Motor and Physical Function Impairments as Contributors to Slow Gait Speed and Mobility Difficulty in Middle-Aged and Older Adults

Background Motor function impacts ability to perform daily activities and maintain independence. Yet, the interrelatedness of upper and lower extremity motor impairments and the magnitude of their contribution to slow gait and mobility difficulty are not well investigated. Methods Participants in the Baltimore Longitudinal Study of Aging (N=728, aged 50-99) completed motor and physical function tests including grip and knee extension strength, pegboard, finger tapping, standing balance, chair stands, fast-paced 400m walk, and usual gait speed. Slow gait was defined as usual gait speed <1.0m/s. Mobility difficulty was defined as self-reported difficulty walking ¼ mile or climbing stairs. Structural equation modeling (SEM) examined the interrelationships of motor measures and their contributions to slow gait and mobility difficulty, adjusting for demographics and comorbidities. Results Poorer manual dexterity (-0.571 standard deviation (SD) units, p<0.001) and lower muscle strength (upper and lower extremity) (-0.447 SD units, p=0.014) were most strongly associated with slow gait speed, followed by slower chair stand pace (-0.195 SD units, p=0.002) and greater lap time variation (0.102 SD units, p=0.028). Lower muscle strength (-0.582 SD units, p=0.001) was most strongly associated with mobility difficulty, followed by slower chair stand pace (-0.322 SD units, p<0.001), slower gait speed (-0.247 SD units, p<0.001), and poorer standing balance (-0.190 SD units, p=0.043). Conclusions Components of manual dexterity and strength were the strongest correlates of slow gait and mobility difficulty in mid-to-late life. Longitudinal studies examining relationships between changes in these motor parameters and mobility are needed to elucidate possible causal effects.

Positive Association between High Protein Food Intake Frequency and Physical Performance and Higher-Level Functional Capacity in Daily Life

Nutritional factors, including low protein intake and poor dietary variety, affect age-associated impairment in physical performance resulting in physical frailty. This cross-sectional study investigated the association between intake frequency of major high protein foods and both physical performance and higher-level functional capacity using the food frequency score (FFS) and high protein food frequency score (PFFS) among community-dwelling older adults. The data of 1185 older adults categorized into quartiles based on FFS and PFFS were analyzed. After adjusting for covariates, FFS and PFFS were significantly associated with physical performance [FFS, usual gait speed (p for trend = 0.007); PFFS, usual gait speed (p for trend < 0.001), maximum gait speed (p for trend = 0.002), timed up and go (p for trend = 0.025)], and higher-level functional capacity [FFS (p for trend < 0.001); PFFS (p for trend < 0.001)]. After excluding PFFS data, the participants’ scores were associated with only higher-level functional capacity. Multi-regression analysis with higher-level functional capacity as the covariate showed that FFS and PFFS were significantly correlated with physical performance. Hence, improving food intake frequency, particularly that of high protein foods, and dietary variety may help maintain higher-level functional capacity and physical performance in community-dwelling older adults.

Association between anemia, physical performance and cognitive function in Iranian elderly people: evidence from Bushehr Elderly Health (BEH) program

Background and objectives The present study aimed to investigate the relation between anemia and hemoglobin (Hgb) concentration, physical performance, and cognitive function in a large sample of Iranian elderly population. Methods Data were collected from Bushehr elderly health (BEH) program. A total of 3000 persons aged ≥60 years were selected through multistage random sampling. Hemoglobin values lower than 12 and 13 g/dL were considered as anemia for women and men, respectively. The cognitive function was measured using the Mini-cog test and Category fluency test (CFT), and the physical function was measured using handgrip strength (muscle strength), Relative handgrip strength (RHGS), and 4.57-m usual gait speed. Univariate and adjusted multivariate logistic regression and linear regression with Stata MP (version 15) were run, and a p-value of < 0.05 was used as statistically significant for all analyses. Results Among participants, 7.43% were anemic, and 115 (51.57%) simultaneously had anemia and cognitive disorder. There were significant associations between red blood cell count (RBC), hemoglobin (Hgb), platelet count (PLT), and hematocrit percentage (HCT) with cognitive impairment. Additionally, Hgb concentration was significantly associated with all physical measures (Mean handgrip, Relative handgrip, and usual gait speed) and late recall (mini-cog) among the whole participants. This association remained statistically significant after considering multi-cofounders. In contrast, after stratifying the participants by gender, the association between Hgb concentration and usual gait speed was decreased in both men and women; moreover, Hgb association with cognitive measures (category fluency test and late recall) was no longer significant (all p-values > 0.05). Conclusion There was a cross-sectional and significant association between anemia and functional variables (e.g., Relative and mean handgrip) in Iranian elderly population, whereas Semantic memory, Late recall, and walking were more affected by gender.

