt, Belgium
| | - Ricardo Mourilhe-Rocha
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Complexo Hospitalar Américas-Vitória and Samaratino Barra, Rio de Janeiro, RJ, Brazil
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Liutsko L, Leonov S, Pashenko A, Polikanova I. Is Frequency of Practice of Different Types of Physical Activity Associated with Health and a Healthy Lifestyle at Different Ages? Eur J Investig Health Psychol Educ 2024; 14:256-271. [PMID: 38275342 PMCID: PMC10814358 DOI: 10.3390/ejihpe14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Physical activity (PA) has been shown to be related to physical and mental health. Yet there are few studies on how the frequency of PA relates to health and a healthy lifestyle. We aimed to investigate how the frequency of different PAs is associated with the following health indicators: body mass index (BMI), substance consumption, physical health, and mental health. We focused on three types of PA: (1) medium- to high-intensity aerobic exercise; (2) low- to medium-intensity relaxing exercise; and (3) outdoor leisure PA. A total of 9617 volunteers, aged 19 to 81, participated in the study. The relationships between the frequencies of the three types of PA and health-related and sociodemographic factors were analyzed using multinomial logistic regression. We found that women more frequently engaged in PA type 2, and men in types 1 and 3. A higher frequency of PA was associated with lower BMI and less or no smoking behavior; higher education (PAs 1 and 3); higher age (PAs 2 and 3); better physical health (PAs 1 and 3); and better mental health (PA 3). In conclusion, higher frequency of different PAs was significantly associated with better physical and mental health, less smoking, higher age, and a higher level of education.
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Affiliation(s)
- Liudmila Liutsko
- ISAN, International Society of Applied Neuropsychology, 08787 La Pobla de Claramunt, Spain
- IDIAP JGol, 08007 Barcelona, Spain
| | - Sergey Leonov
- Federal Scientific Centre for Psychological and Interdisciplinary Research, Moscow 125009, Russia; (S.L.); (A.P.)
| | - Alexander Pashenko
- Federal Scientific Centre for Psychological and Interdisciplinary Research, Moscow 125009, Russia; (S.L.); (A.P.)
| | - Irina Polikanova
- Federal Scientific Centre for Psychological and Interdisciplinary Research, Moscow 125009, Russia; (S.L.); (A.P.)
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Franklin BA, Wedig IJ, Sallis RE, Lavie CJ, Elmer SJ. Physical Activity and Cardiorespiratory Fitness as Modulators of Health Outcomes: A Compelling Research-Based Case Presented to the Medical Community. Mayo Clin Proc 2023; 98:316-331. [PMID: 36737120 DOI: 10.1016/j.mayocp.2022.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Abstract
The beneficial health effects and prognostic significance of regular moderate-to-vigorous physical activity (PA), increased cardiorespiratory fitness (CRF), or both are often underappreciated by the medical community and the patients they serve. Individuals with low CRF have higher annual health care costs, higher rates of surgical complications, and are two to three times more likely to die prematurely than their fitter counterparts when matched for risk factor profile or coronary calcium score. Increased levels of habitual PA before hospitalization for acute coronary syndromes are also associated with better short-term cardiovascular outcomes. Accordingly, this review examines these relations and the potential underlying mechanisms of benefit (eg, exercise preconditioning), with specific reference to the incidence of cardiovascular, cancer, and coronavirus diseases, and the prescriptive implications and exercise thresholds for optimizing health outcomes. To assess the evidence supporting or refuting the benefits of PA and CRF, we performed a literature search (PubMed) and critically reviewed the evidence to date. In aggregate, these data are presented in the context of clarifying the impact that regular PA and/or increased CRF have on preventing and treating chronic and infectious diseases, with reference to evidence-based exercise thresholds that the medical community can embrace and promote.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation Department, Beaumont Health, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Isaac J Wedig
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA
| | - Robert E Sallis
- Department of Family and Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA.
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Associations Between Physical Activity Vital Sign in Patients and Health Care Utilization in a Health Care System, 2018-2020. J Phys Act Health 2023; 20:28-34. [PMID: 36493760 DOI: 10.1123/jpah.2022-0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Physical inactivity is a risk factor for many chronic conditions. This retrospective cohort study examined associations between physical activity (PA) with health care utilization (HU). METHODS A PA vital sign was recorded in clinics from January 2018 to December 2020. Patients were categorized as inactive, insufficiently active, or sufficiently active by US PA aerobic guidelines. Associations between PA vital sign and visits (inpatient admissions, emergency department, urgent care, and primary care) were estimated using population average regression by visit type. RESULTS 23,721 patients had at least one PA vital sign recorded, with a mean age of 47.3 years and mean body mass index (BMI) of 28; 52% were female and 63% were White. Sufficiently active patients were younger, male, White, and had lower BMI than insufficiently active patients. Achieving 150 minutes per week of moderate to vigorous PA per 1000 patient years was associated with 34 fewer emergency department visits (P < .001), 19 fewer inpatient admissions (P < .001), and 38 fewer primary care visits (P < .001) compared with inactive patients. Stronger associations between lower PA and higher HU were present among those who were older or had a higher comorbidity. BMI, sex, ethnicity, and race did not modify the association between PA and HU. CONCLUSIONS Meeting aerobic guidelines was associated with reduced HU for inpatient, primary care, and emergency department visits.
