Mobility as a predictor of all-cause mortality in older men and women: 11.8 year follow-up in the Tromsø study

Astrid Bergland, Lone Jørgensen, Nina Emaus, Bjørn Heine Strand, Astrid Bergland, Lone Jørgensen, Nina Emaus, Bjørn Heine Strand

Abstract

Background: Disability in older adults is associated with loss of independence, institutionalization, and death. The aim of this study was to study the association between the Timed Up and Go (TUG) test and all-cause mortality in a population-based sample of older men and women.

Methods: Our study population was home dwellers aged 65 and above, who participated in the fifth wave of the Tromsø study. This study included the TUG test and a range of lifestyle and mortality predictors. Participants were linked to the Cause of Death Registry and followed up for mortality for a maximum of 11.8 years. Cox regression was used to investigate the association between TUG and total mortality.

Results: Mean TUG score was 12.6 s, and men performed better than women. The oldest participants had poorer TUG score compared to younger participants, increasing 0.25 s per year. There was a significant association between TUG and all-cause mortality, and the association was equally strong in men and women. Across the TUG-score categories, from quickest fifth to slowest fifth, the mortality increased in a step-wise fashion. Compared to the quickest fifth, the slowest fifth had hazard ratio (HR) of 1.79 (95% confidence interval (CI) 1.33, 2.42) in a model adjusted for age and gender. For each standard deviation TUG-score the increase in HR was 1.23 (95% CI 1.14, 1.33). The association between the TUG score and mortality remained significant after adjusting for self-reported health, body mass index, smoking and education.

Conclusions: A significant association between the TUG score and mortality was observed in both men and women. Identifying older people with poor TUG may aid in identifying those at risk and thus targeted interventions may be applied.

Keywords: Mobility; Mortality; Predictors; Self-rated health.

