Lower limb function and 10-year survival in population aged 75 years and older (original) (raw)
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Measures of Lower Body Function and Risk of Mortality over 7 Years of Follow-up
American Journal of Epidemiology, 2007
The study examined whether a test of walking speed provides similar predictive information on mortality risk as does a summary measure of lower body function. Data were from the Hispanic Established Population for the Epidemiologic Study of the Elderly database and included Mexican Americans aged 65 years or more (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000). Primary measures included a short physical performance battery, a test of walking speed, and mortality. The average age of the sample was 72.0 years, and 58.3 percent were women. The observed hazard ratio of mortality risk was similar for the full short physical performance battery and walking speed alone, in both unadjusted and adjusted baseline models. A time-dependent walking speed measure showed a more than twofold increased risk of mortality for individuals categorized with slower walking speed. The results also showed a linear association between continuous walking speed and mortality with and without adjustment for baseline covariates. This study provides evidence that walking speed alone can provide similar information on mortality risk as does a more comprehensive summary measure of physical performance. Because walking speed is a quick and easy-toadminister test, findings have implications for clinical use, especially among underserved minority groups where cultural and language barriers may exist.
The study examined whether a test of walking speed provides similar predictive information on mortality risk as does a summary measure of lower body function. Data were from the Hispanic Established Population for the Epidemiologic Study of the Elderly database and included Mexican Americans aged 65 years or more (1993– 2000). Primary measures included a short physical performance battery, a test of walking speed, and mortality. The average age of the sample was 72.0 years, and 58.3 percent were women. The observed hazard ratio of mortality risk was similar for the full short physical performance battery and walking speed alone, in both unadjusted and adjusted baseline models. A time-dependent walking speed measure showed a more than twofold increased risk of mortality for individuals categorized with slower walking speed. The results also showed a linear association between continuous walking speed and mortality with and without adjustment for baseline covariates. This study provides evidence that walking speed alone can provide similar information on mortality risk as does a more comprehensive summary measure of physical performance. Because walking speed is a quick and easy-to-administer test, findings have implications for clinical use, especially among underserved minority groups where cultural and language barriers may exist.
A Comparison of Objective Physical Performance Tests and Future Mortality in the Elderly People
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2016
Background: Physical performance is an important predictor of mortality, but little is known on the comparative prognostic utility of different objective physical performance tests in community-dwelling older adults. We compared the prognostic usefulness of several objective physical performance tests on mortality, adjusting our analyses for potential confounders. Methods: Among 3,099 older community-dwelling participants included in the Progetto Veneto Anziani study, 2,096 were followed for a mean of 4.4 years. Physical performance tests measured were Short Physical Performance Battery (SPPB), 4-meter gait speed, chair stands time, leg extension and flexion, handgrip strength, and 6-Minute Walking Test (6MWT), treated as continuous variables and categorized in genderspecific quartiles. The main outcome was mortality assessed with death certificates. Results: Participants who died during the follow-up (n = 327) scored significantly worse in all physical performance tests measured at baseline than those who survived (n = 1,769). Using a Harrell's C-index, the highest C-index was observed for 6MWT in men (C-index = 0.735; 95% confidence interval [CI]: 0.701-0.770, p < .0001) and SPPB in women (C-index = 0.781; 95% CI: 0.740-0.822, p = .0009). However, in both genders, only SPPB, 4-meter walking speed, and 6MWT are significant predictors of mortality. Analyses using sex-specific quartiles substantially confirmed these findings. Conclusions: Slow gait speed, 6MWT, and SPPB are significant predictors for mortality in community-dwelling older men and women. Physicians should consider using these tests to identify elderly individuals who are at higher risk of death to improve clinical decision making.