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Jemna DV, David M, Depret MH, Ancelot L. Physical activity and healthcare utilization in France: evidence from the European Health Interview Survey (EHIS) 2014. BMC Public Health 2022; 22:1355. [PMID: 35840906 PMCID: PMC9288017 DOI: 10.1186/s12889-022-13479-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Background A growing need and focus on preventing and controlling the diseases and promoting a healthier lifestyle is more evident at global, regional, and national levels. In this respect, it is well-known the positive association between physical activity and population’s health, but also its negative association with the demand of healthcare, which could lead to lower spending on healthcare systems. In France, a lack of physical activity, a high prevalence of sedentary behaviours, and a continuous deterioration of these behaviours are observed since 2006. Therefore, promoting and increasing physical activities could contribute to major societal issues. Within this context, the study aims to analyse how the use of different healthcare services are related to physical activity in a nationally representative sample of French population. Methods The data used was retrieved from the second wave of the EHIS-ESPS 2014. The relationship between physical activity and healthcare utilization, controlled by a set of socioeconomic, demographic, and health behaviour factors, was explored both at the level of the entire population and separately for two age groups (less than 65 years, 65 years and older), employing probit and recursive multivariate probit models. Results Our findings underline that the relation between healthcare utilization and physical activity depends on the type of healthcare services and age group. In this respect, only among adult respondents, we observe a significant negative association between physical activity and prescribed medicines consumption and day hospitalization, while preventive services use is positively related to physical activity. Common to both age groups, the positive association of physical activity with general physician services and non-prescribed medicines reveal that moderately and highly active adults and elders may be more health conscious and therefore may seek referrals to generalist and other prevention measures more frequently than their inactive counterparts. This explanation is also sustained by the negative association between physical activity and overnight hospitalization or home healthcare services. Conclusions This study highlights the double role of physical activity on health as preventive measure and treatment and thus support the implementation of public health policies aimed at increasing the level of physical activity in French population. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13479-0.
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Affiliation(s)
- Dănuț-Vasile Jemna
- Faculty of Economics and Business Administration, "Alexandru Ioan Cuza" University of Iași, Iași, Romania
| | - Mihaela David
- "Gh. Zane" Institute for Economic and Social Research - Romanian Academy, Iași Branch; "Alexandru Ioan Cuza" University of Iași, Iași, Romania.
| | - Marc-Hubert Depret
- Centre de Recherche sur l'Intégration Economique et Financière, Institut des Risques Industriels, Assurantiels et Financiers, University of Poitiers, Poitiers, France
| | - Lydie Ancelot
- Centre de Recherche sur l'Intégration Economique et Financière, Institut des Risques Industriels, Assurantiels et Financiers, University of Poitiers, Poitiers, France
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Jo H, Lee HH, Kim DH, Kong ID. Satisfaction with the walking-related environment during COVID-19 in South Korea. PLoS One 2022; 17:e0266183. [PMID: 35442995 PMCID: PMC9020742 DOI: 10.1371/journal.pone.0266183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to examine the satisfaction level differences between urban and rural areas with regard to their walking environment during the COVID-19 pandemic in South Korea. This online cross-sectional research was conducted using a mobile health application. Overall, 1,032 local residents who participated in the mobile healthcare program of a public health center were classified as being from either urban (n = 481, 46.6%) or rural areas (n = 551, 53.4%) for the purpose of this study. The Walkability Checklist, which includes sociodemographic information, was employed using a Chi-square test and a multivariate logistic regression to investigate whether or not the participants were satisfied with the environmental factors associated with walking. It was found that both urban and rural areas were more likely to be unsatisfied with walking comfort (adjusted OR: 24.472, 95% CI: 14.937-40.096). Regarding the walking comfort aspects of the walking environment, urban residents chose poor landscape ("needed more grass, flowers, or trees"; aOR: 13.561, 95% CI: 3.619-50.823) as their primary dissatisfaction, and rural residents chose messy streets ("dirty, lots of litter or trash"; aOR: 29.045, 95% CI: 6.202-136.015). Compared with urban residents, rural residents were more discontented with the walking environment. Thus, to promote walking activities at the community level, it is necessary to focus on walking comfort, and implement efforts related to environmental beautification.
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Affiliation(s)
- Hoon Jo
- Artificial Intelligence Big Data Medical Center, Yonsei University Wonju College of Medicine, Wonju, South Korea
- Department of Rehabilitation Therapy, Hallym University Graduate School of Health Science, ChunCheon, South Korea
| | - Ho Hee Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dong-Hyun Kim
- Department of Social and Preventive Medicine, Hallym University College of Medicine; ChunCheon, South Korea
| | - In Deok Kong
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, South Korea
- Center for Exercise Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Messi M, Mueller Y, Haller DM, Zeller A, Neuner-Jehle S, Streit S, Burnand B, Herzig L. A cross-sectional study of Swiss ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model. BMC FAMILY PRACTICE 2020; 21:150. [PMID: 32718315 PMCID: PMC7385958 DOI: 10.1186/s12875-020-01221-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Multimorbidity is frequently encountered in primary care and is associated with increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients' use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen's model to explore factors associated with this use. METHOD In a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model: predisposing factors (patient's demographics), enabling factors (health literacy (HLS-EU-Q6), deprivation (DipCare)), and need factors (patient's quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions, and of medications). Logistic regressions (dichotomous variables) and negative binomial regressions (count variables) were calculated to identify predictors of multimorbid patients' healthcare use. RESULTS Analyses included 843 multimorbid patients; mean age 73.0 (SD 12.0), 28-98 years old; 48.3% men; 15.1% (127/843) used homecare. Social deprivation (OR 0.75, 95%CI 0.62-0.89) and absence of an informal caregiver (OR 0.50, 95%CI 0.28-0.88) were related to less homecare services use. The use of other allied health services (34.9% (294/843)) was associated with experiencing pain (OR 2.49, 95%CI 1.59-3.90). The number of contacts with a GP (median 11 (IQR 7-16)) was, among other factors, related to the absence of an informal caregiver (IRR 0.90, 95%CI 0.83-0.98). The number of specialists involved (mean 1.9 (SD 1.4)) was linked to the treatment burden (IRR 1.06, 95%CI 1.02-1.10). CONCLUSION Multimorbid patients in primary care reported high use of ambulatory healthcare services variably associated with the Andersen model's factors: healthcare use was associated with objective medical needs but also with contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patient profiles.
