Background Functional assessment is an important part of theevaluation of elderly persons. We conducted this study to determinewhether objective measures of physical function can predictsubsequent disability in older persons.
Methods This prospective cohort study included men and women71 years of age or older who were living in the community, whoreported no disability in the activities of daily living, andwho reported that they were able to walk one-half mile (0.8km) and climb stairs without assistance. The subjects completeda short battery of physical-performance tests and participatedin a follow-up interview four years later. The tests includedan assessment of standing balance, a timed 8-ft (2.4-m) walkat a normal pace, and a timed test of five repetitions of risingfrom a chair and sitting down.
Results Among the 1122 subjects who were not disabled at baseline and who participated in the four-year follow-up, lowerscores on the base-line performance tests were associated witha statistically significant, graduated increase in the frequencyof disability in the activities of daily living and mobility-relateddisability at follow-up. After adjustment for age, sex, andthe presence of chronic disease, those with the lowest scoreson the performance tests were 4.2 to 4.9 times as likely tohave disability at four years as those with the highest performancescores, and those with intermediate performance scores were1.6 to 1.8 times as likely to have disability.
Conclusions Among nondisabled older persons living in the community,objective measures of lower-extremity function were highly predictiveof subsequent disability. Measures of physical performance mayidentify older persons with a preclinical stage of disabilitywho may benefit from interventions to prevent the developmentof frank disability.
In recognition of the importance of both extending life andincreasing the number of years during which people are freeof disability, the national health objectives for the year 2000included as an overarching goal an increase in years of healthylife, with a full range of functional capacity at each stageof life.1 Disability in the older population, and the attendantneed for informal and formal care, will increasingly affectolder people, their families, and the health care system asthe population continues to age.2
The addition of functional evaluation to the traditional clinicalexamination provides information that is critical in the comprehensiveassessment of elderly persons.3,4 Disability can be identifiedaccurately through responses to a wide variety of questionsabout the ability to perform activities ranging from basic self-careto household activities and more strenuous tasks. Increasingly,functional status has also been characterized through the useof measures of physical performance, which are objective testsof subjects' performance of standardized tasks, evaluated accordingto predetermined criteria that may include counting repetitionsor timing the activity.5 These measures have been shown to predictoutcomes such as falls, institutionalization, and death.6,7,8,9,10,11,12
Nearly all studies involving the use of performance measureshave been of groups that included disabled persons. In thesepopulations, performance measures predict adverse outcomes suchas institutionalization and death because of their ability toidentify subjects with substantial reductions in function. Whathas not been clearly demonstrated is whether measures of physicalperformance can provide useful prognostic information aboutolder persons who report little or no disability. In the analysespresented here, we tested the hypothesis that performance measurescapture information on the range of functioning in people whoare not currently disabled and that such information can beused to predict the subsequent onset of disability. The measureswe used assessed general lower-extremity function, and the typesof disability we evaluated involve lower-extremity functionand have a substantial effect on the ability of older personsto remain independent.
Methods
Study Population
The data for this report were collected as part of the EstablishedPopulations for Epidemiologic Studies of the Elderly, a seriesof collaborative, longitudinal studies of aging initiated andfunded by the Epidemiology, Demography, and Biometry Programof the National Institute on Aging. The eligible populationconsisted of all persons 65 years of age or older who livedin Iowa and Washington counties, Iowa. In this rural area thevast majority of residents live in 16 small towns. In 1981 and1982, 3673 persons (80 percent of those eligible) participatedin a comprehensive interview, previously described in detail.13Nearly all the participants were white, and the education andincome levels of this cohort were higher than in the other communitiesin the Established Populations for Epidemiologic Studies ofthe Elderly (East Boston, Massachusetts; New Haven, Connecticut;and five counties in north central North Carolina).13,14 Follow-upinterviews were conducted annually for 7 years and again at10 years.
At the sixth annual follow-up interview, conducted in 1988 andconsidered the base line for the analyses presented here, aquestionnaire similar to that used in 1981 and 1982 was administeredand physical-performance measures were added to the protocolfor the first time. At that time, interviews were conductedwith 2547 of the 2711 subjects (94.0 percent) not known to havedied since 1982. To select a cohort of people without disabilityfor these analyses, we excluded the following: 278 people livingin institutions; 111 living at home who were unable to participatein the interview because of cognitive or physical impairment,for whom a proxy respondent had to be interviewed; 628 who reportedthat they had a disability in the activities of daily living(defined below) or had mobility-related disability (definedas the inability to walk a half mile [0.8 km] or climb stairswithout assistance); and 98 who reported no disability but wereunable to complete the performance tests described below. Dataon disability or performance measures were missing for 69 subjects(2.7 percent), most of whom had to be interviewed by telephonebecause they had left the geographic area.
Among the 1363 persons who reported no disability and completedthe performance tests, 208 (15.3 percent) died during the nextfour years. Of those not known to have died, 33 (2.9 percent)were lost to follow-up, leaving 1122 for whom data on disabilitystatus at the four-year follow-up interview were available;these served as the primary subjects of this report. As comparedwith these subjects, those who were interviewed in 1988 butnot included in the final analyses had a higher mean age (81.5vs. 77.1 years), had a similar sex distribution (66.1 vs. 64.9percent female), and were less likely to have 12 or more yearsof education (43.4 vs. 56.9 percent). Disability in the activitiesof daily living was present in 26.4 percent of those excludedfrom the analyses.
To evaluate a separate hypothesis that better scores on measuresof physical performance are associated with improvement in thedegree of disability, we performed additional analyses of dataon 359 subjects who reported disability in mobility but no disabilityin the activities of daily living at base line. The criteriafor inclusion and exclusion were otherwise the same as thoselisted above.
Chronic Conditions at Base Line
The presence of chronic conditions — defined as a historyof heart attack, stroke, cancer, or hip fracture — wasascertained from the subjects' reports. The conditions consideredwere those that had previously been found to be associated withloss of mobility15 and for which data had been collected atall follow-up evaluations. Subjects were considered to havea history of heart attack, stroke, cancer, or hip fracture onlyif they reported having spent one or more nights in the hospitalfor the condition.
