Life-Space Mobility and Healthcare Costs and Utilization in Older Men

Abstract

Objectives: To determine the association of life-space score with subsequent healthcare costs and utilization.Design: Prospective cohort study (Osteoporotic Fracture in Men [MrOS]). Setting: Six US sites. Participants: A total of 1,555 community-dwelling men (mean age 79.3 years; 91.5% white, non-Hispanic) participating in the MrOS Year 7 (Y7) examination linked with their Medicare claims data. Measurements: Life-space during the past month was assessed as 0 (daily restriction to one’s bedroom) to 120 (daily trips outside one’s town without assistance) and categorized (0-40, 41-60, 61-80, 81-100, 101-120). Total annualized direct healthcare costs and utilization were ascertained during 36 months following the Y7 examination. Results: Mean total annualized costs (2020 U.S. dollars) steadily increased across category of life-space score, from $7,954 (standard deviation [SD] 16,576) among men with life-space scores of 101-120 to $26,430 (SD 28,433) among men with life-space scores of 0-40 (p <0.001). After adjustment for demographics, men with a life-space score of 0-40 vs. men with a life-space score of 101-120 had greater mean total costs (cost ratio [CR] = 2.52; 95% confidence interval [CI] = 1.84-3.45) and greater risk of subsequent hospitalization (odds ratio [OR] 4.72, 95%CI 2.61-8.53) and skilled nursing facility (SNF) stay (OR 7.32, 95%CI 3.65-14.66). Simultaneous consideration of demographics, medical factors, self-reported health and function, and the frailty phenotype substantially attenuated the association of low life-space with total healthcare costs (CR for 0-40 vs. 101-120 1.29; 95%CI 0.91-1.84) and hospitalization (OR 1.76, 95%CI 0.89-3.51); the association of life-space with SNF stay remained significant (OR 2.86, 95%CI 1.26-6.49). Conclusion: Our results highlight the importance of function and mobility in predicting future healthcare costs and suggest the simple and convenient life-space score may in part capture risks from major geriatric domains and improve identification of older, community-dwelling adults likely to require costly care.