title: Aggregate health burden and the risk of hospitalization in older persons post hip replacement surgery.
abstract: BACKGROUND
  We sought to understand the association between aggregate health burden-chronic conditions, functionally limiting health problems and mental well-being-and the likelihood of hospitalization among older persons post hip replacement surgery.
  
  
  METHODS
  Eight hundred and twenty-eight Medicare recipients from three U.S. states completed a questionnaire 3 years postsurgery. Using administrative data (Medicare Provider Analysis and Review), participants were prospectively followed for 12 months postquestionnaire to capture hospitalizations. Using logistic regression, demographic, socioeconomic, and behavioral characteristics and medical comorbidities were considered as predictors. Subsequently, musculoskeletal (MSK) functional and geriatric problems were added as predictors, then mental well-being and activity limitations. Path analysis was employed to elucidate interrelationships between these predictors, investigating whether mediated effects through mental well-being and activity limitations were operational.
  
  
  RESULTS
  Mean age was 76 years (range: 67-96); 63% were women; 23% had ≥1 hospitalization(s). When medical comorbidity, MSK limitations, and geriatric problems were considered, each was independently associated with hospitalization (odds ratios: 1.3, 1.1, 1.2, respectively). When mental well-being and activity limitations were added, these variables were predictive of hospitalization (odds ratios: 1.2, 1.1, respectively), while MSK limitations and geriatric problems were no longer predictive. Path analysis results suggested that the influence of medical comorbidity and MSK and geriatric problems were mediated through mental well-being and activity limitations.
  
  
  CONCLUSIONS
  Several health domains predict hospitalization, beyond and including medical comorbidity. Efforts aimed at delaying/minimizing hospitalizations in this population should consider an array of domains for potentially targeted intervention. These findings can serve as a baseline against which future research can assess the impact of changes to the health care system.
authors.affiliation: Department of Orthopedic Surgery, Toronto Western Hospital, 399 Bathurst St, EW 1-427, Toronto, ON, Canada M5T 2S8. perrucci@uhnres.utoronto.ca
authors.forename: Anthony V
authors.initials: AV
authors.lastname: Perruccio
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wright
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D015897:Comorbidity; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004522:Educational Status; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006311:Hearing Disorders / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008569:Memory Disorders / Q000453:epidemiology; D008603:Mental Health; D009765:Obesity / Q000453:epidemiology; D004856:Postural Balance; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology; D014786:Vision Disorders / Q000453:epidemiology