Abstract
Poor performance in physical tests such as grip strength and walking speed is a risk factor for disability in old age, although whether such measures improve the discrimination of clinical prediction models when traditional clinical risk factors are already known is not clear. The prevalence of disability in mid-life is relatively low and hence screening in this age group may present an opportunity for early identification of those at increased future risk who may benefit most from preventative interventions. Data were drawn from two waves of the Medical Research Council National Survey of Health and Development. We examined whether several chronic conditions, poor health behaviours and lower scores on three measures of physical performance (grip strength, chair rise speed and standing balance time) at age 53 were associated with self-reported mobility and/or personal care disability at age 69. We used the area under the curve statistic (AUC) to assess model discrimination. At age 69, 44% (826/1855) of participants reported mobility and/or personal care disability. Our final clinical prediction model included sex, knee osteoarthritis, taking 2+ medications, smoking, increased BMI and poor performance in all three physical tests, with an AUC of 0.740 compared with 0.708 for a model which did not include the performance measures. Measures of physical performance in midlife improve discrimination in clinical prediction models for disability over 16 years. Importantly, these and similar measures are also potential targets of future diet, exercise and pharmacological intervention in mid-life.
Highlights
Disability becomes increasingly common in old age with 45% of adults aged 65 and above in the UK reporting disability, most commonly related to mobility (Department of Work and Pensions, 2015)
These studies again typically used baseline assessments at older ages, with an exception that weaker grip strength in men at mean age 54 has been associated with increased risk of disability 25 years later (Rantanen et al, 1999).There is limited evidence, on whether these associations translate into improvements in the clinical prediction of individuals' future risk of disability
A previous study at mean age 75 years found that walking speed increased the area under the curve statistic (AUC) for incident disability over 3 years when added to history of one or more common diseases
Summary
Disability becomes increasingly common in old age with 45% of adults aged 65 and above in the UK reporting disability, most commonly related to mobility (Department of Work and Pensions, 2015). Lower physical performance assessed using simple measures such as grip strength and walking speed has been associated with incident or progressive disability in 22 studies and summarised in a systematic review (den Ouden et al, 2011). These studies again typically used baseline assessments at older ages, with an exception that weaker grip strength in men at mean age 54 has been associated with increased risk of disability 25 years later (Rantanen et al, 1999).There is limited evidence, on whether these associations translate into improvements in the clinical prediction of individuals' future risk of disability. Results: At age 69, 44% (826/1855) of participants reported mobility and/or personal care disability
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