Incident Mobility Limitation Research Articles

Handgrip Strength: An Early Warning Sign for Mobility Decline? A Meta-Analysis of Diagnostic Accuracy Studies

Background: Mobility limitations significantly impact the quality of life of older adults. Early identification of individuals at risk is crucial for timely intervention. This meta-analysis investigates the diagnostic accuracy of handgrip strength (HGS) in predicting future mobility decline in older adults. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted for diagnostic accuracy studies published between 2018 and 2024, evaluating the ability of baseline HGS to predict incident mobility limitations in older adults (≥60 years). Mobility limitations were defined as difficulties in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs). The primary outcomes were sensitivity, specificity, and diagnostic odds ratio (DOR) of HGS for predicting mobility decline. A bivariate random-effects model was used to pool data. Results: Seven diagnostic studies with a total of 3,870 participants were included. The pooled sensitivity of HGS for predicting mobility decline was 0.72 (95% CI: 0.65-0.78), and the pooled specificity was 0.70 (95% CI: 0.66-0.74). The pooled DOR was 4.85 (95% CI: 3.21-7.32), indicating good discriminatory ability. Conclusion: This meta-analysis demonstrates that HGS has moderate sensitivity and specificity for predicting future mobility decline in older adults. HGS assessment can be a valuable tool for identifying individuals at risk, although further research is needed to determine optimal cut-off points and combine HGS with other risk factors for improved prediction.

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States.

BackgroundPreventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults.MethodsWe used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71–80 years). Oral health measures included tooth loss, periodontal disease, self‐rated oral health, and self‐reported dry mouth. Participants were followed for onset of disability over a follow‐up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability.ResultsIn the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self‐report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27–3.42; OR = 1.73, 95% CI 1.03–2.90). Fair/poor self‐rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13–3.06), and fair/poor self‐rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04–1.94).ConclusionsOral health problems in older adults, particularly tooth loss, self‐reported dry mouth and self‐rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.

Lower urinary tract symptoms and incident functional limitations among older community-dwelling men.

Lower urinary tract symptoms (LUTS) are associated with frailty phenotype, a risk factor for functional decline. Our objective was to determine the association between baseline LUTS and 2-year risk of new functional limitation among older men. We analyzed data from the Osteoporotic Fractures in Men (MrOS) study with baseline at Year 7 and follow-up through Year 9. Participants included 2716 community-dwelling men age ≥ 71 years without any baseline self-reported functional limitation. LUTS severity (American Urologic Association Symptom Index) was classified as none/mild (score 0-7), moderate (8-19), and severe (20-35). At baseline and follow-up, men reported their ability to complete several mobility, activities of daily living (ADLs), and cognition-dependent tasks. Risk was estimated for 3 incident functional limitation outcomes: (1) mobility (any difficulty walking 2-3 blocks or climbing 10 steps), (2) ADL (any difficulty bathing, showering, or transferring), and (3) cognition-dependent (any difficulty managing money or medications). We used Poisson regression with a robust variance estimator to model adjusted risk ratios (ARR) and 95% CIs controlling for age, site, and comorbidities; other demographic/lifestyle factors did not meet criteria for inclusion. Overall, the 2-year risk was 15% for mobility, 10% for ADLs, and 4% for cognition-dependent task limitations. Compared to none/mild LUTS, risk of incident mobility limitations was increased for moderate (ARR=1.35, 95% CI: 1.12, 1.63) and severe LUTS (ARR=1.98, 95% CI: 1.48, 2.64). Men were also at higher risk for incident ADL limitations if they reported moderate (ARR=1.32, 95% CI: 1.05, 1.67) and severe LUTS (ARR=1.62, 95% CI: 1.07,2.43). Results were somewhat attenuated after adjusting for the frailty phenotype but remained statistically significant. LUTS were not associated with incident cognition-dependent task limitations. LUTS severity is associated with incident mobility and ADL limitations among older men. Increased clinical attention to risk of functional limitations among older men with LUTS is likely warranted.

