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Role of Gait Speed, Strength, and Balance in Predicting Adverse Outcomes of Acutely Ill Older Outpatients

  • Published:
The journal of nutrition, health & aging

Abstract

Aim

To evaluate the ability of the Short Physical Performance Battery (SPPB) for predicting 1-year adverse outcomes of acutely ill older outpatients.

Methods

Prospective study with 512 acutely ill older outpatients (79.4±8.3 years, 63% female) in an acute care day hospital. The SPPB was administered at admission. Participants were classified as low (0–4 points), intermediate (5–8 points), or high (9–12 points) performance. Primary outcomes were new dependence in basic activities of daily living (ADL), hospitalization, and death at 1 year. Cox models tested whether the SPPB predicted outcomes after adjustment for sociodemographic factors, comorbidities and well-known geriatric conditions. We also estimated whether the chair-stand and balance tests improve the SPPB’s ability to identify patients at high risk of adverse outcomes.

Results

Patients with intermediate or low SPPB performance were at higher risk of 1-year new ADL dependence (32% vs 13%: adjusted hazard ratio [aHR]=2.00; 95%CI=1.18–3.37; 58% vs 13%: aHR=3.40; 95%CI=2.00–5.85, respectively), hospitalization (43% vs 29%: aHR=1.56; 95%CI=1.04–2.33; 44% vs 29%: aHR=1.80; 95%CI=1.15–2.82), and death (18% vs 6%: aHR=2.54; 95%CI=1.17–5.53; 21% vs 6%: aHR=2.70; 95%CI=1.17–6.21). Use of all three components (versus gait speed alone) improved predictions of new ADL dependence (Harrell’s C=0.73 vs 0.70;P=0.01), hospitalization (Harrell’s C=0.60 vs 0.57;P=0.04), and death (Harrell’s C=0.67 vs 0.62;P=0.04).

Conclusions

The SPPB is as a powerful tool for identifying acutely ill older outpatients at high-risk of adverse outcomes. The combination of the three components of the SPPB resulted in better predictive performance than gait speed alone.

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References

  1. Cesari M, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, et al. Evidence for the domains supporting the construct of intrinsic capacity. J Gerontol A Biol Sci Med Sci 2018 Feb 2;73(12):1653–60.

    Article  Google Scholar 

  2. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332(9):556–561.

    Article  CAS  Google Scholar 

  3. Guralnik JM, Simonsick EM, Ferrucci L et al. A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:85–94.

    Article  Google Scholar 

  4. Studenski S, Perera S, Wallace D et al. Physical performance measures in the clinical setting. J Am Geriatr Soc 2003;51(3):314–322.

    Article  Google Scholar 

  5. Volpato S, Cavalieri M, Guerra G et al. Performance-based functional assessment in older hospitalized patients: feasibility and clinical correlates. J Gerontol A Biol Sci Med Sci 2008;63(12):1393–1398.

    Article  Google Scholar 

  6. Volpato S, Cavalieri M, Sioulis F et al. Predictive value of the Short Physical Performance Battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci 2011 Jan;66(1):89–96.

    Article  Google Scholar 

  7. Chiarantini D, Volpato S, Sioulis F et al. Lower extremity performance measures predict long-term prognosis in older patients hospitalized for heart failure. J Card Fail 2010;16:390–395.

    Article  Google Scholar 

  8. Corsonello A, Lattanzio F, Pedone C et al. Prognostic Significance of the Short Physical Performance Battery in Older Patients Discharged from Acute Care Hospitals. Rejuvenation Res 2012;15(1):41–48.

    Article  Google Scholar 

  9. Bissett M, Cusick A, Lannin NA. Functional assessments utilised in emergency departments: a systematic review. Age Ageing 2013;42(2):163–72.

    Article  Google Scholar 

  10. Graf CE, Zekry D, Giannelli S, Michel JP, Chevalley T. Efficiency and applicability of comprehensive geriatric assessment in the emergency department: a systematic review. Aging Clin Exp Res 2011;23(4):244–254.

    Article  Google Scholar 

  11. Conroy SP, Stevens T, Parker SG, Gladman JR. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’. Age Ageing 2011;40(4):436–443.

    Article  Google Scholar 

  12. Studenski SA. Gait speed in hospitalized older people: comment on “assessing gait speed in acutely ill older patients admitted to an acute care for elders hospital unit.” Arch Intern Med 2012;172(4):358–359.

    Article  Google Scholar 

  13. Wennie Huang WN, Perera S, VanSwearingen J, Studenski S. Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. J Am Geriatr Soc 2010;58(5):844–852.

    Article  Google Scholar 

  14. Guralnik JM, Ferrucci L, Pieper CF et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000;55(4):M221–31.

    Article  CAS  Google Scholar 

  15. Ehlenbach WJ, Larson EB, Curtis JR, Hough CL. Physical Function and Disability After Acute Care and Critical Illness Hospitalizations in a Prospective Cohort of Older Adults. J Am Geriatr Soc 2015;63(10):2061–2069.

