Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 63, Issue 6, Pages 1129-1136Publisher
WILEY
DOI: 10.1111/jgs.13442
Keywords
aged; cohort study; disability; epidemiology; motor decline
Categories
Funding
- EHESP (Ecole des Hautes Etudes en Sante Publique), Rennes, France
- National Institutes of Health (National Institute on Aging) [R01AG013196, R01AG034454]
- Institut National de la Sante et de la Recherche Medicale (INSERM)
- Victor Segalen-Bordeaux II University
- Sanofi-Synthelabo Company
- Fondation pour la Recherche Medicale
- Caisse Nationale Maladie des Travailleurs Salaries
- Direction Generale de la Sante
- Conseils Regionaux of Bourgogne
- Fondation de France
- Ministry of Research-INSERM Program
- Cohortes et collections de donnees biologiques
- Mutuelle Generale de l'Education Nationale
- Institut de la Longevite
- Conseil General de la Cote d'or
- Fondation Plan Alzheimer
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ObjectivesTo determine whether fast gait speed at study baseline and change in gait speed had independent associations with disability onset. DesignCohort study with 11-year follow-up (1999-2010). SettingThree-City Study center, Dijon, France. ParticipantsCommunity-dwelling individuals aged 65 to 85 (N=3,814, 61% female). MeasurementsFast gait speed (over 6m) was assessed up to five times and disability (mobility (Rosow-Breslau scale), instrumental activities of daily living (IADLs; Lawton-Brody scale), basic activities of daily living (ADLs; Katz scale)) six times. A hierarchical disability indicator was constructed; participants were considered disabled if they reported difficulties with mobility and IADLs or with mobility, IADLs, and ADLs. The association between baseline fast gait speed and its slope of change and disability incidence was examined using joint models for longitudinal and time-to-event data. ResultsOver follow-up, 628 participants (68% women) developed disability. Mean fast gait speed at baseline was 1.54m/s, and annual decline was 0.017m/s. The hazard ratio of disability per standard deviation (SD)(-0.22m/s) slower baseline fast gait speed was 1.77 (95% confidence interval (CI)=1.60-1.94) and for one-SD (-0.013m/s) faster annual decline was 1.38 (95% CI=1.10-1.73) when both parameters were included in a sex- and age-adjusted model. All associations remained statistically significant in multivariable models, except for slope of change when chronic conditions were added to the model; of chronic conditions, dyspnea was the main contributor. ConclusionAccelerated decline in fast gait speed was associated with disability independent of baseline fast gait speed. These results confirm the importance of measuring gait speed repeatedly in elderly adults to identify those at higher risk of disability and the need to identify determinants of decline, because they are likely to be targets for prevention and treatment to reduce disability risk.
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