Hospitalization-Associated Change in Gait Speed and Risk of Functional Limitations for Older Adults

Abstract

Background Hospitalization-associated functional decline is a common problem for older adults, but it is unclear how hospitalizations affect physical performance measures such as gait speed. We sought to determine hospitalization-associated change in gait speed and likelihood of new limitations in mobility and activities of daily living (ADLs). Methods We used longitudinal data over 5 years from the Health, Aging and Body Composition Study, a prospective cohort of black and white community-dwelling men and women, aged 70–79 years, who had no limitations in mobility (difficulty walking 1/4 mile or climbing 10 steps) or ADLs (transferring, bathing, dressing, and eating) at baseline. Gait speed, and new self-reported limitations in mobility and ADLs were assessed annually. Selected participants (n = 2,963) had no limitations at the beginning of each 1-year interval. Hospitalizations were self-reported every 6 months and verified with medical record data. Generalized estimating equations were used to examine hospitalization-associated change in gait speed and odds of new limitations over each 1-year interval. Fully adjusted models included demographics, hospitalization within the past year, health conditions, symptoms, body mass index, and health-related behaviors. Results In fully adjusted models, any hospitalization was associated with decrease in gait speed (−0.04 m/s; 95% confidence interval [CI]: −0.05 to −0.03) and higher odds of new limitations in mobility or ADLs (odds ratio = 1.97, 95% CI: 1.70–2.28), and separately with increased odds of new mobility limitation (odds ratio = 2.22, 95% CI: 1.90–2.60) and new ADL limitations (odds ratio = 1.84, 95% CI: 1.53–2.21). Multiple hospitalizations within a year were associated with gait speed decline (−0.06 m/s; 95% CI: −0.08 to −0.04) and greater odds of new limitations in mobility or ADLs (odds ratio = 2.96, 95% CI: 2.23–3.95). Conclusions Functionally independent older adults experienced hospitalization-associated declines in gait speed and new limitations in mobility and ADLs.

Walking Cadence Affects the Recruitment of the Medial-Lateral Balance Mechanisms

“…There is an ongoing debate about whether or not walking slower is more stable (Bruijn et al, 2009 ). We know certain patient populations reduce their gait speed and increase their cadence (Himann et al, 1988 ; Lauretani et al, 2003 ; Buckley et al, 2018 ; Duan-Porter et al, 2019 ), but is the motivation to improve stability? Key factors that lead to the decrease in gait speed in older adults remains unresolved, but we speculate that the control of balance plays a larger role than previously recognized.…”

Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review

“…Included studies were all secondary analyses of data derived from 25 established cohorts. The cohorts from which the highest number of studies originated were the Nordic Research on Ageing Study (11 studies; Avlund, Damsgaard, & Osler, 2004;Avlund, Damsgaard, Sakari-Rantala, Laukkanen, & Schroll, 2002;Avlund, Davidsen, & Schultz-Larsen, 1995;Avlund, Lund, Holstein, & Due, 2004;Avlund, Osler, Damsgaard, Christensen, & Schroll, 2000;Avlund, Pedersen, & Schroll, 2003;Avlund, Vass, & Hendriksen, 2003;Jørgensen, Lund, Siersma, & Nilsson, 2017; Nilsson, Avlund, & Lund, 2010;Nilsson, Lund, & Avlund, 2008;Schroll, Avlund, & Davidsen, 1997), the Health, Ageing and Body Composition Study (seven studies; Carbone et al, 2013;Duan-Porter et al, 2019;Koster et al, 2005;Lee et al, 2005;Mehta et al, 2007;Thorpe et al, 2011;Visser et al, 2005), and the first Women's Health and Ageing Study (four studies; Brenes et al, 2005;Leveille, Bean, Ngo, McMullen, & Guralnik, 2007;Leveille et al, 2001;Onder et al, 2003). The majority of studies were based on populations from the United States (27 studies; 11 cohorts) or Finland (16 studies; five cohorts).…”

Effects of a multicomponent high intensity exercise program on physical function and health-related quality of life in older adults with or at risk of mobility disability after discharge from hospital: a randomised controlled trial

“…Reduced physical function with increasing age can have tremendous negative consequences, both for the older individuals, their families and the society, hence preserving physical function, independence and HRQOL in older adults is central to the global response to population ageing [1]. Hospitalization often exacerbates the effects of ageing on physical function, and many older people suffer from mobility limitations and reduced HRQOL after discharge [2][3][4][5].…”