    Article  Google Scholar 

  16. Stenholm S, Guralnik JM, Bandinelli S, Ferrucci L. The prognostic value of repeated measures of lower extremity performance: should we measure more than once? J Gerontol A Biol Sci Med Sci 2014;69(7):894–899.

    Article  Google Scholar 

  17. Aliberti MJ, Suemoto CK, Fortes-Filho SQ et al. The Geriatric Day Hospital: Preliminary Data on an Innovative Model of Care in Brazil for Older Adults at Risk of Hospitalization. J Am Geriatr Soc 2016;64(10):2149–2153.

    Article  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373–383.

    Article  CAS  Google Scholar 

  19. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914–919.

    Article  CAS  Google Scholar 

  20. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189–198.

    Article  CAS  Google Scholar 

  21. Yesavage JA, Brink TL, Rose TL et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982;17(1):37–49.

    Article  Google Scholar 

  22. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377–381.

    Article  Google Scholar 

  23. Newson RB. Comparing the predictive powers of survival models using Harrell’s C or Somers’ D. Stata Journal 2010;10(3):339.

    Article  Google Scholar 

  24. Pavasini R, Guralnik J, Brown JC et al. Short Physical Performance Battery and allcause mortality: systematic review and meta-analysis. BMC Med 2016;14(1):215. doi: https://doi.org/10.1186/s12916-016-0763-7

    Article  Google Scholar 

  25. Theou O, Squires E, Mallery K et al. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 2018;18(1):139.

    Article  Google Scholar 

  26. Wald HL, Ramaswamy R, Perskin MH et al. The Case for Mobility Assessment in Hospitalized Older Adults: American Geriatrics Society White Paper Executive Summary. J Am Geriatr Soc 2019;67(1):11–16.

    Article  Google Scholar 

  27. Hatheway OL, Mitnitski A, Rockwood K. Frailty affects the initial treatment response and time to recovery of mobility in acutely ill older adults admitted to hospital. Age Ageing 2017;46(6):920–925.

    PubMed  Google Scholar 

  28. Van Ancum JM, Scheerman K, Jonkman NH et al. Change in muscle strength and muscle mass in older hospitalized patients: a systematic review and meta-analysis. Exp Gerontol 2017;92:34–41.

    Article  Google Scholar 

  29. Ostir GV, Berges I, Kuo Y-F, Goodwin JS, Ottenbacher KJ, Guralnik JM. Assessing Gait Speed in Acutely Ill Older Patients Admitted to an Acute Care for Elders Hospital Unit. Arch Intern Med 2012;172(4):353–358. doi:https://doi.org/10.1001/archinternmed.2011.1615.

    Article  Google Scholar 

  30. Bodilsen AC, Klausen HH, Petersen J et al. Prediction of Mobility Limitations after Hospitalization in Older Medical Patients by Simple Measures of Physical Performance Obtained at Admission to the Emergency Department. PLoS One 2016; 19;11(5):e0154350. doi: https://doi.org/10.1371/journal.pone.0154350.

    Article  Google Scholar 

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Funding

Funding: This study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (2014/50007-4).

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Authors and Affiliations

  1. Institute of Orthopedics and Traumatology, University of Sao Paulo Medical School, Sao Paulo, Brazil

    Sileno Queiroz Fortes-Filho, J. A. Melo-Fortes & L. E. Garcez-Leme

  2. University of the State of Amazonas, Manaus, Brazil

    Sileno Queiroz Fortes-Filho

  3. Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School Sao Paulo, Sao Paulo, Brazil

    M. J. R. Aliberti, D. Apolinario, M. C. Sitta & W. Jacob-Filho

  4. Universidade de Sao Paulo Instituto de Ortopedia e Traumatologia, Sao Paulo, Brazil

    Sileno Queiroz Fortes-Filho

Authors
  1. Sileno Queiroz Fortes-Filho
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  2. M. J. R. Aliberti
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  3. D. Apolinario
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  4. J. A. Melo-Fortes
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Corresponding author

Correspondence to Sileno Queiroz Fortes-Filho.

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Declarations of interest: None.

Ethical standards: The authors declare that the study procedures comply with current ethical standards for research involving human participants and follows the principles outlined in the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of the University of Sao Paulo Medical School (Brazil).

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Fortes-Filho, S.Q., Aliberti, M.J.R., Apolinario, D. et al. Role of Gait Speed, Strength, and Balance in Predicting Adverse Outcomes of Acutely Ill Older Outpatients. J Nutr Health Aging 24, 113–118 (2020). https://doi.org/10.1007/s12603-019-1279-6

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  • DOI: https://doi.org/10.1007/s12603-019-1279-6

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