Is There Evidence of an Association Between Acute Health Care Utilization and Function in Older Adults Over Time? A Population-Based Cohort Study

Abstract

Background and Objectives Acute healthcare use varies by age, with older adults the highest users of acute healthcare services. Using data from The Irish Longitudinal Study on Ageing (TILDA), the aim of this study was to investigate the association between acute healthcare utilisation (Emergency Department (ED) visit with or without hospitalisation) at baseline and subjective and objective measures of function measured at four-year follow-up. Research Design and Methods This study represents a secondary analysis of a prospective cohort study, where data from Wave 1 (baseline) and Wave 3 of TILDA were analysed in conjunction with a public and patient involvement group of older adults. Acute healthcare utilisation was defined as an ED visit with or without hospitalisation in the previous 12 months. Function was assessed objectively using the Timed-Up-and Go (TUG) test and a measure of grip strength, and subjectively using self-report limitations in activities of daily living (ADL) and instrumental ADL (IADL). Results A total of 1516 participants met the study inclusion criteria. Mean age was 70.9 ±4.6 years and 48% were male. At baseline, 1280 participants reported no acute healthcare use. 118 indicated an ED visit but no hospitalisation in the previous twelve months and 118 reported both an ED visit and hospitalisation. Adjusting for all covariates, compared to those with no acute healthcare utilisation, those with an ED visit with no hospital admission had poorer TUG performance at follow up (β= 0.67, 95% CI: 0.34, 1.29, p=0.039). Discussion and Implications This paper supports previous research that acute healthcare events, specifically ED usage, are associated with reduced function for older adults as assessed by TUG at follow-up. No associations were observed for grip strength, ADL or IADL. Further research is required in this area, exploring ED visits and the possible benefits of evaluating older adults at this stage.