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BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Research

The effect of outdoor activities on the medical expenditure of older people: multiple chain mediating effects of health benefits

Author: Ge Zhu

Published in: BMC Public Health | Issue 1/2024

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Abstract

Background

With the global aging population, attention to the health and medical issues of older adults is increasing. By analyzing the relationship between older people's participation in outdoor activities and medical expenditure, this study aims to provide a scientific basis for improving their quality of life and reducing the medical burden.

Methods

Data on outdoor activity participation, medical expenditures, and relevant variables were collected through questionnaires and databases. A multi-chain mediation effect model was established to analyze the impact of outdoor activities on the medical expenditure of older people, considering mediation effects and heterogeneity.

Results

Results revealed that increased participation in outdoor activities among older adults correlated with lower medical expenditures. Outdoor activities positively influenced their health by improving mental health, cognition, eating habits, and activities of daily living, resulting in reduced medical expenditures. Robustness tests confirmed the consistent effect of outdoor activities on older people's medical expenditure.

Conclusion

These findings contribute to understanding the relationship between outdoor activities, health, and medical expenditure in older people, guiding policy formulation and interventions. Encouraging and supporting older adults in outdoor activities can enhance their quality of life and alleviate medical resource strain. The study's conclusions can also inform health promotion measures for other populations and serve as a basis for future research in this area.
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Literature
1.
Weng PY, Chiang YC. Psychological restoration through indoor and outdoor leisure activities[J]. J Leis Res. 2014;46(2):203–17.CrossRef
2.
3.
de Oliveira LSSCB, Souza EC, Rodrigues RAS, et al. The effects of physical activity on anxiety, depression, and quality of life in elderly people living in the community[J]. Trends in psychiatry and psychotherapy. 2019;41:36–42.PubMedCrossRef
4.
Gabrielsen LE, Harper NJ. The role of wilderness therapy for adolescents in the face of global trends of urbanization and technification[J]. Int J Adolesc Youth. 2018;23(4):409–21.
5.
Conklin AI, Forouhi NG, Surtees P, et al. Social relationships and healthful dietary behaviour: evidence from over-50s in the EPIC cohort, UK[J]. Soc Sci Med. 2014;100:167–75.PubMedCrossRefPubMedCentral
6.
Boulos C, Salameh P, Barberger-Gateau P. Social isolation and risk for malnutrition among older people[J]. Geriatr Gerontol Int. 2017;17(2):286–94.PubMedCrossRef
7.
Modrzejewska A, Czepczor-Bernat K, Modrzejewska J, et al. Eating motives and other factors predicting emotional overeating during COVID-19 in a sample of Polish adults[J]. Nutrients. 2021;13(5):1658.PubMedCrossRefPubMedCentral
8.
Schneider S, Diehl K, Görig T, et al. Contextual influences on physical activity and eating habits-options for action on the community level[J]. BMC Public Health. 2017;17(1):1–7.CrossRef
9.
10.
Tison GH, Avram R, Kuhar P, et al. Worldwide effect of COVID-19 on physical activity: a descriptive study[J]. Ann Intern Med. 2020;173(9):767–70.PubMedCrossRef
11.
Liu H. Determining the effect of air quality on activities of daily living disability: using tracking survey data from 122 cities in China[J]. BMC Public Health. 2022;22(1):835.PubMedCrossRefPubMedCentral
12.
Payne K, McAllister M, Davies LM. Valuing the economic benefits of complex interventions: when maximising health is not sufficient[J]. Health Econ. 2013;22(3):258–71.PubMedCrossRef
13.
Gold SM, Köhler-Forsberg O, Moss-Morris R, et al. Comorbid depression in medical diseases[J]. Nat Rev Dis Primers. 2020;6(1):69.PubMedCrossRef
14.
Ridley M, Rao G, Schilbach F, et al. Poverty, depression, and anxiety: Causal evidence and mechanisms[J]. Science. 2020;370(6522):eaay0214.PubMedCrossRef
15.
Srivastava S, Sulaiman KM, Drishti D, et al. Factors associated with psychiatric disorders and treatment seeking behaviour among older adults in India[J]. Sci Rep. 2021;11(1):24085.PubMedCrossRefPubMedCentral
16.
Wong SYS, Zhang D, Sit RWS, et al. Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care[J]. Br J Gen Pract. 2020;70(700):e817–24.PubMedCrossRefPubMedCentral
17.
Maresova P, Javanmardi E, Barakovic S, et al. Consequences of chronic diseases and other limitations associated with old age–a scoping review[J]. BMC Public Health. 2019;19:1–17.CrossRef
18.
Chesser AK, Keene Woods N, Smothers K, et al. Health literacy and older adults: A systematic review[J]. Gerontology and geriatric medicine. 2016;2:2333721416630492.PubMedCrossRefPubMedCentral
19.
Taniguchi Y, Kitamura A, Ishizaki T, et al. Association of trajectories of cognitive function with cause-specific mortality and medical and long-term care costs[J]. Geriatr Gerontol Int. 2019;19(12):1236–42.PubMedCrossRef
20.
Stewart Williams J, Kowal P, Hestekin H, et al. Prevalence, risk factors and disability associated with fall-related injury in older adults in low-and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE)[J]. BMC Med. 2015;13(1):1–12.CrossRef
