Mobility Limitations and Cognitive Deficits as Predictors of Institutionalization among Community-Dwelling Older People

Abstract

Purpose: Mobility limitations and cognitive disorders have often been observed as risks for institutionalization. However, their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported. Design: A prospective cohort study with 10-year surveillance on institutionalization. Subjects: Study population (n = 476) consisted of 75- and 80-year-old people who were community-dwelling, had not been diagnosed with dementia, and participated in tests on walking speed and cognitive capacity at a research centre. Measures: Cognitive capacity was measured with three validated psychometric tests that were from the Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Schaie- Thurstone Adult Mental Abilities Test. Mobility was measured with walking speed over a 10-m distance. Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows: no limitation, solely mobility limitation, solely cognitive deficits, and combined mobility limitation and cognitive deficits. Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups. Results: Eleven percent of the participants were institutionalized during the 10-year surveillance. The risk for institutionalization was 4.9 times greater (95% confidence interval: 2.1–11.2) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations. Conclusions: The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home. This might be due to a decreased reserve capacity and ineffective compensatory strategies. Therefore, interventions targeted to improve even one limitation, or prevent accumulation of these risk factors, could significantly reduce the risk of institutionalization.

Genetic and environmental factors impact age-related impairment of negative geotaxis in Drosophila by altering age-dependent climbing speed

“…Drosophila is emerging as an important model for investigating age-related locomotor impairment, a significant clinical issue for the elderly (Woo et al 1999;Boyd et al 2005;Braam et al 2005;Hillsdon et al 2005;Onder et al 2005;Volpato et al 2005;Cesari et al 2006a;Cesari et al 2006b;von Bonsdorff et al 2006). In flies, negative geotaxis is a commonly used measure for locomotion and its senescence .…”

“…In humans, age-related locomotor impairments are particularly important. Elderly individuals with impaired locomotor abilities are less independent and require more clinical care (Boyd et al 2005), are at much greater risk for being institutionalized (von Bonsdorff et al 2006), and are at greater risk for depression (Braam et al 2005). Additionally, age-related locomotor impairment is associated with increased risk for falling and skeletal fractures as well as a variety of co-morbidities including coronary artery/cerebrovascular disease, obesity, diabetes, and hypertension (Boyd et al 2005;Hillsdon et al 2005;Onder et al 2005;Volpato et al 2005;Cesari et al 2006a;Cesari et al 2006b).…”

Walking for the Assessment of Balance in Healthy Subjects Older than 40 Years

“…1 m/s are more likely to develop several health problems, mainly the risk of falling. Moreover, the risk for institutionalization was 4.9 times greater (95% CI: 2.1-11.2) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations in a prospective cohort study with 10-year surveillance [15] .…”

Impact of Osteoarthritis on Difficulty Walking: A Population‐Based Study

“…However, a growing body of literature indicates that self-reported difficulty with walking, which may result from inadequately treated hip or knee OA, is a strong independent risk factor for adverse outcomes in people with chronic diseases. As many as 30% of older adults report difficulty walking (12), which is associated with reduced quality of life (13), higher risk for institutionalization (14), and higher annual health care costs (15). More recently, difficulty walking has also been linked with cardiovascular (CV) events, diabetes mellitus complications (in people with diabetes mellitus) (16), and death (17)(18)(19)(20).…”