Predicting Trajectories of Functional Decline in 60- to 70-Year-Old People

Nini H Jonkman, Vieri Del Panta, Trynke Hoekstra, Marco Colpo, Natasja M van Schoor, Stefania Bandinelli, Luca Cattelani, Jorunn L Helbostad, Beatrix Vereijken, Mirjam Pijnappels, Andrea B Maier

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

BACKGROUND: Early identification of people at risk of functional decline is essential for delivering targeted preventive interventions.

OBJECTIVE: The aim of this study is to identify and predict trajectories of functional decline over 9 years in males and females aged 60-70 years.

METHODS: We included 403 community-dwelling participants from the InCHIANTI study and 395 from the LASA study aged 60-70 years at baseline, of whom the majority reported no functional decline at baseline (median 0, interquartile range 0-1). Participants were included if they reported data on ≥2 measurements of functional ability during a 9-year follow-up. Functional ability was scored with 6 self-reported items on activities of daily living. We performed latent class growth analysis to identify trajectories of functional decline and applied multinomial regression models to develop prediction models of identified trajectories. Analyses were stratified for sex.

RESULTS: Three distinct trajectories were identified: no/little decline (219 males, 241 females), intermediate decline (114 males, 158 females), and severe decline (36 males, 30 females). Higher gait speed showed decreased risk of functional limitations in males (intermediate limitations, odds ratio [OR] 0.74, 95% CI 0.57-0.97; severe limitations, OR 0.42, 95% CI 0.26-0.66). The final model in males further included the predictors fear of falling and alcohol intake (no/little decline, area under the receiver operating curve [AUC] 0.68, 95% CI 0.62-0.73; intermediate decline, AUC 0.63, 95% CI 0.56-0.69; severe decline, AUC 0.79, 95% CI 0.71-0.87). In females, higher gait speed showed a decreased risk of intermediate limitations (OR 0.51, 95% CI 0.38-0.68) and severe limitations (OR 0.18, 95% CI 0.07-0.44). Other predictors in females were age, living alone, economic satisfaction, balance, physical activity, BMI, and cardiovascular disease (no/little decline, AUC 0.80, 95% CI 0.75-0.85; intermediate decline, AUC 0.74, 95% CI 0.69-0.79; severe decline, AUC 0.95, 95% CI 0.91-0.99).

CONCLUSION: Already in people aged 60-70 years, 3 distinct trajectories of functional decline were identified in these cohorts over a 9-year follow-up. Predictors of trajectories differed between males and females, except for gait speed. Identification of people at risk is the basis for targeting interventions.

Original languageEnglish
Pages (from-to)212-221
Number of pages10
JournalGerontology
Volume64
Issue number3
Early online date13 Dec 2017
DOIs
Publication statusPublished - 2018

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Area Under Curve
Odds Ratio
Aptitude
Independent Living
Activities of Daily Living
Fear
Cardiovascular Diseases
Alcohols
Economics
Growth
Walking Speed

Bibliographical note

© 2017 The Author(s) Published by S. Karger AG, Basel.

Keywords

  • Accidental Falls/prevention & control
  • Activities of Daily Living
  • Aged
  • Aging/physiology
  • Alcohol Drinking
  • Cohort Studies
  • Fear
  • Female
  • Healthy Aging/physiology
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Regression Analysis
  • Risk Factors
  • Walking Speed

