Researchers from the Federal University of São Carlos (UFSCar) in the state of São Paulo, Brazil, in partnership with colleagues from University College London in the United Kingdom, have discovered an effective, simple and inexpensive method to predict the risk of functional disability in the elderly. . They analyzed data from over 3,000 people over the age of 60 living in England and found that slow walking alone can be considered a predictor of loss of ability to perform basic activities and instruments of daily life (BADL and IADL).
Our study showed that the only measurement of walking speed is sufficient to effectively predict the loss of functional capacity in the elderly. Based on our results, we can say that slow walking precedes this loss by several years. This is an important result because it makes it easier to track the issue. It also allows not only physiotherapists, clinicians and geriatricians but also any health professional to detect the risk.”
Tiago da Silva Alexandre, Professor, UFSCar Department of Gerontology and Principal Investigator of the study
An article on the study is published in the Cachexia, Sarcopenia and Muscle Diary. The study was supported by FAPESP and analyzed data on the fitness, overall health and gait of participants in the English Longitudinal Study of Aging (ELSA).
Loss of ability to perform BADL (getting out of bed, bathing, eating, walking, dressing, etc.) and IADL (cleaning, laundry, preparing meals, using transportation, shopping, managing finances, managing medications, etc.) can precede or appear at the same time as frailty.
Frailty, a condition found in a large proportion of older adults, can be defined as a clinically recognizable state of increased vulnerability resulting from a decline in physiological reserve and function associated with aging, increasing the risk of falls, hospitalization and death. Diagnosis involves a series of assessments to measure parameters such as walking speed, grip strength, level of physical activity, exhaustion, and unintentional weight loss.
“Fragility is not synonymous with disability, but it is a risk factor for loss of functional capacity,” said Alexandre. “We assessed frailty syndrome based on five symptoms or parameters. Subjects with one or two of these were classified as pre-frail and those with three or more as frail. This methodology is complex, requiring materials and questionnaires. It is not universally used.”
The researchers compared overall frailty with each of the five components, finding that walking slowness alone was the best predictor of BADL and IADL for both genders. “It’s an early indicator. The discovery makes it easier for healthcare professionals to spot a problem. They can start looking for the causes of sluggishness earlier,” said Dayane Capra de Oliveira, first author of the paper.
According to Alexandre, the earlier the problem is identified, the more resources and approaches can be brought in to deal with it. “It is more difficult to start treatment when a subject is already having difficulty in several daily activities,” he said. “There are options, but the results aren’t as good as they can be when the problem is caught early. That’s why it’s so important to offer a simpler, safer and cheaper approach to predict the loss of functional capacity.”
The authors detected a higher risk of disability in BADL and IADL in pre-frail women than in pre-frail men. The incidence of pre-frailty was a predictor of disability only in women. They note that females have been found to have greater physiological reserves than males and are more resilient to changes in several systems. This may be due to men’s higher incidence of life-threatening disorders such as stroke, cancer and lung disease, as well as unhealthy habits such as smoking and drinking, and the need exhausting manual labor, while women live longer with debilitating conditions. such as osteoarthritis, depression and high blood pressure.
Previous research has found differences in these processes in men and women aged 60 and over, Alexandre noted. “In the same vein, our study also suggests that men undergo a very short process of decline to disability due to these more serious illnesses, which can lead to death quite quickly, whereas frailty and disability last longer for women,” he said.
For Capra, the study points to a much faster route to early detection of decline and impending loss of ability to perform daily activities in older adults. “This will help implement rapid interventions before disability materializes,” he said.
São Paulo Research Foundation (FAPESP)
Capra de Oliveira, D. et al. (2021) Is slowness a better discriminator of disability than frailty in older people?. Journal of Sarcopenia and Muscle Cachexia. doi.org/10.1002/jcsm.12810.