老年人生活空间流动性与医疗保健费用及利用
Life-space mobility and healthcare costs and utilization in older men.
机构信息
Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.
Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota, USA.
出版信息
J Am Geriatr Soc. 2021 Aug;69(8):2262-2272. doi: 10.1111/jgs.17187. Epub 2021 May 7.
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.
目的
确定生活空间评分与随后的医疗保健费用和利用之间的关联。
设计
前瞻性队列研究（男性骨质疏松性骨折[MrOS]）。
地点
美国 6 个地点。
参与者
总共 1555 名居住在社区的男性（平均年龄 79.3 岁；91.5%为白种人，非西班牙裔），他们参加了 MrOS 第 7 年（Y7）检查，并与他们的医疗保险索赔数据相关联。
测量
过去一个月的生活空间评估为 0（每天限制在卧室）至 120（每天在自己的城镇外旅行而无需帮助），并进行分类（0-40、41-60、61-80、81-100、101-120）。在 Y7 检查后 36 个月期间确定了总年度直接医疗保健费用和利用情况。
结果
在生活空间评分类别中，男性的平均总年度费用（2020 年美元）稳步增加，从生活空间评分为 101-120 的男性的 7954 美元（标准差[SD] 16576）到生活空间评分为 0-40 的男性的 26430 美元（SD 28433）（p<0.001）。在调整人口统计学因素后，生活空间评分为 0-40 的男性与生活空间评分为 101-120 的男性相比，总费用的平均差异更大（费用比[CR] 2.52；95%置信区间[CI] 1.84-3.45），随后住院（优势比[OR] 4.72，95%CI 2.61-8.53）和熟练护理机构（SNF）入住（OR 7.32，95%CI 3.65-14.66）的风险更高。生活空间评分与总医疗保健费用（0-40 与 101-120 的 CR 1.29；95%CI 0.91-1.84）和住院（OR 1.76，95%CI 0.89-3.51）之间的关联不再具有统计学意义，同时考虑了人口统计学因素、医疗因素、自我报告的健康和功能以及脆弱表型；生活空间与 SNF 入住的关联仍然显著（OR 2.86，95%CI 1.26-6.49）。
结论
我们的研究结果强调了功能和移动性在预测未来医疗保健费用方面的重要性，并表明简单方便的生活空间评分可能部分反映了主要老年领域的风险，并有助于识别可能需要昂贵护理的年龄较大、居住在社区的男性。
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