Low protein intake, physical activity, and physical function in European and North American community-dwelling older adults: a pooled analysis of four longitudinal aging cohorts

ABSTRACTBackgroundDietary protein may slow the decline in muscle mass and function with aging, making it a sensible candidate to prevent or modulate disability progression. At present, studies providing reliable estimates of the association between protein intake and physical function, and its interaction with physical activity (PA), in community-dwelling older adults are lacking.ObjectivesWe investigated the longitudinal relation between protein intake and physical function, and the interaction with PA.MethodsWe undertook a pooled analysis of individual participant data from cohorts in the PROMISS (PRevention Of Malnutrition In Senior Subjects in the European Union) consortium (the Health Aging and Body Composition Study, Quebec Longitudinal Study on Nutrition and Successful Aging, Longitudinal Aging Study Amsterdam, and Newcastle 85+) in which 5725 community-dwelling older adults were followed up to 8.5 y. The relation between protein intake and walking speed was determined using joint models (linear mixed-effects and Cox proportional hazards models) and the relation with mobility limitation was investigated using multistate models.ResultsHigher protein intake was modestly protective of decline in walking speed in a dose-dependent manner [e.g., protein intake ≥1.2 compared with 0.8 g/kg adjusted body weight (aBW)/d: β = 0.024, 95% CI: 0.009, 0.032 SD/y], with no clear indication of interaction with PA. Participants with protein intake ≥0.8 g/kg aBW/d had also a lower likelihood of incident mobility limitation, which was observed for each level of PA. This association seemed to be dose-dependent for difficulty walking but not for difficulty climbing stairs. No associations between protein intake and other mobility limitations transitions were observed.ConclusionsHigher daily protein intake can reduce physical function decline not only in older adults with protein intake below the current RDA of 0.8 g/kg BW/d, but also in those with a protein intake that is already considered sufficient. This dose-dependent association was observed for each level of PA, suggesting no clear synergistic association between protein intake and PA in relation to physical function.

Body Weight, BMI, Percent Fat and Associations with Mortality and Incident Mobility Limitation in Older Men.

How different measures of adiposity are similarly or differentially related to mobility limitation and mortality is not clear. In total, 5849 community-dwelling men aged ≥65 years (mean age: 72 years) were followed mortality over 10 years and self-reported mobility limitations (any difficulty walking 2–3 blocks or with climbing 10 steps) at six contacts over 14 years. Baseline measures of adiposity included weight, BMI and percent fat by DXA. Appendicular lean mass (ALM, by DXA) was analyzed as ALM/ht2. Proportional hazards models estimated the risk of mortality, and repeated measures generalized estimating equations estimated the likelihood of mobility limitation. Over 10 years, 27.9% of men died; over 14 years, 48.0% of men reported at least one mobility limitation. We observed U-shaped relationships between weight, BMI, percent fat and ALM/ht2 with mortality. There was a clear log-linear relationship between weight, BMI and percent fat with incident mobility limitation, with higher values associated with a greater likelihood of mobility limitation. In contrast, there was a U-shaped relationship between ALM/ht2 and incident mobility limitation. These observational data suggest that no single measure of adiposity or body composition reflects both the lowest risk of mortality and the lowest likelihood for developing mobility limitation in older men.

Selenium and impaired physical function in US and Spanish older adults

BackgroundSelenium (Se) is a trace element with a narrow safety margin. ObjectivesTo evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults. DesignNHANES 2011–2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017–2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lower-extremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis. ResultsMeta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 μg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 μg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations. DiscussionIn US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms.

Recovery From Mobility Limitation in Middle-Aged African Americans: The Jackson Heart Study.

Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery. Participants from the Jackson Heart Study underwent 3 in-person exams from 2000 to 2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome. Among 4526 participants (mean [SD] age = 54.5 (12.8) years) without a mobility limitation at baseline, 1445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by 1 year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = .05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and OR: 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation. Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery.

