Lower Short Physical Performance Battery Scores Research Articles

Utility of SARC-F for Assessing Physical Function in Elderly Patients With Cardiovascular Disease

ObjectivesA simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function. DesignCross-sectional study. SettingSingle university hospital. ParticipantsA total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD. MeasurementsSARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group). ResultsThe sarcopenia prevalence rate was 25.5% and increased with age (P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates. ConclusionThe SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings.

Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross-sectional study.

ObjectivesData on acute geriatric patients' nutritional status are lacking, and the associations among physical function, sarcopenia, health status and nutritional status are not sufficiently investigated in this population. The aims of this study are to investigate (1) nutritional status and sarcopenia in a group of acute geriatric patients, (2) the association between nutritional status, physical function and sarcopenia in acute geriatric patients, controlling for health status.DesignA cross-sectional study.SettingTwo acute geriatric hospital wards in Norway.ParticipantsThis study included 120 patients with a mean age of 82.6±8 years. The following inclusion criteria were used: age ≥65 years and admitted to an acute geriatric ward. The exclusion criteria included terminal illness, Mini-Mental State Examination <23, language difficulties or severe aphasia.Main outcome measuresNutritional status was assessed using the Mini Nutritional Assessment (MNA). Physical function was measured using the Barthel activities of daily life index and the Short Physical Performance Battery (SPPB). Sarcopenia was diagnosed using the mid-arm muscle circumference, gait speed and grip strength, in accordance with the EWGSOP algorithm. Diseases are organised by organ system classification.ResultsOn the basis of the MNA classification, nearly one in two patients were at risk of malnutrition, while one in four were malnourished. Sarcopenia was present in 30% of the patients. A multivariate linear regression model was estimated and showed significant independent associations between SPPB score (β 0.64, 95% CI 0.38 to 0.90), sarcopenia (β −3.3, 95% CI −4.9 to −1.7), pulmonary disease (β −2.1, 95% CI −3.7 to −0.46), cancer (β −1.7, 95% CI −3.4 to −0.033) and nutritional status.ConclusionsOur study shows a high prevalence of risk of malnutrition, malnutrition and sarcopenia. Further, the results indicate that a low total SPPB score, sarcopenia, cancer and pulmonary disease are significantly associated with declines in nutritional status, as measured by the MNA, in acute geriatric patients.

Sarcopenia as a Predictor of Future Cognitive Impairment in Older Adults.

We investigated the association between the indices of sarcopenia and future risk of cognitive impairment in older adults. Community-based prospective cohort study. Community. A total of 297 participants aged ≥65 years without cognitive impairment at baseline (mean age, 71.9 ± 6.6 years; men:women, 158:139) and who underwent cognitive evaluation at the 5-year follow-up. Sarcopenia parameters including appendicular lean mass (ALM), handgrip strength, and the Short Physical Performance Battery (SPPB) score at baseline were compared according to the later progression of mild cognitive impairment (MCI) and/or dementia. The operational criteria suggested by the Foundation for the National Institutes of Health Sarcopenia Project were used. We performed multivariate logistic regression analysis to identify the independent indicators of the progression of cognitive impairment. Among the 297 participants, 242 (81.5%) remained cognitively normal (nonprogression group), whereas 55 (18.5%) showed progression of cognitive impairment (50 subjects (16.8%) to MCI and 5 subjects (1.7%) to dementia) (progression group). Compared with the nonprogression group, subjects in the progression group were older, had a lower educational level, and had lower physical function as assessed by the SPPB; a higher percentage were depressed. Other baseline markers of sarcopenia, including the ALM-to-body mass index ratio and handgrip strength did not differ significantly between the groups. The association between a low SPPB score (<9) and progression of cognitive impairment was maintained after adjustment for conventional risk factors for cognitive impairment (hazard ratio 2.222, 95% confidence interval 1.047-4.716, P = 0.038). Decreased physical performance, as assessed by the SPPB, but not other markers of sarcopenia, was independently associated with the risk of later cognitive impairment in older adults.

