Restricted Activity among Community-Living Older Persons: Incidence, Precipitants, and Health Care Utilization
Abstract
BACKGROUND: Restricted activity is a potentially important indicator of health and functional status. Yet, relatively little is known about the incidence, precipitants, or health care utilization associated with restricted activity among older persons. OBJECTIVE: To more accurately estimate the rate of restricted activity among community-living older persons, to identify the health-related and non-health-related problems that lead to restricted activity, and to determine whether restricted activity is associated with increased health care utilization. DESIGN: Prospective cohort study. SETTING: New Haven, Connecticut. PARTICIPANTS: 754 nondisabled members of a large health plan, 70 years of age or older, who were categorized according to their risk for disability (low, intermediate, or high). MEASUREMENTS: Occurrence of restricted activity (defined as having stayed in bed for at least half a day or having cut down on one's usual activities because of an illness, injury, or another problem), problems leading to restricted activity, and health care utilization were ascertained during monthly telephone interviews for up to 2 years. RESULTS: In median follow-up of 15 months, 76.6% of participants reported restricted activity during at least 1 month and 39.3% reported restricted activity during 2 consecutive months. The rates of restricted activity per 100 person-months were 19.0 episodes for all participants and 16.9, 27.3, and 22.7 episodes for participants at low, intermediate, and high risk for disability, respectively. Of the 24 prespecified health-related and non-health-related problems, the rates per 100 person-months of restricted activity ranged from 0.1 episode for "problem with alcohol" to 65.5 episodes for "been fatigued." On average, participants identified 4.5 different problems as a cause for their restricted activity. Health care utilization was substantially greater during months with restricted activity than months without restricted activity. The corresponding rates per 100 person-months were 63.8 and 45.1 for physician office visits, 12.5 and 1.0 for emergency department visits, 14.1 and 0.3 for hospital admissions, and 67.6 and 45.1 for any health care utilization (P < 0.001 for each pairwise comparison). CONCLUSIONS: Restricted activity is common among community-living older persons, regardless of risk for disability, and it is usually attributable to several concurrent health-related problems. Although restricted activity is associated with a substantial increase in health care utilization, older persons with restricted activity often do not seek medical attention.
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The Yale Precipitating Events Project is a cohort study based in New Haven CT that enrolled individuals aged 70 years or older.
“The Yale Precipitating Events Project (PEP) is a cohort study based in New Haven CT that enrolled individuals aged 70 years or older.”
From A standard procedure for creating a frailty index (2008) · cites this paper as [16]
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Gill, T. M., Allore, H. G., & Guo, Z. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.11.1317 · Cited by 91 · see citing works
Self-citationFatigue and the prediction of negative health outcomes: A systematic review with meta-analysis
Knoop, V., Cloots, B., Costenoble, A., Debain, A., Azzopardi, R. V., Vermeiren, S., Jansen, B., Scafoglieri, A., Bautmans, I., Bautmans, I., et al. (2021) · Ageing Research Reviews · doi:10.1016/j.arr.2021.101261 · Cited by 89 · see citing works
Portegijs, E., Buurman, B. M., Essink-Bot, M.-L., Zwinderman, A. H., & de Rooij, S. E. (2012) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2012.04.003 · Cited by 88 · see citing works
Mobility-Related Fatigue, Walking Speed, and Muscle Strength in Older People
Mänty, M., de Leon, C. F. M., Rantanen, T., Era, P. A., Pedersen, B. K., Ekmann, A., Schroll, M., & Avlund, K. (2011) · The Journals of Gerontology Series A · doi:10.1093/gerona/glr183 · Cited by 88 · see citing works
Lee, E. A., Brettler, J. W., Kanter, M. H., Steinberg, S. G., Khang, P. S., Distasio, C. C., Martin, J., Dreskin, M., Thompson, N., Cotter, T. M., et al. (2019) · The Permanente Journal · doi:10.7812/tpp/18.212 · Cited by 90 · see citing works
Bathing Disability and the Risk of Long-Term Admission to a Nursing Home
Gill, T. M., Allore, H. G., & Han, L. (2006) · The Journals of Gerontology Series A · doi:10.1093/gerona/61.8.821 · Cited by 86 · see citing works
Self-citationPhysical and cognitive function
Steel, N., Huppert, F. A., McWilliams, B., & Melzer, D. R. (2003) · UEA Digital Repository (University of East Anglia) · Cited by 84 · see citing works
Baker, D. I., King, M. B., Fortinsky, R. H., Graff, L., Gottschalk, M., Acampora, D., Preston, J. A., Brown, C. J., & Tinetti, M. E. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53218.x · Cited by 84 · see citing works
End-of-life care and outcomes.