Scientific Reports, 2014
To discern if physical function test are better mortality predictors than muscle mass in elderly hospitalized patients, we analyzed the prognostic value of muscle mass malnutrition and compared it with physical muscle function tests, including the six-minute walking test (6MWT) and hand grip strength. We included the ankle brachial index (ABI) to assess arterial disease, related to muscle atrophy due to hypoperfusion. We also analyzed the relationship of ABI with malnutrition, physical function tests and survival. We studied 310 hospitalized patients older than 60 years. To assess nutritional status, we determined BMI, triceps skinfold and mid-arm muscle area; we performed a subjective nutritional assessment; and evaluated the degree of inflammatory stress. We assessed physical function by hand grip strength and 6MWT. We evaluated arterial disease by ABI. Forty-one patients died during hospitalization; 269 were discharged and followed for a mean 808 days, reaching a mortality of 49%. Muscle malnutrition was frequent and was related to mortality, but the best predictors were physical function tests: inability to perform the 6MWT and low handgrip strength. Function tests were closely related to each other and correlated with nutritional data. Reduced ABI was related to impaired nutritional status, physical function tests and mortality. M alnutrition is frequent among elderly hospitalized patients and is related to prognosis. In this regard, muscle and serum protein levels are more relevant than fat stores 1,2. Muscle protein may be assessed as a mass amount by mid-arm anthropometry, for example, or by physical function assessment including stair climbing ability, handgrip strength or distance covered in a walking test. Regarding prognosis, poor performance in physical function tests is related to mortality in the same way as loss of muscle mass is 2-7. Sarcopenia is the age-related loss of muscle mass and function 8,9. There are three main conditions which lead to sarcopenia: first, starvation or semi-starvation, with a negative balance of calories and protein; second, an inflammatory disease with associated active protein degradation (sarcopenic cachexia); and third, muscle atrophy secondary to neuromuscular impairment, reduced mobility or chronic hypoxia induced by arteriosclerosis. All these conditions are closely related to ageing. As function tests may assess muscle quality, their relationship with prognosis would be better than that of muscle mass. Our objective is to compare, in elderly hospitalized patients, the prognostic value of muscle mass estimated by mid-arm anthropometrics and subjective assessment with muscle function estimated by the ability to climb stairs, handgrip strength and the 6 minute walking test (6MWT). In addition, as the relationship between arteriosclerosis and sarcopenia has not been extensively studied, we included the ankle brachial index (ABI), a noninvasive test, to evaluate possible muscle atrophy related to arteriosclerotic low blood flow and its possible relationship with muscle malnutrition, loss of physical function and prognosis 10-12. Methods In an observational study, we included 310 consecutively admitted patients older than 60 years, hospitalized in the Internal Medicine Department of the Hospital Universitario de Canarias; 159 men and 151 women aged 61-99 years. Comorbidity. Diseases were categorized and recorded according to diagnoses at medical reports. They included previous cardiovascular diseases: coronary disease, 67 (21.6%), stroke, 59 (19%) and peripheral arterial disease, 73 (23.5%), as well as cardiovascular risk factors:
The Journals of Gerontology, 2012
Background. Gender-specific trajectories of lower extremity function (LEF) and the potential for bias in LEF estimation due to differences in survival have been understudied. Methods. We evaluated longitudinal data from 690 initially nondisabled adults age 70 or older from the Precipitating Events Project. LEF was assessed every 18 months for 12 years using a modified Short Physical Performance Battery (mSPPB). Hierarchical linear models with adjustments for length-of-survival estimated the intraindividual trajectory of LEF and differences in trajectory intercept and slope between men and women. Results. LEF declined following a nonlinear trajectory. In the full sample, and among participants with high (mSPPB 10-12) and intermediate (mSPPB 7-9) baseline LEF, the rate-of-decline in mSPPB was slower in women than in men, with no gender differences in baseline mSPPB scores. Among participants with low baseline LEF (mSPPB ≤6), men had a higher starting mSPPB score, whereas women experienced a deceleration in the rate-of-decline over time. In all groups, participants who survived longer had higher starting mSPPB scores and slower rates-of-decline compared with those who died sooner. Conclusions. Over the course of 12 years, older women preserve LEF better than men. Nonadjustment for differences in survival results in overestimating the level and underestimating the rate-of-decline in LEF over time.
Journal of Aging and Physical Activity, 2014
Associations of objectively measured physical activity (PA) with objectively measured lower limb function in adults age 70 and older were studied. Lower limb function was assessed using the Short Physical Performance Battery (SPPB) and PA by an accelerometer providing mean daily counts per minute (CPM), mean daily steps and minutes of moderate or vigorous PA (MVPA) per day. A minority (32 [13%]) scored low (≤6 out of a maximum of 12) on the SPPB, but only 3 (1%) achieved recommended PA levels. Adjusting for confounders, the odds ratio of low SPPB (≤6) comparing those in the lowest one third to highest two thirds of mean CPM was 55 (95%CI: 6, 520); for mean steps per day it was 23 (95%CI: 4, 137) and for minutes of MVPA per day 56 (95%CI: 6, 530). Low levels of PA are common and are associated with poor levels of lower limb function in older adults.
Journal of Aging and Health, 2012
Objectives: To assess the validity and reliability of the Short Physical Performance Battery (SPPB) in adults 65 to 74 years old, capable in all basic activities of daily living (ADL), in Quebec and Brazil. Methods: Participants were recruited in St. Bruno (Quebec) by local advertisements (n = 60) and in Santa Cruz (Brazil) by random sampling (n = 64). The SPPB includes tests of gait, balance, and lower-limb strength. Disability status was categorized as intact mobility, limited mobility, and difficulty in any of ADL. Results: There was a graded decrease in mean SPPB scores with increasing limitation of lower limbs, disability, and poor health. Using the test-retest reliability the authors evaluated the intraclass at CAPES on April 8, 2012 jah.sagepub.com Downloaded from 2 Journal of Aging and Health XX(X) correlation coefficient, which was high in both samples: .89 (95% CI: 0.83, 0.93) in St. Bruno and .83 in Santa Cruz (95% CI: 0.73, 0.89). Discussion: This study provides evidence for the validity and reliability of SPPB in diverse populations.