Taking prevention to the next step: implementation of a brief, sustainable frailty assessment in a cardiology clinic

BackgroundFrailty measurement is recommended when assessing older adults with cardiovascular disease to individualise prevention and treatment. We sought to address this by incorporating routine gait speed measurement by clinicians into an outpatient preventive cardiology clinic.MethodsQuality improvement (QI) project initiated at VA Boston in January 2015 to measure usual gait speed in m/s over a 4 m distance for patients aged 70 and older. The primary outcome was completion and documentation of 4 m usual gait speed. Data were manually extracted from the electronic health record. Frequency distributions and descriptive statistics are presented.InterventionsSeveral change interventions were implemented over a 5-year period (January 2015–December 2019) addressing (1) stakeholder engagement and project champions, (2) staff education, (3) assessment space, (4) electronic health record template update and (5) sustaining the initiative. Statistical process control charts were used to monitor proportion of gait speed measurement and to detect shifts resulting from 5 phase change interventions.ResultsDuring this QI project, 178 patients aged 70 and older attended the clinic, accounting for 1042 individual clinic visits. Gait speed was measured at least once for 157 patients; 21 were never assessed. At the end of the first month (January 2015), gait speed was measured during 40% of clinic visits and rose to a median measurement rate of 78% at clinic visits during the 2018–2019 study period. An unanticipated result was the spread of the initiative to other cardiology clinics.ConclusionsGait speed measurement was successfully embedded into clinic assessments for older adults at a cardiology clinic following targeted interventions. This project highlights the feasibility of incorporating a brief frailty assessment such as gait speed, into non-geriatric medicine clinics.

Relationship Between Perceived Physical and Mental Fatigability and Physical Performance in Very Old Adults

To investigate the relationship between perceived physical and mental fatigability and physical performance in community-dwelling very old adults (≥80 years). We examined the association in one retired community in Beijing including 404 very old adults. Pittsburgh Fatigability Scale (PFS), Chinese version, was used to assess perceived fatigability in physical domain (PFS-P) and mental domain (PFS-M). High fatigability is defined as PFS-P ≥ 15, and PFS-M ≥ 13. Physical performance measures include grip strength, usual gait speed, chair stand and Short Physical Performance Battery (SPPB) test. Women have higher PFS scores (both PFS-P & PFS-M) and higher prevalence of high fatigability than men. After adjusting for sex, usual gait speed and SPPB scores were significantly associated with PFS-P & PFS-M, while grip strength and chair stand performance were significantly associated with PFS-P only. After multivariable adjustment, usual gait speed (B=-3.745, P=0.021) and chair stand performance (B=0.335, P=0.005) were significantly associated with PFS-P, while usual gait speed (B=-2.656, P=0.006) and SPPB scores (B=-0.214, P=0.029) were significantly associated with PFS-M. Perceived physical and mental fatigability is highly prevalent in very older adults and they differ by sex. The significant associations between PFS scores and performance measures suggest that PFS is of potential clinical importance, especially when testing performance measures are not feasible. Utilization of PFS score can assist in identifying target populations who are at risk of reduced physical functions, such as older with depression, older women. Interventions to improve usual gait speed are likely to reduce both perceived physical and mental fatigability.

Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

Background Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce. Methods In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression. Results On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time. Conclusions Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward.

The effect of different test protocols and walking distances on gait speed in older persons

Background and aims Walking is the core physical activity of older persons. The assessment of walking capacity is increasingly important for clinical purposes and clinical research. Differences between assessment tools and protocols for short walks to obtain gait characteristics can be responsible for changes, e.g., in gait speed from 0.1 to 0.2 m/s. The purpose of this study was to generate further knowledge for the harmonization and/or standardization of short walk-test protocols for assessing gait characteristics under supervised conditions. Methods For this cross-sectional study, 150 community-dwelling older adults (mean age 80.5 ± 4.5 years) were recruited. Participants performed eight walks differing in the distance (8-versus 4-m), static versus dynamic trials and comparing different test speed instructions (usual versus maximal) on an electronic walkway. Results A meaningful significant difference in mean usual gait speed was documented comparing the 4-m dynamic and static test protocol (0.12 m/s; p = 0.001). For the same comparison over an 8-m distance (dynamic versus static) and for the comparison between usual gait speed over 4-and 8-m, the differences in gait speed were smaller, but still statistically significant (p = 0.001). Conclusions Gait speed was faster, if the test protocol did not include a static start or stop. The differences were greater for a shorter walking distance. This aspect should be considered for the comparison of study results and is particularly relevant for systematic reviews and meta-analyses.

