Ability to Walk 1/4 Mile Predicts Subsequent Disability, Mortality, and Health Care Costs
Ability to Walk 1/4 Mile Predicts Subsequent Disability, Mortality, and Health Care Costs
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DOI：
10.1007/s11606-010-1543-2
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发表时间：
2011-02-01
影响因子：
5.7
通讯作者：
Degenholtz, Howard B.
中科院分区：
文献类型：
--
作者：
Hardy, Susan E.;Kang, Yihuang;Degenholtz, Howard B.
背景：行动能力，如步行1/4英里，是老年人中一个有价值但未被充分利用的健康指标。为了将移动性成功地整合到临床实践和卫生政策中，需要一个易于评估的标记来预测随后的健康结局。目的：确定移动性（定义为自我报告的行走1/4英里的能力）与死亡率、功能下降以及随后一年的医疗保健利用率和成本之间的关联。设计：对2003 - 2004年Medicare当前受益人调查纵向数据的分析，Medicare受益人的全国代表性样本。参与者：参与者包括5895名65岁或65岁以上参加Medicare的社区居住成年人。流动性（自我报告的行走1/4英里的能力），死亡率，日常生活活动（ADL）的事件困难，总的年度医疗保健费用和住院率。关键结果：在老年人中，28%的人报告困难和17%的基线无法行走1/4英里。与无困难并调整人口统计学、社会经济状况、慢性病和健康行为的患者相比，有困难[AOR（95% CI）：1.57（1.10-2.24）]和无能力[AOR（CI）：2.73（1.79-4.15）]的患者死亡率更高。随着自我报告的行走14英里的能力下降，新的功能性残疾也更频繁地发生（基线时行走14英里无困难、困难或无法行走14英里的患者中，工具性ADL的后续事件残疾分别为11%、29%和47%，基础ADL为4%、14%和23%）。有困难的人的年度医疗保健总费用高出2773美元（95%CI 1443 -4102美元），无能力的人高出3919美元（CI 1948 -5890美元）。对于每100人，在基线时报告行走14英里困难的老年人经历了额外的14次住院治疗（95% CI 8-20），而那些无法接受治疗的患者则额外经历了22次住院治疗（CI 14-30），与没有行走困难的人相比。结论：行动不便，一个简单的自我报告的措施，是一个强大的预测未来的健康，功能和利用独立于通常的健康和人口统计指标。行动障碍可用于针对高风险患者进行护理管理和预防干预。
BACKGROUND: Mobility, such as walking 1/4 mile, is a valuable but underutilized health indicator among older adults. For mobility to be successfully integrated into clinical practice and health policy, an easily assessed marker that predicts subsequent health outcomes is required.OBJECTIVE: To determine the association between mobility, defined as self-reported ability to walk 1/4 mile, and mortality, functional decline, and health care utilization and costs during the subsequent year.DESIGN: Analysis of longitudinal data from the 20032004 Medicare Current Beneficiary Survey, a nationally representative sample of Medicare beneficiaries.PARTICIPANTS: Participants comprised 5895 community-dwelling adults aged 65 years or older enrolled in Medicare.MAIN MEASURES: Mobility (self-reported ability to walk 1/4 mile), mortality, incident difficulty with activities of daily living (ADLs), total annual health care costs, and hospitalization rates.KEY RESULTS: Among older adults, 28% reported difficulty and 17% inability to walk 1/4 mile at baseline. Compared to those without difficulty and adjusting for demographics, socioeconomic status, chronic conditions, and health behaviors, mortality was greater in those with difficulty [AOR (95% CI): 1.57 (1.10-2.24)] and inability [AOR (CI): 2.73 (1.79-4.15)]. New functional disability also occurred more frequently as self-reported ability to walk 1/4 mile declined (subsequent incident disability among those with no difficulty, difficulty, or inability to walk 1/4 mile at baseline was 11%, 29%, and 47% for instrumental ADLs, and 4%, 14%, and 23% for basic ADLs). Total annual health care costs were $2773 higher (95% CI $1443-4102) in persons with difficulty and $3919 higher (CI $1948-5890) in those who were unable. For each 100 persons, older adults reporting difficulty walking 1/4 mile at baseline experienced an additional 14 hospitalizations (95% CI 8-20), and those who were unable experienced an additional 22 hospitalizations (CI 14-30) during the follow-up period, compared to persons without walking difficulty.CONCLUSIONS: Mobility disability, a simple self-report measure, is a powerful predictor of future health, function, and utilization independent of usual health and demographic indicators. Mobility disability may be used to target high-risk patients for care management and preventive interventions.