Walk…or Die: Gait Speed and Survival in Older People

Thanks as always to our SALSAmigo, Khurram Khan, for this meta analysis from colleagues at UPMC. Let’s keep helping our friends, family, and patients move through the world a little better.

DR. STEPHANIE STUDENSKI, MD, MPH, DR. SUBASHAN PERERA, PHD, DR. KUSHANG PATEL, PHD, DR. CATERINA ROSANO, MD, PHD, DR. KIMBERLY FAULKNER, PHD, DR. MARCO INZITARI, MD, PHD, DR. JENNIFER BRACH, PHD, DR. JULIE CHANDLER, PHD, DR. PEGGY CAWTHON, PHD, DR. ELIZABETH BARRETT CONNOR, MD, DR. MICHAEL NEVITT, PHD, DR. MARJOLEIN VISSER, PHD, DR. STEPHEN KRITCHEVSKY, PHD, DR. STEFANIA BADINELLI, MD, DR. TAMARA HARRIS, MD, DR. ANNE B. NEWMAN, MD, DR. JANE CAULEY, PHD, DR. LUIGI FERRUCCI, MD, PHD, AND DR. JACK GURALNIK, MD, PHD

CONTEXT

Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates.

OBJECTIVE

To evaluate the relationship between gait speed and survival.

DESIGN, SETTING, AND PARTICIPANTS

Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34 485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s.

MAIN OUTCOME MEASURES

Survival rates and life expectancy.

RESULTS

There were 17 528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%–88.8%)and 10-year survival rate was 59.7% (95%CI, 46.5%–70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87–0.90; P<. 001). Survival increased across the full range of gait speeds, with significant increments per 0.1 m/s. At age 75, predicted 10-year survival across the range of gait speeds ranged from 19% to 87% in men and from 35% to 91% in women. Predicted survival based on age, sex, and gait speed was as accurate as predicted based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization.

CONCLUSION

In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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