Associations between difficulty in 6 basic activities of daily living and cognitive and lower extremity physical functions in older adults

Background: It is important for older adults to maintain independence in activities of daily living (ADL) to have optimal quality of life. Many factors including the biological, psychological, and social factors have been linked to disability in basic ADL (BADL). Previous studies have investigated the relationship between BADL dependence and functions in older adults. However, the relationship between BADL difficulty and functions has not been well examined. Selfreported BADL difficulty reflects an individual’s awareness, and may serve the researcher better when the interest is about the disease consequences and the objective is to evaluate intervention effectiveness. Purpose:Unlikemuchof the previous research examining the BADL dependence, the purpose of the study is to investigate the relationship between BADL difficulty and cognitive and physical functions in community-dwelling older adults. Self-reported difficulty is believed to precede dependence. Identifying older adults with BADL difficulties may help clinicians to detect early functional decline. Methods: In the cross-sectional study, a convenience sample of 51 community-dwelling older adults was recruited. Interviews were conducted to collect data on self-reported difficulty in six BADLs (bathing, dressing, eating, transfer: getting in/out of bed/chairs, walking, using toilet), clock drawing tests (CLOX1&CLOX2),Mini-Mental State Exam (MMSE), and 5 physical function tests including Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), gait speed, 5 times sit-to-stand test, and Timed Up & Go Test (TUG). For each BADL task, the student’s t test and Mann–Whitney testwere use to compare differences between older adults with and without difficulty. Results: Among the six BADLs, walking, toileting and transfer are associated with poor cognitive or lower extremity physical functions. Compared to older adults who reported walking difficulty (n= 8, CLOX1= 5.71 ± 4.31, CLOX2 = 8.71 ± 2.29, BBS = 40.38 ± 7.27, SPPB = 4.25 ± 2.49, gait speed = 0.41 ± 0.15 m/sec, TUG = 26.16 ± 6.69 sec), older adults without walking difficulty performed better in cognitive and physical function tests (n = 43, CLOX1 = 9.80 ± 3.31, CLOX2 = 11.64± 2.53, BBS = 49.24± 7.03, SPPB = 7.45± 2.46, gait speed = 0.73± 0.28 m/sec, TUG = 15.90 ± 6.12 sec). Difficulty in toileting is associated with lower SPPB score (2.50 ± 0.71) and longer TUG time (30.27 ± 4.59 sec) (p < .05). Difficulty in transfer is associated with lowerMMSE (17.00± 0.00) andCLOX2 score (5.00± 0.00) (p< .05). Conclusion(s): In older adults, difficulty in walking and toileting is associated with poor lower extremity physical function. Difficulty in walking and transfer is associated with lower cognitive function. Implications: Self-reported difficulty in BADL, such as walking,may suggest the need for further cognitive and physical function screening. Screening older adults with BADL difficulty would allow clinicians to identify high-risk individuals and provide early interventions to prevent or delay onset of future BADL dependence.

Abstract P279: Neighborhood Socioeconomic Status and Physical Function in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Functional impairments influence the performance of activities of daily living and may result in dependence on others for basic self-care needs. Lower individual-level socioeconomic status (SES) is associated with more self-reported disability and lower measured walking speeds which convey a higher risk of cardiovascular and all-cause mortality. The role of neighborhood-level SES on these functional outcomes has not been widely examined. Hypothesis: We hypothesized that residing in a socioeconomically disadvantaged neighborhood is inversely associated with physical function, after accounting for individual-level SES. Methods: We included 5,388 participants (42% male, 19% black, mean age: 76 years) from the 2011-2013 examination of the ARIC cohort. Neighborhood SES was constructed from census-tract data and an index score was derived based on aggregate z-score estimates from the following 6 dimensions: median household income; median value of owner-occupied units; % adults with a high school degree; % adults with a college degree; % households receiving interest, dividend or rental income; and % adults employed in executive, managerial or professional occupations. Race-specific tertiles were generated to indicate low, middle and high neighborhood SES. The Short Physical Performance Battery (SPPB) was used to derive a summary score (0-12) of physical function based on the individual’s performance on gait speed, chair stands and balance exercises. Negative binomial regression was used to quantify the difference in the log of expected counts in the SPPB score between race-stratified low, middle and high neighborhood SES, adjusting for age, sex, body mass index (BMI), smoking, hypertension, diabetes, study center, and education as a measure of individual-level SES. The multivariable-adjusted effect of neighborhood SES on a 4-meter walking speed test and on grip strength was estimated by least-squares regression. Results: Blacks had a slower walking speed, higher grip strength and lower SPPB score compared to whites. Hypertension, higher BMI, and lower education were more prevalent among white and black individuals from low SES neighborhoods, compared to those from high SES neighborhoods. White participants residing in a low SES neighborhood had a 1.1 kilogram (95% CI: 0.3, 1.9) greater grip strength compared to those residing in high SES neighborhoods. Neighborhood SES was not associated with walking speed and SPPB in either whites or blacks. Associations were robust to adjustment for education. Conclusions: Individual but not neighborhood-level SES was associated with poorer physical function. The prevalence of adverse clinical comorbidities was higher among both black and white participants living in disadvantaged neighborhoods. Poorer individual, modifiable health and SES measures may be targets for interventions to reduce functional disparities.

