Effects of mobility and cognition on hospitalization and inpatient days in women in late life

Kristine E. Ensrud; Li Yung Lui; Misti L. Paudel; John T. Schousboe; Allyson M. Kats; Jane A. Cauley; Charles E. McCulloch; Kristine Yaffe; Peggy M. Cawthon; Teresa A. Hillier; Brent C. Taylor

doi:10.1093/gerona/glw040

Effects of mobility and cognition on hospitalization and inpatient days in women in late life

Kristine E. Ensrud, Li Yung Lui, Misti L. Paudel, John T. Schousboe, Allyson M. Kats, Jane A. Cauley, Charles E. McCulloch, Kristine Yaffe, Peggy M. Cawthon, Teresa A. Hillier, Brent C. Taylor

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Abstract

Background: This study examines effects of mobility and cognition on hospitalization and inpatient days among women late in life. Methods: Prospective study of 663 women (mean age 87.7 years) participating in the Study of Osteoporotic Fractures Year 20 examination (2006-2008) linked with their inpatient claims data. At Year 20, mobility ascertained by Short Physical Performance Battery categorized as poor, intermediate, or good. Cognitive status adjudicated based on neuropsychological tests and classified as normal, mild cognitive impairment, or dementia. Hospitalizations (n = 182) during 12 months following Year 20. Results: Reduced mobility and poorer cognition were each associated in a graded manner with higher inpatient health care utilization, even after accounting for each other and traditional prognostic indicators. For example, adjusted mean inpatient days per year were 0.94 (95% confidence interval [CI] 0.52-1.45) among women with good mobility increasing to 2.80 (95% CI 1.64-3.89) among women with poor mobility and 1.59 (95% CI 1.08-2.03) among women with normal cognition increasing to 2.53 (95% CI 1.55-3.40) among women with dementia. Women with poor mobility/dementia had a nearly sixfold increase in mean inpatient days per year (4.83, 95% CI 2.73-8.54) compared with women with good mobility/normal cognition (0.84, 95% CI 0.49-1.44). Conclusions: Among women late in life, mobility limitations and cognitive deficits were each independent predictors of higher inpatient health care utilization even after considering each other and conventional predictors. Additive effects of reduced mobility and poorer cognition may be important to consider in medical decision making and health care policy planning for the growing population of adults aged ?85 years.

Original language	English (US)
Pages (from-to)	82-88
Number of pages	7
Journal	Journals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume	72
Issue number	1
DOIs	https://doi.org/10.1093/gerona/glw040
State	Published - Jan 2017

Bibliographical note

Funding Information:
The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576. This manuscript is the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System.

Keywords

Cognitive status
Elderly women
Hospitalization
Physical performance

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Ensrud, K. E., Lui, L. Y., Paudel, M. L., Schousboe, J. T., Kats, A. M., Cauley, J. A., McCulloch, C. E., Yaffe, K., Cawthon, P. M., Hillier, T. A., & Taylor, B. C. (2017). Effects of mobility and cognition on hospitalization and inpatient days in women in late life. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 72(1), 82-88. https://doi.org/10.1093/gerona/glw040

Ensrud, KE, Lui, LY, Paudel, ML, Schousboe, JT, Kats, AM, Cauley, JA, McCulloch, CE, Yaffe, K, Cawthon, PM, Hillier, TA & Taylor, BC 2017, 'Effects of mobility and cognition on hospitalization and inpatient days in women in late life', Journals of Gerontology - Series A Biological Sciences and Medical Sciences, vol. 72, no. 1, pp. 82-88. https://doi.org/10.1093/gerona/glw040

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title = "Effects of mobility and cognition on hospitalization and inpatient days in women in late life",

abstract = "Background: This study examines effects of mobility and cognition on hospitalization and inpatient days among women late in life. Methods: Prospective study of 663 women (mean age 87.7 years) participating in the Study of Osteoporotic Fractures Year 20 examination (2006-2008) linked with their inpatient claims data. At Year 20, mobility ascertained by Short Physical Performance Battery categorized as poor, intermediate, or good. Cognitive status adjudicated based on neuropsychological tests and classified as normal, mild cognitive impairment, or dementia. Hospitalizations (n = 182) during 12 months following Year 20. Results: Reduced mobility and poorer cognition were each associated in a graded manner with higher inpatient health care utilization, even after accounting for each other and traditional prognostic indicators. For example, adjusted mean inpatient days per year were 0.94 (95% confidence interval [CI] 0.52-1.45) among women with good mobility increasing to 2.80 (95% CI 1.64-3.89) among women with poor mobility and 1.59 (95% CI 1.08-2.03) among women with normal cognition increasing to 2.53 (95% CI 1.55-3.40) among women with dementia. Women with poor mobility/dementia had a nearly sixfold increase in mean inpatient days per year (4.83, 95% CI 2.73-8.54) compared with women with good mobility/normal cognition (0.84, 95% CI 0.49-1.44). Conclusions: Among women late in life, mobility limitations and cognitive deficits were each independent predictors of higher inpatient health care utilization even after considering each other and conventional predictors. Additive effects of reduced mobility and poorer cognition may be important to consider in medical decision making and health care policy planning for the growing population of adults aged ?85 years.",