Measures of Physical Performance
Lower-extremity function was assessed by measures of standingbalance, walking speed, and ability to rise from a chair thathave previously been described in detail.9 Assessments werecarried out in the subjects' homes by interviewers who had beenspecially trained in the protocols. (The performance-measureprotocol, data-entry form, and videotape used to train interviewersare available from the authors on request.) Correlations betweenobservers of more than 0.93 for walking speed7 and test–retestcorrelations of more than 0.89 for walking speed,7 0.73 forrepeated rising from a chair,16 and 0.97 for balance17 havebeen reported for these measures.
On the basis of the performance of more than 5000 persons atthree sites in the Established Populations for EpidemiologicStudies of the Elderly, we created five performance scores (from0 to 4) for each test, with a score of 0 representing the inabilityto complete the test and 4 the highest level of performance.9The results of the tests were moderately correlated, with Spearmancorrelation coefficients for scores on the various tests rangingfrom 0.39 to 0.48. The subjects included in these analyses hadscores ranging from 1 to 4 on each test.
For tests of standing balance, the subjects were asked to attemptto maintain their feet in the side-by-side, semi-tandem (heelof one foot beside the big toe of the other foot), and tandem(heel of one foot directly in front of the other foot) positionsfor 10 seconds each. The subjects were given a score of 1 ifthey could hold a side-by-side standing position for 10 secondsbut were unable to hold a semi-tandem position for 10 seconds,a score of 2 if they could hold a semi-tandem position for 10seconds but were unable to hold a full tandem position for morethan 2 seconds, a score of 3 if they could stand in the fulltandem position for 3 to 9 seconds, and a score of 4 if theycould stand in the full tandem position for 10 seconds.
An 8-ft (2.4-m) walk at the subjects' normal pace was timed,and the participants were scored according to quartiles forthe length of time required. The time of the faster of two walkswas used for scoring, as follows: >5.7 seconds, a score of1; 4.1 to 5.6 seconds, a score of 2; 3.2 to 4.0 seconds, a scoreof 3; and <3.1 seconds, a score of 4.
Subjects were asked to fold their arms across their chests andto stand up from a sitting position once; if they successfullyrose from the chair, they were asked to stand up and sit downfive times as quickly as possible. Quartiles for the lengthof time required for this measure were used for scoring, asfollows: >16.7 seconds, a score of 1; 13.7 to 16.6 seconds,a score of 2; 11.2 to 13.6 seconds, a score of 3; and <11.1seconds, a score of 4.
A summary performance score was created by adding the scoresfor the tests of standing balance, walking, and repeatedly risingfrom a chair. The validity of this scale has been demonstratedin analyses showing a gradient of risk of admission to a nursinghome and mortality along the full range of the scale.9 The subjectsincluded in these analyses had summary scores ranging from 3to 12. Among the 1122 subjects with follow-up data at four years,the base-line summary performance scores were distributed asfollows: 0.09 percent had a score of 3, 1.3 percent a scoreof 4, 2.4 percent a score of 5, 6.3 percent a score of 6, 9.2percent a score of 7, 15.4 percent a score of 8, 18.8 percenta score of 9, 18.8 percent a score of 10, 17.1 percent a scoreof 11, and 10.6 percent a score of 12.
Disability Status at Follow-Up
The presence of disability at follow-up was assessed on thebasis of reports of the subjects or their proxies. Because theperformance tests at base line measured lower-extremity function,definitions of disability related to lower-extremity functionwere used. A three-level hierarchical scale based on the questionsused to exclude those with disability at base line was usedto classify the subjects at follow-up as having no disability,having mobility-related disability only (the inability to walka half mile or climb stairs without help),15,18 or having adisability in the activities of daily living (the inabilityto perform one or more of the following basic activities withoutthe help of another person: moving from a bed to a chair, usingthe toilet, bathing, and walking across a small room19,20) andmobility-related disability. Less than 0.7 percent of the subjectsdid not fit into one of these categories because they reportedhaving a disability in the activities of daily living and nomobility-related disability; these persons were classified ashaving a disability in the activities of daily living.
Subjects' reports of their degree of disability have generallybeen found to be highly reliable and valid.21,22 Evaluationof the reliability of the measures used here by repeated testingafter three weeks showed agreement of 89 percent for measuresof mobility and more than 96 percent for activities of dailyliving.23 Subjects' reports of their ability to move from abed to a chair, use the toilet, walk, and climb stairs havebeen shown to be valid in comparisons with direct, standardizedobservations of their performance on these tasks,24,25,26,27with agreement rates ranging from 68 to 97 percent.25,26,27The mortality rates in subgroups of this cohort defined by thedisability categories appear to validate the use of our hierarchicalscale as a predictor of mortality.28 Similarly, the validityof the measures of function in the activities of daily living29and of mobility15 in predicting admission to a nursing homehas been demonstrated by studies of the Established Populationsfor Epidemiologic Studies of the Elderly cohort.
Statistical Analysis
Disability at four years was analyzed according to base-linescores on the individual tests of lower-extremity function andthe summary performance score. The Mantel–Haenszel chi-squarestatistic was used to test the linear association between performanceon the tests and disability at follow-up. Multiple logistic-regressionanalysis was used to assess the independent association of thesummary performance score with disability status at follow-up,after adjustment for age, sex, and the number of chronic conditions.
Results
Among the 1122 subjects who were not disabled at base line andwere followed for four years, 212 (18.9 percent) had mobility-relateddisability and 112 (10.0 percent) had disability in the activitiesof daily living at follow-up. Table 1 shows disability statusat four years according to scores on the individual tests oflower-extremity function. Those with better performance (higherscores) had significantly less disability in mobility and disabilityin the activities of daily living at four years.
Table 1. Presence and Type of Disability at Four Years of Follow-up, According to Scores on Base-line Measures of Perform ance.
