Impairments in physical performance and cognitive status as predisposing factors for functional dependence among nondisabled older persons.

BACKGROUND Little is known about the processes underlying the development of functional dependence. We set out to determine whether impairments in physical performance and cognitive status contribute independently to the risk of functional dependence in nondisabled older persons. METHODS Among a probability sample of 1,103 community-living adults, aged 72 years and older, we evaluated the 945 subjects who reported no disability in the activities of daily living. Subjects underwent a comprehensive assessment, including physical performance and cognitive testing. RESULTS Among the 775 subjects alive with complete outcomes data, 221 (28.5%) developed dependence in activities of daily living at either the 1- or 3-year follow-up interview. The rates of functional dependence were 18%, 20%, 26%, and 50% (p < .001) and 18%, 23%, 31%, and 47% (p < .001), respectively, across quarters of worsening physical performance and cognitive status. Compared with subjects in the best group, those with the worst physical performance and cognitive status were more than five times as likely to develop functional dependence (67% vs 13%; p < .001). After adjustment for age, gender, number of chronic conditions, and housing stratum, the risk of functional dependence increased across quarters of both worsening physical performance (relative risks [RR] 1.0, 1.1, 1.3, 2.1) and cognitive status (RR 1.0, 1.3, 1.5, 2.0), independent of the effect of the other. Similar results were found for subjects who developed functional dependence at one year, for those who developed functional dependence at three years, and for the combined endpoint of functional dependence or death. CONCLUSIONS Impairments in physical performance and cognitive status contribute independently to the risk of functional dependence in nondisabled, community-living older adults. A better understanding of the processes underlying functional dependence may facilitate the design of effective and efficient strategies to prevent or slow functional decline.

[1]  M J Graney,et al.  Comparison of subjective ratings of function with observed functional ability of frail older persons. , 1991, American journal of public health.

[2]  T M Gill,et al.  Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. , 1995, JAMA.

[3]  G P Samsa,et al.  Comparing Proxy and Patients' Perceptions of Patients' Functional Status: Results from an Outpatient Geriatric Clinic , 1992, Journal of the American Geriatrics Society.

[4]  D B Reuben,et al.  An Objective Measure of Physical Function of Elderly Outpatients , 1990, Journal of the American Geriatrics Society.

[5]  A. LaCroix,et al.  Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. , 1993, American journal of epidemiology.

[6]  D. G. Slone,et al.  Neuropsychometric Correlates of the Mini-Mental State Examination: Preliminary Data , 1987, Perceptual and motor skills.

[7]  L. Branch,et al.  A prospective study of functional status among community elders. , 1984, American journal of public health.

[8]  R B Wallace,et al.  Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. , 1995, The New England journal of medicine.

[9]  Kathleen A. Turano,et al.  Preclinical Disability , 1991 .

[10]  M. Tinetti,et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. , 1994, The New England journal of medicine.

[11]  S Wacholder,et al.  Binomial regression in GLIM: estimating risk ratios and risk differences. , 1986, American journal of epidemiology.

[12]  A. Jette,et al.  The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community. , 1990, American journal of public health.

[13]  Christianna S. Williams,et al.  Assessing Risk for the Onset of Functional Dependence Among Older Adults: The Role of Physical Performance , 1995, Journal of the American Geriatrics Society.

[14]  T. M. Kashner,et al.  Patient-proxy response comparability on measures of patient health and functional status. , 1988, Journal of clinical epidemiology.

[15]  L. Berkman,et al.  Cognitive functioning and the incidence of limitations in activities of daily living in an elderly community sample. , 1995, American journal of epidemiology.

[16]  S B Roberts,et al.  Exercise training and nutritional supplementation for physical frailty in very elderly people. , 1994, The New England journal of medicine.

[17]  K G Manton,et al.  A longitudinal study of functional change and mortality in the United States. , 1988, Journal of gerontology.

[18]  J. Guralnik,et al.  Physical disability in older Americans. , 1993, Journal of gerontology.

[19]  E. Wagner,et al.  Preventing frail health. , 1992, Clinics in geriatric medicine.

[20]  A. Miller,et al.  Risk factors for spontaneous abortion and its recurrence. , 1988, American journal of epidemiology.

[21]  J. Murphy,et al.  Risk of functional decline among well elders. , 1989, Journal of clinical epidemiology.

[22]  L G Branch,et al.  Short‐Term Variability of Measures of Physical Function in Older People , 1990, Journal of the American Geriatrics Society.

[23]  D B Reuben,et al.  The predictive validity of self-report and performance-based measures of function and health. , 1992, Journal of gerontology.

[24]  M. Tinetti,et al.  Predictors and prognosis of inability to get up after falls among elderly persons. , 1993, JAMA.

[25]  Physical Performance and Sensory Functions as Determinants of Independence in Activities of Daily Living in the Old and the Very old a , 1992, Annals of the New York Academy of Sciences.

[26]  N. Roos,et al.  Predictors of successful aging: a twelve-year study of Manitoba elderly. , 1991, American journal of public health.

[27]  G. Odenheimer.  Acquired cognitive disorders of the elderly. , 1989, The Medical clinics of North America.

[28]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.