The Association Between Life-Space and Health Care Utilization in Older Adults with Heart Failure

Lo, Alexander X.; Flood, Kellie L.; Kennedy, Richard E.; Bittner, Vera; Sawyer, Patricia; Allman, Richard M.; Brown, Cynthia J.

doi:10.1093/gerona/glv076

Cited by 23 publications

(35 citation statements)

References 43 publications

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“…In their original description of the LSA, Baker et al recommended a 10‐point change be considered significant, based on the difference in LSA scores between patients who considered their mobility restricted and unrestricted. Other studies also recommended a 10‐point change based on LSA scores of patients before and after hospitalization for medical illness . Our MIC of five points is lower than previous estimates and suggests that while these events are associated with considerable change in life space, less dramatic events experienced by older adults may also have a significant impact on life space.…”

Section: Discussioncontrasting

confidence: 64%

Determination of the Minimal Important Change in the Life‐Space Assessment

Kennedy

Almutairi

Williams

et al. 2018

J American Geriatrics Society

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Background/Objectives The University of Alabama at Birmingham (UAB) Life‐Space Assessment (LSA) is a widely used measure of community mobility. To assist clinicians and researchers with assessing the significance of changes in scores, we determined the minimal important change associated with a change in health status. Setting Homes of community‐dwelling older adults. Participants A total of 419 African American and non‐Hispanic white adults 75 years and older participating in the UAB Study of Aging II, a longitudinal epidemiological study across the state of Alabama. Intervention None. Measurements Linear mixed models were used to compare change in LSA scores over 1‐month intervals (N = 9712) between participants reporting improvement, no change, or decline in activities of daily living walking scores, accounting for the correlation among scores for the same participant over time. Results A decline in walking status was associated with a mean decrease in LSA scores of 2.93 points (95% confidence interval [CI] = 1.69‐4.17 points), indicating lower mobility. An improvement in walking status was associated with a mean increase in LSA scores of 2.51 points (95% CI = 1.26‐3.77 points), indicating higher mobility. Conclusion A change in LSA scores of five or more is clinically important, exceeding the 95% CI for the change in LSA associated with change in walking status. Changes exceeding this threshold should prompt further investigation by providers with a goal of preserving mobility. J Am Geriatr Soc 67:565–569, 2019.

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Section: Discussioncontrasting

confidence: 64%

Determination of the Minimal Important Change in the Life‐Space Assessment

Kennedy

Almutairi

Williams

et al. 2018

J American Geriatrics Society

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“…The LSA has been validated in community-dwelling older adults, and multiple publications support its clinical validity in that population. 16 In addition to its association with poor outcomes in older adults, such as mortality, 7 hospitalization and emergency room visits, 20 and nursing home admission, 8 restricted Life-Space mobility is associated with frailty, unintentional weight loss, cognitive decline, and falls, and precedes limitations in activities of daily living in this population. 18 , 21 – 25 Many COPD patients also experience these common features of aging and frequently limit participation in social activities; however, this is rarely assessed.…”

Section: Discussionmentioning

confidence: 99%

Life-Space mobility and clinical outcomes in COPD

Iyer¹,

Wells²,

Bhatt³

et al. 2018

COPD

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BackgroundSocial isolation is a common experience in patients with COPD but is not captured by existing patient-reported outcomes, and its association with clinical outcomes is unknown.MethodsWe prospectively enrolled adults with stable COPD who completed the University of Alabama at Birmingham Life Space Assessment (LSA) (range: 0–120, restricted Life-Space mobility: ≤60 and a marker of social isolation in older adults); six-minute walk test (6MWT), and the University of California at San Diego Shortness of Breath Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale. The occurrence of severe exacerbations (emergency room visit or hospitalization) was recorded by review of the electronic record up to 1 year after enrollment. We determined associations between Life-Space mobility and clinical outcomes using regression analyses.ResultsFifty subjects had a mean ± SD %-predicted FEV1 of 42.9±15.5, and 23 (46%) had restricted Life-Space mobility. After adjusting for age, gender, %-predicted FEV1, comorbidity count, inhaled corticosteroid/long-acting beta2-agonist use, and prior cardiopulmonary rehabilitation, subjects with restricted Life-Space had an increased risk for severe exacerbations (adjusted incidence rate ratio 4.65, 95% CI 1.19–18.23, P=0.03). LSA scores were associated with 6MWD (R=0.50, P<0.001), dyspnea (R=−0.58, P<0.001), quality of life (R=−0.34, P=0.02), and depressive symptoms (R=−0.39, P=0.005).ConclusionRestricted Life-Space mobility predicts severe exacerbations and is associated with reduced exercise tolerance, more severe dyspnea, reduced quality of life, and greater depressive symptoms.

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“…However, it is expected that an emergency department visit or hospitalization is an important enough event that most participants would recall it, particularly within a short (4 week) timeframe. 27 Reasons for the emergency department visits are also patient reported, so no conclusions can be drawn about appropriateness of the emergency department visit.…”

Section: Discussionmentioning

confidence: 99%

Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults

Brown

Kennedy

et al. 2016

The American Journal of Medicine

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Purpose To assess effects of emergency department visits on mobility as measured by Life-Space Assessment (LSA) scores and to compare life-space trajectories associated with emergency department visit only, hospitalization, and no event. Methods 410 community-dwelling adults age ≥75 who were living in the community, able to communicate by telephone, could schedule an in-home interview, and answer questions independently were followed from June 2010-August 2014. In-home baseline and monthly telephone follow-up interviews collected data on LSA scores, emergency department use, and hospitalizations. Life-space is measured using a validated patient-reported tool reflecting community mobility and quality of life. Trajectories of LSA before and after an emergency department visit or hospitalization were compared to no event occurrence. Results Mean age was 81.7 (SD 4.8) years; 57% were female and 35% were African American. During three years of follow-up, 83 persons (20%) had an emergency department visit without subsequent hospitalization and 164 (40%) were hospitalized. While baseline LSA scores were similar, in the month following an emergency department visit, adjusted LSA scores decreased by 6.1 points (p=.01) in comparison to hospitalized participants who experienced an average 18.0 points decrease (p<.0001). Neither those with an emergency department visit only nor hospitalization recovered to their prior level of community mobility. Moreover, those with an emergency department visit showed no significant improvement in LSA scores up to 1 year later. Conclusions Older adults who experienced an emergency department visit or hospitalization had an associated decrease in community mobility without significant recovery.

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The Association Between Life-Space and Health Care Utilization in Older Adults with Heart Failure

Cited by 23 publications

References 43 publications

Determination of the Minimal Important Change in the Life‐Space Assessment

Determination of the Minimal Important Change in the Life‐Space Assessment

Life-Space mobility and clinical outcomes in COPD

Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults

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