Restricted Activity among Community-Living Older Persons: Incidence, Precipitants, and Health Care Utilization

Abstract

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.

Incidence of Physical Disability Related to Musculoskeletal Disorders in the Elderly: Results From a Primary Care–Based Registry

“…The co-occurrence of different causes of disability in more than two-thirds of the cases supported our decision of using general syndromes in the case definition, which allowed for an easy definition of the cases, even if some of them could be related to other nonmusculoskeletal problems. The specific diagnoses by GPs were mostly axial and peripheral osteoarthritis, followed by soft tissue problems and inflammatory diseases, as expected (2,8,16,24,25). The presence of a high Charlson index, a high level of pain, and associated MSD comorbidities reflects the spectrum of the more prevalent diseases at this age (26) and gives a clear idea of the complex management needed to improve the situation.…”

“…The Rosser system (21) classifies function and mobility in 8 different levels, and we determined the fourth level as the cut point, mostly because it reflects well when physical disability, in addition to an individual health problem, starts to be a societal challenge. When we compared other incidence studies, our estimations were lower (16,22). In the study by Gill et al (16,22), restricted activity was identified by monthly calls, but included all causes of disability and was directed to a previously selected, high-risk population.…”

“…In the study by Gill et al (16,22), restricted activity was identified by monthly calls, but included all causes of disability and was directed to a previously selected, high-risk population. In the study by da Silva et al (16,22), where a higher IR of disability was found in women (although the sample was representative), restricted activity was based on the modified Katz Index, included all causes of disability, and was identified by 1 retrospective interview.…”

“…The first is that elderly people with health problems often do not seek medical attention (16), and the second is that 10% of the population in Madrid is covered by private insurance (23) and such patients may not have been captured in our study. The true incidence might be higher, as GPs are overloaded and many times they are not able to detect new APDEs.…”

Fatigue in older adults: an early indicator of the aging process?

“…Two cross-sectional studies show that older persons who report fatigue have significantly less good physical performance (61,62), slower walking speed, and more mobility-and IADL-disability (62). A few longitudinal studies show that participants with fatigue have more restricted activity at 1½ year follow-up (63), poorer physical function, ADL and slower gait speed at 3-year follow-up (64), increased healthcare utilization and mortality (15), and higher risk of mortality during 10-year follow-up (65).…”