title: Physical activity and other health-related factors predict health care utilisation in older adults: the ActiFE Ulm study.
abstract: BACKGROUND
  Health care utilisation (HCU) can be a useful outcome for estimating costs and patient needs. It can also be used as a surrogate parameter for healthy ageing. The aim of this study was to analyse the associations of formerly described and potentially new parameters influencing health care utilisation in older adults in Germany.
  
  
  METHODS
  The ActiFE Ulm (Activity and Function in the Elderly in Ulm) study is a population-based study in 1,506 community dwelling older adults aged 65-90 years in Ulm and surrounding areas in southwestern Germany. Between March 2009 and April 2010 a full geriatric assessment was performed including accelerometer-based average daily walking duration, comorbidity, medication, physical and psychological functioning, health care utilisation, sociodemographic factors etc. The association between above named measures and health care utilisation, represented by the number of drugs, the days in hospital and the number of physician contacts over one year was calculated in multiple regression models. Analysis was conducted among subjects with complete information (n = 1,059, mean age 76 years, 55% male).
  
  
  RESULTS
  The average number of drugs was 4.5 and over 95% of participants visited a physician at least once a year while still more than 65% contacted their physician more than twice a year. Reduced physical activity, BMI, self-rated health and/or comorbidity and male sex were the best predictors of health care utilisation in community dwelling older adults when looking at both the number of drugs and the number of physician contacts over 12 months together. With regard to single diseases entities the best predictors of both the number of drugs and the number of physician contacts were asthma, chronic obstructive pulmonary disease (COPD)/chronic bronchitis and chronic neurological diseases (mostly Parkinson's disease). The number of drugs was most strongly associated with coronary heart disease, diabetes, and high blood pressure.
  
  
  CONCLUSIONS
  Reduced walking activity, self-rated health and/or comorbidity and male sex are the best predictors of health care utilisation as measured by the number of drugs and number of physician contacts over 12 months. Walking activity could be regarded as the most promising modifiable predictor of HCU in older adults.
authors.affiliation: Agaplesion Bethesda Clinic, Geriatric Center Ulm University, Zollernring 26, 89073 Ulm, Germany. michael.denkinger@bethesda-ulm.de
authors.forename: M D
authors.initials: MD
authors.lastname: Denkinger
authors.forename: A
authors.initials: A
authors.lastname: Lukas
authors.forename: F
authors.initials: F
authors.lastname: Herbolsheimer
authors.forename: R
authors.initials: R
authors.lastname: Peter
authors.forename: T
authors.initials: T
authors.lastname: Nikolaus
mesh_terms: D056044:Actigraphy / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009043:Motor Activity; D012959:Socioeconomic Factors; D014600:Utilization Review