P1543FACTORS ASSOCIATED WITH CHANGE IN FUNCTIONAL STATUS IN HEMODIALYSIS PATIENTS

Background and Aims Hemodialysis (HD) patients have poor functional capacity. Expert clinical practice guidelines strongly recommend an assessment of functional status (FS) and treatment strategies in chronic kidney disease patients. A previous study demonstrated a high level of disability in daily activities in most HD patients, and a dose-response association was seen between poor FS at baseline and adverse clinical outcomes in HD patients. Moreover, a recent study reported that patients with a decline in FS over a 1-year period are at an elevated risk of mortality. Therefore, identifying factors that predict a decline in FS is important for developing treatment strategies. The purpose of this study was to investigate the factors that predict this decline in HD patients. Method A total of 146 outpatients (mean age of 66.1±11.0 years; 48% were female) undergoing maintenance HD thrice a week at an HD center were included. FS was assessed based on the ability to perform activities of daily living (ADLs) and instrumental ADLs (IADLs) as self-reported on the Katz Index of Independence and the Lawton-Brody IADL scale, respectively The Katz Index of Independence examines five tasks of ADLs, and the Lawton-Brody IADL scale examines eight tasks of IADLs. Both have been validated in the general population. We then calculated the FS score by combining the scores of the Katz Index of Independence and Lawton-Brody IADL scale in accordance with the algorithm developed in a previous study, and the assessments were conducted at baseline and after 1 year. We classified patients into two groups based on having or not having at least a 1-point decline in the FS score. Background factors such as age, sex, body mass index, comorbidities score, hemodialysis time, primary kidney disease, hemoglobin level, and geriatric nutritional risk index were collected at baseline. In addition, for physical function, the usual gait speed and handgrip strength and for body composition, the skeletal muscle mass by bioelectrical impedance analysis were analyzed at baseline. To investigate factors predicting a decline in FS 1 year later, logistic regression analysis was used. Results Over the study period, 29.5% of the patients showed a decline in the FS score. Patients who showed a decline were older (71.2 years vs. 64.0 years), had weaker handgrip strength (22.9 kg vs. 24.8 kg), and exhibited slower usual gait speed (1.06 m/s vs. 1.22 m/s) than those who did not show decline at baseline. To predict a decline in FS 1 year later, age (odds ratio: 1.07, 95% confidence interval [CI]:1.02-1.13, p=0.003) and usual gait speed (odds ratio: 0.17, 95% CI: 0.03-0.96, p=0.04) were determined as significant factors. Conclusion Gait speed was a predictor of a decline in FS after 1 year. These findings underscore the significance of gait speed assessment in addition to monitoring the patient's FS. Moreover, intervention in maintaining gait speed may be essential in preventing the FS from deteriorating over time.

P1544AASSOCIATION BETWEEN PHYSICAL FRAILTY AND INSOMNIA SYMPTOMS AMONG PATIENTS ON HEMODIALYSIS

Background and Aims Community-dwelling older adults with physical frailty have been suffering from symptoms of insomnia, which have been associated with higher risk of falling and cardiovascular events. Therefore, insomnia symptoms should be assessed for disease management. Most of patients undergoing hemodialysis (HD) have both physical frailty and insomnia symptoms. However, only a few studies reported the association between physical frailty and insomnia symptoms in patients undergoing HD. Therefore, this study aimed to investigate whether insomnia symptoms were one of the useful factors to discriminate physical frailty in patients undergoing HD. Method This study included 231 outpatients undergoing HD three times a week. Physical frailty was measured using the frailty screening index, consisting five components (shrinking, physical function, physical activity, forgetfulness, and exhaustion). Insomnia symptoms were measured using the Athens Insomnia Scale (AIS), a self-administered questionnaire consisting of eight questions, each scored from 0 to 3. Age, sex, body mass index (BMI), HD vintage, comorbidity score, dialysis shift, depressive symptoms, use of sleep medications, usual gait speed, and physical activity (steps/non-HD day) were also investigated. Patients were classified as frailty (the frailty screening index score ≥ 3) and non-frailty (&lt; 3). The analysis of covariance (ANCOVA) was used to compare the AIS scores between frailty and non-frailty. To examine whether the AIS score had the discriminative ability of the frailty complementary to clinical characteristics comparable to the usual gait speed and physical activity, receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was compared using four models: clinical characteristics (age, sex, BMI, and comorbidity score) only (Model 1), Model 1 plus AIS score (Model 2), Model 1 plus usual gait speed (Model 3), and Model 1 plus physical activity (Model 4). Results The median age was 68 (interquartile range: 59–75) years, 59% were men and 37% had frailty. In ANCOVA, the AIS score in the group of frailty was significantly higher than those of non-frailty even after adjusting age, sex, BMI, HD vintage, comorbidity score, dialysis shift, depressive symptoms, and use of sleep medications (p = 0.004). Through the ROC analysis, Model 2 [AUC: 0.70, 95% confidence intervals (CI): 0.63–0.76], Model 3 (AUC: 0.70, 95%CI: 0.63–0.77), and Model 4 (AUC: 0.69, 95%CI: 0.61–0.76) showed significantly better discriminative ability as compared to Model 1 (AUC: 0.64, 95%CI: 0.56–0.71, all P &lt; 0.05) (Figure). Moreover, AUCs were significantly increased by adding the AIS score to Model 3 (from 0.70 [95%CI: 0.63–0.77] to 0.74 [95%CI: 0.67–0.80], p &lt; 0.05). In addition, AUCs were increased by adding the AIS score to Model 4 (from 0.69 [95%CI: 0.61–0.76] to 0.73 [95%CI: 0.65–0.80], p = 0.07) with a trend toward statistical significance. Conclusion This study examined the association between physical frailty and insomnia symptoms in patients undergoing HD. The AIS score had the discriminative ability of the frailty complementary to clinical characteristics comparable to the usual gait speed and physical activity. Future studies should investigate the causal relationship between physical frailty and insomnia symptoms in patients undergoing HD in detail.