Lorenz, K., Lynn, J., Morton, S. C., Dy, S. M., Mularski, R. A., Shugarman, L. R., Sun, V. C.-Y., Wilkinson, A., Maglione, M., & Shekelle, P. (2004) · PubMed Central · Cited by 85 · see citing works
Gill, T. M., Gahbauer, E. A., Lin, H., Han, L., & Allore, H. G. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2012.11.011 · Cited by 83 · see citing works
Self-citationSymptoms, Symptom Beliefs, and Quality of Life of Older Breast Cancer Survivors: A Comparative Study
Heidrich, S. M., Egan, J. J., Hengudomsub, P., & Randolph, S. M. (2006) · Oncology nursing forum · doi:10.1188/06.onf.315-322 · Cited by 83 · see citing works
Reid, M. C., Williams, C. S., & Gill, T. M. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51357.x · Cited by 81 · see citing works
Self-citationBathing Disability in Community‐Living Older Persons: Common, Consequential, and Complex
Naik, A. D., Concato, J., & Gill, T. M. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52513.x · Cited by 80 · see citing works
Self-citationTwo Recruitment Strategies for a Clinical Trial of Physically Frail Community‐Living Older Persons
Gill, T. M., McGloin, J. M., Gahbauer, E. A., Shepard, D. M., & Bianco, L. M. (2001) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2001.49206.x · Cited by 79 · see citing works
Self-citationAbdulraheem, I. S., Oladipo, A. R., & Amodu, M. O. (2011) · Journal of Aging Research · doi:10.4061/2011/369894 · Cited by 78 · see citing works
Treatment of Death in the Analysis of Longitudinal Studies of Gerontological Outcomes
Murphy, T. E., Han, L., Allore, H. G., Peduzzi, P. N., Gill, T. M., & Lin, H. (2010) · The Journals of Gerontology Series A · doi:10.1093/gerona/glq188 · Cited by 78 · see citing works
Self-citationd’Uva, T. B., Lindeboom, M., O’Donnell, O., & van Doorslaer, E. K. A. (2011) · The Journal of Human Resources · doi:10.3368/jhr.46.4.875 · Cited by 78 · see citing works
Barry, L. C., Guo, Z., Kerns, R. D., Duong, B. D., & Reid, M. C. (2003) · Pain · doi:10.1016/s0304-3959(02)00471-2 · Cited by 76 · see citing works
Gill, T. M., Zang, E. X., Murphy, T. E., Leo-Summers, L. S., Gahbauer, E. A., Festa, N., Falvey, J. R., & Han, L. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.4260 · Cited by 73 · see citing works
Self-citationJoint Trajectories of Cognition and Frailty and Associated Burden of Patient-Reported Outcomes
Liu, Z., Han, L., Gahbauer, E. A., Allore, H. G., & Gill, T. M. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.10.010 · Cited by 74 · see citing works
Self-citationMelzer, D. R. (2004) · Age and Ageing · doi:10.1093/ageing/afh075 · Cited by 72 · see citing works
Are BMI and inflammatory markers independently associated with physical fatigability in old age?
Cooper, R., Popham, M., Santanasto, A. J., Hardy, R., Glynn, N. W., & Kuh, D. J. (2018) · International Journal of Obesity · doi:10.1038/s41366-018-0087-0 · Cited by 72 · see citing works
Resiliency Over Time of Elders’ Age Stereotypes After Encountering Stressful Events: Table 1.