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Affiliation(s)
- Mia Messi
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yolanda Mueller
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andreas Zeller
- Center for Primary Health Care, University of Basel, Basel, Switzerland
| | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Bernard Burnand
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Lilli Herzig
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
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Yu H, Schwingel A. Associations Between Sedentary Behavior, Physical Activity, and Out-of-Pocket Health Care Expenditure: Evidence From Chinese Older Adults. J Aging Phys Act 2018; 27:1-8. [PMID: 29893610 DOI: 10.1123/japa.2017-0206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examined the associations between sedentary behavior, physical activity, and health care expenditures among Chinese older adults. METHOD We conducted a survey on 4,165 older men and women living in major cities in China. Sedentary behavior and physical activity were measured by the Physical Activity Scale for the Elderly questionnaire. Health care costs were assessed by self-reported out-of-pocket health care expenditures across outpatient care, inpatient care, medication, and formal caregiver expenses. RESULTS Sedentary behavior was associated with an increase in annual out-of-pocket health care expenditures by approximately USD$37 for each additional sedentary hour (p < .001). Physical activity was associated with a decrease in annual health care expenditures by approximately USD$1.2 for each one Physical Activity Scale for the Elderly score (p < .001). Physical activity was a less salient indicator of health care expenditure for men than women. CONCLUSIONS Reducing sedentary behavior among older men and women and promoting physical activity, especially among men, may be important strategies to reduce out-of-pocket health care expenditures in China.
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Vagnoni E, Biavati GR, Felisatti M, Pomidori L. Moderating healthcare costs through an assisted physical activity programme. Int J Health Plann Manage 2018; 33:1146-1158. [PMID: 30074649 DOI: 10.1002/hpm.2596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 07/04/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND During the last decades, physical inactivity has become increasingly important due to its effects on health; in the medical field, it has been highlighted that physical inactivity is one of the leading cause of death. Moreover, the increasing trend in a sedentary lifestyle has also led to economic concerns; for this reason, the need to develop healthcare programmes to raise awareness of the benefits of physical exercise among the global population has arisen. OBJECTIVE This paper analyses the relationship between moderate physical activity, cost of pharmaceuticals and health services utilization with regard to a primary care community programme based on moderate exercise intervention. The study highlights the effect of an exercise programme for people in sheltered accommodation in terms of effects on their quality of life and in terms of economic sustainability. METHODOLOGY A randomized controlled trial of an exercise programme was designed. A total of 150 patients were randomized in two groups. The intervention group was recruited from Centro Esercizio Vita whereas the participants of the control group were recruited from general practitioners. RESULTS At 9 months after randomization, the exercise-based group presented a lower average cost for drugs (p-value 0.039), an overall better health status perception (p-value 0.0019) and accessed general practitioners less frequently (p-value 0.058). CONCLUSIONS Our study shows that assisted physical activity practiced on the basis of an exercise programme, over a period of nine months, has overall positive consequences in terms of reduction in health expenditure and quality of life.
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Affiliation(s)
- Emidia Vagnoni
- University of Ferrara, Department of Economics and Management, Ferrara, Italy
| | - Giulia Rita Biavati
- University of Ferrara, Department of Economics and Management, Ferrara, Italy
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Lilly FR, Culpepper J, Stuart M, Steinwachs D. Stroke survivors with severe mental illness: Are they at-risk for increased non-psychiatric hospitalizations? PLoS One 2017; 12:e0182330. [PMID: 28800605 PMCID: PMC5553814 DOI: 10.1371/journal.pone.0182330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study examined outcomes for two groups of stroke survivors treated in Veteran Health Administration (VHA) hospitals, those with a severe mental illness (SMI) and those without prior psychiatric diagnoses, to examine risk of non-psychiatric medical hospitalizations over five years after initial stroke. METHODS This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VHA medical center during fiscal year 2003. The survivors were followed using administrative data documenting inpatient stroke treatment, patient demographics, disease comorbidities, and VHA hospital admissions. Multivariate Poisson regression was used to examine the relationship between patients with and without SMI diagnosis preceding the stroke and their experience with non-psychiatric medical hospitalizations after the stroke. RESULTS The study included 100 patients with SMI and 423 without SMI. Unadjusted means for pre-stroke non-psychiatric hospitalizations were higher (p = 0.0004) among SMI patients (1.47 ± 0.51) compared to those without SMI (1.00 ± 1.33), a difference which persisted through the first year post-stroke (SMI: 2.33 ± 2.46; No SMI: 1.74 ± 1.86; p = 0.0004). Number of non-psychiatric hospitalizations were not significantly different between the two groups after adjustment for patient sociodemographic, comorbidity, length of stay and inpatient stroke treatment characteristics. Antithrombotic medications significantly lowered risk (OR = 0.61; 95% CI: 0.49-0.73) for stroke-related readmission within 30 days of discharge. CONCLUSIONS No significant differences in medical hospitalizations were present after adjusting for comorbid and sociodemographic characteristics between SMI and non-SMI stroke patients in the five-year follow-up. However, unadjusted results continue to draw attention to disparities, with SMI patients experiencing more non-psychiatric hospitalizations both prior to and up to one year after their initial stroke. Additionally, stroke survivors discharged on antithrombotic medications were at lower risk of re-admission within 30 days suggesting the VHA should continue to focus on effective stroke management irrespective of SMI.
