Background and purpose
Walking speed is an important dimension of gait function and is known to decline with age. Gait function is a process of dynamic balance and motor control that relies on multiple sensory inputs (e.g. visual, proprioceptive and vestibular) and motor outputs. These sensory and motor physiologic systems also play a role in static postural control, which has been shown to decline with age. In this study, we evaluated whether imbalance that occurs as part of healthy aging is associated with slower walking speed in a nationally-representative sample of older adults.
Methods
We performed a cross-sectional analysis of the previously collected1999–2002 National Health and Nutrition Examination Survey (NHANES) data to evaluate whether age-related imbalance is associated with slower walking speed in older adults aged 50 to 85 (n=2,116). Balance was assessed on a pass/fail basis during a challenging postural task—Condition 4 of the modified Romberg test, and walking speed was determined using a 20-feet (6.10 m) timed walk. Multivariable linear regression was used to evaluate the association between imbalance and walking speed, adjusting for demographic and health-related covariates. A structural equation model was developed to estimate the extent to which imbalance mediates the association between age and slower walking speed.
Results
In the unadjusted regression model, inability to perform the NHANES balance task was significantly associated with 0.10 m/s slower walking speed (95% confidence interval [CI]: −0.13, −0.07; p<0.01). In the multivariable regression analysis, inability to perform the balance task was significantly associated with 0.06 m/s slower walking speed (95% CI: −0.09, −0.03; p<0.01), an effect size equivalent to 12 years of age. The structural equation model estimated that age-related imbalance mediates 12.2% of the association between age and slower walking speed in older adults.
Conclusion
In a nationally-representative sample, age-related balance limitation was associated with slower walking speed. Balance impairment may lead to walking speed declines. Additionally, reduced static postural control and dynamic walking speed that occur with aging may share common etiologic origins, including the decline in visual, proprioceptive, and vestibular sensory and motor functions.
IMPORTANCEThe net benefit of aspirin for prevention of cardiovascular disease (CVD), particularly primary prevention, remains debated in people with and without diabetes. Recent studies suggest that the benefits of preventive aspirin may be outweighed by the potential for harm in older adults; therefore, it is important to monitor current aspirin use in order to minimize risk for future harm in the oldest segment of the population.OBJECTIVE To determine the prevalence of preventive aspirin use in older US adults with and without diabetes for both primary and secondary prevention by age, sex, and CVD risk category.
Myocardial steatosis is unrelated to hepatic, adipocyte, or peripheral insulin sensitivity. Although it is frequently observed in insulin-resistant subjects, further studies are necessary to identify and delineate pathogenic mechanisms that differentially affect cardiac and hepatic steatosis.
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