Non‐Esterified Fatty Acids and Risks of Frailty, Disability, and Mobility Limitation in Older Adults: The Cardiovascular Health Study

Non-esterified fatty acids (NEFAs) play central roles in the relationship between adiposity and glucose metabolism, and they have been implicated in the pathogenesis of cardiovascular disease, but few studies have assessed their effects on complex geriatric syndromes like frailty that cross multiple organ systems. We sought to determine the relationships between NEFAs and incident frailty, disability, and mobility limitation in a population-based cohort of older persons. We analyzed 4,710 Cardiovascular Health Study (CHS) participants who underwent measurement of circulating total fasting NEFAs in 1992-1993 and were assessed for frailty in 1996-1997 and for disability and mobility limitation annually. We used ordinal logistic regression to model incident frailty, linear regression to model components of frailty, and Cox regression to model disability and mobility limitation in relation to baseline NEFAs. To ensure proportional hazards, we truncated follow-up at 9 years for disability and 6.5 years for mobility limitation. A total of 42 participants became frail and 510 became pre-frail over a 4-year period, and we documented 1,720 cases of disability and 1,225 cases of mobility limitation during follow-up. NEFAs were positively associated in a dose-dependent manner with higher risks of incident frailty, disability, and mobility limitation. The adjusted odds ratios for frailty were 1.37 (95% confidence interval [CI] = 1.01-1.86; P = .04) across extreme tertiles and 1.17 (95% CI = 1.03-1.33; P = .01) per standard deviation increment. The corresponding hazard ratios for incident disability were 1.14 (95% CI = 1.01-1.30; P = .04) and 1.11 (95% CI = 1.06-1.17; P < .0001); those for incident mobility limitation were 1.23 (95% CI = 1.06-1.43; P = .006) and 1.15 (95% CI = 1.08-1.22; P < .0001). Results were largely consistent among both men and women. Among individual components of frailty, NEFAs were significantly associated with self-reported exhaustion (β = .07; standard error = .03; P = .02). Circulating NEFAs are significantly associated with frailty, disability, and mobility limitation among older adults. These results highlight the broad spectrum of adverse health issues associated with NEFA in older adults.

Poor oral health and incidence of disability: results from studies of older people in the UK and USA

Abstract Background To examine the association between oral health markers and disability 4 years later in two population-based studies of older people in the UK and USA. Methods Analyses were conducted in the British Regional Heart Study (BRHS) comprising older men (n = 2147) and the Health, Aging and Body Composition (HABC) Study comprising American older men and women (n = 3075). Data from a 4-year follow up period were used. Oral health measures included tooth loss, periodontal disease, dry mouth, and self-rated oral health. Mobility limitations and Activities of Daily Living (ADL) were markers of disability. Logistic regression was performed and analyses were adjusted for confounders (age, socioeconomic position, lifestyle factors, and chronic diseases). Results Over a 4-year follow-up, 15% of subjects in the BRHS and 19% in the HABC Study developed mobility limitations. In both studies, 12% of participants developed ADL problems. In the BRHS, tooth loss (complete and partial), periodontal disease, dry mouth and accumulation of oral health problems were associated with an increased risk of developing mobility limitations after adjustment for confounders (partial tooth loss, OR = 1.86, 95% CI 1.18-2.94, ≥3 dry mouth symptoms, OR = 1.97, 95%CI 1.25-3.09). Similar results were observed for the risk of developing ADL problems. In the HABC Study, complete tooth loss and accumulation of oral health problems were associated with greater risk of incident mobility limitations (OR = 1.77, 95%CI 1.13-2.76; OR = 1.18, 95% CI 1.02-1.37, respectively). Moreover, self-rated oral health was associated with increased risk of ADL problems, after adjustment for confounders. Conclusions Poor oral health was associated with increased risk of developing disability in community-dwelling older people. Screening tools of oral health may be helpful in identifying oral health problems, improving oral health status and promoting health and good quality of life. Key messages Poor oral health is associated with a higher risk of developing disability in later life. This highlights the importance of oral health on maintaining independence in older people.

Body Weight, BMI, Percent Fat, Lean Mass and Their Long-Term Associations with Mortality and Incident Mobility Limitation