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Affiliation(s)
- Flavius Robert Lilly
- Graduate School, University of Maryland, Baltimore, Maryland, United States of America
| | - Joel Culpepper
- Veterans Affairs Maryland Health Care System, Baltimore, Maryland, United States of America
| | - Mary Stuart
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
| | - Donald Steinwachs
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Marsh AP, Applegate WB, Guralnik JM, Jack Rejeski W, Church TS, Fielding RA, Gill TM, King AC, Kritchevsky SB, Manini TM, McDermott MM, Newman AB, Stowe CL, Walkup MP, Pahor M, Miller ME. Hospitalizations During a Physical Activity Intervention in Older Adults at Risk of Mobility Disability: Analyses from the Lifestyle Interventions and Independence for Elders Randomized Clinical Trial. J Am Geriatr Soc 2017; 64:933-43. [PMID: 27225353 DOI: 10.1111/jgs.14114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine whether moderate-intensity physical activity (PA) and health education (HE) are differentially associated with categories of hospitalizations or subgroups of participants. DESIGN Multicenter randomized controlled trial in which participants were randomized to a PA or HE program for an average of 2.6 years. SETTING Eight field centers. PARTICIPANTS Sedentary men and women aged 70-89 with lower extremity physical limitations but able to walk 400-m in 15 minutes or less (N = 1,635). INTERVENTIONS Structured, moderate-intensity PA (n = 818) at a center (2×/wk) and at home (3-4×/wk) that included aerobic, strength, balance, and flexibility training or HE (n = 817) of educational workshops and upper extremity stretching exercises. MEASUREMENTS All-cause inpatient hospitalizations ascertained at 6-month intervals. RESULTS There were 1,458 hospitalizations (49.1% of PA, 44.4% of HE; risk difference = 4.68%, 95% confidence interval (CI) = -0.18-9.54; hazard ratio (HR) = 1.16, 95% CI = 1.00-1.34). The intervention effect on incident hospitalization did not differ according to race, sex, Short Physical Performance Battery score, age, or history of cardiovascular disease or diabetes mellitus. PA was associated with higher rates of hospitalization in the middle baseline gait speed category, than HE (<0.8 m/s: HR = 0.93, 95% CI = 0.76-1.14; 0.8-1.0 m/s: HR = 1.54, 95% CI = 1.23-1.94; >1.0 m/s: HR = 1.05, 95% CI = 0.67-1.65; interaction P = .005). CONCLUSION A PA program in older adults at risk for mobility disability did not lead to a different risk of specific types of hospitalizations than a HE program overall. Baseline gait speed may be a marker for risk of hospitalization during a PA intervention, because individuals with moderate baseline gait speed in the PA group had slightly higher rates of hospitalization than those in the HE group. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01072500.
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Affiliation(s)
- Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - William B Applegate
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center on Aging, Wake Forest University, Winston-Salem, North Carolina
| | - Jack M Guralnik
- Division of Gerontology, Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Timothy S Church
- Division of Gerontology, Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Abby C King
- Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California.,Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Stephen B Kritchevsky
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center on Aging, Wake Forest University, Winston-Salem, North Carolina
| | - Todd M Manini
- Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida.,Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mary M McDermott
- Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida.,Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne B Newman
- Department of Epidemiology and Medicine, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cynthia L Stowe
- Division of Public Health Sciences, Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Michael P Walkup
- Division of Public Health Sciences, Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida.,Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael E Miller
- Division of Public Health Sciences, Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Kang SW, Xiang X. Physical activity and health services utilization and costs among U.S. adults. Prev Med 2017; 96:101-105. [PMID: 28040516 DOI: 10.1016/j.ypmed.2016.12.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 11/28/2022]
Abstract
The objective of this study was to examine the relationship between physical activity and health services utilization and costs among adults aged 18 or older in the U.S. Data came from the Medical Expenditure Panel Survey-Household component from 2007 through 2011 (n=117,361). Regular physical activity was defined as spending half an hour or more in moderate or vigorous physical activity at least three times a week. The following categories of self-reported health services utilization and costs were examined: preventive, office-based, outpatient, inpatient, emergency department, home health, and prescription medicines. The association of physical activity and health services utilization and costs was estimated using two-part models. Adults who engaged in regular physical activity were more likely to use preventive (ORs ranged from 1.06 to 1.34, p<0.05) and office-based services (OR=1.05, 95% CI=1.01-1.10, p<0.05). Combining results from both parts of the two-part models, physically active adults incurred significantly lower utilization of inpatient (0.09 vs 0.12 visit per person), emergency room (0.18 vs 0.19 visit per person), home health care (1.21 vs 1.92 visit per person), and prescription medicines (12.66 vs 13.75 number of prescriptions per person) and spent $27 less per capita expenditures for office-based visits, $351 less for inpatient visits, and $52 less for home health care visits. Promoting regular physical activity may reduce health care costs through decreasing demand for secondary and tertiary care services.
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Affiliation(s)
- Sung-Wan Kang
- School of Social Work, University of Illinois at Urbana-Champaign, 1010 W. Nevada, Urbana, IL 61801, USA.
| | - Xiaoling Xiang
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair Street, Chicago, IL 60611, USA.
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Daily Energy Expenditure and Its Relation to Health Care Costs in Patients Undergoing Ambulatory Electrocardiographic Monitoring. Am J Cardiol 2017; 119:658-663. [PMID: 27986262 DOI: 10.1016/j.amjcard.2016.10.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 01/24/2023]
Abstract
Our increasingly sedentary lifestyle is associated with a heightened risk of obesity, diabetes, heart disease, and cardiovascular mortality. Using the recently developed heart rate index formula in 843 patients (mean ± SD age 62.3 ± 15.7 years) who underwent 24-hour ambulatory electrocardiographic (ECG) monitoring, we estimated average and peak daily energy expenditure, expressed as metabolic equivalents (METs), and related these data to subsequent hospital encounters and health care costs. In this cohort, estimated daily average and peak METs were 1.7 ± 0.7 and 5.5 ± 2.1, respectively. Patients who achieved daily bouts of peak energy expenditure ≥5 METs had fewer hospital encounters (p = 0.006) and median health care costs that were nearly 50% lower (p <0.001) than their counterparts who attained <5 METs. In patients whose body mass index was ≥30 kg/m2, there were significant differences in health care costs depending on whether they achieved <5 or ≥5 METs estimated by ambulatory ECG monitoring (p = 0.005). Interestingly, patients who achieved ≥5 METs had lower and no significant difference in their health care costs, regardless of their body mass index (p = 0.46). Patients with previous percutaneous coronary intervention who achieved ≥5 METs had lower health care costs (p = 0.044) and fewer hospital encounters (p = 0.004) than those who achieved <5 METs. In conclusion, average and peak daily energy expenditures estimated from ambulatory ECG monitoring may provide useful information regarding health care utilization in patients with and without previous percutaneous coronary intervention, irrespective of body habitus. Our findings are the first to link lower intensities of peak daily energy expenditure, estimated from ambulatory ECG monitoring, with increased health care utilization.