Risk of falls in patients with ankylosing spondylitis.

Risk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. The aims of this study were to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients. Eighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 ± 11.5 years from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last 1 year. Their demographics, disease characteristics including Bath AS Disease Activity Index, Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), and risk factors for falls were recorded. The Short Physical Performance Battery (SPPB) test was used for evaluation of static and dynamic balance. Erythrocyte sedimentation rate, C-reactive protein, and 25-hydroxyvitamin D levels were measured. Forty of 306 patients reported at least 1 fall in the recent 1 year. The patients with history of falls had higher mean age and longer disease duration than did nonfallers (P = 0.001). In addition, these patients' BASMI and BASFI values were higher than those of nonfallers (P = 0.002; P = 0.000, respectively). We found that the patients with history of falls had lower SPPB scores (P = 0.000). We also found that the number of falls increased with longer disease duration and older age (R = 0.117 [P = 0.041] and R = 0.160 [P = 0.005]). Our results show that decreased SPPB scores were associated with increased number of falls (R = 0.183, P = 0.006). Statistically significant correlations were found between number of falls and AS-related lost job (R = 0.140, P = 0.014), fear of falling (R = 0.316, P = 0.000), hip involvement (R = 0.112, P = 0.05), BASMI (R =0.234, P = 0.000), and BASFI (R = 0.244, P = 0.000). Assessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.

Graph Theory Analysis of Functional Brain Networks and Mobility Disability in Older Adults

The brain's structural integrity is associated with mobility function in older adults. Changes in function may be evident earlier than changes in structure and may be more directly related to mobility. Therefore, we assessed whether functional brain networks varied with mobility function in older adults. Short Physical Performance Battery (SPPB) and resting state functional magnetic resonance imaging were collected on 24 young (mean age = 26.4±5.1) and 48 older (mean age = 72.04±5.1) participants. Older participants were divided into three groups by SPPB score: Low SPPB (score = 7-9), Mid SPPB (score = 10), High SPPB (score = 11-12).Graph theory-based methods were used to characterize and compare brain network organization. Connectivity in the somatomotor cortex distinguished between groups based on SPPB score. The community structure of the somatomotor cortex was significantly less consistent in the Low SPPB group (mean = 0.097±0.05) compared with Young (mean = 0.163±0.09, p = .03) SPPB group. Striking differences were evident in second-order connections between somatomotor cortex and superior temporal gyrus and insula that reached statistical significance. The Low SPPB group (mean = 140.87±109.30) had a significantly higher number of connections than Young (mean = 45.05±33.79, p = .0003) or High (mean = 49.61±35.31, p = .002) SPPB group. Older adults with poorer mobility function exhibited reduced consistency of somatomotor community structure and a greater number of secondary connections with vestibular and multisensory regions of the brain. Further study is needed to fully interpret these effects, but analysis of functional brain networks adds new insights to the contribution of the brain to mobility.

Relationship Between Poor Physical Function, Inflammatory Markers, and Comorbidities in HIV-Infected Women on Antiretroviral Therapy

HIV-infected individuals may be at increased risk of poor physical function. Chronic inflammation has been associated with decreased physical function in the elderly and may also influence physical function in HIV-infected individuals. This cross-sectional study assessed physical function in 65 HIV-infected women aged 40 and older on stable antiretroviral treatment using the Short Physical Performance Battery (SPPB): a standardized test of balance, walking speed, and lower- extremity strength developed for elderly populations. The relationship between low SPPB score, selected demographic and medical characteristics, and high inflammatory biomarker profile was analyzed using Fisher's exact test and Wilcoxon rank sum test. The median age of subjects was 49 years (interquartile range [IQR] 45-55), and the median CD4 T-cell count was 675 cells/mm(3) (IQR 436-828). Thirteen subjects (20%) had a low SPPB score. Subjects with a low SPPB score were more likely to be cigarette smokers (p=0.03), had more medical comorbidities (p=0.01), and had higher levels of interleukin-6 (IL-6) (p<0.05). They also tended to be older (median age 55 vs. 48, p=0.06), more likely to have diabetes (p=0.07), and have higher levels of soluble tumor necrosis factor-1 (p=0.09). Twenty percent of women aged 40 and older with well-treated HIV had poor physical-function performance, which was associated with the high burden of comorbidities in this population and with increased IL-6. However, it is unclear from this cross-sectional study whether increased inflammation was related to poor physical function or to other factors, such as age and medical comorbidities.

