title: Predicting the risk of mobility difficulty in older women with screening nomograms: the Women's Health and Aging Study II. Construct and predictive validity of a self-reported measure of preclinical mobility limitation. Knee extension strength cutpoints for maintaining mobility. Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial The dynamics of disability and functional change in an elderly cohort: results from the Alameda County Study. Mobility performance and its sensory, psychomotor and musculoskeletal determinants from age 75 to age 80 Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Socioeconomic position and incident mobility impairment in the Cardiovascular Health Study Musculoskeletal pain is associated with incident mobility disability in community-dwelling elders. Mediterranean diet and mobility decline in older persons Personal mastery and lower body mobility in community-dwelling older persons: the Invecchiare in Chianti study. Assistive walking device use and knee osteoarthritis: results from the Health, Aging and Body Composition Study (Health ABC Study). Inflammatory markers and incident mobility limitation in the elderly. Benzodiazepine use and physical disability in community-dwelling older adults. The dynamic nature of mobility disability in older persons. Anthropometric indices predict physical function and mobility in older Australians: the Australian Longitudinal Study of Ageing. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. Measuring life-space mobility in community-dwelling older adults. Clinimetric properties of the performance-oriented mobility assessment. Education predicts incidence of preclinical mobility disability in initially high-functioning older women. The Women's Health and Aging Study II. Use of Stance Time Variability for Predicting Mobility Disability in Community-Dwelling Older Persons: A Prospective Study Association of visual impairment with mobility and physical function. Type and intensity of activity and risk of mobility limitation: the mediating role of muscle parameters. Stopping to rest during a 400-meter walk and incident mobility disability in older persons with functional limitations. Assessing mobility in older adults: the UAB Study of Aging Life-Space Assessment. Muscle strength and BMI as predictors of major mobility disability in the Lifestyle Interventions and Independence for Elders pilot (LIFE-P). The combined effect of visual impairment and cognitive impairment on disability in older people. Joint effects of adiposity and physical activity on incident mobility limitation in older adults. Persistent mobility deficit in the absence of deficits in activities of daily living: a risk factor for mortality. Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors? Dog ownership, walking behavior, and maintained mobility in late life. Relative weight and mobility: a longitudinal study in a biracial population of older adults. Homocysteine and mobility in older adults. Effects of comprehensive geriatric assessment and targeted intervention on mobility in persons aged 75 years and over: a randomized controlled trial Validity and Reliability of the Short Physical Performance Battery in Two Diverse Older Adult Populations in Quebec and Brazil Risk Factors and Precipitants of Long-Term Disability in Community Mobility
abstract: BACKGROUND A major obstacle to screening for early mobility disability ( ie , mobility difficulty ) , a major public health concern , is the lack of a method that identifies those who are at high risk . The goal of this study was to develop easy-to-use clinical nomograms for estimation of the probability of incident mobility difficulty . METHODS We conducted a population -based prospect i ve study using data from 266 high physically and cognitively functioning older women , aged 70 to 80 years , who were free of mobility disability at the baseline evaluation of the Women 's Health and Aging Study II . The outcome measure was incident mobility disability within 18 months , defined as self-reported difficulty walking 0.8 km , climbing 10 steps , or transferring from or into a car or bus . Logistic regression and receiver operating characteristic curve analyses were used for evaluation of the optimal combination of self-reported and performance-based mobility measures . Bootstrap sampling and estimation was used for validation . RESULTS Predictive nomograms were developed based on a final model that included 3 simple-to-obtain measures of pre clinical disability : self-report of modification in mobility tasks without having difficulty with them , one-leg stance balance , and time to walk 1 m at a usual pace . Final model accuracy ( as estimated by the area under the receiver operating characteristic curve ) was 73 % ( SE = 0.04 ) . Validation analysis confirmed the high accuracy of these nomograms . CONCLUSIONS An original tool was developed for assessment of the risk of mobility difficulty in older women that can be used to assist physicians and research ers in deciding which women to target for preventive interventions OBJECTIVES To vali date self-reported pre clinical mobility limitation concept and self-report assessment method against muscle power and walking speed , and to study the predictive validity of pre clinical mobility limitation with respect to future risk of manifest mobility limitation . DESIGN Observational prospect i ve cohort study and cross-sectional analysis . SETTING Research laboratory and community . PARTICIPANTS A total of 632 community-living ( age range , 75 - 81 y ) women and men took part in the baseline assessment s and 302 persons in the semi-annual interviews on mobility limitation over 2 years . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Walking speed , muscle power , and self-reported pre clinical and manifest mobility limitation . Pre clinical mobility limitation was defined as self-reported tiredness or modification of task performance without task difficulty . At baseline , 4 subgroups were created according to self-reported pre clinical mobility limitation in any of 3 mobility tasks ( walking 2 km , walking 0.5 km , climbing up stairs ) : no limitation , pre clinical limitation , and minor and major manifest limitation . RESULTS At baseline , participants with pre clinical mobility limitation showed intermediate levels of walking speed and muscle power , compared with those with no limitation or manifest mobility limitation . Participants reporting baseline pre clinical mobility limitation had 3- to 6-fold higher age- and sex-adjusted risk of progressing to major manifest mobility limitation during the 2-year follow-up compared with participants with no limitation at baseline , whereas the risk among those with minor limitation at baseline was 14- to 18-fold higher compared with those with no limitation . CONCLUSIONS The self-report assessment tool proved to be a valid measure to capture the early signs of disability and may serve as an inexpensive tool for identifying those nondisabled persons at high risk for future disability OBJECTIVES To identify levels of knee extensor strength that are associated with high and low risk of incident  severe mobility limitation ( SML ) in initially well-functioning older adults . DESIGN Prospect i ve cohort study . SETTING University clinic center . PARTICIPANTS One thous and three hundred fifty-five men and 1,429 women ( aged 73.6+/-2.85 ) who reported no mobility limitation . MEASUREMENTS Unilateral knee extensor isokinetic strength of participants was obtained . Participants were followed over a median of 5.90 years for the onset of SML , defined as two consecutive reports of a lot of difficulty or inability to walk one-quarter of a mile or climb 10 steps . Deciles of knee extension strength relative to body weight were evaluated to identify cutpoints most predictive of incident SML . Cutpoints were then compared with prevalence of having slow gait speed ( < 1.22 m/s ) and mortality . RESULTS Two sex-specific knee extension strength cutpoints were found . High and low risk of SML corresponded to less than 1.13 newton-meters (Nm)/kg ( 1st decile ) and more than 1.71 Nm/kg ( 6th decile ) in men and less than 1.01 Nm/kg ( 3rd decile ) and more than 1.34 Nm/kg ( 7th decile ) in women , respectively . Moderate risk was defined as being between the low- and high-risk cutpoints . Individuals with knee extension strength in the high- and moderate-risk categories were more likely to have a gait speed less than 1.22 m/s ( hazard ratio (HR)=7.00 , 95 % confidence interval (CI)=5.47 - 8.96 and HR=2.14 7.00 , 95 % CI=1.73 - 2.64 , respectively ) and had a higher risk of death ( HR=1.77 , 95 % CI=1.41 - 2.23 