Abstract Objectives Adiposity is often approximated by body mass index (BMI), weight, and % fat from dual energy x-ray absorptiometry (DXA). We aimed to describe how different measures of adiposity and body composition are similarly or differentially related to mobility limitation and mortality. Methods Older community-dwelling men aged ≥65 yrs were followed for 10 years for mortality (N = 5849) and at six study contacts over 14 year for self-reported mobility limitations (any difficulty walking 2–3 blocks or with climbing 10 steps, N = 5841). Baseline measures of adiposity included weight, BMI, % fat by DXA. Appendicular lean mass (ALM, by DXA) was analyzed as ALM/ht2. Proportional hazards models estimated the risk of mortality and repeated measures generalized estimating equations estimated the likelihood of mobility limitation. Adiposity and ALM/ht2 measures were analyzed as quintiles and with splines. Results Over 10 years, 27.9% of men died; over 14 years, 48.0% of men reported at least one mobility limitation. We observed U-shaped relationships between weight, BMI, % fat and ALM/ht2 with mortality. There was a log-linear relationship between weight, BMI and % fat with incident mobility limitation, with higher values associated with greater likelihood of mobility limitation: for those with the lowest values of each of these metrics (quintile 1), the likelihood of mobility limitation was 1.6 to 3.5 times greater than those with the highest values for these metrics (quintile 5, P &amp;lt; .001 for all). In contrast, there was a U-shaped relationship between ALM/ht2 and incident mobility limitation. Conclusions These observational data suggest that there is not a single weight, BMI or % fat value that can represent both the lowest risk of mortality and also the lowest likelihood for developing mobility limitation over time in older men. Funding Sources National Institute on Aging and Abbott Nutrition.

Abstract P408: Cardiovascular Health And Recovery From Mobility Limitation in Middle Aged African Americans: The Jackson Heart Study

Despite a well-established literature demonstrating that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery. Although poor cardiovascular health is a risk factor for mobility limitation, its role in recovery is less clear. The present study investigated demographic and cardiovascular factors associated with recovery from incident mobility limitation within one year in the Jackson Heart Study, a cohort study of African Americans in Jackson, MS. Participants underwent three in-person interviews and exams from 2000-2013, and mobility limitations were assessed by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the following year. Candidate predictor variables were assessed in logistic regression models and included sociodemographic factors, behaviors, cardiovascular health measures, and chronic conditions. Multiple imputation using chained equations was used to address missing data. Among 5,276 participants [mean (SD) age = 55.4 (12.9) years], 1,759 (33%) had an incident mobility limitation over 12 years of follow-up, and 953 (54%) reported recovery from mobility limitation by one year later. Young women were more likely to recover from mobility limitation than young men. However, with increasing age, women were less likely to recovery from mobility limitation compared with men (p-value for age and gender interaction = 0.03). In adjusted models, being married was associated with a greater likelihood of recovering (OR: 1.26; 95% CI: 1.02, 1.55), whereas a history of heart failure and current statin use were associated with a lower likelihood of recovering (OR = 0.57; 95% CI: 0.34, 0.98 and 0.77; 95% CI: 0.61, 0.98, respectively). In conclusion, the majority of incident mobility limitations in this population of middle-aged African Americans was transient. Being married may support recovery from limitations by providing a form of structural social support. Cardiovascular health status appears to be an important factor in recovery.

Sarcopenia Characteristics Are Associated with Incident Mobility Limitations in African Caribbean Men: The Tobago Longitudinal Study of Aging.

Sarcopenia varies by ethnicity, and has a major impact on health in older adults. However, little is known about sarcopenia characteristics in African ancestry populations outside the United States. We examined sarcopenia characteristics in 2,142 African Caribbean men aged 59.0 ± 10.4 years (range: 40-92 years) in Tobago, and their association with incident mobility limitations in those aged 55+ (n = 738). Body mass index (BMI), grip strength, dual-x-ray absorptiometry (DXA) appendicular lean mass (ALM), and self-reported mobility limitations were measured at baseline, and 6 years later. Change in sarcopenia characteristics, including grip strength, grip strength/BMI, ALMBMI, and ALM/ht2, were determined. Foundations for the National Institutes of Health Sarcopenia Project (FNIH) and European Working Group for Sarcopenia in Older People 2 (EWGSOP2) cut-points were also examined. Odds ratios (OR) and 95% confidence intervals (CI) for mobility limitation were calculated using multivariable linear regression models adjusted for covariates. Overall, sarcopenia prevalence was quite low using the FNIH (0.3%) and EWGSOP2 (0.6%) operational cut-points, but was higher in those aged 75+ (2.1% [FNIH] and 3.7% [EWGSOP2]). Prevalence was also higher when based on "weakness", versus "low ALM." When sarcopenia markers were examined separately, baseline levels, but not changes, were associated with incident mobility limitations. Baseline grip strength/BMI was a particularly strong risk factor for incident mobility limitations (OR per SD: 0.50; 95% CI: 0.37-0.68). Our findings suggest that grip strength normalized to body mass, measured at one time point, may be a particularly useful phenotype for identifying African Caribbean men at risk for future mobility limitations.