References

    1. Guralnik JM, Fried LP, Salive ME. Disability as a public health outcome in the aging population. Annu Rev Public Health. 1996;17(1):25–46. doi: 10.1146/annurev.pu.17.050196.000325.
    1. Rula EY, Pope JE, Hoffman JC. Potential Medicare savings through prevention and risk reduction. Popul Health Manag. 2011;14(S1):35–44.
    1. Allen SM, Ciambrone D. Community care for people with disability: blurring boundaries between formal and informal caregivers. Qual Health Res. 2003;13(2):207–226. doi: 10.1177/1049732302239599.
    1. Anderson G, Knickman JR. Changing the chronic care system to meet people’s needs. Health Aff. 2001;20(6):146–160. doi: 10.1377/hlthaff.20.6.146.
    1. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255–263. doi: 10.1093/gerona/59.3.M255.
    1. Van Nostrand JF, Miller B, Furner SE. Selected issues in long-term care: profile of cognitive disability of nursing home residents and the use of informal and formal care by elderly in the community. Vital Health Stat 3. 1993;27:143–185.
    1. Wolinsky FD, Culler SD, Callahan CM, Johnson RJ. Hospital resource consumption among older adults: a prospective analysis of episodes, length of stay, and charges over a seven-year period. J Gerontol. 1994;49(5):240–252. doi: 10.1093/geronj/49.5.S240.
    1. Bernard SL, Kincade JE, Konrad TR, Arcury TA, Rabiner DJ, Woomert A, et al. Predicting mortality from community surveys of older adults: the importance of self-rated functional ability. J Gerontol Ser B Psychol Sci Soc Sci. 1997;52(3):155–163. doi: 10.1093/geronb/52B.3.S155.
    1. Fried LP, Kronmal Richard A, Newman Anne B, Bild Diane E, Mittelmark Maurice B, Polak Joseph F, et al. Risk factors for 5-year mortality in older adults. J Am Med Assoc. 1998;279(8):585–592. doi: 10.1001/jama.279.8.585.
    1. Kattainen A, Reunanen A, Koskinen S, Martelin T, Knekt P, Aromaa A. Disability predicted mortality in men but not women with coronary heart disease. J Clin Epidemiol. 2004;57(5):513–521. doi: 10.1016/j.jclinepi.2003.10.004.
    1. Lamarca R, Ferrer M, Andersen PK, Liestol K, Keiding N, Alonso J. A changing relationship between disability and survival in the elderly population: differences by age. J Clin Epidemiol. 2003;56(12):1192–1201. doi: 10.1016/S0895-4356(03)00201-4.
    1. Pudaric S, Sundquist J, Johansson S-E. Country of birth, instrumental activities of daily living, self-rated health and mortality: a Swedish population-based survey of people aged 55–74. Soc Sci Med. 2003;56(12):2493–2503. doi: 10.1016/S0277-9536(02)00284-8.
    1. Scott WK, Macera CA, Cornman CB, Sharpe PA. Functional health status as a predictor of mortality in men and women over 65. J Clin Epidemiol. 1997;50(3):291–296. doi: 10.1016/S0895-4356(96)00365-4.
    1. Tager IB, Haight TJ, Hollenberg M, Satariano WA. Physical functioning and mortality in older women: an assessment of energy costs and level of difficulty. J Clin Epidemiol. 2003;56(8):807–813. doi: 10.1016/S0895-4356(03)00149-5.
    1. van den Brink CL, Tijhuis M, van den Bos GA, Giampaoli S, Nissinen A, Kromhout D. The contribution of self-rated health and depressive symptoms to disability severity as a predictor of 10-year mortality in European elderly men. Am J Public Health. 2005;95(11):2029–2034. doi: 10.2105/AJPH.2004.050914.
    1. Mänty M, Heinonen A, Leinonen R, Törmäkangas T, Sakari-Rantala R, Hirvensalo M, et al. Construct and predictive validity of a self-reported measure of preclinical mobility limitation. Arch Phys Med Rehabil. 2007;88(9):1108–1113. doi: 10.1016/j.apmr.2007.06.016.
    1. Gill TM, Gahbauer EA, Murphy TE, Han L, Allore HG. Risk factors and precipitants of long-term disability in community mobility: a cohort study of older persons. Ann Intern Med. 2012;156(2):131–140. doi: 10.7326/0003-4819-156-2-201201170-00009.
    1. Gorgon E, Said C, Galea M. Mobility on discharge from an aged care unit. Physiother Res Int. 2007;12(2):72–81. doi: 10.1002/pri.348.