and HR=1.51 , 95 % CI=1.24 - 1.84 , respectively ) than individuals in the low-risk category . Adjustment for demographic factors , health behaviors , and medical conditions did not alter these associations . CONCLUSION Knee extensor strength cutpoints provide objective markers to identify initially well-functioning older adults at high and low risk of future mobility limitation Background Interventions that enhance mobility in frail older people are needed to maintain health and independence , yet definitive evidence of effective interventions is lacking . Our objective was to assess the impact of a multifactorial intervention on mobility-related disability in frail older people . Methods We conducted a r and omised , controlled trial with 241 frail community-dwelling older people in Sydney , Australia . Participants were classified as frail using the Cardiovascular Health Study definition , did not have severe cognitive impairment and were recently discharged from an aged care and rehabilitation service . The experimental group received a 12 month multifactorial , interdisciplinary intervention targeting identified frailty components . Two physiotherapists delivered a home exercise program targeting mobility , and coordinated management of psychological and medical conditions with other health professionals . The control group received usual care .  Disability in the mobility domain was measured at baseline and at 3 and 12 months using the International Classification of Functioning , Disability and Health framework . Participation ( involvement in life situations ) was assessed using the Life Space Assessment and the Goal Attainment Scale . Activity ( execution of mobility tasks ) was measured using the 4-metre walk and self-report measures . Results The mean age of participants was 83.3 years ( SD : 5.9 years ) . Of the participants recruited , 216 ( 90 % ) were followed-up at 12 months . At this time point , the intervention group had significantly better scores than the control group on the Goal Attainment Scale ( odds ratio 2.1 ; 95 % confidence interval ( CI ) 1.3 to 3.3 , P = 0.004 ) and Life Space Assessment ( 4.68 points , 95 % CI 1.4 to 9.9 , P = 0.005 ) . There was no difference between groups on the global measure of participation or satisfaction with ability to get out of the house . At the activity level , the intervention group walked 0.05 m/s faster over 4 m ( 95 % CI 0.0004 to 0.1 , P = 0.048 ) than the control group , and scored higher on the Activity Measure for Post Acute Care ( P < 0.001 ) . Conclusions The intervention reduced mobility-related disability in frail older people . The benefit was evident at both the participation and activity levels of mobility-related disability . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : ANZCTRN12608000507381 OBJECTIVE To examine changes in functional status over time by age , gender , and ethnicity in a representative sample of older persons . DESIGN Six-year prospect i ve cohort study . SETTING Alameda County , California . PARTICIPANTS 508 persons 65 years old and older at baseline in 1984 . MAIN OUTCOME MEASURES Activities of daily living ( ADL ) dependence , mobility impairment , and functioning on an 18-item scale . RESULTS The prevalence of ADL dependence and mobility impairment at baseline increased with age , while function decreased . Particularly striking differences occurred for those 80 and older . Changes in function over the 6-year follow-up showed a similar pattern . While death rates for males were higher , females had poorer initial functioning , and surviving females declined more than surviving males . The incidence of ADL dependence and mobility impairment during follow-up was similar for males and females , although females survived longer with incident disability than did males . Blacks had poorer baseline functioning , more ADL dependence and mobility impairment , and declined more than non-Blacks during follow-up . Some of the baseline difference in function between Blacks and non-Blacks was due to higher rates of chronic illness and co-morbidity . In spite of the general downward trend in functioning over the 6 years , 13 % of the males and 20 % of the females improved . CONCLUSION Age-related changes in function for older persons are complex and result in much heterogeneity . Clarifying the reasons for such heterogeneity is an important and challenging area of research Background and aims : Prospect i ve studies on the simultaneous effects of multiple determinants on objective ly assessed mobility are few . The aim of this study was to analyse mobility performance , its stability and sensory , psychomotor and musculoskeletal determinants in an older population from age 75 to age 80 . Methods : Sixty-three men and 121 women aged 75 participated at baseline and , five years later , in the follow-up phase of this population -based prospect i ve study .  Maximal walking speed and step-mounting height were assessed at baseline and follow-up . Maximal isometric knee extension strength , st and ing balance on force platform , reaction time , visual acuity and limitations in range of motion ( ROM ) of hips and knees were assessed at baseline . Structural equation modeling was used to analyse the associations . Results : The stability of mobility performance from baseline to the five-year follow-up was high ( coefficient 0.80 in men , 0.78 in women ) . In men , knee extension strength , st and ing balance , ROM limitations and visual acuity explained 69 % of the variation in mobility performance at baseline and , indirectly , 59 % of that variation at follow-up . Among women , knee extension strength , st and ing balance , visual acuity and reaction time explained 52 % of the variation of mobility performance at baseline and , indirectly , 30 % at the five-year follow-up . Conclusions : Results indicate that the predictive effects of sensory , psychomotor and musculoskeletal functions on mobility performance extend over five years in older people . In seeking to prevent mobility limitations , vision , reaction time and lower extremity ROM need to be targeted , in addition to muscle strength and balance BACKGROUND in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs . OBJECTIVE to examine whether  tiredness in daily activities  is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women . DESIGN a prospect i ve study with 1 1/2-year follow-up . SETTING 34 communities in four counties in Denmark . SUBJECTS 1396 older non-disabled adults ( 74 - 75 and 80 years old ) living in 17 of the participating communities . METHODS question naire surveys at baseline and at 1 1/2-year follow-up . Tiredness in daily activities  was measured by questions about tiredness in six mobility activities . Onset of mobility disability was measured as onset of need for help in one to six mobility activities . RESULTS men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up , when adjusted by the covariates . In addition , low social participation , poor psychological function , and physical inactivity were independent risk factors of onset of mobility disability among men , and home help , low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women . CONCLUSION older people who complain about tiredness are at higher risk of becoming disabled than others . This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective BACKGROUND numerous tests have been suggested as fall risk indicators . However , the validity of these assessment s has not been demonstrated in large representative sample s of community-dwelling older people . OBJECTIVE the objective of this study was to examine the comparative ability and clinical utility of eight mobility tests for predicting multiple falls in older community-dwelling people . METHODS design -- prospect i ve cohort study ; subjects--362 subjects aged 74 - 98 years ; measurements --the sit-to-st and test with one and five repetitions , the pick-up-weight test , the half-turn test , the alternate-step test ( AST ) , the six-metre-walk test ( SMWT )  and  stair ascent and descent tasks . Falls were monitored for 1 year with fall calendars . RESULTS in the 12-month follow-up period , 80 subjects ( 22.1 % ) suffered two or more falls . Multiple fallers performed significantly worse than non-multiple fallers in the sit-to-st and test with five repetitions ( STS-5 ) , the AST , the  half-turn test  , the  SMWT  and the stair-descent test .  