@article {7579, title = {Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries.}, journal = {BMC Geriatr}, volume = {11}, year = {2011}, month = {2011 Aug 16}, pages = {43}, publisher = {11}, abstract = {

BACKGROUND: Most prior studies have focused on short-term (<= 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.

METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.

RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6\% on ADL abilities, 32.3\% on IADL abilities, and 30.9\% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.

CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cohort Studies, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Health Surveys, Humans, Insurance Benefits, Longitudinal Studies, Male, Medicare, Mobility Limitation, Prospective Studies, Time Factors, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-43}, author = {Frederic D Wolinsky and Suzanne E Bentler and Jason Hockenberry and Michael P Jones and Maksym Obrizan and Paula A Weigel and Kaskie, Brian and Robert B Wallace} } @article {7527, title = {A longitudinal study of chiropractic use among older adults in the United States.}, journal = {Chiropr Osteopat}, volume = {18}, year = {2010}, month = {2010 Dec 21}, pages = {34}, publisher = {18}, abstract = {

BACKGROUND: Longitudinal patterns of chiropractic use in the United States, particularly among Medicare beneficiaries, are not well documented. Using a nationally representative sample of older Medicare beneficiaries we describe the use of chiropractic over fifteen years, and classify chiropractic users by annual visit volume. We assess the characteristics that are associated with chiropractic use versus nonuse, as well as between different levels of use.

METHODS: We analyzed data from two linked sources: the baseline (1993-1994) interview responses of 5,510 self-respondents in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD), and their Medicare claims from 1993 to 2007. Binomial logistic regression was used to identify factors associated with chiropractic use versus nonuse, and conditional upon use, to identify factors associated with high volume relative to lower volume use.

RESULTS: There were 806 users of chiropractic in the AHEAD sample yielding a full period prevalence for 1993-2007 of 14.6\%. Average annual prevalence between 1993 and 2007 was 4.8\% with a range from 4.1\% to 5.4\%. Approximately 42\% of the users consumed chiropractic services only in a single calendar year while 38\% used chiropractic in three or more calendar years. Chiropractic users were more likely to be women, white, overweight, have pain, have multiple comorbid conditions, better self-rated health, access to transportation, higher physician utilization levels, live in the Midwest, and live in an area with fewer physicians per capita. Among chiropractic users, 16\% had at least one year in which they exceeded Medicare{\textquoteright}s "soft cap" of 12 visits per calendar year. These over-the-cap users were more likely to have arthritis and mobility limitations, but were less likely to have a high school education. Additionally, these over-the-cap individuals accounted for 58\% of total chiropractic claim volume. High volume users saw chiropractors the most among all types of providers, even more than family practice and internal medicine combined.

CONCLUSION: There is substantial heterogeneity in the patterns of use of chiropractic services among older adults. In spite of the variability of use patterns, however, there are not many characteristics that distinguish high volume users from lower volume users. While high volume users accounted for a significant portion of claims, the enforcement of a hard cap on annual visits by Medicare would not significantly decrease overall claim volume. Further research to understand the factors causing high volume chiropractic utilization among older Americans is warranted to discern between patterns of "need" and patterns of "health maintenance".

}, issn = {1746-1340}, doi = {10.1186/1746-1340-18-34}, author = {Paula A Weigel and Jason Hockenberry and Suzanne E Bentler and Maksym Obrizan and Kaskie, Brian and Michael P Jones and Robert L. Ohsfeldt and Gary E Rosenthal and Robert B Wallace and Frederic D Wolinsky} }