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1 Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, Taipei.
2 Division of Gerontology Research, National Health and Research Institutes, Taipei, Taiwan.
3 School of Dentistry, National Yang Ming University, Taipei, Taiwan.
4 Department of Dentistry, Veteran General Hospital, Taipei, Taiwan.
Address correspondence to Yau-Hua Yu, DDS, DMSc, School of Dentistry, National Yang Ming University,155 Sec. 2, Li-Nong Street, Taipei (112), Taiwan. E-mail: yauhuayu{at}gmail.com
Background. Atherosclerotic peripheral arterial disease (PAD), common among older adults, is associated with poor low-extremity functioning. In considering functional status, varying domains exist, including activities of daily living (ADL), instrumental activities of daily living (IADL), low-extremity mobility (LEM), and leisure and/or social activities (LSA). However, little is known about how PAD is related to functional status beyond low-extremity functioning.
Methods. A total of 1798 participants 60 years old or older was selected from the population-based National Health and Nutrition Examination Survey 1999–2002 in the United States. ADL, IADL, LSA, LEM, and general physical activities (GPA) were obtained by self-report. Peak leg force was obtained from an isokinetic dynamometer. Habitual gait speed was obtained from a 20-foot timed walk. PAD was defined as an ankle–brachial blood pressure index <0.9 in either leg.
Results. After multivariable adjustment, the odds ratios (ORs) for dependence in IADL, LSA, and LEM comparing participants with PAD to those without were 1.60 (95% confidence interval [CI], 1.11–2.29), 1.63 (95% CI, 1.08–2.44), and 2.29 (95% CI, 1.64–3.18), respectively. Additional adjustment of peak leg force and/or habitual gait speed diminished the relations of PAD to dependence in IADL and LSA. PAD was associated with an 18.06 Newton reduction (p =.003) in peak leg force and a 0.05 m/s reduction (p =.002) in habitual gait speed.
Conclusion. PAD was independently associated with multiple domains of functional dependence. The association between PAD and dependence in IADL and LSA was to a large extent mediated by leg force and gait speed.
Key Words: Peripheral arterial disease • Muscle strength • Gait speed • Disability • National Health and Nutrition Examination Survey
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