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Fisher KL, Harrison EL, Reeder BA, Sari N, Chad KE. Is Self-Reported Physical Activity Participation Associated with Lower Health Services Utilization among Older Adults? Cross-Sectional Evidence from the Canadian Community Health Survey. J Aging Res 2015; 2015:425354. [PMID: 26347491 PMCID: PMC4541001 DOI: 10.1155/2015/425354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/17/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To examine relationships between leisure time physical activity (LTPA) and health services utilization (H) in a nationally representative sample of community-dwelling older adults. Methods. Cross-sectional data from 56,652 Canadian Community Health Survey respondents aged ≥ 50 years (48% M; 52% F; mean age 63.5 ± 10.2 years) were stratified into three age groups and analysed using multivariate generalized linear modeling techniques. Participants were classified according to PA level based on self-reported daily energy expenditure. Nonleisure PA (NLPA) was categorized into four levels ranging from mostly sitting to mostly lifting objects. Results. Active 50-65-year-old individuals were 27% less likely to report any GP consultations (ORadj = 0.73; P < 0.001) and had 8% fewer GP consultations annually (IRRadj = 0.92; P < 0.01) than their inactive peers. Active persons aged 65-79 years were 18% less likely than inactive respondents to have been hospitalized overnight in the previous year (ORadj = 0.82, P < 0.05). Higher levels of NLPA were significantly associated with lower levels of HSU, across all age groups. Conclusion. Nonleisure PA appeared to be a stronger predictor of all types of HSU, particularly in the two oldest age groups. Considering strategies that focus on reducing time spent in sedentary activities may have a positive impact on reducing the demand for health services.
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Affiliation(s)
- Koren L. Fisher
- Department of Kinesiology, California State University, Fullerton 800 N. State College Boulevard, Fullerton, CA 92831, USA
- Department of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, Canada S7N 5B2
| | - Elizabeth L. Harrison
- School of Physical Therapy, University of Saskatchewan, 1121 College Drive, Saskatoon, SK, Canada S7N 0W3
| | - Bruce A. Reeder
- Department of Community Health and Epidemiology, University of Saskatchewan, Box 7, Health Science Building, 107 Wiggins Road, Saskatoon, SK, Canada S7N 5E5
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Arts 815, 9 Campus Drive, Saskatoon, SK, Canada S7N 5A5
| | - Karen E. Chad
- Department of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, Canada S7N 5B2
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Blodgett J, Theou O, Kirkland S, Andreou P, Rockwood K. The association between sedentary behaviour, moderate-vigorous physical activity and frailty in NHANES cohorts. Maturitas 2014; 80:187-91. [PMID: 25542406 DOI: 10.1016/j.maturitas.2014.11.010] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/12/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES (1) To examine how sedentary behaviour and moderate-vigorous (MVPA) are each experienced during the day across different levels of frailty; (2) estimate and compare the extent to which high levels of sedentary behaviour and low levels of MVPA are associated with increased frailty and self-reported health, disability and healthcare utilization. METHODS Community dwelling adults aged 50+ from the National Health and Nutrition Examination Survey (2003-2004; 2005-2006). Frailty was measured with the frailty index and physical activity was measured using ActiGraph accelerometers. RESULTS On average, people engaged in about 8.5h of sedentary behaviour each day. The most frail individuals were more sedentary and less likely to meet weekly MVPA guidelines (9.57 h/day; 8.3%) than non-frail individuals (8.18 h/day; 1.1%; p<0.001). Frail individuals failed to demonstrate the patterns of the healthier individuals-higher levels of sedentary behaviour on Sundays and in the evenings and decreasing MVPA throughout the week. High sedentary behaviour and low MVPA were independently associated with higher levels of frailty, poor self-reported health, high ADL disability and higher healthcare usage. CONCLUSIONS Many people over the age of 50, and most of those who are frail, were highly sedentary with very few meeting the recommended weekly levels of MVPA. Sedentary behaviour and MVPA were independently associated with frailty and adverse health outcomes in middle to older aged adults. Future research should focus on a longitudinal study to determine the temporal relationship between sedentary behaviour and frailty.
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Affiliation(s)
- Joanna Blodgett
- Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, 5790 University Avenue, Halifax, NS, Canada B3H 1V7
| | - Olga Theou
- Geriatric Medicine, Department of Medicine, Dalhousie University, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, Canada.
