The Johns Hopkins Gazette: November 27, 2000
November 27, 2000
VOL. 30, NO. 12


Easy-to-Use Clinical Tests Help Determine Risk for Early Disabilities

By Karen Infeld
Johns Hopkins Gazette Online Edition

A series of simple tests can help care providers predict whether older women will develop physical disabilities in the near future, Johns Hopkins researchers have found.

Measuring the time it takes an older woman to walk a meter, the length of time she can balance on one leg, or the adaptations she has made in performing simple tasks can identify those at highest risk, according to a report published in the Sept. 11 issue of the Archives of Internal Medicine.

"Clinicians do not have an easy-to-use screening tool to assist them in identifying older adults who are at highest risk of developing mobility difficulty in the short term," says Paulo Henrique M. Chaves, lead author of the study and an instructor of medicine. "There are several tests to assess mobility and predict subsequent loss, but it is impossible for physicians to perform them all during a patient visit given time constraints. We studied a range of measures and figured out the best combination of tests to be used in a clinical setting."

About 35 to 50 percent of women ages 70 to 80 have a hard time with general mobility tasks like walking a few blocks, climbing a flight of stairs or doing heavy housework, Chaves says: "When they have difficulty, they become more sedentary. They often lose their independence and develop substantial social and health care needs. It's a major public health problem."

Researchers studied 266 women ages 70 to 79 who lived in the Baltimore area and reported no difficulty in mobility tasks; nearly half lived alone. The women underwent a comprehensive evaluation at Hopkins between August 1994 and February 1996 and returned to the clinic for a follow-up assessment 18 months later. After a year and a half, about 24 percent of study participants developed some disability, such as difficulty walking three to five blocks, climbing 10 steps or getting into or out of a car or bus.

Comparing the two evaluations, researchers noted they could best predict mobility problems by looking at whether women had changed the way they perform daily tasks, the time it took them to walk a meter at their usual pace and how long they could balance on one leg. They developed predictive graphs, called nomograms, that other physicians could use to assess mobility risk in their own patients.

"Care providers who adopt these nomograms in their practice could use the results to reassure patients with high function, and seek further clinical evaluation for patients at high risk for mobility loss," Chaves says. Telling patients their risk also "raises awareness of potential problems, which might encourage older adults at high risk for functional decline to engage in preventive activities such as getting regular physical exercise and eating healthy."

Chaves asserts, though, that improved performance in these tests doesn't automatically translate into true risk reduction. "People shouldn't think that if they start walking faster, their risk will necessarily be lower," he says. "We are currently designing interventions that we hope will preserve mobility and prevent disability."

The study was supported by the National Institute on Aging and the Brazilian Federal Agency for Post-Graduate Education.

Other authors of the report were Elizabeth S. Garrett and Linda P. Fried. Chaves also is an assistant professor with the Open University for Studies on Aging and Care of the Elderly at the State University of Rio de Janeiro, Brazil.

Related Web sites:

Johns Hopkins' Welch Center for Prevention, Epidemiology and Clinical Research
National Institute on Aging