keywords = "Cognitive status, Elderly women, Hospitalization, Physical performance",

author = "Ensrud, {Kristine E.} and Lui, {Li Yung} and Paudel, {Misti L.} and Schousboe, {John T.} and Kats, {Allyson M.} and Cauley, {Jane A.} and McCulloch, {Charles E.} and Kristine Yaffe and Cawthon, {Peggy M.} and Hillier, {Teresa A.} and Taylor, {Brent C.}",

note = "Funding Information: The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576. This manuscript is the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System.",

year = "2017",

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doi = "10.1093/gerona/glw040",

language = "English (US)",

volume = "72",

pages = "82--88",

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T1 - Effects of mobility and cognition on hospitalization and inpatient days in women in late life

AU - Ensrud, Kristine E.

AU - Lui, Li Yung

AU - Paudel, Misti L.

AU - Schousboe, John T.

AU - Kats, Allyson M.

AU - Cauley, Jane A.

AU - McCulloch, Charles E.

AU - Yaffe, Kristine

AU - Cawthon, Peggy M.

AU - Hillier, Teresa A.

AU - Taylor, Brent C.

N1 - Funding Information: The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576. This manuscript is the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System.

PY - 2017/1

Y1 - 2017/1

N2 - Background: This study examines effects of mobility and cognition on hospitalization and inpatient days among women late in life. Methods: Prospective study of 663 women (mean age 87.7 years) participating in the Study of Osteoporotic Fractures Year 20 examination (2006-2008) linked with their inpatient claims data. At Year 20, mobility ascertained by Short Physical Performance Battery categorized as poor, intermediate, or good. Cognitive status adjudicated based on neuropsychological tests and classified as normal, mild cognitive impairment, or dementia. Hospitalizations (n = 182) during 12 months following Year 20. Results: Reduced mobility and poorer cognition were each associated in a graded manner with higher inpatient health care utilization, even after accounting for each other and traditional prognostic indicators. For example, adjusted mean inpatient days per year were 0.94 (95% confidence interval [CI] 0.52-1.45) among women with good mobility increasing to 2.80 (95% CI 1.64-3.89) among women with poor mobility and 1.59 (95% CI 1.08-2.03) among women with normal cognition increasing to 2.53 (95% CI 1.55-3.40) among women with dementia. Women with poor mobility/dementia had a nearly sixfold increase in mean inpatient days per year (4.83, 95% CI 2.73-8.54) compared with women with good mobility/normal cognition (0.84, 95% CI 0.49-1.44). Conclusions: Among women late in life, mobility limitations and cognitive deficits were each independent predictors of higher inpatient health care utilization even after considering each other and conventional predictors. Additive effects of reduced mobility and poorer cognition may be important to consider in medical decision making and health care policy planning for the growing population of adults aged ?85 years.

AB - Background: This study examines effects of mobility and cognition on hospitalization and inpatient days among women late in life. Methods: Prospective study of 663 women (mean age 87.7 years) participating in the Study of Osteoporotic Fractures Year 20 examination (2006-2008) linked with their inpatient claims data. At Year 20, mobility ascertained by Short Physical Performance Battery categorized as poor, intermediate, or good. Cognitive status adjudicated based on neuropsychological tests and classified as normal, mild cognitive impairment, or dementia. Hospitalizations (n = 182) during 12 months following Year 20. Results: Reduced mobility and poorer cognition were each associated in a graded manner with higher inpatient health care utilization, even after accounting for each other and traditional prognostic indicators. For example, adjusted mean inpatient days per year were 0.94 (95% confidence interval [CI] 0.52-1.45) among women with good mobility increasing to 2.80 (95% CI 1.64-3.89) among women with poor mobility and 1.59 (95% CI 1.08-2.03) among women with normal cognition increasing to 2.53 (95% CI 1.55-3.40) among women with dementia. Women with poor mobility/dementia had a nearly sixfold increase in mean inpatient days per year (4.83, 95% CI 2.73-8.54) compared with women with good mobility/normal cognition (0.84, 95% CI 0.49-1.44). Conclusions: Among women late in life, mobility limitations and cognitive deficits were each independent predictors of higher inpatient health care utilization even after considering each other and conventional predictors. Additive effects of reduced mobility and poorer cognition may be important to consider in medical decision making and health care policy planning for the growing population of adults aged ?85 years.

KW - Cognitive status

KW - Elderly women

KW - Hospitalization

KW - Physical performance

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Effects of mobility and cognition on hospitalization and inpatient days in women in late life

Abstract

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