Purpose in Life and Hospitalization for Ambulatory Care-Sensitive Conditions in Old Age.

ABSTRACT

OBJECTIVE: To test the hypothesis that higher level of purpose in life is associated with lower subsequent odds of hospitalization. DESIGN: Longitudinal cohort study. SETTING: Participants' residences in the Chicago metropolitan area. PARTICIPANTS: A total of 805 older persons who completed uniform annual clinical evaluations. MEASUREMENTS Participants annually completed a standard self-report measure of purpose in life, a component of well-being. Hospitalization data were obtained from Part A Medicare claims records. Based on previous research, ICD-9 codes were used to identify ambulatory care-sensitive conditions (ACSCs) for which hospitalization is potentially preventable. The relation of purpose (baseline and follow-up) to hospitalization was assessed in proportional odds mixed models. RESULTS: During a mean of 4.5 years of observation, there was a total of 2,043 hospitalizations (442 with a primary ACSC diagnosis; 1,322 with a secondary ACSC diagnosis; 279 with no ACSCs). In initial analyses, higher purpose at baseline and follow-up were each associated with lower odds of more hospitalizations involving ACSCs but not hospitalizations for non-ACSCs. Results were comparable when those with low cognitive function at baseline were excluded. Adjustment for chronic medical conditions and socioeconomic status reduced but did not eliminate the association of purpose with hospitalizations involving ACSCs. CONCLUSIONS: In old age, higher level of purpose in life is associated with lower odds of subsequent hospitalizations for ambulatory care-sensitive conditions.