| | - Susan Kirkland
- Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, 5790 University Avenue, Halifax, NS, Canada B3H 1V7; Geriatric Medicine, Department of Medicine, Dalhousie University, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, Canada
| | - Pantelis Andreou
- Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, 5790 University Avenue, Halifax, NS, Canada B3H 1V7
| | - Kenneth Rockwood
- Geriatric Medicine, Department of Medicine, Dalhousie University, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, Canada; Centre for Health Care of the Elderly, QEII Health Sciences Centre, Capital District Health Authority, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, Canada
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Cesari M, Demougeot L, Boccalon H, Guyonnet S, Abellan Van Kan G, Vellas B, Andrieu S. A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability: the FiND questionnaire. PLoS One 2014; 9:e101745. [PMID: 24999805 PMCID: PMC4084999 DOI: 10.1371/journal.pone.0101745] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/10/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The "frailty syndrome" (a geriatric multidimensional condition characterized by decreased reserve and diminished resistance to stressors) represents a promising target of preventive interventions against disability in elders. Available screening tools for the identification of frailty in the absence of disability present major limitations. In particular, they have to be administered by a trained assessor, require special equipment, and/or do not discriminate between frail and disabled individuals. Aim of this study is to verify the agreement of a novel self-reported questionnaire (the "Frail Non-Disabled" [FiND] instrument) designed for detecting non-mobility disabled frail older persons with results from reference tools. METHODOLOGY/PRINCIPAL FINDINGS Data are from 45 community-dwelling individuals aged ≥60 years. Participants were asked to complete the FiND questionnaire separately exploring the frailty and disability domains. Then, a blinded assessor objectively measured the frailty status (using the phenotype proposed by Fried and colleagues) and mobility disability (using the 400-meter walk test). Cohen's kappa coefficients were calculated to determine the agreement between the FiND questionnaire with the reference instruments. Mean age of participants (women 62.2%) was 72.5 (standard deviation 8.2) years. Seven (15.6%) participants presented mobility disability as being unable to complete the 400-meter walk test. According to the frailty phenotype criteria, 25 (55.6%) participants were pre-frail or frail, and 13 (28.9%) were robust. Overall, a substantial agreement of the instrument with the reference tools (kappa = 0.748, quadratic weighted kappa = 0.836, both p values<0.001) was reported with only 7 (15.6%) participants incorrectly categorized. The agreement between results of the FiND disability domain and the 400-meter walk test was excellent (kappa = 0.920, p<0.001). CONCLUSIONS/SIGNIFICANCE The FiND questionnaire presents a very good capacity to correctly identify frail older persons without mobility disability living in the community. This screening tool may represent an opportunity for diffusing awareness about frailty and disability and supporting specific preventive campaigns.
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Affiliation(s)
- Matteo Cesari
- Institut du Vieillissement, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Laurent Demougeot
- Institut du Vieillissement, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Henri Boccalon
- Institut du Vieillissement, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sophie Guyonnet
- Institut du Vieillissement, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Gabor Abellan Van Kan
- Institut du Vieillissement, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Bruno Vellas
- Institut du Vieillissement, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Sandrine Andrieu
- Institut du Vieillissement, Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
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Simmonds B, Fox K, Davis M, Ku PW, Gray S, Hillsdon M, Sharp D, Stathi A, Thompson J, Coulson J, Trayers T. Objectively assessed physical activity and subsequent health service use of UK adults aged 70 and over: a four to five year follow up study. PLoS One 2014; 9:e97676. [PMID: 24866573 PMCID: PMC4035293 DOI: 10.1371/journal.pone.0097676] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 04/23/2014] [Indexed: 01/30/2023] Open
Abstract
Objectives To examine the associations between volume and intensity of older peoples' physical activity, with their subsequent health service usage over the following four to five years. Study Design A prospective cohort design using baseline participant characteristics, objectively assessed physical activity and lower limb function provided by Project OPAL (Older People and Active Living). OPAL-PLUS provided data on numbers of primary care consultations, prescriptions, unplanned hospital admissions, and secondary care referrals, extracted from medical records for up to five years following the baseline OPAL data collection. Participants and Data Collection OPAL participants were a diverse sample of 240 older adults with a mean age of 78 years. They were recruited from 12 General Practitioner surgeries from low, middle, and high areas of deprivation in a city in the West of England. Primary care consultations, secondary care referrals, unplanned hospital admissions, number of prescriptions and new disease diagnoses were assessed for 213 (104 females) of the original 240 OPAL participants who had either consented to participate in OPAL-PLUS or already died during the follow-up period. Results In regression modelling, adjusted for socio-economic variables, existing disease, weight status, minutes of moderate-to-vigorous physical activity (MVPA) per day predicted subsequent numbers of prescriptions. Steps taken per day and MVPA also predicted unplanned hospital admissions, although the strength of the effect was reduced when further adjustment was made for lower limb function. Conclusions Community-based programs are needed which are successful in engaging older adults in their late 70s and 80s in more walking, MVPA and activity that helps them avoid loss of physical function. There is a potential for cost savings to health services through reduced reliance on prescriptions and fewer unplanned hospital admissions.
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Affiliation(s)
- Bethany Simmonds
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Kenneth Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom; School of Sport & Exercise Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mark Davis
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Po-Wen Ku
- Graduate Institute of Sports and Health, National Changhua University of Education, Changhua City, Changua, Taiwan
| | - Selena Gray
- Department of Health and Applied Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Melvyn Hillsdon
- Sport and Health Sciences, Exeter University, Exeter, United Kingdom
| | - Debbie Sharp
- The School of Social and Community Medicine, The University of Bristol, Bristol, United Kingdom
| | - Afroditi Stathi
- Department for Health, The University of Bath, Bath, United Kingdom
| | - Janice Thompson
- School of Sport & Exercise Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Joanna Coulson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Tanya Trayers
- The School of Social and Community Medicine, The University of Bristol, Bristol, United Kingdom
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Palacios-Ceña D, Hernández-Barrera V, Jiménez-García R, Valle-Martín B, Fernández-de-las-Peñas C, Carrasco-Garrido P. Has the prevalence of health care services use increased over the last decade (2001-2009) in elderly people? A Spanish population-based survey. Maturitas 2013; 76:326-33. [PMID: 23972333 DOI: 10.1016/j.maturitas.2013.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/18/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES (1) To describe the prevalence of general practitioner visits and hospitalization according to sex and age groups; (2) to identify which factors are independently associated with a higher use of health care services among elderly Spanish; and (3) to study the time trends in the prevalence of use of health care services 2001-2009. STUDY DESIGN Observational study. We analyzed data from the Spanish National Health Surveys conducted in 2001 (n=21,058), 2003 (n=21,650), 2006 (n=29,478) and 2009 (n=22,188). We included responses from adults aged 65 years and older. OUTCOME MEASURES The main variables were the number of general practitioner visits in the last 4 weeks and hospitalization in the past year. We stratified the adjusted models by the main variables. We analyzed socio-demographic characteristics, health related variables, using multivariate logistic regression models. RESULTS The total number of subjects was 24,349 (15,041 woman, 9309 men). Women were significantly older than men (P<0.001). Women had higher prevalence of general practitioner visits than men in all surveys. Men had significantly higher prevalence of hospitalizations than women in the years 2001, 2006 and 2009. When we adjusted the hospitalization by possible confounders using logistic regressions, men had a higher probability of being hospitalized than women (OR 1.53, 1.39-1.69). The variables that were significantly associated with a higher use of health care services were lower educational level, worse self-rated health, chronic conditions, polypharmacy, and the level of disability. The number of general practitioner visits among women and men significantly increased from 2001 to 2009 (women: OR 1.43, 1.27-1.61; men: OR 1.71, 1.49-1.97). CONCLUSIONS The current study revealed an increase in health care services utilization from 2001 to 2009 in the older Spanish population.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Health Sciences, Universidad Rey Juan Carlos, Avenida Atenas s/n, 28922 Alcorcon, Madrid, Spain.
