Physical activity as a predictor of disability and social and health service use in older people

The purpose of the study was to investigate whether functional status and physical activity history predict all-cause hospital and long-term care use among older community-dwelling people. In addition, the effects of physical activity counseling on instrumental activities of daily living (IADL) disability and home care service use in an older sedentary population were studied.Data from three larger studies were used. The Evergreen project cohorts born in 1910 and 1914 consisted of 617 persons. From the Evergreen project interview data on individuals born in 1908-1923, a decedent population was investigated (n=846). Screening and Counseling for Physical Activity and Mobility among Older People, SCAMOB, was a 2-year physical activity counseling randomized controlled trial with a 1.5 year follow-up (n=632). Data on physical activity, walking speed, cognitive capacity, disability and health status were obtained in face-to-face interviews in the participants’ homes or at research centre examinations. Register-based data was collected on home care use for 3.5 years and for hospital and long-term care use for up to 16 years.The risk of long-term care was higher for older people with co-occurring mobility limitation and cognitive deficits compared to people with no limitations. Among men, hospital care in the last year of life decreased with higher levels of physical activity from midlife onwards. Among women, end-of-life long-term care increased with lower physical activity levels. The physical activity counseling intervention had no effect on IADL disability. However, subgroup analyses showed that the incidence of IADL disability for those with no IADL disability at baseline was lower in the intervention group. In addition, the secondary analyses suggested that home care use was lower in the intervention group. The study stresses the beneficial effect of midlife and old age physical activity in compressing end-of-life disability and related service use. The effectiveness of an easily implemented physical activity counseling intervention which decreases disability and related service use should be studied more closely in different target groups.