Vitamin K Status and Mobility Limitation and Disability in Older Adults: The Health, Aging, and Body Composition Study.

Vitamin K has been implicated in chronic diseases associated with increased risk for mobility disability, such as osteoarthritis and cardiovascular disease. However, the association between vitamin K status and mobility disability is unknown. Therefore, we examined the association between vitamin K status and incident mobility disability in the Health, Aging, and Body Composition Study. Plasma phylloquinone (vitamin K1) was categorized as <0.5, 0.5-<1.0 and ≥1.0 nmol/L (n = 1,323, 48% male). Plasma ucMGP, which increases when vitamin K status is low, was measured in 716 participants and categorized into tertiles. Mobility limitation and disability, defined as two consecutive semiannual reports of having any or a lot of difficulty walking a one-fourth mile or climbing 10 steps without resting, were assessed over a median 6-10 years of follow-up. Multivariate Cox proportional hazard models were used to evaluate the association between vitamin K status and incident mobility limitation and disability. Participants with plasma phylloquinone less than 0.5 nmol/L were more likely to develop mobility limitation and disability compared to those with at least 1.0 nmol/L (adjusted HR (95% CI) mobility limitation: 1.27 (1.05-1.53); disability: 1.34 (1.01-1.76)). After further adjustment for knee pain, the associations were partially attenuated (HR (95% CI) mobility limitation: 1.20 (0.99-1.45); disability: 1.26 (0.96-1.67)). Plasma ucMGP was not associated with incident mobility limitation, but was nonlinearly associated with incident mobility disability (HR (95% CI), compared to tertile 1: tertile 2 = 1.64 (1.19-2.27), tertile 3 = 1.17 (0.83-1.66), fully adjusted). Our results suggest vitamin K may be involved in the disablement process in older age. Future studies are needed to confirm our findings and clarify the underlying mechanism.

Abstract P260: NEFAs, Incident Disability, Mobility Limitation and Frailty

Background: Non-esterified fatty acids (NEFAs) play central roles in the relationship between adiposity and glucose metabolism and have been implicated in the pathogenesis of cardiovascular disease, but few studies have assessed their effects on complex geriatric syndromes like frailty that cross multiple organ systems. We sought to determine the relationships between NEFAs and incident frailty, disability, and mobility limitation in a population-based cohort of elders. Methods: We measured circulating total NEFAs in 2742 non-frail Cardiovascular Health Study (CHS) participants (mean age 74 years) from stored samples collected in 1992-3. Participants underwent assessment of frailty again in 1996-7 and continue to report their activities of daily living and mobility restrictions. We used ordinal logistic regression to model frailty and Cox regression was used to model disability and mobility limitation in relation to baseline NEFAs. To minimize departure from proportional hazards, we truncated follow-up at 9 years for disability and 6.5 years for mobility limitation. Results: A total of 251 participants became frail and 1411 became pre-frail over a four-year period, and we documented 1448 cases of disability and 1609 cases of mobility limitation during follow-up. NEFAs were positively associated in a dose-dependent manner with higher risks of incident frailty, disability, and mobility limitation. The adjusted odds ratios for frailty were 1.31 (95%CI=1.07-1.61, p=0.01) across extreme tertiles and 1.13 (95%CI=1.04-1.23, P=0.004) per standard deviation increment. The corresponding hazard ratios for incident disability were 1.40 (95%CI=1.05-1.87, p=0.02) and 1.22 (95%CI=1.09-1.37, P=0.001), while those for incident mobility limitation were 1.28 (95%CI=0.90-1.84, p=0.17) and 1.18 (95%CI=1.02-1.36, P=0.03). Results were largely consistent among both men and women. Conclusion: Circulating NEFAs are significantly associated with frailty, disability, and mobility limitation among older adults. These results highlight the broad spectrum of adverse health issues associated with NEFA in elders.