Cite this

Jonkman, N. H., Del Panta, V., Hoekstra, T., Colpo, M., van Schoor, N. M., Bandinelli, S., ... Maier, A. B. (2018). Predicting Trajectories of Functional Decline in 60- to 70-Year-Old People. Gerontology, 64(3), 212-221. https://doi.org/10.1159/000485135
Jonkman, Nini H ; Del Panta, Vieri ; Hoekstra, Trynke ; Colpo, Marco ; van Schoor, Natasja M ; Bandinelli, Stefania ; Cattelani, Luca ; Helbostad, Jorunn L ; Vereijken, Beatrix ; Pijnappels, Mirjam ; Maier, Andrea B. / Predicting Trajectories of Functional Decline in 60- to 70-Year-Old People. In: Gerontology. 2018 ; Vol. 64, No. 3. pp. 212-221.
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abstract = "BACKGROUND: Early identification of people at risk of functional decline is essential for delivering targeted preventive interventions.OBJECTIVE: The aim of this study is to identify and predict trajectories of functional decline over 9 years in males and females aged 60-70 years.METHODS: We included 403 community-dwelling participants from the InCHIANTI study and 395 from the LASA study aged 60-70 years at baseline, of whom the majority reported no functional decline at baseline (median 0, interquartile range 0-1). Participants were included if they reported data on ≥2 measurements of functional ability during a 9-year follow-up. Functional ability was scored with 6 self-reported items on activities of daily living. We performed latent class growth analysis to identify trajectories of functional decline and applied multinomial regression models to develop prediction models of identified trajectories. Analyses were stratified for sex.RESULTS: Three distinct trajectories were identified: no/little decline (219 males, 241 females), intermediate decline (114 males, 158 females), and severe decline (36 males, 30 females). Higher gait speed showed decreased risk of functional limitations in males (intermediate limitations, odds ratio [OR] 0.74, 95{\%} CI 0.57-0.97; severe limitations, OR 0.42, 95{\%} CI 0.26-0.66). The final model in males further included the predictors fear of falling and alcohol intake (no/little decline, area under the receiver operating curve [AUC] 0.68, 95{\%} CI 0.62-0.73; intermediate decline, AUC 0.63, 95{\%} CI 0.56-0.69; severe decline, AUC 0.79, 95{\%} CI 0.71-0.87). In females, higher gait speed showed a decreased risk of intermediate limitations (OR 0.51, 95{\%} CI 0.38-0.68) and severe limitations (OR 0.18, 95{\%} CI 0.07-0.44). Other predictors in females were age, living alone, economic satisfaction, balance, physical activity, BMI, and cardiovascular disease (no/little decline, AUC 0.80, 95{\%} CI 0.75-0.85; intermediate decline, AUC 0.74, 95{\%} CI 0.69-0.79; severe decline, AUC 0.95, 95{\%} CI 0.91-0.99).CONCLUSION: Already in people aged 60-70 years, 3 distinct trajectories of functional decline were identified in these cohorts over a 9-year follow-up. Predictors of trajectories differed between males and females, except for gait speed. Identification of people at risk is the basis for targeting interventions.",
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Jonkman, NH, Del Panta, V, Hoekstra, T, Colpo, M, van Schoor, NM, Bandinelli, S, Cattelani, L, Helbostad, JL, Vereijken, B, Pijnappels, M & Maier, AB 2018, 'Predicting Trajectories of Functional Decline in 60- to 70-Year-Old People' Gerontology, vol. 64, no. 3, pp. 212-221. https://doi.org/10.1159/000485135

Predicting Trajectories of Functional Decline in 60- to 70-Year-Old People. / Jonkman, Nini H; Del Panta, Vieri; Hoekstra, Trynke; Colpo, Marco; van Schoor, Natasja M; Bandinelli, Stefania; Cattelani, Luca; Helbostad, Jorunn L; Vereijken, Beatrix; Pijnappels, Mirjam; Maier, Andrea B.

In: Gerontology, Vol. 64, No. 3, 2018, p. 212-221.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Predicting Trajectories of Functional Decline in 60- to 70-Year-Old People

AU - Jonkman, Nini H

AU - Del Panta, Vieri

AU - Hoekstra, Trynke

AU - Colpo, Marco

AU - van Schoor, Natasja M

AU - Bandinelli, Stefania

AU - Cattelani, Luca

AU - Helbostad, Jorunn L

AU - Vereijken, Beatrix

AU - Pijnappels, Mirjam

AU - Maier, Andrea B

N1 - © 2017 The Author(s) Published by S. Karger AG, Basel.