When dichotomised using cut-off points from receiver-operated characteristics ( ROC ) curve analyses , these tests demonstrated reasonable sensitivity and specificity in identifying multiple fallers . A principal components analysis identified only one factor underlying the mobility tests . Poor performances in two mobility tests , however , increased the risk of multiple falls more than poor performance in one test alone ( ORs = 3.66 , 95 % CI = 1.44 , 9.27 and 1.61 , 95 % CI = 0.62 , 4.16 respectively ) . CONCLUSIONS the mobility tests appear to be measuring a similar ' mobility ' construct . Based on feasibility and predictive validity , the AST , STS-5 and SMWTs were the best tests Background We investigated if personal socioeconomic position ( SEP ) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly . Methods We used data from the Cardiovascular Health Study , a longitudinal , population -based examination of coronary heart disease and stroke among persons aged 65 and older in the United States . Results Among 3,684 persons without baseline mobility impairment , lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period , although the strengths of these associations varied by socioeconomic indicator and race/sex group . Conclusion Among independent-living elderly , SEP affected development of mobility impairment into later life . Particular effort should be made to prevent or delay its onset among the elderly with low income , education , and /or who live in economically disadvantaged neighborhoods BACKGROUND Identifying mobility disability risk factors may facilitate development of interventions promoting functional independence in older persons . We tested the hypothesis that musculoskeletal pain is associated with first occurrence of severe mobility disability . METHODS In a prospect i ve observational study at 40 community-based sites , 759 older Catholic clergy in the Rush Religious Orders Study without baseline dementia , stroke , Parkinson 's disease , or severe performance-based mobility disability ( defined as gait speed less than or equal to 0.4 m/s ) and at least one follow-up mobility evaluation were evaluated over a mean of 8.5 ( SD = 3.8 ) years . All participants were queried about musculoskeletal pain in the year before baseline and underwent annual assessment of mobility . RESULTS Using a proportional hazards model adjusted for age , sex , and education , the hazard for incident severe mobility disability was greater for participants reporting pain in the year before baseline ( odds ratio = 1.47 , 95 % confidence interval = 1.17 - 1.85 ) . Results were unchanged after adjusting for self-reported mobility disability , gait speed , depressive symptoms , body mass index , physical activity , chronic medical conditions , and analgesic use . Compared with no report of musculoskeletal pain , musculoskeletal pain in one or two areas was associated with a 30 % greater hazard for incident disability ( odds ratio = 1.31 , 95 % confidence interval = 1.00 - 1.70 ) . Musculoskeletal pain in three or more areas was associated with an 80 % greater hazard for incident disability ( odds ratio = 1.80 , 95 % confidence interval = 1.31 - 2.47 ) . In participants without baseline self-reported mobility disability ( n = 486 ) , musculoskeletal pain was associated with greater hazard for incident self-reported mobility disability ( odds ratio = 1.38 , 95 % confidence interval = 1.11 - 1.73 ) . CONCLUSION In older persons , musculoskeletal pain is associated with incident mobility disability We examined whether adherence to a Mediterranean-style diet has positive effects on mobility assessed over a 9-year follow-up in a representative sample of older adults . This research is part of the InCHIANTI Study , a prospect i ve population -based study of older persons in Tuscany , Italy . The sample for this analysis included 935 women and men aged 65 years and older .  Adherence to the Mediterranean diet was assessed at baseline by the st and ard 10-unit Mediterranean diet score ( MDS ) . Lower extremity function was measured at baseline , and at the 3- , 6- and 9-year follow-up visits using the short physical performance battery ( SPPB ) . At baseline , higher adherence to Mediterranean diet was associated with better lower body performance . Participants with higher adherence experienced less decline in SPPB score , which was of 0.9 points higher ( p<.0001 ) at the 3-year-follow , 1.1 points higher ( p=0.0004 ) at the 6-year follow-up and 0.9 points higher ( p=0.04 ) at the 9-year follow-up compared to those with lower adherence . Among participants free of mobility disability at baseline , those with higher adherence had a lower risk ( HR=0.71 , 95 % CI=0.51 - 0.98 , p=0.04 ) of developing new mobility disability . High adherence to a Mediterranean-style diet is associated with a slower decline of mobility over time in community-dwelling older persons . If replicated , this observation is highly relevant in terms of public health OBJECTIVES To test the hypothesis that , in older persons , sense of personal mastery , defined as the extent to which one regards one 's life chance as being under one 's own control , predicts change in lower extremity performance during a 6-year follow-up . DESIGN Prospect i ve cohort study . SETTING Community based . PARTICIPANTS Six hundred twenty-six participants aged 65 and older . MEASUREMENTS  Personal mastery  was assessed at baseline using  Pearlin 's mastery scale . Lower extremity performance was measured at baseline and at 6-year follow-up using the Short Physical Performance Battery ( SPPB ) of lower extremity function . RESULTS Higher sense of mastery was associated with a significantly less-steep decline in lower extremity performance . Participants in the two lowest quartiles of personal mastery had , respectively , a 2.6 ( 95 % confidence interval (CI)=1.4 - 5.1 , P=.01 ) and 3.2 ( 95 % CI=1.6 - 6.6 , P=.002 ) higher risk of experiencing a substantial decline ( > or =3 points ) in SPPB scores after 6 years as those in the highest quartile . CONCLUSIONS Older individuals with poor sense of personal mastery are at high risk of accelerated lower extremity physical function decline . Whether interventions aim ed at improving personal mastery may prevent disability remains unknown OBJECTIVES To identify factors that predicted incident use of assistive walking devices ( AWDs ) and to explore whether AWD use was associated with changes in osteoarthritis of the knee . DESIGN Prospect i ve cohort study . SETTING Community . PARTICIPANTS Older adults ( N=2639 ) in the Health , Aging and Body Composition ( Health ABC ) Study including a subset of 874 patients with prevalent knee pain . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Incident use of AWDs , mean Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain scores , and the frequency of joint space narrowing on knee radiographs over a 3-year time period . RESULTS AWD use was initiated by 9 % of the entire Health ABC cohort and 12 % of the knee pain subset . Factors that predicted use in both groups were age ≥73 ( entire cohort : odds ratio [OR]=2.07 ; 95 % confidence interval [ CI ] , 1.43 - 3.01 ; knee pain subset : OR=1.87 ; 95 % CI , 1.16 - 3.03 ) , black race ( entire cohort : OR=2.95 ; 95 % CI , 2.09 - 4.16 ; knee pain subset : OR=3.21 ; 95 % CI , 2.01 - 5.11 ) , and lower balance ratios ( entire cohort : OR=3.18 ; 95 % CI , 2.21 - 4.59 ; knee pain subset : OR=3.77 ; 95 % CI , 2.34 - 6.07 ) . Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users . Twenty percent of non-AWD users and 28 % of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least 1 knee . Fourteen percent of non-AWD users and 12 % of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least 1 knee . CONCLUSIONS AWDs are frequently used by older adults . Knee pain and balance problems are significant reasons why older adults initiate use of an AWD . In an exploratory analysis , there was no consistent relation between the use or nonuse of an  AWD and WOMAC pain scores or knee joint space narrowing progression . Further studies of the relation of use of AWDs to changes in knee osteoarthritis are needed OBJECTIVES To examine the relationship between indicators of inflammation and the incidence of  mobility limitation in older persons . DESIGN Prospect i ve cohort study : the Health , Aging and Body Composition Study . SETTING Pittsburgh , Pennsylvania , and Memphis , Tennessee . PARTICIPANTS A total of 2,979 men and women , aged 70 to 79 , without mobility limitation at baseline . MEASUREMENTS  Serum levels of interleukin (IL)-6 , tumor necrosis factor alpha ( TNFalpha ) , and C-reactive protein ( CRP ) and soluble cytokine receptors ( IL-2sR , IL-6sR , TNFsR1 , TNFsR2 )  were measured . Mobility limitation was assessed and defined as reporting difficulty or inability to walk one-quarter of a mile or to climb 10 steps during two