Cross-sectional and longitudinal relationships between physical activity and health services utilization in community-dwelling older adults
Date
2014-05-06
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Degree Level
Doctoral
Abstract
There has been a growing interest among policymakers in the potential role of physical activity (PA) as a strategy to mitigate the challenges associated with an aging population, specifically the potential pressures on the health care system presented by an increasing need and demand for long term management of chronic health conditions. In this dissertation, the relationship between PA and health service utilization among older adults and the role of PA in reducing health services utilization in this population is examined via two studies. Study 1: The purpose of Study 1 was to examine relationships between LTPA and health services utilization in a nationally representative sample of community-dwelling adults aged 50 years and older. Methods: This study involved a secondary analysis of data from the Cycle 3.1 of the Canadian Community Health Survey. The analysis was restricted to individuals aged 50 years and older, resulting in an unweighted sample of 56,652 adults (48%M; 52%F; mean age 63.5±10.2 years), stratified a priori into three age groups (50 – 64 years, 65 – 79 years, 80 years and older). Self-reported use of general physician (GP) services, specialist physician services and hospital services for the 12-month period prior to the survey were the outcomes of interest. The main independent variable of interest was self-reported LTPA for a 3-month period prior to the survey. A comprehensive set of predisposing, enabling, and health need factors associated with health services utilization were included as control variables in all analyses. Separate multiple logistic and negative binomial regression models were used to assess the association between LTPA and each dichotomous and count-based dependent variable, respectively. Bootstrap re-sampling procedures were applied in all regression analyses. Results In the 50-64 year age group, active individuals were 27% less likely to report any contact with a GP (OR=0.73; p<.001) and had 8% fewer GP consultations (IRR=0.92; p<.01) than their inactive counterparts. Among 65 to 79 year olds, active respondents were 18% less likely than their inactive counterparts to have had an overnight hospitalization in the previous 12 months (OR=0.82, p<.05). Across all age groups, higher levels of non-leisure physical activity was associated with lower health services utilization.
Study 2: The purpose of Study 2 was to investigate the effects of a randomized community-based PA intervention (50+ in motion) on participants’ health service utilization and healthcare costs over a 5-year period. Methods: 50+ in motion was a randomized clinical trial comparing the effectiveness of a class-based (CB) and home-based (HB) exercise program for older adults with select chronic health conditions (hypertension, dyslipidemia, type 2 diabetes mellitus, osteoarthritis, overweight or obesity). Of the 172 participants randomized, 59 CB and 69 HB participants granted access to their administrative health data. Data pertaining to GP and specialist physician services utilization and costs as well as hospital services utilization and costs were obtained for all consenting participants from the Saskatchewan Ministry of Health for the year prior to enrolment in the 50+ in motion study through to 48-months post-randomization, for a total of 5-years of data. Independent variables including demographic characteristics, physical activity, sedentary behaviour, cardiovascular endurance, functional fitness, body composition, blood pressure, and self-reported physical and mental health status were collected directly from participants prior to randomization and then annually for 4 years. Longitudinal effects of the 50+ in motion intervention on health services utilization and healthcare costs were assessed using the generalized estimating equation (GEE) approach with covariates selected for inclusion based on methods of purposeful selection. Results: There were no significant differences in health services utilization or health care costs between the CB and HB interventions until the final year of the study when the HB group had 60% more GP visits than the CB group and were 89% less likely than the CB group to be frequent users of specialist services. There were no significant differences between the randomization groups in healthcare costs. Measures of functional fitness emphasizing lower body strength, endurance and power were more consistently associated with lower health services utilization than CV endurance, body composition or physical activity. Sedentary behavior was associated with higher hospital costs, independent of physical activity, functional fitness and health status.
Overall Conclusion: Taken together, the two studies in this thesis address a significant gap in the Canadian literature and provide novel insights into the relationships between PA, health and health services utilization in older adults. While further research is needed to improve our understanding of the relationships between physical activity and sedentary behaviour, physical fitness, and health services utilization, the findings presented in this thesis suggest reducing sedentary behaviour and improving functional fitness in older adults may be as important as physical activity, if not more so, in terms of potential impact on health services utilization and health care costs. For health care professionals and policymakers at all levels, the findings highlight the advantages of a multi-pronged, interdisciplinary approach to the development of public health initiatives and interventions focused on increasing PA participation and functional fitness among older adults.
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Keywords
Physical activity, older adults, health services utilization, health care costs
Citation
Degree
Doctor of Philosophy (Ph.D.)
Department
Kinesiology
Program
Kinesiology