The association of the summary performance score at base linewith disability status four years later is shown in Figure 1.There is a clear gradient in the risk of mobility-related disabilityand disability in the activities of daily living across thefull range of performance scores; higher scores, indicatingbetter functional status at base line, are associated with alower risk of subsequent disability.
Figure 1. Disability Status at Four Years According to the Base-line Summary Performance Scores among 1121 Subjects with No Disability at Base Line.
Higher scores indicate better performance on the tests and thus better functional status. One person with a score of 3 has been excluded. P<0.001 for the association between performance scores and disability status, by the chi-square test. ADL denotes activities of daily living.
Table 2 shows the results of two separate logistic-regressionmodels used to estimate the relative risk of disability fortwo levels of performance, as compared with the highest levelof performance, with adjustment for age, sex, and the numberof chronic conditions. The subjects with summary performancescores of 4, 5, or 6 were 4.2 to 4.9 times more likely to havedisability in the activities of daily living or mobility-relateddisability at four years than those with scores of 10, 11, or12, and those with performance scores of 7, 8, or 9 were 1.6to 1.8 times more likely to become disabled. Very similar resultswere found in analyses that assessed the risk of disabilityafter one year of follow-up in 1276 subjects (data not shown).At one year, the relative risk of disability in the activitiesof daily living was 5.7 (95 percent confidence interval, 2.0to 16.6) for those with performance scores of 4 to 6, and 2.1(95 percent confidence interval, 0.8 to 5.6) for those withperformance scores of 7 to 9; for mobility-related disabilitythe relative risks were 5.0 (95 percent confidence interval,3.0 to 8.2) and 2.1 (95 percent confidence interval, 1.4 to3.1), respectively. Individual measures of performance werealso significant predictors of disability in adjusted models.For example, the relative risks of mobility-related disabilityat four years for subjects with the poorest scores on the testsof walking, rising from a chair, and balance, as compared withthose with the best scores, were 4.8 (95 percent confidenceinterval, 2.4 to 9.6), 4.1 (95 percent confidence interval,2.3 to 7.2), and 1.9 (95 percent confidence interval, 1.2 to2.9), respectively.
Table 2. Adjusted Relative Risk of Disability at Four Years of Follow-up, According to the Summary Performance Score at Base Line.
Analyses were conducted that further restricted the base-linepopulation by excluding subjects who reported needing help inother activities of daily living (dressing or eating) or indoing heavy housework or who said they had any difficulty withlifting weights of more than 10 lb (4.5 kg); pushing or pullinga large object; stooping, crouching, or kneeling; extendingtheir arms above shoulder level; or writing or handling smallobjects (these items are derived from Nagi30). After these exclusions,there remained 400 subjects with four years of follow-up. Althoughthe number of subjects with disability at follow-up was smallin this subgroup, relations between lower-extremity functionas measured in the tests and subsequent disability were similarto those in the full cohort. At four years, the relative riskof disability in the activities of daily living was 7.1 (95percent confidence interval, 2.4 to 20.9) for subjects withsummary performance scores of 4 to 6, as compared with thosewith scores of 10 to 12, and 1.3 (95 percent confidence interval,0.6 to 2.9) for those with performance scores of 7 to 9; therelative risks of mobility-related disability were 4.2 (95 percentconfidence interval, 1.6 to 11.3) and 1.9 (95 percent confidenceinterval, 1.1 to 3.3), respectively.
Figure 2 shows the results of an analysis of a group of subjectswho had mobility-related disability but no disability in theactivities of daily living at base line; unlike the previouslydescribed analyses, it included subjects who were unable tocomplete one or more performance tests. Those with higher summaryperformance scores at base line were still less likely to havedisability in the activities of daily living and more likelyto report no disability at follow-up. Logistic-regression analysisin which we controlled for age, sex, and the number of chronicconditions showed that those with summary performance scoresof 7 or higher were 2.8 times as likely (95 percent confidenceinterval, 1.2 to 6.7 times) to have no disability at four yearsas those with scores below 7.
Figure 2. Disability Status at Four Years According to the Base-line Summary Performance Score among 359 Subjects with Mobility-Related Disability at Base Line.
ADL denotes activities of daily living.
Discussion
Our study provides strong evidence that measures of lower-extremityfunction in a nondisabled population predict the subsequentonset of disability. The performance measures showed a gradientof risk among our nondisabled subjects and could be used toidentify subgroups at very low and high risk of disability.The results were similar when the analyses were further limitedto subjects with a very high level of functioning, who reportedthat they had no difficulty or needed no help with a largergroup of activities than was used initially to select the studypopulation.
The Iowa population we studied is not representative of allolder persons, and our findings should be replicated in nonrural,racially mixed populations. The results of this study are compatiblewith the report of Seeman and colleagues16 that in a highlyfunctional but more diverse older population, poorer resultson tests of physical performance at base line were associatedwith greater decline in scores on the performance measures threeyears later. A limitation of our study is that we did not validatethe disability-outcome measures by direct observation of thesubjects in this population. A further limitation is that weincluded only the subjects who survived for four years. Nonetheless,the association of performance with disability was very similarat one and four years, indicating that lower-extremity functionpredicts the onset of disability in both the short and the longterm.
A number of risk factors for disability have been reported,including specific chronic diseases, health-related behavioralfactors, and sociodemographic characteristics.15,31,32,33 Althoughthese factors can be used to identify persons who are at increasedrisk of disability, the characterization of a functional statethat predicts disability could also be useful in studying theprocess by which people become disabled and in developing strategiesfor intervention. The World Health Organization and others haveproposed models to explain the functional consequences of disease.30,34,35Although they differ in certain aspects, these models portraya progression from disease through various stages of functionalchange that are compatible with the path from decreased lower-extremityfunction to disability that we used as the framework for thisstudy. Fried et al.36 have hypothesized the existence of a stageof preclinical disability in which there is a decrease in functionalability, a need to use compensatory strategies, and a greaterrisk of functional decline and of the onset of disability. Thedemonstration that poorer scores on tests of physical performancein subjects without disability predict the subsequent developmentof disability provides evidence that this state of preclinicaldisability can be identified.
Lower-extremity function probably predicts the subsequent developmentof disability in large part because it reflects the effectsof chronic disease, coexisting conditions, and physiologic declinethat have not yet caused frank disability. Although the presenceof certain diseases at base line was controlled for in our analyses,our data set did not include information either on an extensivelist of conditions or on the severity of the diseases that wereincluded. It is conceivable that if comprehensive data on existingdiseases, their severity, and coexisting conditions were enteredinto the models, the performance score would no longer be anindependent predictor of disability. However, disuse unrelatedto disease status, a lower level of fitness, increased susceptibilityto injury in those with impaired function, and a host of othermodifiers of the relation between disease and disability makeit unlikely that disease status alone would predict subsequentdisability. Again, the tests of physical performance might captureinformation about many of these factors, including aspects ofwell-being, such as motivation, that are hard to measure.
Alternative explanations for the findings must also be considered.Subjects with poorer scores on the performance tests may alreadyhave had mild disability that was not assessed by the questionnaireused to select the study population. In this case, the measuresof performance would have reflected the presence of mild disability,which in itself would place subjects at greater risk for subsequentserious disability. Another explanation is that those with poorerperformance scores may have stated inaccurately that they werenot disabled at base line and correctly reported their disabilityat follow-up. These two explanations are unlikely to explainour findings completely, however, since it was also shown thatthe performance measures predicted disability in analyses thatincluded only the subjects who reported no disability at baseline in a long list of functional areas.
Primary prevention of disease is the ultimate method of preventingdisability. There is also a great need for prevention amongpersons who have chronic diseases that could lead to disabilityand among those whose mild reductions in function could progressto severe disability. These results have implications for clinicaltrials of interventions to reduce the onset and progressionof disability. A number of studies have shown that interventionsmay improve characteristics such as strength, gait, and balance.37,38Our study provides evidence that subjects with higher levelsof functioning in these areas have a lower incidence of subsequentdisability. This situation is analogous to others in which anintervention is shown to affect an intermediate end point, suchas blood pressure, and epidemiologic studies have shown thatthe intermediate end point is related to an outcome of ultimateimportance, such as the incidence of stroke. The only way trulyto evaluate the efficacy of the intervention is through a randomizedclinical trial in which the outcome measure is the end pointof ultimate concern. In addition to providing evidence thatintermediate end points are related to the incidence of disability,our results suggest that measures of performance may be valuablein identifying persons who are currently not disabled but areat increased risk for subsequent disability and therefore goodcandidates for a trial of an intervention to prevent disability.
We also found that in those with moderate disability —in this case, mobility-related disability — measures oflower-extremity function were related to the worsening or improvementof disability. Trials of interventions designed to improve performancein a group such as this could lead not only to the preventionof severe disability but also to the promotion of recovery fromdisability.
Supported by a contract (N01-AG-0-2106) and a grant (AG-10127-01)from the National Institute on Aging.
We are indebted to Yong Lee and Geane Schubert for their importantcontributions in the analysis of the data.
Source Information
From the Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, Md. (J.M.G., E.M.S., M.E.S.); the Geriatrics Department, Hospital "I Fraticini," National Institute for Research and Care of the Elderly (INRCA), Florence, Italy (L.F.); and the Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City (R.B.W.).
Address reprint requests to Dr. Guralnik at the National Institute on Aging, 7201 Wisconsin Ave., Rm. 3C-309, Bethesda, MD 20892.
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(2008). Prognostic Value of Functional Performance for Mortality in Patients With Peripheral Artery Disease. J Am Coll Cardiol
51: 1482-1489
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Tomey, K. M., Sowers, M. R., Crandall, C., Johnston, J., Jannausch, M., Yosef, M.
(2008). Dietary Intake Related to Prevalent Functional Limitations in Midlife Women. Am J Epidemiol
167: 935-943
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Ershler, W. B
(2008). Influence of the Oldest Tumor Host on Tumor Biology. aacredbook
2008: 191-195
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Lauretani, F., Semba, R. D., Bandinelli, S., Dayhoff-Brannigan, M., Giacomini, V., Corsi, A. M., Guralnik, J. M., Ferrucci, L.
(2008). Low Plasma Carotenoids and Skeletal Muscle Strength Decline Over 6 Years. J. Gerontol. A Biol. Sci. Med. Sci.
63: 376-383
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Giuliani, C. A., Gruber-Baldini, A. L., Park, N. S., Schrodt, L. A., Rokoske, F., Sloane, P. D., Zimmerman, S.
(2008). Physical Performance Characteristics of Assisted Living Residents and Risk for Adverse Health Outcomes. Gerontologist
48: 203-212
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McGinn, A. P., Kaplan, R. C., Verghese, J., Rosenbaum, D. M., Psaty, B. M., Baird, A. E., Lynch, J. K., Wolf, P. A., Kooperberg, C., Larson, J. C., Wassertheil-Smoller, S.
(2008). Walking Speed and Risk of Incident Ischemic Stroke Among Postmenopausal Women. Stroke
39: 1233-1239
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Hajjar, I., Lackland, D., Cupples, L. A., Lipsitz, L. A.
(2008). Response to Blood Pressure and Disability: First Steps in Future Studies. Hypertension
51: e26-e26
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Baezner, H., Blahak, C., Poggesi, A., Pantoni, L., Inzitari, D., Chabriat, H., Erkinjuntti, T., Fazekas, F., Ferro, J. M., Langhorne, P., O'Brien, J., Scheltens, P., Visser, M. C., Wahlund, L. O., Waldemar, G., Wallin, A., Hennerici, M. G., On behalf of the LADIS Study Group,
(2008). Association of gait and balance disorders with age-related white matter changes: The LADIS Study. Neurology
70: 935-942
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Dolansky, M. A., Moore, S. M.
(2008). Older Adults' Early Disability Following a Cardiac Event. West J Nurs Res
30: 163-180
[Abstract]
(2008). Functional Outcomes for Clinical Trials in Frail Older Persons: Time To Be Moving: Working Group on Functional Outcome Measures for Clinical Trials. J. Gerontol. A Biol. Sci. Med. Sci.
63: 160-164
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Bartali, B., Frongillo, E. A., Guralnik, J. M., Stipanuk, M. H., Allore, H. G., Cherubini, A., Bandinelli, S., Ferrucci, L., Gill, T. M.
(2008). Serum Micronutrient Concentrations and Decline in Physical Function Among Older Persons. JAMA
299: 308-315
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Rejeski, W. J., King, A. C., Katula, J. A., Kritchevsky, S., Miller, M. E., Walkup, M. P., Glynn, N. W., Pahor, M., for the LIFE Investigators,
(2008). Physical Activity in Prefrail Older Adults: Confidence and Satisfaction Related to Physical Function. J. Gerontol. B Psychol. Sci. Soc. Sci.
63: P19-P26
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Alvarado, B. E., Guerra, R. O., Zunzunegui, M. V.
(2007). Gender Differences in Lower Extremity Function in Latin American Elders: Seeking Explanations From a Life-Course Perspective. J Aging Health
19: 1004-1024
[Abstract]
Peterson, M. J., Sloane, R., Cohen, H. J., Crowley, G. M., Pieper, C. F., Morey, M. C.
(2007). Effect of Telephone Exercise Counseling on Frailty in Older Veterans: Project LIFE. American Journal of Men's Health
1: 326-334
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Fantin, F., Francesco, V. D., Fontana, G., Zivelonghi, A., Bissoli, L., Zoico, E., Rossi, A., Micciolo, R., Bosello, O., Zamboni, M.
(2007). Longitudinal Body Composition Changes in Old Men and Women: Interrelationships With Worsening Disability. J. Gerontol. A Biol. Sci. Med. Sci.
62: 1375-1381
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Bouchard, D. R., Beliaeff, S., Dionne, I. J., Brochu, M.
(2007). Fat Mass But Not Fat-Free Mass Is Related to Physical Capacity in Well-Functioning Older Individuals: Nutrition as a Determinant of Successful Aging (NuAge) The Quebec Longitudinal Study. J. Gerontol. A Biol. Sci. Med. Sci.
62: 1382-1388
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Sowers, M., Tomey, K., Jannausch, M., Eyvazzadeh, A., Nan, B., Randolph, J. Jr
(2007). Physical Functioning and Menopause States. Obstet Gynecol
110: 1290-1296
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Netz, Y., Axelrad, S., Argov, E.
(2007). Group physical activity for demented older adults feasibility and effectiveness. Clin Rehabil
21: 977-986
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Corti, M.-C., Baggio, G., Sartori, L., Barbato, G., Manzato, E., Musacchio, E., Ferrucci, L., Cardinali, G., Donato, D., Launer, L. J., Zambon, S., Crepaldi, G., Guralnik, J. M.
(2007). White Matter Lesions and the Risk of Incident Hip Fracture in Older Persons: Results From the Progetto Veneto Anziani Study. Arch Intern Med
167: 1745-1751
[Abstract][Full Text]
McDermott, M. M., Guralnik, J. M., Tian, L., Ferrucci, L., Liu, K., Liao, Y., Criqui, M. H.
(2007). Baseline Functional Performance Predicts the Rate of Mobility Loss in Persons With Peripheral Arterial Disease. J Am Coll Cardiol
50: 974-982
[Abstract][Full Text]
Russo, A., Cesari, M., Onder, G., Zamboni, V., Barillaro, C., Pahor, M., Bernabei, R., Landi, F.
(2007). Depression and Physical Function: Results From the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study). J Geriatr Psychiatry Neurol
20: 131-137
[Abstract]
Landi, F., Russo, A., Cesari, M., Pahor, M., Bernabei, R., Onder, G.
(2007). HDL-cholesterol and physical performance: results from the ageing and longevity study in the sirente geographic area (ilSIRENTE Study). Age Ageing
36: 514-520
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Brach, J. S., Studenski, S. A., Perera, S., VanSwearingen, J. M., Newman, A. B.
(2007). Gait Variability and the Risk of Incident Mobility Disability in Community-Dwelling Older Adults. J. Gerontol. A Biol. Sci. Med. Sci.
62: 983-988
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Rosano, C., Aizenstein, H. J., Studenski, S., Newman, A. B.
(2007). A Regions-of-Interest Volumetric Analysis of Mobility Limitations in Community-Dwelling Older Adults. J. Gerontol. A Biol. Sci. Med. Sci.
62: 1048-1055
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Ostir, G. V., Kuo, Y.-F., Berges, I. M., Markides, K. S., Ottenbacher, K. J.
(2007). Measures of Lower Body Function and Risk of Mortality over 7 Years of Follow-up. Am J Epidemiol
166: 599-605
[Abstract][Full Text]
Conradsson, M., Lundin-Olsson, L., Lindelof, N., Littbrand, H., Malmqvist, L., Gustafson, Y., Rosendahl, E.
(2007). Berg Balance Scale: Intrarater Test-Retest Reliability Among Older People Dependent in Activities of Daily Living and Living in Residential Care Facilities. ptjournal
87: 1155-1163
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Inzitari, M., Baldereschi, M., Carlo, A. D., Bari, M. D., Marchionni, N., Scafato, E., Farchi, G., Inzitari, D., for the ILSA Working Group,
(2007). Impaired Attention Predicts Motor Performance Decline in Older Community-Dwellers With Normal Baseline Mobility: Results From the Italian Longitudinal Study on Aging (ILSA). J. Gerontol. A Biol. Sci. Med. Sci.
62: 837-843
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Takata, Y., Ansai, T., Akifusa, S., Soh, I., Yoshitake, Y., Kimura, Y., Sonoki, K., Fujisawa, K., Awano, S., Kagiyama, S., Hamasaki, T., Nakamichi, I., Yoshida, A., Takehara, T.