Prevalence of low protein intake in older persons: A multi-cohort approach

Rationale: Low protein intake in older adults was found to be associated with sarcopenia, poor physical functioning and incident mobility limitations. This study aimed to assess the variation in the prevalence of low protein intake in older adults across multiple cohorts and national surveys.

Strong Relation Between Muscle Mass Determined by D3-creatine Dilution, Physical Performance, and Incidence of Falls and Mobility Limitations in a Prospective Cohort of Older Men.

Direct assessment of skeletal muscle mass in older adults is clinically challenging. Relationships between lean mass and late-life outcomes have been inconsistent. The D3-creatine dilution method provides a direct assessment of muscle mass. Muscle mass was assessed by D3-creatine (D3Cr) dilution in 1,382 men (mean age, 84.2 years). Participants completed the Short Physical Performance Battery (SPPB); usual walking speed (6 m); and dual x-ray absorptiometry (DXA) lean mass. Men self-reported mobility limitations (difficulty walking 2-3 blocks or climbing 10 steps); recurrent falls (2+); and serious injurious falls in the subsequent year. Across quartiles of D3Cr muscle mass/body mass, multivariate linear models calculated means for SPPB and gait speed; multivariate logistic models calculated odds ratios for incident mobility limitations or falls. Compared to men in the highest quartile, those in the lowest quartile of D3Cr muscle mass/body mass had slower gait speed (Q1: 1.04 vs Q4: 1.17 m/s); lower SPPB (Q1: 8.4 vs Q4: 10.4 points); greater likelihood of incident serious injurious falls (odds ratio [OR] Q1 vs Q4: 2.49, 95% confidence interval [CI]: 1.37, 4.54); prevalent mobility limitation (OR Q1 vs Q4,: 6.1, 95% CI: 3.7, 10.3) and incident mobility limitation (OR Q1 vs Q4: 2.15 95% CI: 1.42, 3.26); p for trend < .001 for all. Results for incident recurrent falls were in the similar direction (p = .156). DXA lean mass had weaker associations with the outcomes. Unlike DXA lean mass, low D3Cr muscle mass/body mass is strongly related to physical performance, mobility, and incident injurious falls in older men.

Body Composition Remodeling and Incident Mobility Limitations in African Ancestry Men.

Mobility limitations are common, with higher prevalence in African Americans compared with whites, and are associated with disability, institutionalization, and death. Aging is associated with losses of lean mass and a shift to central adiposity, which are more pronounced in African Americans. We aimed to examine the association of body composition remodeling with incident mobility limitations in older men of African ancestry. Seven-year changes in body composition were measured using peripheral quantitative computed tomography (pQCT) of the calf and whole-body dual x-ray absorptiometry (DXA) in 505 African ancestry men aged ≥60 years and free of self-reported mobility limitations at baseline. Self-reported incident mobility limitations were assessed at 7-year follow-up. Odds of developing mobility limitations associated with baseline and change in body composition were quantified using separate logistic regression models. Seventy-five men (14.9%) developed incident mobility limitations over 6.2 ± 0.6 years. Baseline body composition was not associated with incident mobility limitations. After adjustment for covariates, gaining total and intermuscular fat were associated with incident mobility limitations (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.21-2.13; OR: 1.51; 95% CI: 1.18-1.94). Changes in DXA lean mass were not related to mobility limitations; however, maintaining pQCT calf muscle area was protective against mobility limitations (OR: 0.65; 95% CI: 0.48-0.87). Increases in body fat, and particularly intermuscular fat, and decreases in calf skeletal muscle area were associated with a higher risk of developing mobility limitations. Our findings emphasize the importance of body composition remodeling in the development of mobility limitations among African ancestry men.

FEAR OF FALLING PREDICTS INCIDENCE OF FUNCTIONAL LIMITATION TWO YEARS LATER

We examined if fear of falling (FOF) predicts incident functional limitation over a 2-year period in older adults using self-reported and performance-based measures. In 2012, 1,601 participants were recruited from Canada, Colombia, and Brazil, and were re-assessed in 2014. We quantified FoF using the Falls Efficacy Scale-International (FES-I). Functional limitation measures were (1) self-reported mobility limitation, and (2) physical performance limitation, score<9 on the Short Physical Performance Battery (SPPB limitation). We entered in the analysis only those without functional limitation at baseline. In 2014, 131 (14.3%) and 166 (15.4%) participants reported incident mobility and SPPB limitation, respectively. After adjusting for age, sex, socioeconomic, and health covariates in logistic regression models, one-point increase in FES-I (range: 116–64) at baseline predicted a 6% increase in the chance of reporting mobility limitation (95%CI: 1.04–1.09) and a 5% increase in the chance of having SPPB limitation in 2014 (95%CI: 1.02–1.07). It is increasingly important to study FOF’s effect on functional limitation and to take necessary measures that prevent the transition to end-stage disability.