consecutive semiannual assessment s over 30 months . RESULTS Of the 2,979 participants , 30.1 % developed incident mobility limitation . After adjustment for confounders ( demographics , prevalent conditions at baseline , body composition ) , the relative risk ( RR ) of incident mobility limitation per st and ard deviation ( SD ) increase was 1.19 ( 95 % confidence interval (CI)=1.10 - 1.28 ) for IL-6 , 1.20 ( 95 % CI=1.12 - 1.29 ) for TNFalpha , and 1.40 ( 95 % CI=1.18 - 1.68 ) for CRP . The association between inflammation and incident mobility limitation was especially strong for the onset of more severe mobility limitation and when the levels of multiple inflammatory markers were high . When persons with baseline or incident cardiovascular disease events or persons who were hospitalized during study follow-up were excluded , findings remained similar . In a subset ( n=499 ) , high levels of the soluble receptors IL2sR and TNFsR1 ( per SD increase : RR=1.23 ( 95 % CI=1.04 - 1.46 ) and RR=1.28 ( 95 % CI=1.04 - 1.57 ) , respectively ) were also associated with incident mobility limitation . CONCLUSION Findings suggest that inflammation is prognostic for incident mobility limitation over 30 months , independent of cardiovascular disease events and incident severe illness OBJECTIVES To determine whether benzodiazepine use is associated with incident disability in mobility and activities of daily living ( ADLs ) in older individuals . DESIGN A prospect i ve cohort study . SETTING Four sites of the Established Population s for Epidemiologic Studies of the Elderly . PARTICIPANTS This study included 9,093 subjects ( aged > or = 65 ) who were not disabled in mobility or ADLs at baseline . MEASUREMENTS Mobility disability was defined as inability to walk half a mile or climb one flight of stairs . ADL disability was defined as inability to perform one or more basic ADLs ( bathing , eating , dressing , transferring from a bed to a chair , using the toilet , or walking across a small room ) . Trained interviewers assessed outcomes annually . RESULTS At baseline , 5.5 % of subjects reported benzodiazepine use . In multivariable models , benzodiazepine users were 1.23 times as likely as nonusers ( 95 % confidence interval ( CI ) = 1.09 - 1.39 ) to develop mobility disability and 1.28 times as likely ( 95 % CI = 1.09 - 1.52 ) to develop ADL disability . Risk for incident mobility was increased with short- ( hazard ratio ( HR ) = 1.27 , 95 % CI = 1.08 - 1.50 ) and long-acting benzodiazepines ( HR = 1.20 , 95 % CI = 1.03 - 1.39 ) and no use . Risk for ADL disability was greater with short- ( HR = 1.58 , 95 % CI = 1.25 - 2.01 ) but not long-acting ( HR = 1.11 , 95 % CI = 0.89 - 1.39 ) agents than for no use . CONCLUSION Older adults taking benzodiazepines  have a greater risk for incident mobility and ADL disability . Use of short-acting agents does not appear to confer any safety benefits over long-acting agents OBJECTIVES To determine the rates of clinical ly meaningful transitions in mobility disability ; evaluate how these transitions differ according to age , sex , and physical frailty ; and depict the duration of the result ing episodes of mobility disability . DESIGN Prospect i ve cohort study . SETTING General community in greater New Haven , Connecticut , from March 1998 to October 2004 . PARTICIPANTS Seven hundred fifty-four community-living older persons , aged 70 and older , who were nondisabled ( i.e. , required no personal assistance ) in four activities of daily living . MEASUREMENTS  Mobility disability , defined as the inability to  walk  one quarter of a mile and to  climb a flight of stairs , respectively without personal assistance  , was assessed every month for up to 5 years . RESULTS For both mobility tasks , rates per 1,000 person-months were higher for transitions from no disability to intermittent disability ( 34.7 for walking one quarter of a mile and 17.4 for climbing a flight of stairs ) , intermittent to continuous disability ( 52.0 and 42.5 ) , continuous to intermittent disability ( 35.4 and 31.5 ) , and intermittent to no disability ( 68.6 and 85.4 ) than for other transitions . Older age , female sex , and physical frailty were associated with greater likelihood of transition to states of greater disability and lower likelihood of regaining independent mobility . CONCLUSION Mobility disability in older persons is a highly dynamic process , characterized by frequent transitions between states of independence and disability . Programs design ed to enhance independent mobility should focus not only on the prevention of mobility disability but also on the restoration and maintenance of independent mobility in older persons who become disabled OBJECTIVE To evaluate , in terms of function and mobility , the predictive value of commonly adopted anthropometric ' definitions ' used in the nutritional assessment of older adults , in a cohort of older Australians . DESIGN Prospect i ve cohort study - Australian Longitudinal Study of Ageing ( ALSA ) . SETTING Adelaide , South Australia ( 1992 - 1994 ) . SUBJECTS Data were analysed from 1272 non-institutionalised ( 685 males , 587 females ) older adults > or = 70 years old in South Australia . Seven ' definitions ' commonly used in the anthropometric assessment of both under- and overnutrition ( including four using body mass index ( BMI ) , waist-to-hip ratio , waist circumference and percentage weight change ) were evaluated at baseline , for their ability to predict functional and mobility limitation assessed ( by self-report question naire ) at two years follow-up . All question naires were administered and anthropometry performed by trained investigators . The associations between the definitions and decline in mobility and physical function were evaluated over two years using multiple logistic regression . RESULTS A BMI > 85th percentile or > 30 kg m-2 or a waist circumference of > 102 cm in males and > 88 cm in females increased risk of functional and mobility limitations . Over two years , a loss of 10 % body weight significantly increased the risk of functional and mobility limitations . CONCLUSION Maintaining weight within older adults , irrespective of initial body weight , may be important in preventing functional and mobility limitations . Excessive weight is associated with an increased risk of limitation in function and mobility , both key components of health-related quality of life BACKGROUND Lower muscle mass has been correlated with poor physical function ; however , no studies have examined this relationship prospect ively . This study aims to investigate whether low muscle mass , low muscle strength , and greater fat infiltration into the muscle predict incident mobility limitation . METHODS Our study cohort included 3075 well-functioning black and white men and women aged 70 - 79 years participating in the Health , Aging , and Body Composition study . Participants were followed for 2.5 years . Muscle cross-sectional area and muscle tissue attenuation ( a measure of fat infiltration ) were measured by computed tomography at the mid-thigh , and knee extensor strength by using a KinCom dynamometer .  Incident mobility limitation was defined as two consecutive self-reports of any difficulty walking one-quarter mile or climbing 10 steps . RESULTS Mobility limitations were developed by 22.3 % of the men and by 31.8 % of the women . Cox 's proportional hazards models , adjusting for demographic , lifestyle , and health factors , showed a hazard ratio of 1.90 [ 95 % confidence interval ( CI ) , 1.27 - 2.84 ] in men and 1.68 ( 95 % CI , 1.23 - 2.31 ) in women for the lowest compared to the highest quartile of muscle area ( p < .01 for trend ) . Results for muscle strength were 2.02 ( 95 % CI , 1.39 - 2.94 ) and 1.91 ( 95 % CI , 1.41 - 2.58 ) , p < .001 trend , and for muscle attenuation were 1.91 ( 95 % CI , 1.31 - 2.83 ) and 1.68 ( 95 % CI , 1.20 - 2.35 ) , p < .01 for trend . When included in one model , only muscle attenuation and muscle strength independently predicted mobility limitation ( p < .05 ) . Among men and women , associations were similar for blacks and whites . CONCLUSION Lower muscle mass ( smaller cross-sectional thigh muscle area ) , greater fat infiltration into the muscle , and lower knee extensor muscle strength are associated with increased risk of mobility loss in older men and women . The association between low muscle mass and functional decline seems to be a function of underlying muscle strength OBJECTIVES To evaluate the validity and reliability of a st and ardized approach for assessing life-space mobility ( the University of Alabama at Birmingham Study of Aging Life-Space