The Institute for Aging Research, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
J Am Med Dir Assoc. 2013 Feb;14(2):125-9. doi: 10.1016/j.jamda.2012.10.023. Epub 2012 Dec 6.
Rising health care use among older people presents a challenge to medical care. Physical activity (PA) is beneficial; however, it is unknown if initiating PA among the very old reduces health service use. We examined the effects of changing PA levels on emergency room (ER) visits and hospitalization at ages 78 and 85.
A representative sample (born 1920-1921) from the Jerusalem Longitudinal Cohort Study (1990-2010) were assessed at ages 78 and 85 for self-reported PA; ER visits and hospitalization; and social, functional, and medical domains.
We examined 896 and 1173 subjects at ages 78 and 85, respectively. ER usage at ages 78 and 85 respectively was lower among active subjects (15.8% vs 37.4%, P < .0001; 30.6% vs 50.8%, P < .0001), as was hospitalization (10.5% vs 16.7%, P < .05; 22.1% vs 37.8%, P < .0001). We adjusted for gender, education, loneliness, functional dependence, cognitive impairment, depression, diabetes, heart disease, hypertension, neoplasm, renal disease, self-rated health, body mass index, and smoking. PA at age 78 was associated with a reduced likelihood of ER visits (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.27-0.89), but not hospitalization (OR 1.14, 95% CI 0.54-2.42); at age 85 with a reduced likelihood for ER visits (OR 0.72, 95% CI 0.52-0.99) and hospitalization (OR 0.68, 95% CI 0.48-0.98). Compared with subjects consistently active at ages 78 and 85, initiating PA between ages 78 and 85 resulted in similar lower likelihood of ER visits (OR 0.6, 95% CI 0.23-1.56) and hospitalization (OR 1.20, 95% CI 0.48-3.02); stopping PA and never being active between 78 and 85 were respectively associated with increased ER visits (OR 1.72, 95% CI 1.02-2.88; OR 2.18, 95% CI 1.04-4.57) and hospitalization (OR 1.85, 95% CI 1.06-3.23; OR 2.01, 95% CI 0.92-4.4).
Among the oldest old, not only continuing but also becoming physically active is associated with reduced health service use. Initiating PA among the very old should be encouraged.
老年人医疗保健使用量的增加给医疗保健带来了挑战。身体活动（PA）是有益的；然而，目前尚不清楚在非常老的人中开始进行 PA 是否会减少卫生服务的使用。我们研究了改变 PA 水平对 78 岁和 85 岁时急诊室（ER）就诊和住院的影响。
来自耶路撒冷纵向队列研究（1990-2010 年）的代表性样本（出生于 1920-1921 年）在 78 岁和 85 岁时接受自我报告的 PA 评估；急诊室就诊和住院情况；以及社会、功能和医疗领域。
我们分别检查了 78 岁和 85 岁的 896 名和 1173 名受试者。78 岁和 85 岁时急诊室使用分别在积极的受试者中较低（15.8%对 37.4%，P<0.0001；30.6%对 50.8%，P<0.0001），住院率也较低（10.5%对 16.7%，P<0.05；22.1%对 37.8%，P<0.0001）。我们调整了性别、教育、孤独、功能依赖、认知障碍、抑郁、糖尿病、心脏病、高血压、肿瘤、肾脏疾病、自我评估健康、体重指数和吸烟。78 岁时的 PA 与急诊室就诊的可能性降低相关（优势比[OR]0.49，95%置信区间[CI]0.27-0.89），但与住院无关（OR 1.14，95%CI 0.54-2.42）；85 岁时与急诊室就诊的可能性降低相关（OR 0.72，95%CI 0.52-0.99）和住院（OR 0.68，95%CI 0.48-0.98）。与 78 岁和 85 岁时一直积极活动的受试者相比，78 岁至 85 岁之间开始进行 PA 活动与急诊室就诊（OR 0.6，95%CI 0.23-1.56）和住院（OR 1.20，95%CI 0.48-3.02）的可能性降低相似；78 岁至 85 岁之间停止 PA 活动且一直不活动分别与急诊室就诊（OR 1.72，95%CI 1.02-2.88；OR 2.18，95%CI 1.04-4.57）和住院（OR 1.85，95%CI 1.06-3.23；OR 2.01，95%CI 0.92-4.4）的可能性增加相关。
在最年长的老年人中，不仅持续而且开始进行身体活动与减少卫生服务的使用有关。应鼓励非常老的人开始进行 PA。