    1. Ruuskanen J, Ruoppila I. Physical activity and psychological well-being among people aged 65 to 84 years. Age Ageing. 1995;24(4):292–296. doi: 10.1093/ageing/24.4.292.
    1. Tacken M. Mobility of the elderly in time and space in the Netherlands: an analysis of the Dutch National Travel Survey. Transportation. 1998;25(4):379–393. doi: 10.1023/A:1005042614848.
    1. Ferrucci L, Bandinell S, Benvenuti E, Di Iorio A, Macchi C, Harris T, et al. Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. Am Geriatr Soc. 2000;48(12):1618–1625. doi: 10.1111/j.1532-5415.2000.tb03873.x.
    1. Cooper KM, Bilbrew D, Dubbert PM, Kerr K, Kirchner K. Health barriers to walking for exercise in elderly primary care. Geriatr Nurs. 2001;22(5):258–262. doi: 10.1067/mgn.2001.119470.
    1. Studenski S. Bradypedia: is gait speed ready for clinical use? J Nutr Health Aging. 2009;13(10):878–880. doi: 10.1007/s12603-009-0245-0.
    1. Buchner DM. One lap around the track: the standard for mobility disability? J Gerontol A Biol Sci Med Sci. 2008;63(6):586–587. doi: 10.1093/gerona/63.6.586.
    1. Chaudhry SI, McAvay G, Ning Y, Allore HG, Newman AB, Gill TM. Geriatric impairments and disability: the cardiovascular health study. J Am Geriatr Soc. 2010;58(9):1686–1692. doi: 10.1111/j.1532-5415.2010.03022.x.
    1. Hardy SE, Kang Y, Studenski SA, Degenholtz HB. Ability to walk 1/4 mile predicts subsequent disability, mortality, and health care costs. J Gen Intern Med. 2011;26(2):130–135. doi: 10.1007/s11606-010-1543-2.
    1. Wang C-Y, Yeh C-J, Hu M-H. Mobility-related performance tests to predict mobility disability at 2-year follow-up in community-dwelling older adults. Arch Gerontol Geriatr. 2011;52(1):1–4. doi: 10.1016/j.archger.2009.11.001.
    1. Guralnik JM, Branch LG, Cummings SR, Curb JD. Physical performance measures in aging research. J Gerontol. 1989;44(5):141–146. doi: 10.1093/geronj/44.5.M141.
    1. Guralnik JM, LaCroix AZ, Abbott RD, Berkman LF, Satterfield S, Evans DA, et al. Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. Am J Epidemiol. 1993;137(8):845–857.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, 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(2):85–94. doi: 10.1093/geronj/49.2.M85.
    1. Ayis S, Gooberman-Hill R, Bowling A, Ebrahim S. Predicting catastrophic decline in mobility among older people. Age Ageing. 2006;35(4):382–387. doi: 10.1093/ageing/afl004.
    1. Clark DO, Stump TE, Hui SL, Wolinsky FD. Predictors of mobility and basic ADL difficulty among adults aged 70 years and older. J Aging Health. 1998;10(4):422–440. doi: 10.1177/089826439801000402.
    1. Buchman AS, Wilson RS, Boyle PA, Tang Y, Fleischman DA, Bennett DA. Physical activity and leg strength predict decline in mobility performance in older persons. J Am Geriatr Soc. 2007;55(10):1618–1623. doi: 10.1111/j.1532-5415.2007.01359.x.
    1. Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci. 2005;60(3):324–333. doi: 10.1093/gerona/60.3.324.
    1. American Geriatrics Society, Geriatrics Society, Orthopaedic Surgeons Panel On Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49(5):664–72. .
    1. Lin MR, Hwang HF, Hu MH, Wu HDI, Wang YW, Huang FC. Psychometric comparisons of the timed Up and Go, one‐leg stand, functional reach, and tinetti balance measures in community‐dwelling older people. J Am Geriatr Soc. 2004;52(8):1343–1348. doi: 10.1111/j.1532-5415.2004.52366.x.
    1. Eekhof JAH, De Bock GH, Schaapveld K, Springer MP. Short report: functional mobility assessment at home. Timed up and go test using three different chairs. Can Fam Physician. 2001;47(6):1205–1207.
    1. Samson MM, Meeuwsen I, Crowe A, Dessens J, Duursma SA, Verhaar H. Relationships between physical performance measures, age, height and body weight in healthy adults. Age Ageing. 2000;29(3):235–242. doi: 10.1093/ageing/29.3.235.