PY - 2018

Y1 - 2018

N2 - BACKGROUND: Early identification of people at risk of functional decline is essential for delivering targeted preventive interventions.OBJECTIVE: The aim of this study is to identify and predict trajectories of functional decline over 9 years in males and females aged 60-70 years.METHODS: We included 403 community-dwelling participants from the InCHIANTI study and 395 from the LASA study aged 60-70 years at baseline, of whom the majority reported no functional decline at baseline (median 0, interquartile range 0-1). Participants were included if they reported data on ≥2 measurements of functional ability during a 9-year follow-up. Functional ability was scored with 6 self-reported items on activities of daily living. We performed latent class growth analysis to identify trajectories of functional decline and applied multinomial regression models to develop prediction models of identified trajectories. Analyses were stratified for sex.RESULTS: Three distinct trajectories were identified: no/little decline (219 males, 241 females), intermediate decline (114 males, 158 females), and severe decline (36 males, 30 females). Higher gait speed showed decreased risk of functional limitations in males (intermediate limitations, odds ratio [OR] 0.74, 95% CI 0.57-0.97; severe limitations, OR 0.42, 95% CI 0.26-0.66). The final model in males further included the predictors fear of falling and alcohol intake (no/little decline, area under the receiver operating curve [AUC] 0.68, 95% CI 0.62-0.73; intermediate decline, AUC 0.63, 95% CI 0.56-0.69; severe decline, AUC 0.79, 95% CI 0.71-0.87). In females, higher gait speed showed a decreased risk of intermediate limitations (OR 0.51, 95% CI 0.38-0.68) and severe limitations (OR 0.18, 95% CI 0.07-0.44). Other predictors in females were age, living alone, economic satisfaction, balance, physical activity, BMI, and cardiovascular disease (no/little decline, AUC 0.80, 95% CI 0.75-0.85; intermediate decline, AUC 0.74, 95% CI 0.69-0.79; severe decline, AUC 0.95, 95% CI 0.91-0.99).CONCLUSION: Already in people aged 60-70 years, 3 distinct trajectories of functional decline were identified in these cohorts over a 9-year follow-up. Predictors of trajectories differed between males and females, except for gait speed. Identification of people at risk is the basis for targeting interventions.

AB - BACKGROUND: Early identification of people at risk of functional decline is essential for delivering targeted preventive interventions.OBJECTIVE: The aim of this study is to identify and predict trajectories of functional decline over 9 years in males and females aged 60-70 years.METHODS: We included 403 community-dwelling participants from the InCHIANTI study and 395 from the LASA study aged 60-70 years at baseline, of whom the majority reported no functional decline at baseline (median 0, interquartile range 0-1). Participants were included if they reported data on ≥2 measurements of functional ability during a 9-year follow-up. Functional ability was scored with 6 self-reported items on activities of daily living. We performed latent class growth analysis to identify trajectories of functional decline and applied multinomial regression models to develop prediction models of identified trajectories. Analyses were stratified for sex.RESULTS: Three distinct trajectories were identified: no/little decline (219 males, 241 females), intermediate decline (114 males, 158 females), and severe decline (36 males, 30 females). Higher gait speed showed decreased risk of functional limitations in males (intermediate limitations, odds ratio [OR] 0.74, 95% CI 0.57-0.97; severe limitations, OR 0.42, 95% CI 0.26-0.66). The final model in males further included the predictors fear of falling and alcohol intake (no/little decline, area under the receiver operating curve [AUC] 0.68, 95% CI 0.62-0.73; intermediate decline, AUC 0.63, 95% CI 0.56-0.69; severe decline, AUC 0.79, 95% CI 0.71-0.87). In females, higher gait speed showed a decreased risk of intermediate limitations (OR 0.51, 95% CI 0.38-0.68) and severe limitations (OR 0.18, 95% CI 0.07-0.44). Other predictors in females were age, living alone, economic satisfaction, balance, physical activity, BMI, and cardiovascular disease (no/little decline, AUC 0.80, 95% CI 0.75-0.85; intermediate decline, AUC 0.74, 95% CI 0.69-0.79; severe decline, AUC 0.95, 95% CI 0.91-0.99).CONCLUSION: Already in people aged 60-70 years, 3 distinct trajectories of functional decline were identified in these cohorts over a 9-year follow-up. Predictors of trajectories differed between males and females, except for gait speed. Identification of people at risk is the basis for targeting interventions.

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KW - Activities of Daily Living

KW - Aged

KW - Aging/physiology

KW - Alcohol Drinking

KW - Cohort Studies

KW - Fear

KW - Female

KW - Healthy Aging/physiology

KW - Humans

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Regression Analysis

KW - Risk Factors

KW - Walking Speed

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Jonkman NH, Del Panta V, Hoekstra T, Colpo M, van Schoor NM, Bandinelli S et al. Predicting Trajectories of Functional Decline in 60- to 70-Year-Old People. Gerontology. 2018;64(3):212-221. https://doi.org/10.1159/000485135