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

Bibliographical note

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

Funding

This work was supported by funding from the European Union's Horizon 2020 research and innovation programme (grant agreement number 689238). The InCHIANTI baseline study (1998-2000) was supported as a "targeted project" by the Italian Ministry of Health (ICS110.1/RF97.71) and by the US National Institute on Aging (Contracts 263 MD 9164, 263 MD 8213360); the InCHIANTI Follow-Up 1 (2001-2003) was funded by the US Na-tional Institute on Aging (Contracts N.1-AG-1-1, N.1-AG-1-2111); and the InCHIANTI Follow-Ups 2 and 3 (2004-2010) were fi-nanced by the US National Institute on Aging (Contract N01-AG-5-0002). The Longitudinal Aging Study Amsterdam was sup-ported by a grant from the Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care. The funding agencies had no role in the design, execution, analysis and interpretation of data, or writing of the study.

FundersFunder number
Italian Ministry of HealthICS110.1/RF97.71
Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care
US Na-tional Institute on AgingN01-AG-5-0002, N.1-AG-1-2111, N.1-AG-1-1
US National Institute on Aging263 MD 9164, 263 MD 8213360, 2001-2003
Horizon 2020 Framework Programme689238

    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

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