    1. Bischoff HA, Stähelin HB, Monsch AU, Iversen MD, Weyh A, von Dechend M, et al. Identifying a cut‐off point for normal mobility: a comparison of the timed ‘up and go’test in community‐dwelling and institutionalised elderly women. Age Ageing. 2003;32(3):315–320. doi: 10.1093/ageing/32.3.315.
    1. Bohannon RW. Reference values for the timed Up and Go test: a descriptive meta‐analysis. J Geriatr Phys Ther. 2006;29(2):64–68. doi: 10.1519/00139143-200608000-00004.
    1. Rydwik E, Bergland A, Forsén L, Frändin K. Psychometric properties of timed Up and Go in elderly people: a systematic review. Phys Occup Ther Geriatr. 2011;29(2):102–125. doi: 10.3109/02703181.2011.564725.
    1. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2014;14(1):14. doi: 10.1186/1471-2318-14-14.
    1. Schoene D, Wu SMS, Mikolaizak AS, Menant JC, Smith ST, Delbaere K, et al. Discriminative ability and predictive validity of the timed Up and Go test in identifying older people who fall: systematic review and meta‐analysis. J Am Geriatr Soc. 2013;61(2):202–208. doi: 10.1111/jgs.12106.
    1. Thrane G, Joakimsen RM, Thornquist E. The association between timed up and go test and history of falls: the Tromsø study. BMC Geriatr. 2007;7(1):1. doi: 10.1186/1471-2318-7-1.
    1. Viccaro LJ, Perera S, Studenski SA. Is timed up and go better than gait speed in predicting health, function, and falls in older adults? J Am Geriatr Soc. 2011;59(5):887–892. doi: 10.1111/j.1532-5415.2011.03336.x.
    1. Shimada H, Sawyer P, Harada K, Kaneya S, Nihei K, Asakawa Y, et al. Predictive validity of the classification schema for functional mobility tests in instrumental activities of daily living decline among older adults. Arch Phys Med Rehabil. 2010;91(2):241–246. doi: 10.1016/j.apmr.2009.10.027.
    1. 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. doi: 10.1111/j.1532-5415.2010.02820.x.
    1. Davis DH, Rockwood MR, Mitnitski AB, Rockwood K. Impairments in mobility and balance in relation to frailty. Arch Gerontol Geriatr. 2011;53(1):79–83. doi: 10.1016/j.archger.2010.06.013.
    1. Austin N, Devine A, Dick I, Prince R, Bruce D. Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors. J Am Geriatr Soc. 2007;55(10):1598–1603. doi: 10.1111/j.1532-5415.2007.01317.x.
    1. Tiainen K, Luukkaala T, Hervonen A, Jylhä M. Predictors of mortality in men and women aged 90 and older: a nine-year follow-up study in the vitality 90+ study. Age Ageing. 2013;42(4):468–475. doi: 10.1093/ageing/aft030.
    1. De Buyser SL, Petrovic M, Taes YE, Toye KR, Kaufman JM, Goemaere S. Physical function measurements predict mortality in ambulatory older men. Eur J Clin Investig. 2013;43(4):379–386. doi: 10.1111/eci.12056.
    1. Idland G, Engedal K, Bergland A. Physical performance and 13.5-year mortality in elderly women. Scand J Public Health. 2013;41(1):102–108. doi: 10.1177/1403494812466460.
    1. Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I. Cohort profile: the Tromsø study. Int J Epidemiol. 2012;41(4):961–967. doi: 10.1093/ije/dyr049.
    1. Podsiadlo D, Richardson S. The timed“Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–148. doi: 10.1111/j.1532-5415.1991.tb01616.x.
    1. Hoshide S, Ishikawa J, Eguchi K, Oowada T, Shimada K, Kario K. Cognitive dysfunction and physical disability are associated with mortality in extremely elderly patients. Hypertens Res. 2008;31(7):1331–1338. doi: 10.1291/hypres.31.1331.
    1. Roshanravan B, Robinson-Cohen C, Patel KV, Ayers E, Littman AJ, de Boer IH, et al. Association between physical performance and all-cause mortality in CKD. J Am Soc Nephrol. 2013;24(5):822–830. doi: 10.1681/ASN.2012070702.
    1. Soubeyran P, Fonck M, Blanc-Bisson C, Blanc J-F, Ceccaldi J, Mertens C, et al. Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol. 2012;30(15):1829–1834. doi: 10.1200/JCO.2011.35.7442.
