title: The Association Between Life-Space and Health Care Utilization in Older Adults with Heart Failure.
abstract: BACKGROUND
  Life-space is associated with adverse health outcomes in older adults, but its role in health care utilization among individuals with heart failure is not well understood. We examined the relationship between life-space and both emergency department (ED) utilization and hospitalization.
  
  
  METHODS
  Participants were community-dwelling older adults with a verified diagnosis of heart failure who completed a baseline in-home assessment and at least one follow-up telephone interview. Life-space was measured at baseline and at follow-up every 6 months for 8.5 years. Poisson models were used to determine the association between life-space, measured at the beginning of each 6-month interval, and health care utilization, defined as ED utilization or hospitalization in the immediate ensuing 6 months, adjusting for sociodemographic and clinical confounders.
  
  
  RESULTS
  A total of 147 participants contributed 259 total health care utilization events involving an ED visit or a hospital admission. Multivariate analysis demonstrated an inverse association between life-space and health care utilization, where a clinically significant 10-point difference in life-space was independently associated with a 14% higher rate of ED utilization or hospitalization (incidence rate ratio 1.14, 95% CI 1.04-1.26, p = .004).
  
  
  CONCLUSIONS
  Life-space may be a useful identifier of community-dwelling older adults with heart failure at increased risk of ED visits or hospital admissions in the ensuing 6 months. Life-space may therefore be a potentially important component of intervention programs to reduce health care utilization.
authors.affiliation: Department of Emergency Medicine, Comprehensive Center for Healthy Aging, and alexanderlo@uabmc.edu.
authors.forename: Alexander X
authors.initials: AX
authors.lastname: Lo
authors.affiliation: Comprehensive Center for Healthy Aging, and Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham.
authors.forename: Kellie L
authors.initials: KL
authors.lastname: Flood
authors.affiliation: Comprehensive Center for Healthy Aging, and VA Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kennedy
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham.
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.affiliation: Comprehensive Center for Healthy Aging, and Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sawyer
authors.affiliation: Geriatrics and Extended Care Services, Office of Patient Care Services, Veterans Health Administration, Washington, DC.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.affiliation: Comprehensive Center for Healthy Aging, and Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham. VA Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Brown
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D011788:Quality of Life; D012111:Residence Characteristics; D012919:Social Behavior; D012959:Socioeconomic Factors
keywords: Health care utilization.; Heart failure; Life-space