Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging And Body Composition Study

Abstract

Objectives: To determine how three different physical performance measures (PPMs) combine for added utility in predicting adverse health events in elders.

Design: Prospective cohort study.

Setting: Health, Aging and Body Composition Study.

Participants: Three thousand twenty-four well-functioning older persons (mean age 73.6).

Measurements: Timed gait, repeated chair stands, and balance (semi- and full-tandem, and single leg stands each held for 30 seconds) tests were administered at baseline. Usual gait speed was categorized to distinguish high- and low-risk participants using the previously established 1-m/s cutpoint. The same population-percentile (21.3%) was used to identify cutpoints for the repeated chair stands (17.1 seconds) and balance (53.0 seconds) tests. Cox proportional hazard analyses were performed to evaluate the added value of PPMs in predicting mortality, hospitalization, and (severe) mobility limitation events over 6.9 years of follow-up.

Results: Risk estimates for developing adverse health-related events were similarly large for each of the three high-risk groups considered separately. Having more PPM scores at the high-risk level was associated with a greater risk of developing adverse health-related events. When all three PPMs were considered, having only one poor performance was sufficient to indicate a highly significantly higher risk of (severe) lower extremity and mortality events.

Conclusion: Although gait speed is considered to be the most important predictor of adverse health events, these findings demonstrate that poor performance on other tests of lower extremity function are equally prognostic. This suggests that chair stand and standing balance performance may be adequate substitutes when gait speed is unavailable.

Figure 1

Adjusted* hazard ratios (and 95%CI) for persistent (severe) functional limitation, hospitalization and mortality according to the physical performance measures (PPM; usual gait speed [UGS], balance test [BT] and chair stands [CS] test) in the high risk group. * Adjusted for age, gender, race, site, smoking, alcohol consumption, education, body mass index, Modified Mini Mental State Examination score, physical activity, coronary heart disease, congestive heart failure, diabetes, hypertension, osteoarthritis, peripheral artery disease, cerebrovascular disease, depression, pulmonary disease