    1. Tice JA, Kanaya A, Hue T, Rubin S, Buist DS, LaCroix A, et al. Risk factors for mortality in middle-aged women. Arch Intern Med. 2006;166(22):2469–2477. doi: 10.1001/archinte.166.22.2469.
    1. Robinson TN, Wu DS, Sauaia A, Dunn CL, Stevens-Lapsley JE, Moss M, et al. Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties. Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties. Ann Surg. 2013;258(4):582–588.
    1. Donoghue OA, Horgan NF, Savva GM, Cronin H, O’Regan C, Kenny RA. Association between timed Up‐and‐Go and memory, executive function, and processing speed. J Am Geriatr Soc. 2012;60(9):1681–1686. doi: 10.1111/j.1532-5415.2012.04120.x.
    1. Savva GM, Donoghue OA, Horgan F, O’Regan C, Cronin H, Kenny RA. Using timed up-and-go to identify frail members of the older population. J Gerontol A Biol Sci Med Sci. 2013;68(4):441–446. doi: 10.1093/gerona/gls190.
    1. Rosano C, Aizenstein H, Brach J, Longenberger A, Studenski S, Newman AB. Special article gait measures indicate underlying focal gray matter atrophy in the brain of older adults. J Gerontol A Biol Sci Med Sci. 2008;63(12):1380–1388. doi: 10.1093/gerona/63.12.1380.
    1. Rosano C, Brach J, Longstreth JW, Newman AB. Quantitative measures of gait characteristics indicate prevalence of underlying subclinical structural brain abnormalities in high-functioning older adults. Neuroepidemiology. 2005;26(1):52–60. doi: 10.1159/000089240.
    1. Rosano C, Brach J, Studenski S, Longstreth W, Jr, Newman AB. Gait variability is associated with subclinical brain vascular abnormalities in high-functioning older adults. Neuroepidemiology. 2007;29(3–4):193–200. doi: 10.1159/000111582.
    1. Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis. 2008;51(3):395–406. doi: 10.1053/j.ajkd.2007.11.018.
    1. Van Kan GA, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging. 2009;13(10):881–889. doi: 10.1007/s12603-009-0246-z.
    1. Blain H, Carriere I, Sourial N, Berard C, Favier F, Colvez A, et al. Balance and walking speed predict subsequent 8-year mortality independently of current and intermediate events in well-functioning women aged 75 years and older. J Nutr Health Aging. 2010;14(7):595–600. doi: 10.1007/s12603-010-0111-0.
    1. Ingemarsson AH, Frandin K, Mellstrom D, Moller M. Walking ability and activity level after hip fracture in the elderly–a follow-up. J Rehabil Med. 2003;35(2):76–83. doi: 10.1080/16501970306113.
    1. Pondal M, del Ser T. Normative data and determinants for the timed “Up and Go” test in a population‐based sample of elderly individuals without gait disturbances. J Geriatr Phys Ther. 2008;31(2):57–63. doi: 10.1519/00139143-200831020-00004.
    1. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: six-minute walk test, berg balance scale, timed Up & Go test, and gait speeds. Phys Ther. 2002;82(2):128–137.
    1. Vereeck L, Wuyts F, Truijen S, Van de Heyning P. Clinical assessment of balance: normative data, and gender and age effects. Int J Audiol. 2008;47(2):67–75. doi: 10.1080/14992020701689688.
    1. Bohannon RW, Bubela DJ, Magasi SR, Gershon RC. Relative reliability of three objective tests of limb muscle strength. Isokinetics Exerc Sci. 2011;19(2): 10.3233/IES-2011-0400.
    1. Langhammer A, Krokstad S, Romundstad P, Heggland J, Holmen J. The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms. BMC Med Res Methodol. 2012;12(1):143. doi: 10.1186/1471-2288-12-143.
    1. Hesseberg K, Bergland A, Rydwik E, Brovold T. Physical fitness in older people recently diagnosed with cognitive impairment compared to older people recently discharged from hospital. Dement Geriatr Cogn Dis Extra. 2016;6(3):396–406. doi: 10.1159/000447534.
    1. Hesseberg K, Bentzen H, Ranhoff AH, Engedal K, Bergland A. P physical fitness in older people with mild cognitive impairment and dementia. J Aging Phys Act. 2016;24(1):92–100. doi: 10.1123/japa.2014-0202.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir