Added Value of Physical Performance Measures in Predicting Adverse Health-Related Events: Results from the Health, Aging and Body Composition Study

Authors

  • Matteo Cesari MD, PhD,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • a Stephen B. Kritchevsky PhD,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • b Anne B. Newman MD, MPH,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • c Eleanor M. Simonsick PhD,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • d Tamara B. Harris MD, MS,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • e Brenda W. Penninx PhD,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • f Jennifer S. Brach PT, PhD,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • g Frances A. Tylavsky DrPH,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • h Suzanne Satterfield MD, DrPH,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • h Doug C. Bauer MD,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • i Susan M. Rubin MPH,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • j Marjolein Visser PhD,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • k Marco Pahor MD,

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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  • and a for the Health, Aging and Body Composition Study

    1. From the aDepartment of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, FloridabDepartment of Internal Medicine, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North CarolinacDepartment of Epidemiology, Graduate School of Public HealthgDepartment of Physical Therapy, University of Pittsburgh, Pittsburgh, PennsylvaniadClinical Research Branch, National Institute on Aging, Baltimore, MarylandeIntramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MarylandfDepartment of Psychiatry and EMGO Institute, Vrije University Medical Center, Amsterdam, the NetherlandshDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TennesseeiDivision of General Internal MedicinejDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniakInstitute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
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Address correspondence to Matteo Cesari, Department of Aging and Geriatric Research, Institute on Aging, University of Florida, 210 E. Mowry Road, Gainesville, FL 32611. E-mail: macesari@gmail.com

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.

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