Impaired Higher-Level Functional Capacity as a Predictor of Stroke in Community-Dwelling Older Adults

Abstract

S troke continues to be a major public health concern worldwide. As with other developed countries, it is the leading cause of death and a major neurological cause of long-term disability in Japan.1 Therefore, stroke prevention is a public health priority.Limitations in functional capacity after stroke are prevalent 2 because strokes often affect the memory and physical capabilities required to perform activities of daily living. A small but growing number of studies have challenged the conventional view that disability emerges after acute onset conditions, including stroke; that is, what is often thought of as stroke-related disability actually precedes stroke incidence.3-5 These studies measured disability by assessing basic activities of daily living (BADL), such as feeding, bathing, dressing, toileting, transferring, and continence 3,4 or cognitive function. 5Background and Purpose-Functional capacity is a predictor, as well as a consequence, of stroke. However, little research has been done to examine whether higher-level functional capacity above basic activities of daily living is a predictor of stroke. Methods-We followed 1493 Japanese community-dwelling adults aged ≥60 years (mean age, 70.1 years) who were independent in basic activities of daily living and had no history of stroke. Baseline data were collected using a selfadministered questionnaire. Higher-level functional capacity was measured using the total score and 3 subscales (instrumental activities of daily living, intellectual activity, and social role) derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Adjusted hazard ratios and 95% confidence intervals were calculated by the Cox proportional hazards model. Results-During a mean follow-up of 10.4 years, 191 participants developed a first stroke. Impaired higher-level functional capacity based on total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.15-2.33). Among the 3 subscales, only intellectual activity was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.21-2.22). Social role was significantly associated with stroke only among those aged ≥75 years (hazard ratio, 1.78; 95% confidence interval, 1.07-2.98). Conclusions-Impaired higher-level functional capacity, especially in the domain of intellectual activity, was a predictor of stroke, even among community-dwelling older adults with independent basic activities of daily living at baseline. Lawton defined and systematized 7 stages of competence (ie, functional capacity) from the lowest and most basic function to the highest. 6 The stages were, in ascending order of complexity, life maintenance, functional health, perception and cognition, physical self-maintenance (corresponding to BADL), instrumental self-maintenance (instrumental activities of daily living [IADL]), effectance, and social role.6 Of these stages, the complex capacity to cover the last 3 stag...

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