Activity Limitation Stages Are Associated With Risk of Hospitalization Among Medicare Beneficiaries.
BACKGROUND
Activity limitation stages based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are associated with 3-year mortality in elderly Medicare beneficiaries, yet their associations with hospitalization risk in this population have not been studied.


OBJECTIVE
To examine the independent association of activity limitation stages with risk of hospitalization within a year among Medicare beneficiaries aged 65 years and older.


METHODS
Cohort study.


METHODS
Community.


METHODS
A total of 9447 community-dwelling elderly Medicare beneficiaries from the Medicare Current Beneficiary Survey for years 2005-2009.


METHODS
Stages were derived for ADLs and IADLs separately. Associations of stages with time to first hospitalization and time to recurrent hospitalizations within a year were assessed with Cox proportional hazards models, with which we accounted for baseline sociodemographics, smoking status, comorbidities, and the year of survey entry.


RESULTS
Time to first hospitalization and time to recurrent hospitalizations within 1 year.


RESULTS
The adjusted risk of first hospitalization increased with greater activity limitation stages (except stage III). The hazard ratios (95% confidence intervals) for ADL stages I-IV compared with stage 0 (no limitations) were 1.49 (1.36-1.63), 1.61 (1.44-1.80), 1.54 (1.35-1.76), and 2.06 (1.61-2.63), respectively. The pattern for IADL stages was similar. For recurrent hospitalizations, activity limitation stages were associated with the risk of the first hospitalization but not with subsequent hospitalizations.


CONCLUSIONS
Activity limitation stages are associated with the risk of first hospitalization in the subsequent year among elderly Medicare beneficiaries. Stages capture clinically interpretable profiles of ADL and IADL functionality and describe preserved functions and activity limitation in an aggregated measure. Stage can inform interventions to ameliorate disability and thus reduce the risk of a subsequent hospitalization in this population.


METHODS
IV.
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(∗).
Ling
L
Na
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(†).
Qiang
Q
Pan
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(‡).
Dawei
D
Xie
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(§).
Jibby E
JE
Kurichi
Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(¶).
Joel E
JE
Streim
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(‖).
Hillary R
HR
Bogner
U.S. Department of Veterans Affairs, Geriatrics Research Education and Clinical Center, Los Angeles, CA; Borun Center, UCLA Department of Medicine, University of California, Los Angeles, CA; RAND, Santa Monica, CA(#).
Debra
D
Saliba
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, 803 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021(∗∗). Electronic address: hennessy@upenn.edu.
Sean
S
Hennessy
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057187:Independent Living; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D051346:Mobility Limitation; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014481:United States
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