Relative importance of four functional measures as predictors of 15-year mortality in the older Dutch population

Abstract

BackgroundDecreased physical function is known to raise mortality risk. Little is known about how different physical function measures compare in predicting mortality risk in older men and women. The objective of this study was to compare four, objective and self-reported, physical function measures in predicting 15-year mortality risk in older men and women.MethodsData were used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of the older Dutch population, sampled from municipal records. The 1995–96 cycle, including 727 men and 778 women aged 65–88 years, was considered as the baseline. Mortality was followed up through September 1, 2011. Physical function measures were: lower-body performance (chair stands test, walk test and tandem stand); handgrip strength (grip strength dynamometer); lung function (peak expiratory flow rate); functional limitations (self-report of difficulties in performing six activities of daily living). Cox proportional hazard models were used to determine the predictive value of each physical function measure for 15-year mortality risk, adjusted for demographic, lifestyle and health variables as potential confounders.Results1031 participants (68.5%) had died. After adjustments for confounders, in models assessing single functional measures, peak flow was the strongest predictor of all-cause mortality in men (HR 1.76, CI 1.38–2.26, CI) and lower-body performance in women (HR 1.97,CI 1.40–2.76, CI). In a model including all four functional measures only peak flow was statistically significant in predicting mortality in both genders (men HR 1.54,CI 1.18–2.01 and women HR 1.45,CI 1.08–1.94). In women, lower-body performance (HR 1.66, CI 1.15–2.41) followed by grip strength (HR 1.38, CI 1.02–1.89), and in men, functional limitations (HR 1.43, CI 1.14–1.8) were the other significant predictors of all-cause mortality.ConclusionBoth objective and self-reported measures of physical functioning predicted all-cause mortality in a representative sample of the older Dutch population to different extents in men and women. Peak flow contributed important unique predictive value for mortality in both men and women. In women, however, lower-body performance tests had better predictive ability. A second-best predictor in men was self-reported functional limitations. Peak flow, and possibly one of the other measures, may be used in clinical practice for assessment in the context of time constraints.

Effect of respiratory muscle training on dysphagia in stroke patients—A retrospective pilot study

“…Furthermore, improved peak expiratory flow may contribute to reduced risk of mortality, as peak flow has recently been identified as an independent predictor of mortality in the aging population. 40 The overall findings are in agreement with Pitts et al, 41 EMST improved the penetration/aspiration scores by 41%, and cough acceleration volume by 103%. 41 In contrast, other studies have not found EMST to be beneficial in post-stroke patients.…”

“…Associated improvements in deglutition can be expected to reduce pneumonia and malnutrition. Furthermore, improved peak expiratory flow may contribute to reduced risk of mortality, as peak flow has recently been identified as an independent predictor of mortality in the aging population 40 …”

<p>Grip Strength: An Indispensable Biomarker For Older Adults</p>

“…In addition to these meta-analyses, several recent large-scale studies have further reinforced the value of grip strength as a predictor of mortality in community-dwelling populations. These studies all involved over 1000 participants from each of several specific countries or regions: Japan; 76 Russia; 77 Denmark, 77 the United Kingdom, [77][78][79] Korea, 80 Norway, 81 the United States, 82,83 the Netherlands, 84 Switzerland, 85 Western Europe, 86 and Taiwan. 87 In the last of these studies, "malnutrition synergistically increased the mortality risk" in keeping with low grip strength.…”

Effect of Respiratory Muscle Training on Dysphagia in Stroke Patients - A Retrospective Pilot Study

“…Associated improvements in deglutition can be expected to reduce pneumonia and malnutrition. Furthermore, improved peak expiratory flow may contribute to reduced risk of mortality, as peak flow has recently been identified as an independent predictor of mortality in the aging population [35] .…”