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Physical Activity and Health Service Utilization Among Older People. J Am Med Dir Assoc 2013; 14:125-9. [DOI: 10.1016/j.jamda.2012.10.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 11/20/2022]
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Recommendations for Aerobic Endurance Training Based on Subjective Ratings of Perceived Exertion in Healthy Seniors. J Aging Phys Act 2013; 21:100-11. [DOI: 10.1123/japa.21.1.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The study investigated physiological responses during 2-km walking at a certain intensity of a previously performed maximal exercise test where moderate perceived exertion was reported. Twenty seniors were examined by an incremental walking treadmill test to obtain maximal oxygen uptake (VO2max). A submaximal 2-km walking test was applied 1 wk later. The corresponding moderate perceived exertion (4 on the CR-10 scale) during the VO2maxtest was applied to the 2-km treadmill test. Moderate exertion (mean rating of perceived exertion [RPE]: 4 ± 1) led to 76% ± 8% of VO2maxand 79% ± 6% of maximal heart rate. RPE values drifted with a significant time effect (p= .001, ηp= .58) during the 2-km test from 3 ± 0.7 to 4.6 ± 0.8. Total energy expenditure (EE) was 3.3 ± 0.5 kcal/kg. No gender differences in ventilatory, heart-rate, or EE data occurred. Brisk walking at moderate RPE of 3–5 would lead to a beneficial physiological response during endurance training and a weekly EE of nearly 1,200 kcal when exercising 5 times/wk for 30 min.
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Lehnert T, König HH. [Effects of multimorbidity on health care utilization and costs]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:685-92. [PMID: 22526857 DOI: 10.1007/s00103-012-1475-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Multiple chronic conditions (multimorbidity) are common among elderly patients; however, little is known about the specific effects of multimorbidity on health care utilization and health care costs. This article reviews empirical studies from the international literature that investigated the relationship between multiple chronic conditions and health care utilization (e.g. ambulatory care, stationary care, pharmacotherapy) and/or health care costs in elderly general populations. Although synthesis of studies was complicated, especially because of ambiguous definitions and measurements of multimorbidity, almost all studies observed a positive association of multimorbidity and utilization and costs. Many studies found that utilization and costs significantly increased with each additional chronic condition. In light of these findings coupled with the fear that current care arrangements may be inappropriate for many multimorbid patients, important implications for research and policy are presented and discussed.
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Affiliation(s)
- T Lehnert
- Institut für Medizinische Soziologie, Sozialmedizin und Gesundheitsökonomie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Kim J, Park S. [Impact of level of physical activity on healthcare utilization among Korean adults]. J Korean Acad Nurs 2012; 42:199-206. [PMID: 22699169 DOI: 10.4040/jkan.2012.42.2.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to identify the impact of physical activity on healthcare utilization among Korean adults. METHODS Drawing from the 2008 Korean National Health and Nutrition Examination Survey (NHANES IV-2), data from 6,521 adults who completed the Health Interview and Health Behavior Surveys were analyzed. Association between physical activity and healthcare utilization was tested using the χ²-test. Multiple logistic regression analysis was used to calculate the odds ratios of using outpatient and inpatient healthcare for different levels of physical activity after adjusting for predisposing, enabling, and need factors. A generalized linear model applying a negative binomial distribution was used to determine how the level of physical activity was related to use of outpatient and inpatient healthcare. RESULTS Physically active participants were 16% less likely to use outpatient healthcare (OR, 0.84; 95% CI, 0.74-0.97) and 23% less likely to use inpatient healthcare (OR, 0.77; 95% CI, 0.63-0.93) than physically inactive participants. Levels of outpatient and inpatient healthcare use decreased as levels of physical activity increased, after adjusting for relevant factors. CONCLUSION An independent association between being physically active and lower healthcare utilization was ascertained among Korean adults indicating a need to develop nursing intervention programs that encourage regular physical activity.
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Affiliation(s)
- Jiyun Kim
- Department of Nursing, Gachon University, Seongnam, Korea
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Hannon L, Sawyer P, Allman RM. The influence of community and the built environment on physical activity. J Aging Health 2011; 24:384-406. [PMID: 22049482 DOI: 10.1177/0898264311424430] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine associations between the built environment and leisure-time physical activity (LTPA) among African Americans and Whites. METHOD Independent and control variables were produced from the literature and theory to represent key components of built environment, sense of community, sociodemographic, and health status characteristics. Logistic regression analysis and descriptive statistics were used to measures correlative relationships with physical activity. RESULTS Built environment elements, especially homeownership, were associated with LTPA, particularly among older African American rural residents. DISCUSSION Recommendations include transferring the concept of community ownership to residents living in areas where rates of physical activity are low.