Proximal Superficial Femoral Artery Occlusion, Collateral Vessels, and Walking Performance in Peripheral Artery Disease

We studied associations of magnetic resonance imaging (MRI)-measured superficial femoral artery (SFA) occlusions with functional performance, leg symptoms, and collateral vessel number in peripheral artery disease (PAD). We studied associations of collateral vessel number with functional performance in PAD. Associations of MRI-detected SFA occlusion and collateral vessel number with functional performance among individuals with PAD have not been reported. A total of 457 participants with an ankle brachial index (ABI) <1.00 had MRI measurement of the proximal SFA with 12 consecutive 2.5-μm cross-sectional images. An occluded SFA was defined as an SFA in which at least 1 segment was occluded. A nonoccluded SFA was defined as absence of any occluded slices. Collateral vessels were visualized with magnetic resonance angiography. Lower extremity functional performance was measured with the 6-min walk, 4-m walking velocity at usual and fastest pace, and the Short Physical Performance Battery (SPPB) (0 to 12 scale, 12 = best). Adjusting for age, sex, race, comorbidities, and other confounders, the presence of an SFA occlusion was associated with poorer 6-min walk performance (1,031 vs. 1,169 feet, p = 0.006), slower fast-paced walking velocity (1.15 vs. 1.22 m/s, p = 0.042), and lower SPPB score (9.07 vs. 9.75, p = 0.038) compared with the absence of an SFA occlusion. More numerous collateral vessels were associated with better 6-min walk performance (0 to 3 collaterals-1,064 feet, 4 to 7 collaterals-1,165 feet, ≥8 collaterals-1,246 feet, p trend = 0.007), faster usual-paced walking speed (0 to 3 collaterals-0.84 m/s, 4 to 7 collaterals-0.88 m/s, ≥8 collaterals-0.91 m/s, p trend = 0.029), and faster rapid-paced walking speed (0 to 3 collaterals-1.17 m/s, 4 to 7 collaterals-1.22 m/s, ≥8 collaterals-1.29 m/s, p trend = 0.002), adjusting for age, sex, race, comorbidities, ABI, and other confounders. Among PAD participants, MRI-visualized occlusions in the proximal SFA are associated with poorer functional performance, whereas more numerous collaterals are associated with better functional performance. (Magnetic Resonance Imaging to Identify Characteristics of Plaque Build-Up in People With Peripheral Arterial Disease; NCT00520312).

The short physical performance battery as a predictor for long term disability or institutionalization in the community dwelling population aged 65 years old or older

Background: The short physical performance battery (SPPB) is a physical performance measure that has been used to predict long term disability and/or future institutionalization in adults aged 65 years old or older. The test involves three dedicated physical performance activities, scored from 0 to 4, with a summated score of 12. Higher scores reflect higher levels of function.Objectives: The purpose of this systematic literature review was to investigate the ability of the SPPB to predict long term disability or future institutionalization in community dwellers aged 65 years old or older living in the United States.Methods: This review used the search engines PubMed, CINAHL, and the Cochrane Library, and investigated all articles that studied the SPPB as a predictor of either long term disability or future institutionalization. Studies were included if each incorporated the SPPB, involved a community dwelling population, was written in English, was a longitudinal trial, and reported on functional decline or disability, or institutionalization. Qualitative scoring was assessed using the Newcastle–Ottawa Scale (NOS); each study was scored in three categories: selection, comparability, and outcome.Results: Five articles met the inclusion criteria for this study, of the five, three evaluated the capability of the SPPB to predict long term disability and two used the SPPB to predict institutionalization. Studies found that a baseline score of 4–6 on the SPPB indicated that the individual had a 2·9–4·9 increase in risk of developing a future disability, and a score of 7–9 on the SPPB found a 1·6–2·1 relative risk of developing a future disability. A baseline score of 10–12 on the SPPB was predictive of no future disability. Lower SPPB scores were related to increased odds of institutionalization and increased functional decline/disability. The NOS scores of the included trials ranged from two to three stars for each category demonstrating moderate to good quality.Conclusion: Of the investigated studies on the subject, it can be concluded that the SPPB is a predictor of long term disability or institutionalization in US community dwellers aged 65 years old or older.