(2007). Physical Fitness and 4-Year Mortality in an 80-Year-Old Population. J. Gerontol. A Biol. Sci. Med. Sci.
62: 851-858
[Abstract][Full Text]
Piva, S. R, Goodnite, E. A, Azuma, K., Woollard, J. D, Goodpaster, B. H, Wasko, M. C., Fitzgerald, G K.
(2007). Neuromuscular Electrical Stimulation and Volitional Exercise for Individuals With Rheumatoid Arthritis: A Multiple-Patient Case Report. ptjournal
87: 1064-1077
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Sims, R. V., Ahmed, A., Sawyer, P., Allman, R. M.
(2007). Self-Reported Health and Driving Cessation in Community-Dwelling Older Drivers. J. Gerontol. A Biol. Sci. Med. Sci.
62: 789-793
[Abstract][Full Text]
Eugenia Alvarado, B., Victoria Zunzunegui, M., Beland, F., Sicotte, M., Tellechea, L.
(2007). Social and Gender Inequalities in Depressive Symptoms Among Urban Older Adults of Latin America and the Caribbean. J. Gerontol. B Psychol. Sci. Soc. Sci.
62: S226-S236
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Maraldi, C., Volpato, S., Penninx, B. W., Yaffe, K., Simonsick, E. M., Strotmeyer, E. S., Cesari, M., Kritchevsky, S. B., Perry, S., Ayonayon, H. N., Pahor, M.
(2007). Diabetes Mellitus, Glycemic Control, and Incident Depressive Symptoms Among 70- to 79-Year-Old Persons: The Health, Aging, and Body Composition Study. Arch Intern Med
167: 1137-1144
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Wicherts, I. S., van Schoor, N. M., Boeke, A. J. P., Visser, M., Deeg, D. J. H., Smit, J., Knol, D. L., Lips, P.
(2007). Vitamin D Status Predicts Physical Performance and Its Decline in Older Persons. J. Clin. Endocrinol. Metab.
92: 2058-2065
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Ruo, B., Liu, K., Tian, L., Tan, J., Ferrucci, L., Guralnik, J. M., McDermott, M. M.
(2007). Persistent Depressive Symptoms and Functional Decline Among Patients With Peripheral Arterial Disease. Psychosom. Med.
69: 415-424
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Patel, K. V., Harris, T. B., Faulhaber, M., Angleman, S. B., Connelly, S., Bauer, D. C., Kuller, L. H., Newman, A. B., Guralnik, J. M., for the Health, Aging, and Body Composition Study,
(2007). Racial variation in the relationship of anemia with mortality and mobility disability among older adults. Blood
109: 4663-4670
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Rodin, M. B., Mohile, S. G.
(2007). A Practical Approach to Geriatric Assessment in Oncology. JCO
25: 1936-1944
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Sainio, P., Martelin, T., Koskinen, S., Heliovaara, M.
(2007). Educational differences in mobility: the contribution of physical workload, obesity, smoking and chronic conditions. J. Epidemiol. Community Health
61: 401-408
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Jinks, C., Jordan, K., Croft, P.
(2007). Osteoarthritis as a public health problem: the impact of developing knee pain on physical function in adults living in the community: (KNEST 3). Rheumatology (Oxford)
46: 877-881
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Hilmer, S. N., Mager, D. E., Simonsick, E. M., Cao, Y., Ling, S. M., Windham, B. G., Harris, T. B., Hanlon, J. T., Rubin, S. M., Shorr, R. I., Bauer, D. C., Abernethy, D. R.
(2007). A Drug Burden Index to Define the Functional Burden of Medications in Older People. Arch Intern Med
167: 781-787
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Kuo, H.-K., Liao, K.-C., Leveille, S. G., Bean, J. F., Yen, C.-J., Chen, J.-H., Yu, Y.-H., Tai, T.-Y.
(2007). Relationship of Homocysteine Levels to Quadriceps Strength, Gait Speed, and Late-Life Disability in Older Adults. J. Gerontol. A Biol. Sci. Med. Sci.
62: 434-439
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Host, H. H, Sinacore, D. R, Bohnert, K. L, Steger-May, K., Brown, M., Binder, E. F
(2007). Training-Induced Strength and Functional Adaptations After Hip Fracture. ptjournal
87: 292-303
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de Bruin, E. D, Murer, K.
(2007). Effect of additional functional exercises on balance in elderly people. Clin Rehabil
21: 112-121
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Weiss, C. O., Fried, L. P., Bandeen-Roche, K.
(2007). Exploring the Hierarchy of Mobility Performance in High-Functioning Older Women. J. Gerontol. A Biol. Sci. Med. Sci.
62: 167-173
[Abstract][Full Text]
Inzitari, D., Simoni, M., Pracucci, G., Poggesi, A., Basile, A. M., Chabriat, H., Erkinjuntti, T., Fazekas, F., Ferro, J. M., Hennerici, M., Langhorne, P., O'Brien, J., Barkhof, F., Visser, M. C., Wahlund, L.-O., Waldemar, G., Wallin, A., Pantoni, L., for the LADIS Study Group,
(2007). Risk of Rapid Global Functional Decline in Elderly Patients With Severe Cerebral Age-Related White Matter Changes: The LADIS Study. Arch Intern Med
167: 81-88
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Sachs-Ericsson, N., Schatschneider, C., Blazer, D. G.
(2006). Perception of unmet basic needs as a predictor of physical functioning among community-dwelling older adults.. J Aging Health
18: 852-868
[Abstract]
Yanagita, M., Willcox, B. J., Masaki, K. H., Chen, R., He, Q., Rodriguez, B. L., Ueshima, H., Curb, J. D.
(2006). Disability and Depression: Investigating a Complex Relation Using Physical Performance Measures. AJGP
14: 1060-1068
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Hughes, S. L., Seymour, R. B., Campbell, R. T., Huber, G., Pollak, N., Sharma, L., Desai, P.