Assessment ( LSA ) ) and its ability to detect changes in life-space over time in community-dwelling older adults . DESIGN Prospect i ve , observational cohort study . SETTING Five counties ( three rural and two urban ) in central Alabama . PARTICIPANTS Community-dwelling Medicare beneficiaries ( N=306 ; 46 % male , 43 % African American ) who completed in-home baseline interviews and 2-week and 6-month telephone follow-up interviews . MEASUREMENTS The LSA assessed the range , independence , and frequency of movement over the 4 weeks preceding assessment s. Correlations between the baseline LSA and measures of physical and mental health ( physical performance , activities of daily living , instrumental activities of daily living , a global measure of health ( the short form-12 question survey ) , the Geriatric Depression Scale , and comorbidities ) established validity . Follow-up LSA scores established short-term test-retest reliability and the ability of the LSA to detect change . RESULTS For all LSA scoring methods , baseline and 2-week follow-up LSA correlations were greater than 0.86 ( 95 % confidence interval=0.82 - 0.97 ) . Highest correlations with measures of physical performance and function were noted for the LSA scoring method considering all attributes of mobility . The LSA showed both increases and decreases at 6 months . DISCUSSION Life-space correlated with observed physical performance and self-reported function . It was stable over a 2-week period yet showed changes at 6 months BACKGROUND AND PURPOSE The Performance-Oriented Mobility Assessment ( POMA ) is a widely used instrument that provides an evaluation of balance and gait . It is used clinical ly to determine the mobility status of older adults or to evaluate changes over time . To support the use of the POMA for these purpose s , the clinimetric properties ( in particular , responsiveness ) were determined . SUBJECTS Participants ( 78 % female ; mean age=84.9 years ) were living in either self-care or nursing-care residences .  Concurrent and discriminant validity were assessed with the total group ( N=245 ) , whereas reliability and responsiveness were determined with a sub sample ( n=30 ) . Fall-related predictive validity was assessed with a sub sample of 72 participants . METHODS In addition to the POMA , several reference performance tests were administered . The POMA was assessed on 2 consecutive days by 2 raters ( observers ) . The analyses included the calculation of Spearman rank correlation coefficients ( R ) , limits of agreement ( LOA ) with Bl and -Altman plots , minimal detectable changes at the 95 % confidence level ( MDC(95 ) ) , and sensitivity and specificity with regard to predicting falls . When possible , findings for the total scale ( POMA-T ) were complemented by findings for its balance subscale ( POMA-B ) and its gait subscale ( POMA-G ) . RESULTS The interrater and test-retest reliability for the POMA-T and the POMA-B were good ( R=.74-.93 ) , whereas for the POMA-G , the reliability values , although high as well , were systematic ally slightly lower ( R=.72-.89 ) . The Spearman correlations with the reference performance tests ( R=|.64|- |.68| ) indicated satisfactory concurrent validity for the POMA-T and the POMA-B , but the corresponding findings for the POMA-G ( R=|.52|- |.56| ) were less convincing . The discriminant validity values of the 3 scales were about the same . The LOA for the POMA-T were on the order of -4.0 to 4.0 for test-retest agreement and -3.0 to 3.0 for interrater agreement . On the basis of the MDC(95 ) values , it was concluded that changes in POMA-T scores at the individual level should be at least 5 points and that those at the group level ( n=30 ) should be at least 0.8 point to be considered reliable . Even when optimal cutoff points were used , sensitivity and specificity values ( varying between 62.5 % and 66.1 % ) for the POMA-T as well as for its 2 subscales indicated poor accuracy in predicting falls . DISCUSSION AND CONCLUSION The POMA-T and its subscale POMA-B have adequate reliability and validity for assessing mobility in older adults . The POMA-T is useful for demonstrating intervention effects at the group level . Changes within subjects , however , should be at least 5 points before being interpreted as reliable changes . The accuracy of the POMA-T in predicting falls is poor BACKGROUND To examine the impact of educational attainment on the incidence of  pre clinical mobility disability ( PCD )  . METHODS The Women 's Health and Aging II Study is a prospect i ve observational cohort study of 436 initially high-functioning community-dwelling women aged 70 - 79 years at baseline in Baltimore , Maryl and . We measured the association of highest attained education level with pre clinical mobility disability ( PCD ) over an 11-year period . PCD is defined as self-reported modification in any of four tasks without reporting difficulty in those tasks . The tasks were  walking ½ mile , climbing up steps , doing heavy housework  , and getting in/out of bed or chair  . RESULTS Participants with less than 9 years of education were more likely to acquire incident PCD ( hazard ratio : 3.1 , 95 % confidence interval = 1.2 - 7.7 ) than their counterparts with more education after adjusting for income , marital status , number of diseases , and high self-efficacy . CONCLUSIONS Lower education level is an independent predictor of incident pre clinical mobility disability . This association has important implication s for primary and secondary prevention and can be easily assessed in clinical encounters Background and Purpose : Mobility disability is a serious and frequent adverse health outcome associated with aging . Early identification of individuals at risk for mobility disability is important if interventions to prevent disability are to be instituted . The objectives of this prospect i ve study were to ( 1 ) determine the magnitude of stance time variability ( STV ) that discriminates individuals who currently have mobility disability ( prevalent mobility disability ) and ( 2 ) determine the magnitude of STV that predicts a new onset of mobility disability at 1 year ( incident mobility disability ) . Methods : A total of 552 community-dwelling older adults were evaluated as part of the Cardiovascular Health Study , a longitudinal cohort study . Stance time , in milliseconds , was determined from 2 passes on a 4-m computerized walkway at self-selected walking speed , and STV was defined as the st and ard deviation from approximately 12 individual steps . Mobility disability was defined as self-reported difficulty walking a one-half mile . Receiver operating characteristic ( ROC ) curves were plotted to determine an optimal cutoff value for STV for prevalent and incident mobility disability , and the area under the receiver operating characteristic curve ( AUC ) was computed . Results : The optimal cutoff score for STV ( maximizing sensitivity and specificity ) for prevalent mobility disability was 0.037 seconds ( sensitivity = 65 % , specificity = 65 % , AUC = 0.70 ) and for incident 1-year mobility disability was 0.034 seconds ( sensitivity = 61 % , specificity = 60 % , AUC = 0.65 ) . The use of likelihood ratios demonstrated a gradient of risk across values of STV , with mobility risk increasing as values of STV increased . Discussion and Conclusion : Values of STV may be useful in identifying older adults with mobility disability and at risk for future disability . We recommend the more conservative estimate for identifying risk , STV = 0.034 seconds , which maximizes the sensitivity and minimizes false negatives . The relatively modest values on the validity indices could possibly be improved by increasing the reliability of the measurement of STV . Clinicians should interpret the cutoff values liberally and use STV in conjunction with other measures until further work is completed to vali date STV as an indicator of mobility disability OBJECTIVE To examine the association of distant vision and physical function in the population of older adults . DESIGN Cross-sectional and cohort study . PARTICIPANTS 5143 older residents of three communities ( Established Population s for the Epidemiologic Studies of the Elderly ) who were interviewed in 1988 - 89 , including residents of two communities who were re-interviewed 15 months later ( n = 3133 , 97 % of those eligible ) . MEASURES  Visual acuity screening , self-reported activities of daily living and mobility , and objective physical performance measures of balance , walking , and rising from a chair .  