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Magnitude and Patterns of Decline in Health and Function in 1 Year Affect Subsequent 5-Year Survival

¹ University of Kansas Medical Center, Kansas City.
² University of Pittsburgh and Pittsburgh VA Healthcare System, Pennsylvania.
³ Merck Research Laboratories, Blue Bell, Pennsylvania.
⁴ National Institute on Aging, Bethesda, Maryland.

Address correspondence to Stephanie Studenski, MD, MPH, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213. E-mail: studenskis{at}msx.dept-med.pitt.edu

Background. Indicators of physical function and health status can predict important outcomes in older persons, but little is known about the meaning of change in these measures. This study assessed the magnitude and patterns of change occurring in 1 year in six measures of health and function and estimated the effects on survival for 5 years.

Methods. This prospective cohort study was based in two health care systems. Data were collected during home visits at baseline and every 3 months for 1 year. Subsequent deaths occurring within 5 years were ascertained using the National Death Index.

Results. Of 439 older adults, 88 (20%) died within the subsequent 5 years. The optimal magnitude of decline to predict 5-year mortality was 0.1 meters/second for gait speed, 1 point for the Short Physical Performance Battery, and 0.05 points for Euroqol. Independent contributions were found for decline in gait speed (p =.001 to.002), Short Physical Performance Battery (p =.014 to.026), global health (p <.001), and activities of daily living (p =.005 to.019). More than one half of the episodes of decline were transient. Persistent decline in 1 year consistently predicted death, and transient decline in gait speed and global health increased mortality risk compared with no change.

Conclusions. A decline in gait speed of 0.1 m/s or 1 point in the Short Physical Performance Battery within 1 year increased the subsequent 5-year mortality rate. Transient declines in gait speed and self-reported health are as common as persistent declines and affect mortality risk.