Levy, B. R., Slade, M. D., Chung, P. H., & Gill, T. M. (2014) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbu082 · Cited by 71 · see citing works
Self-citationRestricting Symptoms in the Last Year of Life
Chaudhry, S. I., Murphy, T. E., Gahbauer, E. A., Sussman, L. S., Allore, H. G., & Gill, T. M. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.8732 · Cited by 70 · see citing works
Self-citationd’Uva, T. B., Lindeboom, M., O’Donnell, O., & van Doorslaer, E. K. A. (2011) · The Journal of Human Resources · doi:10.1353/jhr.2011.0005 · Cited by 70 · see citing works
Dharmarajan, K., Han, L., Gahbauer, E. A., Leo-Summers, L. S., & Gill, T. M. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16350 · Cited by 69 · see citing works
Self-citationFragoso, C. A. V., Gahbauer, E. A., Ness, P. H. V., Concato, J., & Gill, T. M. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.01687.x · Cited by 68 · see citing works
Self-citationDisability transitions in the oldest old in the general population. The Leiden 85-plus study
van Houwelingen, A. H., Cameron, I. D., Gussekloo, J., Putter, H., Kurrle, S. E., de Craen, A. J. M., Maier, A. B., den Elzen, W. P. J., & Blom, J. W. (2013) · AGE · doi:10.1007/s11357-013-9574-3 · Cited by 68 · see citing works
Murphy, S. L., Alexander, N. B., Levoska, M. A., & Smith, D. M. (2013) · Arthritis Care & Research · doi:10.1002/acr.22030 · Cited by 68 · see citing works
Gill, T. M., Gahbauer, E. A., Han, L., & Allore, H. G. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.02107.x · Cited by 65 · see citing works
Self-citationThe Epidemiology of Bathing Disability in Older Persons
Gill, T. M., Guo, Z., & Allore, H. G. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00890.x · Cited by 62 · see citing works
Self-citationSubtypes of Disability in Older Persons over the Course of Nearly 8 Years
Gill, T. M., Guo, Z., & Allore, H. G. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01603.x · Cited by 61 · see citing works
Self-citationReidy, P. T., McKenzie, A. I., Mahmassani, Z. S., Morrow, V. R., Yonemura, N. M., Hopkins, P. N., Marcus, R. L., Rondina, M. T., Lin, Y. K., & Drummond, M. J. (2018) · The Journal of Physiology · doi:10.1113/jp276798 · Cited by 60 · see citing works
Association Between Indicators of Disability Burden and Subsequent Depression Among Older Persons
Barry, L. C., Soulos, P. R., Murphy, T. E., Kasl, S. V., & Gill, T. M. (2012) · The Journals of Gerontology Series A · doi:10.1093/gerona/gls179 · Cited by 59 · see citing works
Self-citationDepressive Symptoms and Functional Transitions Over Time in Older Persons
Barry, L. C., Murphy, T. E., & Gill, T. M. (2010) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181ff6669 · Cited by 58 · see citing works
Self-citation
- Authors
- Gill, T. M., Desai, M. M., Gahbauer, E. A., Holford, T. R., & Williams, C. S.
- Affiliations
- Yale University (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2001-09-04
- Volume
- 135
- Issue
- 5
- Pages
- 313-321
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2082921236
- Cited by
- 306
- References
- 31
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 12 · 2023: 8 · 2022: 7 · 2021: 10 · 2020: 14 · 2019: 9 · 2018: 17 · 2017: 15 · 2016: 13 · 2015: 20 · 2014: 18 · 2013: 18 · 2012: 9
- FWCI
- 13.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k23ag000759-02)
- National Institute on Aging (1RO1AG17560-01A1, K23AG00759, R01AG017560)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- older adults, community-dwelling older adults, health care utilization, disability risk, functional status, fatigue, physician visits, emergency department visits, hospitalization, incidence, health insurance beneficiaries, alcohol problems, bed rest, health indicators, health services research
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Female, Persons with Disabilities, Health Services, Humans, Male, Risk Factors, Cohort Studies, Risk Assessment
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