Increasing poor physical function from around age 65 is associated with an increased risk of death


Increasing poor physical (motor) function from around age 65 is associated with an increased risk of death.

Signs of increasing decline, such as difficulty getting up from a chair or getting dressed, emerge up to 10 years before death, the findings show.

The researchers therefore suggest that early detection of changes in motor function “might offer opportunities for prevention and targeted interventions.”

It is well known that motor function, also commonly known as physical function or physical capability, declines with age, but rates of decline differ widely from person to person. And while studies show that decline in cognitive (mental) skills can emerge up to 15 years before death, it’s not clear whether the same is true for physical abilities.

To explore this further, researchers examined several measures of motor function for their associations with mortality over a 10 year period from around age 65.

Their findings are based on over 6,000 participants of the Whitehall II Study, which recruited participants aged 35-55 years in 1985-88 to look at the impact of social, behavioural, and biological factors on long term health.

Between 2007 and 2016, participants underwent motor function assessments on up to three occasions. These included measures of walking speed, chair rise time, and grip strength, along with self-reported measures of functioning and difficulties with activities of daily living, such as dressing, using the toilet, cooking and grocery shopping.

Deaths from any cause were then recorded until October 2019.

After taking account of other potentially influential factors, the researchers found that poorer motor function was associated with an increased mortality risk of 22% for walking speed, 15% for grip strength and 14% for timed chair rises, while difficulties with activities of daily living were associated with a 30% increased risk.

These associations became progressively stronger with later life assessments.

Further analysis showed different patterns of change between participants who died and those who survived.

For example, participants who died had poorer chair rise times than survivors up to 10 years before death, poorer self-reported functioning up to seven years before death, and more difficulties with activities of daily living up to four years before death.

These differences increased steadily in the period leading to death.

This is an observational study, so can’t establish cause and the researchers point to some limitations, such as being unable to examine trajectories of motor function by cause of death or in specific minority groups, and not accounting for events such as falls or hospital admissions.

Nevertheless, they say this study “adds to the sparse literature on terminal decline in motor function and, to our knowledge, is the first to examine terminal and age related long term trajectories of multiple measures of motor function.”

The ageing of populations worldwide makes understanding of the functional status of older adults and change in functioning with age important, they write.

These results suggest that strategies to reduce accelerated decline should start before old age, and that early detection of changes in motor function might offer opportunities for prevention and targeted interventions, they conclude.

This study adds to a rapidly growing evidence base providing novel insights on healthy ageing, say researchers in a linked editorial.

They point out that as the study participants continue to age and more data becomes available, this will help to inform the development of interventions to promote healthy ageing.

Although the authors suggest that “early detection of changes in motor function might offer opportunities for prevention and targeted interventions,” what these interventions would be and what specifically they would be aiming to achieve is unclear, they note.

“Despite the focus on death as an outcome in these analyses, our goal should always be to add life to years, not just years to life.”

Given the physical, social, psychological, and economic tolls of the coronavirus disease 2019 (COVID-19) pandemic,1, 2, 3, 4, 5 scientists around the world have staunchly pursued an understanding of factors contributing to virus-related morbidity, hospitalizations, and mortality. Personal characteristics, including age, gender, and race, as well as comorbidities, including diabetes, obesity, respiratory illnesses, and hypertension, are salient predictors.6 , 7

These effects noted, health behaviors and outcomes are not just a function of the individual but, instead, are also shaped by environmental determinants.8 , 9 Consistent with this perspective, social and community factors that contribute to COVID-19 cases and deaths include public health ordinances,10 structural inequalities,11 collective racial biases,12 and socioeconomic disparities,13 among others.

Missing from the examination of social and environmental factors potentially related to COVID-19 cases and deaths is a focus on physical activity (PA) among community members. Systematic reviews show that most of the scholarship in this area has focused on PA during the pandemic among individuals.14 For example, people around the world were more likely to lead sedentary lives, especially during lockdowns; and these findings were prevalent among countries hit hardest by the pandemic.15, 16, 17

PA decreases were linked with corresponding reductions in psychological well-being18 and subjective health.15 Such inactivity has the potential to have lasting negative effects on people’s physical health.19 As a result, sport managers and public health officials have identified creative solutions for being active at home or in otherwise physically distanced settings.20

Though examination of individual PA during the pandemic is important, a sole focus on that level of analysis necessarily ignores the impact of community norms and behaviors.21 This is an important distinction because community-level PA is associated with better health and lower obesity rates among members of a community as a whole.22, 23, 24

These findings are consistent with related research showing that PA can help reduce the incidence of many COVID-19 risk factors, including obesity, hypertension, heart disease, and respiratory illnesses.25 , 26 Recognizing this possibility, Simpson and Katsanis25 noted, “the available scientific evidence from other viral infections would indicate that physically active people will have less severe symptoms, shorter recovery time, and may be less likely to infect others they come into contact with.”25

Applied to the aggregate level, these suppositions25 suggest that communities with higher levels of PA might also see fewer COVID-19 cases and deaths. The purpose of this study was to examine these possibilities through an analysis of county-level data in the US. Specifically, it was hypothesized that county-level PA rates would be negatively related to COVID-19 cases (Hypothesis 1) and COVID-19 deaths (Hypothesis 2).

reference link:

More information: Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study, BMJ (2021). DOI: 10.1136/bmj.n1743


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