RESULTS Limitations in mobility , activities of daily living , and physical performance were associated with worse visual function . In prospect i ve analyses controlling for potential confounders , participants with severe visual impairment had 3-fold higher odds of incident mobility and activity of daily living limitations than those with acuity of 20/40 or better ( P < 0.001 ) . In prospect i ve analyses investigating the relationship of vision with improvement in function , those with poor vision were about half as likely to improve as those with better acuity , but this relationship was only statistically significant for improvement in mobility limitations . CONCLUSIONS Distant visual function appears to play an important role in physical function , particularly for mobility . An intervention to improve vision  in at-risk elders might preserve function and prevent disability ; this warrants further investigation OBJECTIVES To investigate the association between different types of physical activity behavior and  incident mobility limitation in older men and women and to examine whether muscle parameters mediate these associations . DESIGN Cohort study with 4.5-year follow-up . SETTING Metropolitan areas surrounding Pittsburgh , Pennsylvania , and Memphis , Tennessee . A r and om sample of white Medicare beneficiaries and all age-eligible blacks . PARTICIPANTS Three thous and seventy-five black and white men and women aged 70 to 79 with no self-reported difficulty walking one-quarter of a mile or climbing 10 steps , enrolled in the Health , Aging and Body Composition ( Health ABC ) Study . MEASUREMENTS Participants were classified as exercisers ( reporting > or = 1,000 kcal/wk of exercise activity ) , lifestyle active ( reporting < 1,000 kcal/wk of exercise activity and > or = 2,719 kcal/wk of total physical activity ) , or inactive ( reporting < 1,000 kcal/wk of exercise activity and < 2,719 kcal/wk of total physical activity ) . The study outcome , incident mobility limitation , was defined as two consecutive , semiannual self-reports of any difficulty walking one quarter of a mile or climbing 10 steps . Thigh muscle area , thigh muscle attenuation ( a marker of fat infiltration in muscle ) , appendicular lean soft tissue mass , and isokinetic knee extensor strength were examined as potential mediators . RESULTS Over 4.5 years , 34.3 % of men and 47.4 % of women developed mobility limitation . Inactive persons had twice the risk of incident mobility limitation as exercisers ( hazard ratio (HR)=2.08 , 95 % confidence interval (CI)=1.60 - 2.70 , for men , HR=1.98 , 95 % CI=1.51 - 2.60 , for women ) . Lifestyle-active men and women had an intermediate risk ( HR=1.47 and 1.44 , respectively ) . For the lifestyle active and inactive , absence of walking activity conferred an additional risk of mobility limitation . Muscle parameters did not mediate the relationship between physical activity and mobility limitation , except for knee extensor strength in men . CONCLUSION Exercise and an active lifestyle that includes walking protect against mobility loss in older men and women . Activity effects on muscle parameters do not explain this association OBJECTIVES To examine the association between stopping to rest during a 400-m usual-pace walk test ( 400-MWT ) and incident  mobility disability in older persons with functional limitations . DESIGN Prospect i ve cohort study . SETTING Community based . PARTICIPANTS Four hundred twenty-four participants in the Lifestyle Intervention and Independence for Elders Pilot ( LIFE-P ) Study aged 70 to 89 with functional limitations ( summary score < or = 9 on the Short Physical Performance Battery ( SPPB ) ) but able to complete the 400-MWT within 15 minutes . MEASUREMENTS Rest stops during the 400-MWT were recorded . The onset of mobility disability , defined as being unable to complete the 400-MWT or taking more than 15 minutes to do so , was recorded at Months 6 and 12 . RESULTS Fifty-four ( 12.7 % ) participants rested during the 400-MWT at baseline , of whom 37.7 % experienced mobility disability during follow-up , versus 8.6 % of those not stopping to rest . Performing any rest stop was strongly associated with incident mobility disability at follow-up ( odds ratio (OR)=5.4 , 95 % confidence interval (CI)=2.7 - 10.9 ) after adjustment for age , sex , and clinic site . This association was weaker , but remained statistically significant , after further adjusting for SPPB and time to complete the 400-MWT simultaneously ( OR=2.6 , 95 % CI=1.2 - 5.9 ) . CONCLUSION Stopping to rest during the 400-MWT is strongly associated with incident mobility disability in nondisabled older persons with functional limitations . Given the prognostic value , rest stops should be recorded as part of the st and ard assessment protocol for the 400-MWT BACKGROUND AND PURPOSE The University of Alabama at Birmingham ( UAB ) Study of Aging Life-Space Assessment ( LSA ) is a relatively new instrument to measure mobility . The purpose of this report is to describe the relationships between LSA and traditional measures of physical function , sociodemographic characteristics , depression , and cognitive status . SUBJECTS Subjects were a stratified r and om sample of 998 Medicare beneficiaries aged > or = 65 years . The sample was 50 % African American , 50 % male , and 50 % from rural ( versus urban ) counties . METHODS In-home interviews were conducted . Mobility was measured using the LSA , which documents where and how often subjects  travel and any assistance needed during the 4 weeks prior to the assessment . Basic activities of daily living ( ADL ) and instrumental activities of daily living ( IADL ) , cognitive status , income level , presence of depressive symptoms , and transportation re sources were determined . The  Short Physical Performance Battery ( SPPB ) was used to assess physical performance . RESULTS Simple bivariate correlations indicated a significant relationship between LSA and all variables except residence ( rural versus urban ) . In a regression model , physical function ( ADL , IADL ) and physical performance ( SPPB ) accounted for 45.5 % of the variance in LSA scores . An additional 12.7 % of the variance was explained by sociodemographic variables , and less than 1 % was explained by cognition and depressive symptoms . DISCUSSION AND CONCLUSION The LSA can be used to document patients ' mobility within their home and community . The LSA scores are associated with a person 's physical capacity and other factors that may limit mobility . These scores can be used in combination with other tests and measures to generate clinical hypotheses to explain mobility deficits and to plan appropriate interventions to address these deficits BACKGROUND Muscle weakness and obesity are two significant threats to mobility facing the increasing number of older adults . To date , there are no studies that have examined the association of strength and body mass index ( BMI ) on event rates on a widely used performance measure of major mobility disability . METHODS This study was a secondary analysis of a r and omized controlled trial in which sedentary functionally limited participants ( 70 - 89 years , Short Physical Performance Battery ≤ 9 ) who were able to complete a 400-m walk test at baseline were r and omized to a physical activity or health education intervention and reassessed for major mobility disability every 6 months for up to 18 months . We evaluated whether baseline grip strength and BMI predicted failure to complete the 400-m walk test in 15 minutes or less ( major mobility disability ) . RESULTS Among N = 406 participants with baseline measures  , lower grip strength was associated with an increased risk for developing major mobility disability , with and without covariate adjustment ( p < .01 ) : The hazard ratio ( 95 % confidence interval ) for the lowest versus high sex-specific quartile of grip strength was 6.11 ( 2.24 - 16.66 ) . We observed a U-shaped relationship between baseline BMI and the risk of developing major mobility disability , such that the risk for participants with a BMI of 25 - 29 kg/m(2 ) was approximately half that of participants with BMI less than 25 or 30 kg/m(2 ) or more ( p = .04 in fully adjusted analyses ) . CONCLUSIONS Our data highlight the importance of muscle weakness , low BMI , and obesity as risk factors for major mobility disability in older adults . Being overweight may be protective for major mobility disability OBJECTIVES To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment , cognitive impairment , or the multimorbidity . DESIGN Prospect i ve cohort . SETTING North Carolina . PARTICIPANTS Three thous and eight hundred seventy-eight participants in the North Carolina Established Population s for the Epidemiologic Studies of the Elderly with nonmissing visual status , cognitive status , and disability status data at baseline MEASUREMENTS  Short Portable Mental Status Question naire  ( cognitive impairment defined as > or = 4 errors ) ,  self reported visual acuity ( visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print ) , demographic and health-related variables , disability status ( activities of daily living ( ADLs ) , instrumental activities of daily living ( IADLs ) , mobility ) , death , and time to nursing home placement . RESULTS Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability ( odds ratio (OR)=6.50 , 95 % confidence interval (CI)=4.34 - 9.75 ) , mobility disability ( OR=4.04 , 95 % CI=2.49 - 6.54 ) , ADL disability ( OR=2.84 , 95 % CI=1.87 - 4.32 ) , and incident ADL disability ( OR=3.66 , 95 % , CI=2.36 - 5.65 ) . In each case , the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone , a pattern that was not observed for other adverse outcomes assessed . No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status . CONCLUSION Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability , with each condition contributing additively to disability risk . Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity . When visual or cognitive impairment is present , efforts to maximize the other function may be beneficial OBJECTIVES To examine joint associations of physical activity and adiposity measures ( body mass index ( BMI ) , waist circumference , percentage body fat ) with incident mobility limitation . DESIGN Prospect i ve observational cohort study . SETTING Memphis , Tennessee and Pittsburgh , Pennsylvania . PARTICIPANTS Two thous and nine hundred and eighty-two black and white men and women aged 70 to 79 participating in the Health , Aging and Body Composition ( Health ABC ) study . MEASUREMENTS Mobility limitation was defined as reported difficulty walking one-quarter of a mile or climbing 10 steps during two consecutive semiannual assessment s over 6.5 years . Three measures of adiposity were included in this study : BMI , total percentage body fat , and waist circumference . Physical activity  was assessed using a modified leisure-time physical activity question naire . RESULTS Forty-six percent of the cohort developed mobility limitation .  White and black men with a high BMI ( > or = 30 kg/m(2 ) ) , high total percentage body fat ( > 31.3 % ) , or high waist circumference ( > or = 102 cm ) had an approximately 60 % , 40 % , and 40 % , respectively , higher risk of incident mobility limitation than those with low adiposity . In women , high adiposity was also associated with a significantly higher mobility limitation risk than in those with low adiposity . Low physical activity ( lowest quartile ) was associated with a 70 % higher risk of mobility limitation in all groups . Persons with high adiposity and low physical activity were at particularly high risk of mobility limitation .  People with high adiposity who were physically active had an equally high risk of mobility limitation as inactive people with low adiposity . CONCLUSION High adiposity and low self-reported physical activity predicted the onset of mobility limitation in well-functioning older persons . Preventing weight gain in old age and promoting physical activity in obese and non-obese older persons may therefore be effective strategies to prevent mobility loss and future disability OBJECTIVES To investigate the extent to which self-reported mobility deficit in the absence of impairment in activities of daily living ( ADL ) is associated with elevated mortality risk . DESIGN Prospect i ve cohort study , with annual assessment s of mobility and ADL status and ongoing monitoring of vital status . SETTING Population -based cohort drawn from Medicare enrollees in New York City . PARTICIPANTS One thous and two hundred ninety-eight older adults reporting functional status at baseline ( 1992 - 1994 ) and 2 years later . MEASUREMENTS Subjects reported  mobility ( e.g. ,  walking , climbing stairs , and rising from a chair )  and  ADL ( e.g. ,  bathing , toilet use , dressing , grooming , and feeding )  limitations . Two-year functional status trajectories were noted . We used two additional follow-up periods , at 2 and 4 years , to examine the likelihood that older people with mobility deficit may face an increased risk of death without first passing through a state of enduring ADL disability . RESULTS At 2 years , 12.7 % had incident mobility deficit without ADL disability , and 21.3 % were persistently disabled in mobility without ADL disability . Relative to subjects free of disability at baseline and follow-up , risk of mortality in the incident mobility deficit group was elevated at 2 and 4 years but did not achieve statistical significance . By contrast , for subjects with persistent mobility impairment who did not report ADL impairment , the mortality risk was significantly elevated both at 2 years ( relative risk ( RR ) = 2.5 ; 95 % confidence interval ( CI ) = 1.1 - 5.7 ) ) and 4 years ( RR = 2.9 ; 95 % CI = 1.7 - 4.9 ) ) of follow-up . Mortality was significantly elevated in this group in analyses restricted to respondents with no or only one comorbid condition . CONCLUSION Continuing , self-reported mobility impairment in the absence of ADL deficit is a risk factor for mortality . Older people with self-reported mobility deficit face an increased risk of mortality without first passing through enduring states of ADL disability Background Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function . Although conceived as representing similar concepts , differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically . Objective The purpose of this study was to compare the Short Physical Performance Battery ( SPPB ) with the function component of the Late-Life Function and Disability Instrument ( LLFDI ) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care . Design This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults ( N=137 ) with mobility limitations enrolled in a r and omized controlled trial of exercise . Methods A performance-based measure of function ( the SPPB ) and a self-report measure of function ( the LLFDI ) served as functional outcomes . Physiologic factors included measures of leg strength , leg velocity , and exercise tolerance test ( ETT ) duration , which served as a surrogate measure of aerobic capacity . Psychosocial and health factors included age , sex , height , body mass index , number of chronic conditions , depression , and falls efficacy . Results Separate multivariable regression models predicting SPPB and LLFDI scores described 33 % and 42 % of the variance in each outcome ( R2 ) , respectively . Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures . Leg strength and age were positively associated with SPPB scores , whereas number of chronic conditions , sex , and falls efficacy were associated with the LLFDI scores . Limitations This study included older adults with mobility limitations and may not generalize to other population s. Conclusions Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person 's functioning . The SPPB was associated with age and physiologic factors , whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors OBJECTIVES To examine  dog walking among dog owners and the relationship between walking behavior of dog owners and non-dog owners and maintained gait speed over 3 years . DESIGN Cross-sectional and longitudinal analyses of a prospect i ve cohort study . SETTING Memphis , Tennessee , and Pittsburgh , Pennsylvania . PARTICIPANTS Two thous and five hundred thirty-three community-dwelling adults aged 71 to 82 at 36 months of the Health , Aging and Body Composition Study . MEASUREMENTS  Dog ownership , reported walking behavior , change in walking behavior , and usual and rapid gait speed  over 3 years . RESULTS Of 394 dog owners , only 36 % walked their dogs at least three times per week . Cross-sectionally , dog walkers were more likely to achieve 150 minutes of walking per week and had faster usual and rapid walking speeds ( 1.20 vs 1.14 m/s and 1.62 vs 1.52 m/s , respectively ; P < .01 for both ) than non-dog owners who did not walk at least three times per week and similar speeds as non-dog owners who walked at least 150 minutes per week ( P > .50 ) . Three years later , subjects who had been dog walkers at baseline were approximately twice as likely as any other group to achieve recommended walking levels , independent of covariates . Dog walkers experienced similar declines in usual and rapid walking speed as non-dog owners who walked at least three times per week but maintained their initial mobility advantage . CONCLUSION Although dog ownership appears to facilitate walking behavior , only a minority of older dog owners walk their dogs . The mobility advantage of dog ownership was seen only in dog walkers and was similar to that associated with any walking . Given suboptimal walking activity in older adults , examining the degree to which dog ownership promotes walking activity in persons who do little walking on their own appears worth pursuing PURPOSE We examined the association of relative weight with mobility and changes in mobility over time and whether these associations differed by race . METHODS Data come from a prospect i ve , population -based , observational study of adults aged 65 years or older .  