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Predictive Validity of Different Walking Measures to Identify the Incident Long-Term Care Needs in Older Adults

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

A comfortable walking speed is a suitable measurement of functional status in older adults. In addition to assessing their comfortable walking speed, two complex walking tests were administered to a cohort of older people, assuming that these tests would be a more sensitive predictor of the incident long-term care needs than comfortable walking speed.

Design

A prospective observational study was conducted to collect data.

Setting and Participants

Among the initial 5,563 community-dwelling independent older adults (aged ≥ 65 years), 935 were excluded and the data of 4,628 (mean age, 73.9 ± 5.5 years, 65–94 years; 2,052 men, 2,576 women) older adults were finally analyzed.

Methods

Three walking tasks were administered: comfortable, complicated balance, and Go-stop walking. Complicated balance walking was measured under comfortable walking conditions, with participants having to walk with their hands crossed at the shoulder joint at 90°. For the Go-stop walking test, the time taken to walk 2 meters was measured using a stopwatch. For two years following baseline assessments, participants received monthly follow-ups for incident certification of the need for care under the long-term care insurance (LTCI) system.

Results

Low performance in comfortable, complicated balance, and Go-stop walking were 29.8%, 37.7%, and 35.1%, respectively. During the 24-month follow-up period, 246 participants (5.3%) required LTCI certification. The Youden Index was used to determine the cut-points of the incident long-term care needs in the comfortable, complicated balance, and Go-stop walking conditions, which were 1.055 m/s, 0.936 m/s, and 3.205 seconds, respectively. Participants classified as exhibiting low performance included 1,381 (29.8%) under comfortable walking, 1,746 (37.7%) under complicated balance walking, and 1,623 (35.1%) under the Go-stop walking tests. The C-indices of the comfortable, complicated balance, and Go-stop walking tests were 0.72 (95% confidence interval (CI) 0.69–0.76), 0.71 (95% CI 0.67–0.74), and 0.65 (95% CI 0.61–0.69), respectively. Cox proportional hazards regression model revealed significant relationships between the incident long-term care needs and the comfortable (hazard ratio (HR) 2.14, 95% CI 1.62–2.84), complicated balance (1.81, 1.36–2.41), and Go-stop (1.46, 1.12–1.91) walking conditions.

Conclusions and Implications

The findings suggest that slow walking speed has a considerably greater impact on the incident long-term care needs in older adults. However, the complex walking task did not improve the predictive performance. Comfortable walking speed tests, which can easily be measured to predict the future incident long-term care needs, are effective tools in community health promotion and primary care.

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Acknowledgement: We would like to thank the Tokai City offices for assistance with participant recruitment. We are also grateful to Dr. Park Hyuntae, Dr. Hyuma Makizako, Dr. Daisuke Yoshida, Dr. Ryo Hotta, Mr. Yuya Anan, Dr. SungChul Lee, Dr. Kazuhiro Harada, Dr. Kazuki Uemura, Dr. Hideaki Ishii, Dr. Ippei Chiba, Mr. Yohei Shinkai, and Dr. Osamu Katayama for their contributions to data collection in this study.

Funding

Funding Sources: This work received financial support of the Research Funding for Longevity Sciences (27–22, 28–30) from the National Center for Geriatrics and Gerontology, Research and Development Grants (15dk0207019h0001, 18dk0110021h0003, 18le0110004h0002) of the Japan Agency for Medical Research and Development, Japan. No support was received from the industry. The funding source played no role in the study design or procedure; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department of Preventive Gerontology, Centre for Gerontology and Social Science, Research Institute, National Centre for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan

    Hiroyuki Shimada, T. Doi, K. Tsutsumimoto, K. Makino, K. Harada & K. Tomida

  2. National Centre for Geriatrics and Gerontology, Obu, Japan

    H. Arai

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  1. Hiroyuki Shimada
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  2. T. Doi
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  3. K. Tsutsumimoto
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Contributions

Author Contributions: HS planned the study concept and design, performed analysis and interpretation of data, wrote the first draft of the manuscript, and coordinated the review and editing process leading to the final manuscript. TD participated in the design of the study and wrote the paper. TD, KT, KM, and KH acquired the data and contributed to the editorial process and review of the manuscript. HA supervised the study, suggested several ideas that have been pursued in this research, and participated in the planning, editorial, and review processes that led to the final manuscript.

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Correspondence to Hiroyuki Shimada.

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Statement of Ethics: Written informed consent was obtained from all participants before their inclusion in the study, and the ethics committee of the National Center for Geriatrics and Gerontology approved the study protocol (registration number: 1067-3).

Conflict of Interest Statement: The authors have no conflicts of interest to declare.

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Shimada, H., Doi, T., Tsutsumimoto, K. et al. Predictive Validity of Different Walking Measures to Identify the Incident Long-Term Care Needs in Older Adults. J Nutr Health Aging 27, 759–766 (2023). https://doi.org/10.1007/s12603-023-1978-x

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