Original Study
Incidence of Disability in Frail Older Persons With or Without Slow Walking Speed

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Abstract

Objective

To identify the differences of incidence of disability between frail older persons with and without slow walking speed.

Setting

Japanese community.

Participants

A total of l4,081 older adults aged ≥65 years living in the community, participated in a baseline assessment and were followed for incidence of disability for 29.5 months.

Measurements

Care-needs certification in the national long-term care insurance system of Japan, physical frailty (slow walking speed, muscle weakness, exhaustion, low activity, weight loss), adjusted for several potential confounders such as demographic characteristics; Kaplan-Meier survival curves for incident disability by physical frailty with and without slow walking speed.

Results

During the follow-up period, 198 participants (4.9%) were certified as requiring long-term care insurance in accordance with incident disability. Participants who had prefrailty without slow walking speed (hazard ratio 1.86, 95% confidence interval 1.19–2.92), prefrailty with slow walking speed (3.62, 2.19–5.96), frailty without slow walking speed (4.33, 2.00–9.39), and frailty with slow walking speed (4.68, 2.72–8.05) at the baseline assessment had an increased risk of incident disability compared with nonfrail participants. In stratified analyses, frail older men and frail participants with low cognitive performance had the highest risk of incidence of disability.

Conclusion

The presence of frailty or even prefrailty when older adults showed slow walking speed increased the risk of future disability in community-dwelling older adults.

Section snippets

Participants

This prospective cohort study involved 5104 community-dwelling older adults (≥65 years) enrolled in the Obu Study of Health Promotion for the Elderly (OSHPE).26 OSHPE participants were recruited from Obu, a residential suburb of Nagoya, Japan. Inclusion criteria were an age of ≥65 years at examination in 2011 or 2012, Obu residency, and no previous participation in other studies. Exclusion criteria were the need for support or care certified by the Japanese public LTCI system, disability in

Results

Prevalence rates of each subtype of physical frailty including prefrailty without slow walking speed, prefrailty with slow walking speed, frailty without slow walking speed, and frailty with slow walking speed were 40.4%, 9.1%, 1.6%, and 4.7%, respectively. During the follow-up period, 198 participants (4.9%) were determined as needing certification based on the LTCI system because of incident disability.

Table 1 shows possible confounding factors of ADL limitations for each subtype of frailty.

Discussion

The prevalence rates of physical frailty and prefrailty in this study were 6.3% and 49.5%, respectively, which is consistent with large studies in other countries.6, 35, 36, 37, 38, 39 For instance, in the American Cardiovascular Health Study, the prevalence of frailty among 5317 community-dwelling men and women aged 65 years was 6.9%, and frailty was associated with older age, male gender, being African American, having lower education and income, poorer health, and higher rates of comorbid

Acknowledgment

The authors would like to thank the Obu City Office for assistance with participant recruitment.

References (48)

  • K.E. Ensrud et al.

    Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures

    J Gerontol A Biol Sci Med Sci

    (2007)
  • N.F. Woods et al.

    Frailty: Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study

    J Am Geriatr Soc

    (2005)
  • J.M. Guralnik et al.

    The women's health and aging study: Health and social characteristics of older women with disability

    (1995)
  • L.P. Fried et al.

    Frailty in older adults: Evidence for a phenotype

    J Gerontol A Biol Sci Med Sci

    (2001)
  • S. Al Snih et al.

    Frailty and incidence of activities of daily living disability among older Mexican Americans

    J Rehabil Med

    (2009)
  • K.E. Ensrud et al.

    A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men

    J Am Geriatr Soc

    (2009)
  • L. Ferrucci et al.

    Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report

    J Am Geriatr Soc

    (2004)
  • J.M. Guralnik et al.

    Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability

    N Engl J Med

    (1995)
  • H. Shimada et al.

    Which neuromuscular or cognitive test is the optimal screening tool to predict falls in frail community-dwelling older people?

    Gerontology

    (2009)
  • A. Tiedemann et al.

    The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people

    Age Ageing

    (2008)
  • J.M. Guralnik et al.

    Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery

    J Gerontol A Biol Sci Med Sci

    (2000)
  • M. Cesari et al.

    Prognostic value of usual gait speed in well-functioning older people—Results from the Health, Aging and Body Composition Study

    J Am Geriatr Soc

    (2005)
  • M. Cesari et al.

    Added value of physical performance measures in predicting adverse health-related events: Results from the Health, Aging and Body Composition Study

    J Am Geriatr Soc

    (2009)
  • G. Onder et al.

    Measures of physical performance and risk for progressive and catastrophic disability: Results from the Women's Health and Aging Study

    J Gerontol A Biol Sci Med Sci

    (2005)

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    This work received financial support from Health and Labor Sciences Research Grants (Comprehensive Research on Aging and Health, grant number H24-Choju-Ippan-004), a Grant-in-Aid for Scientific Research (B) (grant number 23300205), and Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology (grant number 22-16), Japan. No support was received from industry. The funding source played no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

    The authors declare no conflicts of interest.

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