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Why Do Many Older Persons Become Disabled in Walking and Driving? FREE

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The full report is titled “Risk Factors and Precipitants of Long-Term Disability in Community Mobility. A Cohort Study of Older Persons.” It is in the 17 January 2012 issue of Annals of Internal Medicine (volume 156, pages 131-140). The authors are T.M. Gill, E.A. Gahbauer, T.E. Murphy, L. Han, and H.G. Allore.

Ann Intern Med. 2012;156(2):I-44. doi:10.7326/0003-4819-156-2-201201170-00003
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What is the problem and what is known about it so far?

Mobility is central to performing many day-to-day activities and engaging in the community. With age, many older persons lose mobility and can no longer walk short distances or drive a car. Persons with prolonged loss of mobility have difficulty regaining independence and remaining in community settings. They also have higher rates of illness and death.

Why did the researchers do this particular study?

To learn more about long-term loss of mobility in older persons. In particular, the researchers wanted to identify the risk factors and causes for long-term disability in walking a quarter mile and driving a car.

Who was studied?

641 persons aged 70 years or older who could walk a quarter mile unassisted or were active drivers. All could perform essential activities of daily living, such as bathing and dressing.

How was the study done?

The researchers assessed the participants' risk factors every 18 months from March 1998 to October 2008. They also assessed the participants' disability in community mobility every month. Participants who said that they needed help from another person to walk a quarter mile were considered to be disabled in walking. Participants who said that they had not driven a car during the past month were considered to be disabled in driving.

The researchers also performed monthly assessments of the participants' exposure to potential causes of disability, including illnesses or injuries leading to hospitalization and restricted activity (defined as having stayed in bed or having cut down on usual activities for at least a half day).

What did the researchers find?

Long-term disability (lasting 6 consecutive months or longer) developed in 318 participants (56%) in walking and 269 participants (53%) in driving. Illnesses and injuries leading to hospitalization and restricted activity were more common among those who developed walking or driving disability.

Risk factors independently associated with walking disability were older age; female sex; chronic conditions; cognitive impairment; low functional self-efficacy; low physical activity; and low or intermediate scores on the Short Physical Performance Battery (SPPB), a tool for objective assessment of lower-extremity function. Risk factors independently associated with driving disability were older age, female sex, severe visual impairment, weight loss, cognitive impairment, low physical activity, slower gross motor coordination, and low SPPB scores.

What were the limitations of the study?

Because of the design of the study, the cause of mobility loss could not be specifically proven. Information was not available on the severity of the illnesses or injuries that led to hospitalization; hospital-acquired complications; or environmental factors that might affect mobility, such as traffic patterns or the presence of sidewalks.

What are the implications of the study?

Multiple risk factors, together with subsequent illness and injury leading to hospitalization and restricted activity, are associated with an increased likelihood of long-term walking and driving disability. Strategies are needed to prevent community mobility disability.





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