Physical performance and incidence of negative events in very old adults: results from the IlSIRENTE study

Background: Declining physical performance in old age is associated with a wide range of negative health related outcomes, including disability, poor quality of life, admission to hospital, admission to residential care, and death (1 3). However, it is unclear which physical capabilities should be prioritized to obtain prognostic information in older adults. Methods: ilSIRENTE was a prospective cohort study of older adults residing in the mountain community of the Sirente geographic area in Central Italy. The study was designed by the Department of Geriatrics of the Università Cattolica del Sacro Cuore (Rome, Italy) an d the teaching nursing home Opera Santa Maria della Pace (Fontecchio, L’Aquila, Italy) in partnership with local administrators and primary care physicians of the Sirente Mountain Community Municipalities. The protocol was approved by the Ethics Committee of the Université Cattolica del Sacro Cuore. Prior to enrollment, all participants or their proxies, when appropriate, provided signed informed consent. Baseline assessments began in December 2003 and were completed in September 2004. Follow up visits took place after 24 months of baseline assessment. Information about medical history, medications, and lifestyle habits (e.g., smoking, alcohol consumption, physical activity) was collected using validated questionnaires. Physical performance was assessed usin g isometric handgrip strength, walking speed at usual and fast pace, 5 time sit to stand test, and sit to stand power measures. Absolute, relative, allometric, and specific muscle power values of lower extremities were calculated using the equations validated by Alcazar et al. (5). Appendicular skeletal muscle mass was estimated from calf circumfe rence using a validated equation (6). History of falls, incident falls, and disability status according to basic Activities of Daily Living (ADLs) were recorded over two years. Survival status was obtained from the participants’ general practitioners and w as confirmed by the National Death Registry over 10 years from enrolment. Linear, binary, and Cox regressions were used to evaluate the association between physical Linear, binary, and Cox regressions were used to evaluate the association between physical performance measures and health outcomes. performance measures and health outcomes. Results: Mean age of the 255 participants was 84.2 ± 5.1 years, and 161 (63.1%) were women. Mean age of the 255 participants was 84.2 ± 5.1 years, and 161 (63.1%) were women. Logistic regression indicated that hanLogistic regression indicated that handdgrip strength was significantly associated with incident ADL grip strength was significantly associated with incident ADL disability, whereas specific muscle power was an independent predictor of death. No significant disability, whereas specific muscle power was an independent predictor of death. No significant associations were observed between any physical performance measure and incident falls.associations were observed between any physical performance measure and incident falls. Conclusion: Our findings indicate selective associations between physical performance tests and Our findings indicate selective associations between physical performance tests and the occurrence of negative events in very old adults, with poor handgrip strength predicting the occurrence of negative events in very old adults, with poor handgrip strength predicting disability and specific muscle power being longitudinally associated with deathdisability and specific muscle power being longitudinally associated with death.