USING PHYSICAL PERFORMANCE MEASURES TO PREDICT THE ONSET OF BASIC ADL DISABILITIES IN COMMUNITY-DWELLING OLDER ADULTS.

Abstract

Purpose/Hypothesis: To assess the predictive value of five physical performance measures for the onset of disability in basic activities of daily living (ADL) at 6, 12, and 18 months. Subjects: 115 community-dwelling older adults (mean age, 80; SD, 6.9; range, 67–98 years) who reported no disability in basic ADLs at baseline were included for analysis. All participants scored 24 or more in Mini-Mental State Exam (MMSE) and 3 to 10 in Short Physical Performance Battery (SPPB). Materials/Methods: In this prospective cohort study, older adults were visited at home every 6 months for 18 months. Basic ADLs were assessed using the 7 ADL items (bathing, dressing, eating, getting in/out of bed/chairs, personal hygiene, walking, using the toilet) from National Health Interview Survey (NHIS) during each visit. The onset of basic ADL disability was defined as self-report of disability in any of the 7 ADL items. Physical performance measures including gait speed, Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and Timed Up & Go Test (TUG) were completed at baseline. Results: After controlling for age and co-morbid conditions, logistic regression analysis of the data indicated that BBS was the most consistent and strong predictor for the onset of disability in basic ADLs over an 18-month period (6 months, OR=0.864, C statistic=0.715; 12 months, OR=0.801, C statistic=0.786; 18 months, OR=0.829, C statistic=0.788). The SPPB and grip strength predicted the onset of disability at 12 and 18 months. Gait speed was not a significant predictor of basic ADL disability at 6, 12, or 18 months. Conclusions: Berg Balance Scale, followed by Short Physical Performance Battery and grip strength were predictive for the onset of basic ADL disability over an 18-month period in community-dwelling older adults. Clinical Relevance: Screening nondisabled older adults with simple clinical tests of physical performance such as BBS, SPPB and grip strength would allow clinicians to distinguish those at increasing risk for ADL disability.