Mid-Life Vascular Risk and Rate of Physical Function Decline Among Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Author:
Skow Laura F1ORCID, Sharrett A Richey1, Gottesman Rebecca F2, Coresh Josef1, Deal Jennifer A1ORCID, Palta Priya3, Sullivan Kevin J4ORCID, Griswold Michael E4, Schrack Jennifer A1ORCID, Windham B Gwen4
Affiliation:
1. Department of Epidemiology, Johns Hopkins School of Public Health , Baltimore, Maryland , USA 2. National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health , Bethesda, Maryland , USA 3. Department of Neurology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA 4. Memory Impairment and Neurodegenerative Dementia (MIND) Center, Department of Medicine, Division of Geriatric Medicine, University of Mississippi Medical Center , Jackson, Mississippi , USA
Abstract
Abstract
Background
Physical function and its decline in older age may be connected to treatable vascular risk factors in mid-life. This study aimed to evaluate whether these factors affect the underlying rate of decline.
Methods
This prospective cohort included 5 481 older adults aged 67–91 in the Atherosclerosis Risk in Communities Study (mean [standard deviation {SD}] age = 75.8 [5.0], 58% women, 21% Black race) without a history of stroke. The main outcome was the rate of Short Physical Performance Battery (SPPB) decline over a median late-life follow-up of 4.8 years. Primary mid-life (aged 45–64) exposures were Visit 1 hypertension (>140/90 mm Hg or treatment), diabetes (>126 mg/dL or treatment), high cholesterol (>240 mg/dL or treatment), and smoking, and number of decades of vascular risk exposure across Visits 1–4.
Results
The average adjusted rate of SPPB decline (points per 5 years) for older adults was −0.79 (confidence interval [CI]: −0.87, 0.71) and was accelerated by mid-life hypertension (+57% decline vs normotension: additional decline of −0.47, 95% CI: −0.64, −0.30), diabetes (+73% decline vs no diabetes: additional decline of −0.67, 95% CI: −1.09, −0.24), elevated systolic blood pressure (+17% decline per SD: −0.16, 95% CI: −0.23, −0.10), and elevated fasting blood glucose (+16% decline per SD: −0.015, 95% CI: −0.24, −0.06). Each decade greater mid-life exposure to hypertension (+32% decline: −0.93, 95% CI: −1.25, −0.61) and diabetes (+35% decline: −1.03, 95% CI: −1.68, −0.38) was associated with faster SPPB decline.
Conclusions
Mid-life control of blood pressure and diabetes may offset aging-related functional decline.
Funder
National Heart, Lung, and Blood Institute National Institute of Neurological Disorders and Stroke National Institute on Aging National Institute on Deafness and Other Communication Disorders
Publisher
Oxford University Press (OUP)
Subject
Geriatrics and Gerontology,Aging
Reference25 articles.
1. Prognostic effect of changes in physical function over prior year on subsequent mortality and long-term nursing home admission;Gill,2018 2. Mobility limitations and cognitive deficits as predictors of institutionalization among community-dwelling older people;von Bonsdorff,2006 3. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery;Guralnik,2000 4. The trajectory of gait speed preceding mild cognitive impairment;Buracchio,2010 5. Assessing the temporal relationship between cognition and gait: slow gait predicts cognitive decline in the Mayo Clinic Study of Aging;Mielke,2013
|
|