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Visual acuity's association with levels of leisure-time physical activity in community-dwelling older adults. J Aging Phys Act 2011; 20:1-14. [PMID: 21945888 DOI: 10.1123/japa.20.1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Little is known about the effect of reduced vision on physical activity in older adults. This study evaluates the association of visual acuity level, self-reported vision, and ocular disease conditions with leisure-time physical activity and calculated caloric expenditure. A cross-sectional study of 911 subjects 65 yr and older from the University of Alabama at Birmingham Study of Aging (SOA) cohort was conducted evaluating the association of vision-related variables to weekly kilocalorie expenditure calculated from the 17-item Leisure Time Physical Activity Questionnaire. Ordinal logistic regression was used to evaluate possible associations while controlling for potential confounders. In multivariate analyses, each lower step in visual acuity below 20/50 was significantly associated with reduced odds of having a higher level of physical activity, OR 0.81, 95% CI 0.67, 0.97. Reduced visual acuity appears to be independently associated with lower levels of physical activity among community-dwelling adults.
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Li CL, Chu SJ, Sheu JT, Huang LYG. Impact of physical activity on hospitalization in older adults: A nationwide cohort from Taiwan. Arch Gerontol Geriatr 2011; 53:141-5. [DOI: 10.1016/j.archger.2010.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 09/22/2010] [Accepted: 09/24/2010] [Indexed: 01/10/2023]
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Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, Riedel-Heller S, König HH. Review: Health Care Utilization and Costs of Elderly Persons With Multiple Chronic Conditions. Med Care Res Rev 2011; 68:387-420. [PMID: 21813576 DOI: 10.1177/1077558711399580] [Citation(s) in RCA: 486] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This systematic literature review identified and summarized 35 studies that investigated the relationship between multiple chronic conditions (MCCs) and health care utilization outcomes (i.e. physician use, hospital use, medication use) and health care cost outcomes (medication costs, out-of-pocket costs, total health care costs) for elderly general populations. Although synthesis of studies was complicated because of ambiguous definitions and measurements of MCCs, and because of the multitude of outcomes investigated, almost all studies observed a positive association of MCCs and use/costs, many of which found that use/costs significantly increased with each additional condition. Several studies indicate a curvilinear, near exponential relationship between MCCs and costs. The rising prevalence, substantial costs, and the fear that current care arrangements may be inappropriate for many patients with MCCs, bring about a multitude of implications for research and policy, of which the most important are presented and discussed.
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Affiliation(s)
- Thomas Lehnert
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hanna Leicht
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Heinrich
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Makhija SK, Gilbert GH, Clay OJ, Matthews JC, Sawyer P, Allman RM. Oral health-related quality of life and life-space mobility in community-dwelling older adults. J Am Geriatr Soc 2011; 59:512-8. [PMID: 21361883 DOI: 10.1111/j.1532-5415.2010.03306.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To quantify the associations between measures of oral health-related quality of life (OHRQoL) and life-space mobility (LSM) in community-dwelling older adults. DESIGN Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural). PARTICIPANTS The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community-dwelling adults aged 65 and older. MEASUREMENTS Participants completed an in-home interview about their OHRQoL and LSM. Life-space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity. RESULTS Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self-rated oral health. CONCLUSION OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well-being have a significant effect on mobility and the social participation of older adults.
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Affiliation(s)
- Sonia K Makhija
- Department of General Dental Sciences, School of Dentistry Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Fitzpatrick TR. The quality of dyadic relationships, leisure activities and health among older women. Health Care Women Int 2010; 30:1073-92. [PMID: 19894152 DOI: 10.1080/07399330903199367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined the combined influence of dyadic relationships and leisure activities on health. We used self-administered survey to collect data at senior centers from French and English older women (N = 257) in Montreal, Quebec. Multiple regression analyses (OLS) were used to examine the main effects of dyadic quality and leisure activities on physical and mental health. Despite controlling for specific dyadic groups, meals, and bingo, we find that the quality of dyadic relationships has a strong influence on mental health measured by spirit, happiness, and an interesting life. Leisure activities are also a significant predictor and appear to improve physical health measured by self-reported health and the number of chronic conditions. Implications for gerontology practitioners in the United States, Canada, and other Western cultures, along with research strategies, are discussed.
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Affiliation(s)
- Tanya R Fitzpatrick
- McGill Center for Research and Teaching on Women, McGill University, Montreal, Quebec, Canada.
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Abstract
Although regular physical activity plays an important role in promoting cardiovascular health, Williams(1) reported that a high level of cardiorespiratory fitness (aerobic capacity) markedly reduces one's risk of cardiovascular disease, and the reduction is greater compared with merely being physically active (Figure 1). Moreover, there appears to be an inverse relationship between cardiorespiratory fitness and complications after bariatric surgery among morbidly obese adults. Other provocative data support the hypothesis that aerobic capacity, expressed as milliliters of oxygen per kilogram of body weight per minute (mL O2/kg/min) or as metabolic equivalents (METs; 1 MET 3.5 mL O2/kg/min), is inversely associated with health care costs. Collectively, these findings and other recent reports suggest that the estimation or direct measurement of aerobic capacity can provide independent and additive data in forecasting future health outcomes.
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Affiliation(s)
- Barry A Franklin
- Cardiac Rehabilitation and Exercise Laboratories, Beaumont Hospital, Royal Oak, MI, USA.
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von Bonsdorff MB, Rantanen T, Leinonen R, Kujala UM, Tormakangas T, Manty M, Heikkinen E. Physical Activity History and End-of-Life Hospital and Long-Term Care. J Gerontol A Biol Sci Med Sci 2009; 64:778-84. [DOI: 10.1093/gerona/glp029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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