(2006). Long-Term Impact of Fit and Strong! on Older Adults With Osteoarthritis. Gerontologist
46: 801-814
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Ferrucci, L., Simonsick, E. M.
(2006). A Little Exercise. J. Gerontol. A Biol. Sci. Med. Sci.
61: 1154-1156
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The LIFE Study Investigators* [*See Appendix for L,
(2006). Effects of a Physical Activity Intervention on Measures of Physical Performance: Results of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Study. J. Gerontol. A Biol. Sci. Med. Sci.
61: 1157-1165
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Forrest, K. Y. Z., Zmuda, J. M., Cauley, J. A.
(2006). Correlates of Decline in Lower Extremity Performance in Older Women: A 10-Year Follow-Up Study. J. Gerontol. A Biol. Sci. Med. Sci.
61: 1194-1200
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Avlund, K., Rantanen, T., Schroll, M.
(2006). Tiredness and Subsequent Disability in Older Adults: The Role of Walking Limitations. J. Gerontol. A Biol. Sci. Med. Sci.
61: 1201-1205
[Abstract][Full Text]
Orwoll, E., Lambert, L. C., Marshall, L. M., Blank, J., Barrett-Connor, E., Cauley, J., Ensrud, K., Cummings, S. R., for the Osteoporotic Fractures in Men Study Group,
(2006). Endogenous testosterone levels, physical performance, and fall risk in older men.. Arch Intern Med
166: 2124-2131
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Williams, C. S., Tinetti, M. E., Kasl, S. V., Peduzzi, P. N.
(2006). The Role of Pain in the Recovery of Instrumental and Social Functioning After Hip Fracture.. J Aging Health
18: 743-762
[Abstract]
Ortega-Alonso, A., Pedersen, N. L., Kujala, U. M., Sipila, S., Tormakangas, T., Kaprio, J., Koskenvuo, M., Rantanen, T.
(2006). A twin study on the heritability of walking ability among older women.. J. Gerontol. A Biol. Sci. Med. Sci.
61: 1082-1085
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Toth, M. J., Sites, C. K., Matthews, D. E., Casson, P. R.
(2006). Ovarian suppression with gonadotropin-releasing hormone agonist reduces whole body protein turnover in women. Am. J. Physiol. Endocrinol. Metab.
291: E483-E490
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Dominguez, L. J, Barbagallo, M., Lauretani, F., Bandinelli, S., Bos, A., Corsi, A. M., Simonsick, E. M, Ferrucci, L.
(2006). Magnesium and muscle performance in older persons: the InCHIANTI study.. Am. J. Clin. Nutr.
84: 419-426
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Kuh, D., Hardy, R., Butterworth, S., Okell, L., Richards, M., Wadsworth, M., Cooper, C., Sayer, A. A.
(2006). Developmental Origins of Midlife Physical Performance: Evidence from a British Birth Cohort. Am J Epidemiol
164: 110-121
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Bischoff-Ferrari, H. A, Giovannucci, E., Willett, W. C, Dietrich, T., Dawson-Hughes, B.
(2006). Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am. J. Clin. Nutr.
84: 18-28
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Russo, A, Onder, G, Cesari, M, Zamboni, V, Barillaro, C, Capoluongo, E, Pahor, M, Bernabei, R, Landi, F
(2006). Lifetime occupation and physical function: a prospective cohort study on persons aged 80 years and older living in a community.. Occup. Environ. Med.
63: 438-442
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Guralnik, J. M., Butterworth, S., Wadsworth, M. E. J., Kuh, D.
(2006). Childhood socioeconomic status predicts physical functioning a half century later.. J. Gerontol. A Biol. Sci. Med. Sci.
61: 694-701
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Asikainen, T.-M., Suni, J. H, Pasanen, M. E, Oja, P., Rinne, M. B, Miilunpalo, S. I, Nygard, C.-H. A, Vuori, I. M
(2006). Effect of Brisk Walking in 1 or 2 Daily Bouts and Moderate Resistance Training on Lower-Extremity Muscle Strength, Balance, and Walking Performance in Women Who Recently Went Through Menopause: A Randomized, Controlled Trial. ptjournal
86: 912-923
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Ayis, S., Gooberman-Hill, R., Bowling, A., Ebrahim, S.
(2006). Predicting catastrophic decline in mobility among older people. Age Ageing
35: 382-387
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Newman, A. B., Simonsick, E. M., Naydeck, B. L., Boudreau, R. M., Kritchevsky, S. B., Nevitt, M. C., Pahor, M., Satterfield, S., Brach, J. S., Studenski, S. A., Harris, T. B.
(2006). Association of Long-Distance Corridor Walk Performance With Mortality, Cardiovascular Disease, Mobility Limitation, and Disability. JAMA
295: 2018-2026
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Villareal, D. T., Banks, M., Sinacore, D. R., Siener, C., Klein, S.
(2006). Effect of Weight Loss and Exercise on Frailty in Obese Older Adults.. Arch Intern Med
166: 860-866
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Prince, R. L., Devine, A., Dhaliwal, S. S., Dick, I. M.
(2006). Effects of Calcium Supplementation on Clinical Fracture and Bone Structure: Results of a 5-Year, Double-blind, Placebo-Controlled Trial in Elderly Women.. Arch Intern Med
166: 869-875
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McDermott, M. M., Liu, K., Guralnik, J. M., Ferrucci, L., Green, D., Greenland, P., Tian, L., Criqui, M. H., Lo, C., Rifai, N., Ridker, P. M., Zheng, J., Pearce, W.
(2006). Functional decline in patients with and without peripheral arterial disease: predictive value of annual changes in levels of C-reactive protein and d-dimer.. J. Gerontol. A Biol. Sci. Med. Sci.
61: 374-379
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Kuo, H.-K., Bean, J. F., Yen, C.-J., Leveille, S. G.
(2006). Linking C-Reactive Protein to Late-Life Disability in the National Health and Nutrition Examination Survey (NHANES) 1999-2002.. J. Gerontol. A Biol. Sci. Med. Sci.
