Slowness Predicts Mortality: A Comparative Analysis of Walking Speed and Moberg Picking-Up Tests

Abstract

Objectives: Slow walking speed (WS) is predictive of mortality but may be difficult to measure, which compromises the assessment of frailty, based on Fried et al's phenotype. The timed Moberg picking-up test (MPUT), developed to evaluate hand's function, was found moderately but significantly correlated with WS. We compared the relationship between slowness, assessed by MPUT and WS tests, and mortality. Design: Observational (prospective cohort study). Setting and Participants: 4731 community-dwelling adults included in 2004, 2009, or 2014 in the ongoing Lausanne cohort 65þ (Lc65þ) were assessed at the age of 66-71 years. Method: Mortality was compared for individuals above and below percentile 80 of MPUT, and respectively WS performance time, according to the Fried criterion. Multivariable analyses using Cox's regression models were adjusted for age, sex, height and grip strength. The predictive capability of MPUT and WS was assessed in adjusted models using Harrell C. Results: Slowness in MPUT and in WS test was associated with mortality at 4, 9, and 14 years (P < .001). Survival curves showed lower survival rates in the highest percentile for both tests (P < .001), regardless of the follow-up period. Cox models indicated a higher risk of death at 4 years [adjusted hazard ratio (95% confidence interval): MPUT, 2.1 (1.5-3.0); WS, 2.2 (1.5-3.1)], 9 years [MPUT 1.7 (1.3-2.3); WS 2.0 (1.5-2.6)] and 14 years 3); WS 1.8 (1.4-2.4)] for participants above the 80th percentile (all P < .001). The 2 tests had similar predictive capability (Harrell C: MPUT, between 61% and 68%; WS, between 62% and 69%). Conclusions and Implications: Poor performance in MPUT is associated with increased mortality at the short and long term among community-dwelling older adults. This alternative to WS in the assessment of slowness has similar predictive capability for mortality and avoids biased estimates because of nonrandom exclusion of individuals unable to complete WS.

Frailty and risk of cardiovascular disease and mortality

“…As weakness was assessed by knee extension strength or POMA battery, which are both objective measurements for muscle strength, its strong predicting value for higher risk of CVD in our study suggested that preventions on muscle strength decline may potentially reduce the risk of CVD and mortality for older adults. Consistent with other studies [ 38 , 39 ], slowness also presented higher risk of all-cause mortality in our study. However, we failed to find significant association between slowness and risk of CVD after adjusting for traditional CVD risk factors and medication therapies.…”

Diagnostic Accuracy of the Short Physical Performance Battery in Detecting Frailty and Prefrailty in Community-Dwelling Older Adults: Results From the PRO-EVA Study

“…Slow gait is defined by the time to perform the walking test, and cut-off points were identified using the 80th percentile. 1,29 Grip strength and walking time were normalized for gender and BMI (quartile), and gender and height (mean), respectively.…”

“…Cut-off points to detect low grip strength were identified using the 20th percentile of the sample for the classification of frailty. Slow gait is defined by the time to perform the walking test, and cut-off points were identified using the 80th percentile 1,29. Grip strength and walking time were normalized for gender and BMI (quartile), and gender and height (mean), respectively.…”

Urinary Phthalate Metabolites and Slow Walking Speed in the Korean Elderly Environmental Panel II Study

“… 45 The current AWGS definition of slowness (walking ) has been shown to predict mild physical disability and has been associated with a higher risk of hospitalization and lower extremity functional limitations, 3 whereas the other two definitions have been associated with severe physical disability and an increased risk of falls and mortality. 46 , 47 …”