Abstract
Background
Health care utilisation (HCU) can be a useful outcome for estimating costs and patient needs. It can also be used as a surrogate parameter for healthy ageing. The aim of this study was to analyse the associations of formerly described and potentially new parameters influencing health care utilisation in older adults in Germany.
Patients and methods
The ActiFE Ulm (Activity and Function in the Elderly in Ulm) study is a population-based study in 1,506 community dwelling older adults aged 65–90 years in Ulm and surrounding areas in southwestern Germany. Between March 2009 and April 2010 a full geriatric assessment was performed including accelerometer-based average daily walking duration, comorbidity, medication, physical and psychological functioning, health care utilisation, sociodemographic factors etc. The association between above named measures and health care utilisation, represented by the number of drugs, the days in hospital and the number of physician contacts over one year was calculated in multiple regression models. Analysis was conducted among subjects with complete information (n = 1,059, mean age 76 years, 55% male).
Results
The average number of drugs was 4.5 and over 95% of participants visited a physician at least once a year while still more than 65% contacted their physician more than twice a year. Reduced physical activity, BMI, self-rated health and/or comorbidity and male sex were the best predictors of health care utilisation in community dwelling older adults when looking at both the number of drugs and the number of physician contacts over 12 months together. With regard to single diseases entities the best predictors of both the number of drugs and the number of physician contacts were asthma, chronic obstructive pulmonary disease (COPD)/chronic bronchitis and chronic neurological diseases (mostly Parkinson’s disease). The number of drugs was most strongly associated with coronary heart disease, diabetes, and high blood pressure.
Conclusion
Reduced walking activity, self-rated health and/or comorbidity and male sex are the best predictors of health care utilisation as measured by the number of drugs and number of physician contacts over 12 months. Walking activity could be regarded as the most promising modifiable predictor of HCU in older adults.
Zusammenfassung
Hintergrund
Die Erfassung einer Inanspruchnahme des Gesundheitswesens kann zur Kostenabschätzung nützlich sein und einen Eindruck vermitteln, welche Erkrankungen Patienten am meisten beeinträchtigen. Somit kann es auch als Surrogat für gesundes Altern verwendet werden. In dieser Analyse sollten die Zusammenhänge bereits bekannter und möglicher neuer Faktoren mit der Inanspruchnahme des Gesundheitswesens bei älteren Menschen in Deutschland beschrieben werden.
Patienten und Methoden
Die Studie ActiFE Ulm (Activity and Function in the Elderly in Ulm) ist eine populationsbasierte Studie bei 1506 zu Hause lebenden Personen zwischen 65 und 90 Jahren, die in der Stadt Ulm und Umgebung wohnen. Zwischen März 2009 und April 2010 wurde ein komplettes geriatrisches Assessment durchgeführt. Darunter waren u. a. eine akzelerometerbasierte Aktivitätsmessung, Assessments der Komorbidität, der Medikation, der physischen und psychischen Funktionen, soziodemographische und zahlreiche weitere Faktoren. Die Zusammenhänge zwischen den oben genannten Parametern und der Inanspruchnahme des Gesundheitswesens, dargestellt durch die Zahl der Medikamente, die stationären Tage im Krankenhaus und die Zahl der Arztbesuche in einem Jahr, wurden mittels multipler Regression (verschiedene Modelle) berechnet. Von 1059 Teilnehmern konnten komplette Daten ausgewertet werden (Alter im Mittel 76 Jahre, 55% Männer).
Ergebnisse
Die mittlere Anzahl an Medikamenten lag bei 4,5, und über 95% der Teilnehmer hatten im letzten Jahr mindestens einmal einen Arzt aufgesucht, mehr als 65% sogar dreimal und öfter. Eine reduzierte körperliche Aktivität, der Body-Mass-Index, die Selbsteinschätzung der Gesundheit und die Komorbidität sowie männliches Geschlecht waren die besten Prädiktoren der Inanspruchnahme des Gesundheitswesens, wenn man die beiden Endpunkte, die Zahl der Medikamente und die Arztbesuche zusammen betrachtet. Bei der Analyse einzelner Krankheitsbilder waren Asthma, COPD/chronische Bronchitis und chronische neurologische Erkrankungen führend. Bei alleiniger Betrachtung der Medikamentenzahl als Endpunkt zeigten KHK, Diabetes, hoher Blutdruck und andere, vor allem kardiologische Krankheitsbilder die stärkste Assoziation. Krankenhausaufenthalte waren nur mit der Anzahl der Medikamente signifikant korreliert.
Schlussfolgerung
Reduzierte körperliche Aktivität, Selbsteinschätzung der Gesundheit, Komorbidität sowie das männliche Geschlecht sind die besten Prädiktoren für die Inanspruchnahme des Gesundheitswesens. Die körperliche Aktivität kann aus Sicht der Prävention und des gesunden Alterns als interessantester modifizierbarer Parameter angesehen werden.
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Acknowledgement
The authors would like to thank all participants in the study.
The ActiFE Ulm study group consists of: B. Böhm, Department of Internal Medicine I – Division of Endocrinology, M. Denkinger, Agaplesion Bethesda Clinic, Ulm, Germany, H. Geiger, Department of Dermatology and Allergology, F. Herbolsheimer, Institute of Epidemiology & Medical Biometry, A. Lukas, Agaplesion Bethesda Clinic, Ulm, Germany, J. Kirchheiner, Institute of Pharmacology of Natural Products & Clinical Pharmacology, W. Koenig, Department of Internal Medicine II – Cardiology, G. Nagel, Institute of Epidemiology & Medical Biometry, T. Nikolaus (PI), Agaplesion Bethesda Clinic, Ulm, Germany, R. Peter (PI), Institute of Epidemiology & Medical Biometry, M. Riepe, Division of Gerontopsychiatry, Dept. of Psychiatry and Psychotherapy II, L. Rudolph, Max-Planck Group for Stem Cell Research, D. Rothenbacher, Institute of Epidemiology & Medical Biometry, K. Scharffetter-Kochanek, Department of Dermatology and Allergology, Ch. Schumann, Department of Internal Medicine II – Pneumology, J.M. Steinacker, Department of Sports- and Rehabilitation Medicine, C. von Arnim, Department of Neurology, G. Weinmayr, Institute of Epidemiology & Medical Biometry. (if not differently indicated: All Ulm University Ulm, Germany; PI = Principle Investigator)
Funding source
The study was funded by a grant from the Ministry of Science, Research and Arts, state of Baden-Wuerttemberg, Germany, as part of the Geriatric Competence Center, Ulm University. Michael Denkinger was supported by a research fellowship program from the Robert Bosch Foundation, Stuttgart, Germany, which did not have any influence on the content.
Conflict of interest
The corresponding author states that there are no conflicts of interest.
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Denkinger, M., Lukas, A., Herbolsheimer, F. et al. Physical activity and other health-related factors predict health care utilisation in older adults. Z Gerontol Geriat 45, 290–297 (2012). https://doi.org/10.1007/s00391-012-0335-1
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DOI: https://doi.org/10.1007/s00391-012-0335-1