61: 380-387
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Littbrand, H., Rosendahl, E., Lindelof, N., Lundin-Olsson, L., Gustafson, Y., Nyberg, L.
(2006). A High-Intensity Functional Weight-Bearing Exercise Program for Older People Dependent in Activities of Daily Living and Living in Residential Care Facilities: Evaluation of the Applicability With Focus on Cognitive Function. ptjournal
86: 489-498
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Lopopolo, R. B, Greco, M., Sullivan, D., Craik, R. L, Mangione, K. K
(2006). Effect of Therapeutic Exercise on Gait Speed in Community-Dwelling Elderly People: A Meta-analysis. ptjournal
86: 520-540
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Giri, J., McDermott, M. M., Greenland, P., Guralnik, J. M., Criqui, M. H., Liu, K., Ferrucci, L., Green, D., Schneider, J. R., Tian, L.
(2006). Statin Use and Functional Decline in Patients With and Without Peripheral Arterial Disease. J Am Coll Cardiol
47: 998-1004
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Wallsten, S. M., Bintrim, K., Denman, D. W., Parrish, J. M., Hughes, G.
(2006). The Effect of Tai Chi Chuan on Confidence and Lower Extremity Strength and Balance in Residents Living Independently at a Continuing Care Retirement Community. Journal of Applied Gerontology
25: 82-95
[Abstract]
McDermott, M. M., Liu, K., Ferrucci, L., Criqui, M. H., Greenland, P., Guralnik, J. M., Tian, L., Schneider, J. R., Pearce, W. H., Tan, J., Martin, G. J.
(2006). Physical Performance in Peripheral Arterial Disease: A Slower Rate of Decline in Patients Who Walk More. ANN INTERN MED
144: 10-20
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Coppin, A. K., Ferrucci, L., Lauretani, F., Phillips, C., Chang, M., Bandinelli, S., Guralnik, J. M.
(2006). Low Socioeconomic Status and Disability in Old Age: Evidence From the InChianti Study for the Mediating Role of Physiological Impairments. J. Gerontol. A Biol. Sci. Med. Sci.
61: 86-91
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Keysor, J. J., Dunn, J. E., Link, C. L., Badlissi, F., Felson, D. T.
(2005). Are Foot Disorders Associated With Functional Limitation and Disability Among Community-Dwelling Older Adults?. J Aging Health
17: 734-752
[Abstract]
Volpato, S., Leveille, S. G., Blaum, C., Fried, L. P., Guralnik, J. M.
(2005). Risk Factors for Falls in Older Disabled Women With Diabetes: The Women's Health and Aging Study. J. Gerontol. A Biol. Sci. Med. Sci.
60: 1539-1545
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Carter, C. S., Onder, G., Kritchevsky, S. B., Pahor, M.
(2005). Angiotensin-Converting Enzyme Inhibition Intervention in Elderly Persons: Effects on Body Composition and Physical Performance. J. Gerontol. A Biol. Sci. Med. Sci.
60: 1437-1446
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Montero-Odasso, M., Schapira, M., Soriano, E. R., Varela, M., Kaplan, R., Camera, L. A., Mayorga, L. M.
(2005). Gait Velocity as a Single Predictor of Adverse Events in Healthy Seniors Aged 75 Years and Older. J. Gerontol. A Biol. Sci. Med. Sci.
60: 1304-1309
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Bruce, D. G., Davis, W. A., Davis, T. M.E.
(2005). Longitudinal Predictors of Reduced Mobility and Physical Disability in Patients With Type 2 Diabetes: The Fremantle Diabetes Study. Diabetes Care
28: 2441-2447
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Whitney, S. L, Wrisley, D. M, Marchetti, G. F, Gee, M. A, Redfern, M. S, Furman, J. M
(2005). Clinical Measurement of Sit-to-Stand Performance in People With Balance Disorders: Validity of Data for the Five-Times-Sit-to-Stand Test. ptjournal
85: 1034-1045
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van der Flier, W. M., van Straaten, E. C.W., Barkhof, F., Verdelho, A., Madureira, S., Pantoni, L., Inzitari, D., Erkinjuntti, T., Crisby, M., Waldemar, G., Schmidt, R., Fazekas, F., Scheltens, P., on behalf of the LADIS Study Group,
(2005). Small Vessel Disease and General Cognitive Function in Nondisabled Elderly: The LADIS Study. Stroke
36: 2116-2120
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Elbaz, A., Ripert, M., Tavernier, B., Fevrier, B., Zureik, M., Gariepy, J., Alperovitch, A., Tzourio, C.
(2005). Common Carotid Artery Intima-Media Thickness, Carotid Plaques, and Walking Speed. Stroke
36: 2198-2202
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Al Snih, S., Fisher, M. N., Raji, M. A., Markides, K. S., Ostir, G. V., Goodwin, J. S.
(2005). Diabetes Mellitus and Incidence of Lower Body Disability Among Older Mexican Americans. J. Gerontol. A Biol. Sci. Med. Sci.
60: 1152-1156
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West, S. K., Munoz, B., Rubin, G. S., Bandeen-Roche, K., Broman, A. T., Turano, K. A.
(2005). Compensatory Strategy Use Identifies Risk of Incident Disability for the Visually Impaired. Arch Ophthalmol
123: 1242-1247
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Collins, T. C, Petersen, N. J, Suarez-Almazor, M.
(2005). Peripheral arterial disease symptom subtype and walking impairment. Vasc Med
10: 177-183
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Deathe, A B., Miller, W. C
(2005). The L Test of Functional Mobility: Measurement Properties of a Modified Version of the Timed "Up & Go" Test Designed for People With Lower-Limb Amputations. ptjournal
85: 626-635
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Reid, M. C., Williams, C. S., Gill, T. M.
(2005). Back Pain and Decline in Lower Extremity Physical Function Among Community-Dwelling Older Persons. J. Gerontol. A Biol. Sci. Med. Sci.
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