Change in 25-Hydroxyvitamin D and Physical Performance in Older Adults

Vitamin D deficiency is common among older adults and is associated with poor physical performance; however, studies examining longitudinal changes in 25-hydroxyvitamin D (25[OH]D) and physical performance are lacking. We examined the association between 25(OH)D and physical performance over 12 months in older adults participating in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P), a multicenter physical activity intervention trial. Plasma 25(OH)D and physical performance, assessed by the short physical performance battery (SPPB) and 400-m walk test, were measured at baseline, 6-month, and 12-month follow-up in community-dwelling adults aged 70-89 years at risk for disability (n = 368). Mixed models were used to examine the association between 25(OH)D and physical performance adjusting for demographics, intervention group, season, body mass index, and physical activity. One half of the participants were vitamin D deficient (25[OH]D < 20 ng/mL) at baseline. In cross-sectional analyses, vitamin D deficiency was associated with lower SPPB scores and slower 400-m walk speeds (mean difference [SE]: 0.35 [0.16], p = .03 and 0.04 [0.02] m/s, p = .01, respectively). Although baseline 25(OH)D status was not significantly associated with change in physical performance over 12 months, individuals who were vitamin D deficient at baseline but no longer deficient at follow-up had significant improvements in SPPB scores (mean difference [SE]: 0.55 [0.22], p = .01) compared with those whose 25(OH)D status remained the same. Increases in 25(OH)D to greater than or equal to 20 ng/mL were associated with clinically significant improvements in physical performance among older adults.

Interruption of Physical Activity Because of Illness in the Lifestyle Interventions and Independence for Elders Pilot Trial

To examine baseline characteristics and change in gait speed and Short Physical Performance Battery (SPPB) scores in participants medically suspended (MS) from a physical activity intervention (PA). Randomized controlled trial. University and community centers. Sedentary older adults (N = 213) randomized to PA in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P). MS was defined as missing 3 consecutive PA sessions in adoption and transition phases or 2 wk in maintenance phase because of a health event. In all, 122 participants completed PA without MS (NMS subgroup), 48 participants underwent MS and resumed PA (SR subgroup), and 43 participants underwent MS and did not complete PA (SNR subgroup). At baseline, SNR walked slower (p = .03), took more prescribed medications (p = .02), and had lower SPPB scores than NMS and SR (p = .02). Changes from baseline to Month 12 SPPB scores were affected by suspension status, adjusted mean (SE) SPPB change: SNR 0.0957 (0.3184), SR 0.9413 (0.3063), NMS 1.0720 (0.1871); p = .03. MS participants unable to return to complete the PA in a trial of mobility-limited sedentary older adults had slower walking speeds, lower SPPB scores, and a higher number of prescribed medications at baseline. Change in SPPB scores at 12 months was related to suspension status.

Comparing Pain Severity Versus Pain Location in the MOBILIZE Boston Study: Chronic Pain and Lower Extremity Function

This study compared measures of chronic pain, for example, number of pain sites and overall pain severity, in relation to lower extremity function in the older population. Six hundred older adults (mean age 77.9 years, 64% female) were queried about presence of chronic pain. Number of pain sites was categorized as none, single site, multisite, or widespread. Pain severity was measured in quartiles of the Brief Pain Inventory pain severity subscale. Lower extremity function was assessed by the Short Physical Performance Battery (SPPB), a composite measure of gait speed, balance, and chair stands. Many older persons reported multisite or widespread pain (40%). Increased pain sites and pain severity were associated with poorer SPPB performance after adjusting for age, sex, height, and weight. With further adjustment for education, comorbid conditions, and depressive symptoms, multisite pain (p < .001) and most severe pain (p < .05) were associated with poorer SPPB performance, but assessed together in the same model, only the association with multisite/widespread pain remained significant (p < .01). When specific joint pain sites were evaluated together, only knee pain was associated with lower SPPB score. Pain severity was independently associated with slower gait, pain location was associated with poorer balance, and chair stands performance was associated with both pain measures. Although multisite pain rather than pain severity was more strongly associated with overall lower extremity function, differences emerged with specific SPPB subtests. Longitudinal studies are needed to understand risk for lower extremity function decline related to chronic pain characteristics in older adults.

