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Measures of Physical Performance and Risk for Progressive and Catastrophic Disability: Results From the Women's Health and Aging Study

¹ Sticht Center on Aging, Wake Forest University of the Health Sciences, Winston–Salem, North Carolina.
² Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy.
³ Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland.
⁴ Laboratory of Clinical Epidemiology, INRCA Geriatric Department, Florence, Italy.
⁵ Departments of Medicine and Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
⁶ Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, Maryland.

Address correspondence to Graziano Onder, MD, PhD, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore - Policlinico A. Gemelli, L.go Francesco Vito 1, 00168 Roma, Italy. E-mail: graziano_onder{at}rm.unicatt.it

Background. Physical performance measures can predict incident disability, but little research has assessed and compared how these measures predict progressive and rapid-onset (catastrophic) disability. The authors evaluated the ability of upper and lower extremity performance measures to predict progressive and catastrophic disability in activities of daily living (ADL), mobility, and upper extremity function.

Methods. The incidence of progressive and catastrophic disability was assessed semiannually during a 3-year period in 884 women participating in the Women's Health and Aging Study I. Four-meter walking speed, balance, and chair stands tests were used to evaluate lower extremity function. The putting-on-blouse test, the Purdue pegboard test, and grip strength were used to assess upper extremity function. Summary performance scores (SPS) for the lower and upper extremities were calculated. Among participants in whom disability developed, those who reported no difficulty in the previous year were defined as cases of catastrophic disability, and those who previously reported little or some difficulty were considered to be cases of progressive disability. Cox proportional hazard regression analyses were used to evaluate the association of performance measures and time to incident disability. The predictive ability of performance measures was compared using receiver-operator characteristic curves.

Results. All lower and upper extremity measures, with the exception of grip strength, significantly predicted the onset of progressive ADL disability, but only walking speed was significantly associated with the onset of catastrophic ADL disability. The chair stands test, walking speed, and the lower extremity SPS were significantly associated with the onset of both progressive and catastrophic mobility disability. Only lower extremity individual tests and SPS significantly predicted the onset of both progressive and catastrophic upper extremity disability. The receiver-operator characteristic curves for ADL and mobility disability showed that all performance measures evaluated had a greater predictive ability for progressive than for catastrophic incident disability. This finding was not consistent for upper extremity disability. The areas under the curve for walking speed and lower extremity SPS were very similar, ranging from 0.58 to 0.81 and from 0.57 to 0.85, and the predictive ability of these two measures was the greatest for all disability outcomes assessed.

Conclusion. Physical performance measures of lower extremity and, in particular, walking speed and lower extremity SPS are valuable tools to predict different forms of disability, especially those with a progressive onset.

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