21.
Shlisky J, Bloom DE, Beaudreault AR, et al. Nutritional considerations for healthy aging and reduction in age-related chronic disease[J]. Adv Nutr. 2017;8(1):17.PubMedCrossRefPubMedCentral
22.
23.
Zhang H, Wei F, Han M, et al. Risk factors for unintentional injuries among the rural elderly: A county-based cross-sectional survey[J]. Sci Rep. 2017;7(1):12533.PubMedCrossRefPubMedCentral
24.
Sharma P, Maurya P, Muhammad T. Number of chronic conditions and associated functional limitations among older adults: cross-sectional findings from the longitudinal aging study in India[J]. BMC Geriatr. 2021;21(1):1–12.CrossRef
25.
Zeng N, Pope Z, Lee JE, et al. A systematic review of active video games on rehabilitative outcomes among older patients[J]. J Sport Health Sci. 2017;6(1):33–43.PubMedCrossRef
26.
StataCorp. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC; 2021.
27.
Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations[J]. J Pers Soc Psychol. 1986;51(6):1173.PubMedCrossRef
28.
Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models[J]. Sociol Methodol. 1982;13:290–312.CrossRef
29.
Becker SO, Woessmann L. Was Weber wrong? A human capital theory of Protestant economic history[J]. Q J Econ. 2009;124(2):531–96.CrossRef
30.
Dippel C, Ferrara A, Heblich S. Causal mediation analysis in instrumental-variables regressions[J]. Stand Genomic Sci. 2020;20(3):613–26.
31.
Coventry PA, Brown JVE, Pervin J, et al. Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis[J]. SSM-population health. 2021;16:100934.PubMedCrossRefPubMedCentral
32.
Vizard T, Davis J, White E, et al. Coronavirus and depression in adults, Great Britain: June 2020[J]. Office for National Statistics. 2020.
33.
Heidarzadeh E, Rezaei M, Haghi MR, et al. Assessing the impact of outdoor activities on mental wellbeing; focusing on the walking path in urban area[J]. Iran J Public Health. 2021;50(10):2132.PubMedPubMedCentral
34.
Aliyas Z. Physical, mental, and physiological health benefits of green and blue outdoor spaces among elderly people[J]. Int J Environ Health Res. 2021;31(6):703–14.PubMedCrossRef
35.
Piva G, Caruso L, Gómez AC, et al. Effects of forest walking on physical and mental health in elderly populations: a systematic review[J]. Rev Environ Health. 2024;39(1):121–36.PubMedCrossRef
36.
Suzuki T, Murase S. Influence of outdoor activity and indoor activity on cognition decline: use of an infrared sensor to measure activity[J]. Telemedicine and e-Health. 2010;16(6):686–90.PubMedCrossRef
37.
38.
Kimura M, Moriyasu A, Kumagai S, et al. Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial[J]. BMC Geriatr. 2013;13:1–11.CrossRef
39.
Burke L, Jancey J, Howat P, et al. Physical activity and nutrition program for seniors (PANS): protocol of a randomized controlled trial[J]. BMC Public Health. 2010;10:1–7.CrossRef
40.
Cabrita M, Lousberg R, Tabak M, et al. An exploratory study on the impact of daily activities on the pleasure and physical activity of older adults[J]. European Review of Aging and Physical Activity. 2017;14:1–11.PubMedCrossRefPubMedCentral
41.
Sun X, Zhou M, Huang L, et al. Depressive costs: medical expenditures on depression and depressive symptoms among rural elderly in China[J]. Public Health. 2020;181:141–50.PubMedCrossRef
42.
Druss BG, Rohrbaugh RM, Rosenheck RA. Depressive symptoms and health costs in older medical patients[J]. Am J Psychiatry. 1999;156(3):477–9.PubMedCrossRef
43.
Moon S, Park HJ, Sohn M. The impact of long-term care service on total lifetime medical expenditure among older adults with dementia[J]. Soc Sci Med. 2021;280:114072.PubMedCrossRef
44.
Kelley AS, McGarry K, Gorges R, et al. The burden of health care costs for patients with dementia in the last 5 years of life[J]. Ann Intern Med. 2015;163(10):729–36.PubMedCrossRefPubMedCentral
45.
Lo YT, Chang YH, Wahlqvist ML, et al. Spending on vegetable and fruit consumption could reduce all-cause mortality among older adults[J]. Nutr J. 2012;11:1–9.CrossRef
46.
Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs[J]. Health Aff. 2002;21(2):245–53.CrossRef
47.
Jin HY, Liu X, Xue QL, et al. The association between frailty and healthcare expenditure among Chinese older adults[J]. J Am Med Dir Assoc. 2020;21(6):780–5.PubMedCrossRef
48.
Chang John T. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004;328(7441):680.PubMedCrossRefPubMedCentral
49.
50.
Close Jacqueline CT, et al. “What is the role of falls?.”  Best Prac Res Clin Rheumatol. 2005;19(6):913–35.CrossRef
51.
Berry Sarah D, Douglas P. Kiel, editors. “Falls as risk factors for fracture.” Osteoporosis; 2013. p. 803–15.
52.
Kelsey JL, Procter-Gray E, Hannan MT, et al. Heterogeneity of falls among older adults: implications for public health prevention[J]. Am J Public Health. 2012;102(11):2149–56.PubMedCrossRefPubMedCentral
53.
54.
Dallmeyer S, Wicker P, Breuer C. How an aging society affects the economic costs of inactivity in Germany: empirical evidence and projections[J]. European review of aging and physical activity. 2017;14:1–9.CrossRef
Metadata
Title
The effect of outdoor activities on the medical expenditure of older people: multiple chain mediating effects of health benefits
Author
Ge Zhu
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18719-z

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