Lower Physical Function Among OAs Increases Health Care Utilization, Expenditures

^{By Julie Gould} 

Researchers recently found that among older adults with lower physical function, both health care utilization and expenditures were higher. The findings were published online in the Journal of the American Geriatrics Society.  

In order to evaluate resource utilization associated with differences in physical functioning in older adults, Joshua D Brown, PharmD, PhD, and colleagues conducted a retrospective panel study. Included in the study were 26,809,552 older adults in the United States, aged 70 years or older.

In order to better understand what prior research led to this study and a review of the findings, we spoke with Dr Brown.

Please introduce yourself.

I am an Assistant Professor in the University of Florida College of Pharmacy and Center for Drug Evaluation & Safety. My research focuses on pharmacoepidemiology, or the study of medication effectiveness and safety within populations. In addition, I have a particular focus on aging including medication use in older adults and health services research in this population and have trained as a Pepper Junior Scholar at the University of Florida Institute on Aging. 

What existing data led you and your co-investigators to conduct this research?

It was really the lack of existing data on this topic. We all know that the population is getting older on average with the “baby boomer” generation having entered retirement age. It is projected that 21% of the population will be ≥65 years or older by 2040. Older adults currently make up about half of all health care expenditures so there will be an increasing burden on the health care system and taxpayer funded insurance programs as these trends continue. One of the studied syndromes of aging is frailty, which, in part, consists of physical frailty and deterioration of physical independence. This brings a host of problems that are costly including increased dependence for every activities of daily living, worsening medical conditions, and with these, increasing costs. Physical frailty is intervenable in that it can be slowed or improved with targeted interventions or treatments. Thus, our group aimed to quantify dollar amounts and utilization counts associated with differences in physical functioning in older adults to provide information that can be used to assess or predict the impact of such interventions or treatments. 

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

The study used public data available from the US Agency for Healthcare Research & Quality. The Medical Expenditures Panel Survey, or MEPS, is nationally representative data and capture metrics on individuals’ quality of life, health care resource utilization, and costs. We studied older adults, ≥70 years-old, and divided them into quartiles based on a measure of physical functioning. We looked at health care resource utilization and costs between these fours groups. What is significant is that we found differences in both of these metrics but it was surprising to see a much larger difference for costs. For health care utilization, like visits to doctors, being hospitalized, or going to the emergency room, there were decreases of about 10-14% with higher physical functioning. This seemed to plateau somewhat when comparing some groups. However, for costs, there were large differences when comparing the lowest functioning group to the other three groups. Between the highest functioning and the lowest functioning groups, there was a difference of 65% lower costs associated with higher physical functioning. 

What are the possible real-world applications of these findings in clinical practice?

We essentially distill these results down to say that any improvements or maintenance of physical functioning can pay off in saved health care costs and some reduction in health care utilization. Overall, this will benefit older adults but, more widely, can benefit the health care system as a whole. Interventions or treatments for slowing aging or influencing physical activity can be assessed for cost-effectiveness using these estimates which will hopefully improve how we assess the value of such interventions or treatments in the future. 

Do you and your co-investigators intend to expand upon this research?

We do. Specifically, we want to evaluate changes in health care costs and utilization during the Lifestyle Interventions and Independence for Elders (LIFE) clinical trial by linking these trial data to Medicare administrative claims data. That way we can directly assess the impact of a physical activity intervention on direct health care costs as the intervention is being implemented.

Reference:

Cheng MS Y, Goodin AJ, Pahor M, Manini T, Brown JD. Healthcare Utilization and Physical Functioning in Older Adults in the United States [published online ahead of print November 22, 2019]. J Am Geriatr Soc. 68:266–271, 2020. doi: https://doi.org/10.1111/jgs.16260