Mobility outcomes were assessed at baseline and two follow-up interviews at 3-year intervals . The study included 4195 participants with a mean age of 73.8 + /- 6.3 ( SD ) years ; 61.4 % were women , and 60.9 % were black . Assessment of mobility included a  brief self-report instrument  and a  performance-based walk test . Body mass index ( BMI , kilograms per square meter ) was used as a measure of relative weight . We used generalized estimating equation models to examine change in mobility outcomes over time as a function of BMI . RESULTS Average BMI was 26.6 + /- 5.7 kg/m(2 ) , with 34.0 % overweight and 23.4 % obese . BMI showed a significant curvilinear association with mobility outcomes at baseline ( p < 0.001 ) , but was not associated with change in mobility during follow-up . Maximum mobility levels occurred at a significantly higher level of BMI among blacks than whites . CONCLUSIONS Higher levels of BMI may lead to mobility impairments earlier in life , but there is little evidence that they increase the rate of decline in mobility in older age itself OBJECTIVES To determine the influence of homocysteine on  mobility decline in older adults . DESIGN Prospect i ve cohort . SETTING Einstein Aging Study , community-based aging study . PARTICIPANTS Five hundred seventy-four older adults without dementia ( mean age 80.2 + /- 5.4 , 61 % women ) . MEASUREMENTS Mobility decline defined using gait velocity measurements at baseline and annual follow-up visits . Linear mixed effects models were used to adjust for age , sex , education , and other potential confounders . RESULTS Higher homocysteine levels were associated with slower gait velocity at baseline . Adjusted for age , sex , and education , a one-unit increase in baseline log homocysteine levels was associated with a 2.95-cm/s faster mobility decline per year ( P=.01 ) over a median follow-up of 1.4 years . The 140 subjects in the highest quartile of homocysteine had a faster rate of mobility decline ( 1.75 cm/s per year faster , P=.01 ) than the 434 subjects in the lowest three quartiles of homocysteine ( < or=15 micromol/L ) . The association between homocysteine and mobility decline remained robust even after adjusting for multiple confounders and accounting for the presence of clinical gait abnormalities . CONCLUSION Higher homocysteine levels are associated with greater risk of mobility decline in community-residing older adults Objective : To assess the effect of a comprehensive geriatric assessment and individually tailored intervention on mobility in older people .  In addition , the effectiveness of the geriatric intervention was evaluated among a subgroup of persons with musculoskeletal pain . Design : Three-year geriatric development project with r and omized assignment to intervention and control group . Setting : Research centre , community and assisted living facilities . Participants : Seven hundred and eighty-one Finnish persons aged 75–98 years were assigned to an intervention ( n = 404 ) or control ( n = 377 ) group . Intervention : A comprehensive geriatric assessment with a multifactorial intervention lasting two years . The intervention included individualized referrals , recommendations , physical activity counselling and supervised resistance training . Measurements : Perceived limitation in walking 400 m was gathered annually during the intervention and at the one-year post-intervention follow-up . Results : The proportion of persons with mobility limitation at the beginning , at the two-year intervention and at the one-year post-intervention follow-up was 16 % , 15 % , 12 % and 14 % , respectively , in the intervention group . In the control group , the corresponding proportions were 19 % , 18 % , 23 % and 26 % . The treatment effect was significant at the end of the two-year intervention ( odds ratio 0.82 , 95 % confidence interval 0.70–0.96 , P = 0.013 ) , and at the one-year post-intervention follow-up ( 0.84 , 0.75–0.94 , P = 0.002 ) . The parallel positive effect of the intervention on mobility was even greater among persons with musculoskeletal pain . Conclusion : The comprehensive geriatric assessment and individually tailored multifactorial intervention had a positive effect on mobility , underlining their importance in health promotion and disability prevention in older people Objectives : To assess the validity and reliability of the Short Physical Performance Battery ( SPPB ) in adults 65 to 74 years old , capable in all basic activities of daily living ( ADL ) , in Quebec and Brazil . Methods : Participants were recruited in St. Bruno ( Quebec ) by local advertisements ( n = 60 ) and in Santa Cruz ( Brazil ) by r and om sampling ( n = 64 ) . The SPPB includes tests of gait , balance , and lower-limb strength . Disability status was categorized as intact mobility , limited mobility , and difficulty in any of ADL . Results : There was a grade d decrease in mean SPPB scores with increasing limitation of lower limbs , disability , and poor health . Using the test – retest reliability the authors evaluated the intraclass correlation coefficient , which was high in both sample s : .89 ( 95 % CI : 0.83 , 0.93 ) in St. Bruno and .83 in Santa Cruz ( 95 % CI : 0.73 , 0.89 ) . Discussion : This study provides evidence for the validity and reliability of SPPB in diverse population BACKGROUND Relatively little is known about why older persons develop long-term disability in community mobility .  OBJECTIVE To identify the risk factors and precipitants for long-term disability in walking a quarter mile and driving a car . DESIGN Prospect i ve cohort study from March 1998 to December 2009 . SETTING Greater New Haven , Connecticut . PARTICIPANTS 641 persons , aged 70 years or older , who were active drivers or nondisabled in walking a quarter mile . Persons who were physically frail were over sample d. MEASUREMENTS C and i date risk factors were assessed every 18 months .  Disability in community mobility and exposure to potential precipitants , including illnesses or injuries leading to hospitalization or restricted activity  , were assessed every month . Disability that lasted 6 or more consecutive months was considered long-term . RESULTS 318 ( 56.0 % ) and 269 ( 53.1 % ) participants developed long-term disability in walking and driving , respectively . Seven risk factors were independently associated with walking disability and 8 were associated with driving disability ; the strongest associations for each outcome were found for older age and lower score on the Short Physical Performance Battery . The precipitants had a large effect on long-term disability , with multivariate hazard ratios for each outcome greater than 6.2 for hospitalization and greater than 2.4 for restricted activity . The largest differences in absolute risk were generally observed in participants with a specific risk factor who were subsequently hospitalized . LIMITATIONS The observed associations may not be causal . The severity of precipitants was not assessed . The effect of the precipitants may have been underestimated because their exposure after the initial onset of disability was not evaluated . CONCLUSION Long-term disability in community mobility is common among older persons . Multiple risk factors , together with subsequent precipitants , greatly increase the likelihood of long-term mobility disability . PRIMARY FUNDING SOURCE National Institute on Aging , National Institutes of Health
target: Commonly measured constructs of mobility included walking , climbing stairs , and lower extremity function .
  There was heterogeneity in ways of defining and measuring mobility limitation in older adults living in the community .
background: Mobility is critical in maintaining independence in older adults .
  This study aims to systematic ally review the scientific literature to identify measures of mobility limitation for community-dwelling older adults .