Fatigue in a Representative Population of Older Persons and Its Association With Functional Impairment, Functional Limitation, and Disability

Older persons often complain of fatigue, but the functional consequences of this symptom are unclear. The aim of the present study was to evaluate fatigue and its association with measures of physical function and disability in a representative sample of the older population. Cross-sectional data from a population-based sample of 1,055 Italian men and women aged 65 and older were analyzed. Fatigue was defined according to two questions evaluating whether participants felt that "everything was an effort" and/or they "could not get going" on three or more days in the past week. Objective measures of physical function were handgrip strength, the Short Physical Performance Battery (SPPB), and 400-m walking speed. Disability was defined as the inability to complete the 400-m walk test and self-reported difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL). The prevalence of fatigue was higher in women (29%) than in men (15%). In age-adjusted analyses, fatigued men and women had weaker handgrip strength, lower SPPB score, slower walking speed, and higher mobility, ADL, and IADL disability than nonfatigued persons. Further adjustment for health behaviors, diseases, inflammatory markers, and thyroid function generally reduced the relationship between fatigue and functional outcomes, but fatigue remained significantly associated with SPPB score, walking speed, and mobility and IADL disability. Older persons who report fatigue had significantly poorer functional status than those who did not report this symptom. The causal link between fatigue and these outcomes should be further investigated.

Low Socioeconomic Status and Disability in Old Age: Evidence From the InChianti Study for the Mediating Role of Physiological Impairments

Low socioeconomic status (SES) has been associated with increased risk of disability in later life. The purpose of this study was to determine if SES has an impact on mobility functioning and to explore which physiological impairments are also associated with SES and may explain its relationship with mobility. The study sample consisted of 1025 individuals aged 65 years or older residing in the Chianti area (Italy). Number of years of education was used as an indicator of SES. Mobility functioning was assessed using gait speed (400 m) and the Short Physical Performance Battery (SPPB). Mobility-related physiological impairments were assessed with tests of executive functioning, nerve conduction velocity, muscle power, hip-ankle range of motion, Ankle-Brachial Index, and visual acuity. Linear regression models were used to study the association between number of years of education and mobility and to estimate the contribution of each of the selected physiological impairments to this association. Adjusting for age and sex, slower gait speed (1.16 vs 1.26 m/s, p <.0001) and lower SPPB scores (9.55 vs 10.11, p =.006) were seen in persons with < or =5 years of total education compared with those persons with >5 years of total education. Leg power and executive function decreased the strength of the association between educational level and gait speed by more than 15%. Controlling for all selected impairments (full model) decreased the education-gait speed association by 49%. Low education continued to be significantly associated with gait speed (p <.01). Adjusting for all physiological impairments substantially reduced the low education-SPPB score association by 100%, and this association was no longer significant. Low SES is related to multiple physiological impairments, which explain a large amount of the association between education and gait limitations. Further work must be done to understand the mechanisms whereby low SES translates into the impairments that play an important role in mobility.

Lower limb function as predictor of falls and loss of mobility with social repercussions one year after discharge among elderly inpatients

Poor mobility of the lower limbs in community-dwelling elderly people is a predictor of functional decline in terms of disability, falls, nursing home admission, and death. However, its predictive value has not been studied in acute care hospital settings. The aims of this observational, prospective study were: 1) to assess the prognostic value of lower limb function; and 2) to compare the predictive value of three performance tests in elderly inpatients. We studied 144 patients aged 70 or older (60 men and 84 women, mean age 78.7 +/- 5.6 years), admitted consecutively to a general internal medicine ward. Before discharge, patients underwent multidimensional assessment, including static and dynamic equilibrium and gait, by the Performance-Oriented Mobility Assessment (POMA), Short Physical Performance Battery (SPPB), and Functional Reach (FR). One-year outcomes were falls, loss of mobility with social repercussions (inability to leave home, or need for nursing home care) and death. In univariate analysis, poor results on any of the three tests were associated with an increased risk of falls, loss of mobility with social repercussions, and death. In multivariate analysis, age, two or more falls, and a low POMA score were predictive of future falls, whereas dependency in instrumental activities of daily living and a low SPPB score were predictive of loss of mobility with social repercussions. No multivariate model was superior to univariate ones in predicting death. No associations were found between other medical or geriatric characteristics and outcomes. Lower limb mobility tests performed in an acute care hospital setting are predictive of future falls, inability to leave home, and/or need for nursing home care.