Healthcare Utilization and Physical Functioning in Older Adults in the United States

OBJECTIVES Decline in physical function is associated with older age. Healthcare utilization and expenditures related to physical functioning declines will likely increase as the proportion of the population of older adults rises. This study evaluated resource utilization associated with differences in physical functioning in a nationally representative sample of older adults. DESIGN A retrospective panel study nationally representative for 26 809 552 older adults in the United States. SETTING Medical Expenditure Panel Survey (MEPS) data from 2013 to 2014. PARTICIPANTS Adults aged 70 years or older who completed both rounds of the Self-Administered Questionnaire in MEPS. MEASUREMENTS Physical Component Score (PCS) from the Short-Form Health Survey as a measure of physical functioning was stratified into quartiles. Healthcare utilization (count of medical visits by setting) and total expenditures were assessed during and after the PCS measurements. Generalized linear mixed models, adjusted for demographic and clinical covariates, estimated the relationship between healthcare utilization and physical functioning. RESULTS The lowest functional status (Q1) was associated with significantly increased healthcare utilization of emergency department, inpatient, home health, outpatient, and total medical visits compared with the three higher quartiles groups (P < .001, all). When compared with the lowest functioning group (Q1), the percentage savings for direct healthcare expenditures were 26.7% (95% confidence interval [CI] = 7.8-41.7) in Q2, 50.1% (95% CI = 35.6-61.4) in Q3, and 65.2% (95% CI = 54.7-73.2) in Q4. Similarly, there were 10.4% (95% CI = 9.2-11.7), 11.9% (95% CI = 10.5-13.6), and 14.0% (95% CI = 2.2%-15.9%) reductions in total medical visits, respectively. CONCLUSION Lower physical functioning was associated with higher healthcare utilization and expenditures. These estimates are conservative because they do not capture long-term care utilization due to the nature of MEPS. These results can be used to benchmark other healthcare resource benefits of interventions to maintain or improve physical functioning in older adults in noninstitutionalized settings.