Television viewing time as a risk factor for frailty and functional limitations in older adults: results from 2 European prospective cohorts

BackgroundSedentariness is an important risk factor for poor health. The main objective of this work was to examine the prospective association between television viewing time and indicators of physical function, mobility, agility, and frailty.MethodsData came from two independent cohorts of community-dwelling older adults: the Seniors-ENRICA (n = 2392, 3.5 year follow-up), and the ELSA (n = 3989, 3.9 year follow-up). At baseline, television viewing and other sedentary behaviors were ascertained using interviewer-administered questionnaires. In the Seniors-ENRICA cohort overall physical function at baseline and follow-up was assessed using the physical component summary (PCS) of the SF-12 Health Survey. Measures for incident mobility and agility limitations in both cohorts were based on standardized questions, and incident frailty was measured with the Fried criteria. Analyses were adjusted for the main confounders, including physical activity at baseline. Results across cohorts were pooled using a random effects model.ResultsLower (worse) scores in the PCS were observed among those in the highest (vs. the lowest) tertile of television viewing time (b-coefficient:-1.66; 95% confidence interval:-2.81,-0.52; p-trend = 0.01). Moreover, the pooled odds ratios (95% CIs) for mobility limitations for the second and third (vs. the lowest) tertile of television viewing were 1.00 (0.84, 1.20) and 1.17 (1.00, 1.38); p-trend = 0.12, respectively. The corresponding results for agility limitations were 1.18 (0.97, 1.44) and 1.25 (1.03, 1.51); p-trend = 0.02. Results for incident frailty were 1.10 (0.80, 1.51) and 1.47 (1.09, 1.97); p-trend = 0.03. No association between other types of sedentary behavior (time seated at the computer, while commuting, lying in the sun, listening to music/reading, internet use) and risk of functional limitations was found.ConclusionsAmong older adults, longer television viewing time is prospectively associated with limitations in physical function independently of physical activity.

Protein Intake and Mobility Limitation in Community-Dwelling Older Adults: the Health ABC Study.

The current Recommended Dietary Allowance (RDA) for protein is based on short-term nitrogen balance studies in young adults and may underestimate the amount needed to optimally preserve physical function in older adults. We examined the association between protein intake and the onset of mobility limitation over 6 years of follow-up in older adults in the Health ABC study. Prospective cohort study. Memphis, Tennessee and Pittsburgh, Pennsylvania. Community-dwelling, initially well-functioning adults aged 70-79 years (n = 1998). Protein intake (g/kg body weight/d) was calculated using an interviewer-administered 108-item food frequency questionnaire at baseline. Mobility limitation was assessed semi-annually and defined as reporting any difficulty walking one-quarter of a mile or climbing 10 steps on 2 consecutive 6-month contacts. The association between protein intake and incident mobility limitation was examined using Cox proportional hazard regression models adjusting for demographics, behavioral characteristics, chronic conditions, total energy intake, and height. Mean (SD) protein intake was 0.91 (0.38) g/kg body weight/d, with 43% reporting intakes less than the RDA (0.8 g/kg body weight/d). During 6 years of follow-up, 705 participants (35.3%) developed mobility limitations. Compared to participants in the upper tertile of protein intake (≥1.0 g/kg body weight/d), participants in the lower two tertiles of protein intake (<0.7 and 0.7 -<1.0 g/kg body weight/d) were at greater risk of developing mobility limitation over 6 years of follow-up (RR (95% CI): 1.86 (1.41-2.44) and 1.49 (1.20-1.84), respectively). Lower protein intake was associated with increased risk of mobility limitation in community-dwelling, initially well-functioning older adults. These results suggest that protein intakes of ≥1.0 g/kg body weight/d may be optimal for maintaining physical function in older adults.