Slowness as a Predictor of Functional Decline in Older Adults: Comparison of Moberg Picking-Up Test and Walking Speed

Sarcopenia-related traits and risk of falls in older adults: results from meta-analysis of cohort studies and Mendelian randomization analyses

BACKGROUND

Observational studies examining sarcopenia-related traits and fall risk remain controversial. Herein, we conducted meta-analyses of cohort studies triangulated with Mendelian randomization (MR) analyses to examine the potential causality between sarcopenia-related traits and risk of falls in older adults.

METHODS

Literature search across PubMed, Embase, and Cochrane Library was performed from inception to February 2023 to identify cohort studies examining sarcopenia-related traits (including hand strength, appendicular lean mass, and walking speed) and falls. We assessed the association between these traits and fall risk using random-effects models to calculate pooled odds ratios (OR) and 95% confidence intervals (CIs). MR analyses were conducted using summary statistics derived from the UK Biobank consortium for sarcopenia-related traits and FinnGen consortium for falls. The inverse-variance weighted method was used as primary analysis.

RESULTS

Our meta-analysis included 34 cohort studies. The combined analysis of sarcopenia-related traits revealed a 33% reduced fall risk with each unit increase in walking speed (OR 0.67, 95% CI 0.54-0.84) and a 2% decrease with each unit increase in hand strength (OR 0.98, 95% CI 0.97-0.99). However, appendicular lean mass had no significant effect on falls. In the MR analyses, only walking speed was causally associated with falls (OR 0.64, 95% CI 0.48-0.84). Hand strength and appendicular lean mass showed no statistically significant causal effect on falls.

CONCLUSION

Evidence from meta-analysis and MR suggests a strong association between walking speed and fall risk in older adults. However, the relationship between hand strength, appendicular lean mass, and falls has not yet been established.

Acceptability, Reliability, and Validity of Virtually Administered Gait Speed Tests

OBJECTIVES

To evaluate the acceptability, reliability (inter- and intrarater), and validity (convergent, known groups, and predictive) of virtually administered gait speed tests for community-dwelling older adults.

DESIGN

A prospective cohort study was performed, tracking health outcomes for a year.

SETTING AND PARTICIPANTS

The 3-m gait speed test at usual and fast pace was administered to community-dwelling older adults over Zoom.

METHOD

To examine acceptability, participants completed questionnaires regarding telehealth usability and experience. Virtual gait speed tests were administered at baseline and 24 to 72 hours later to evaluate reliability. Self-report mobility measures were used to examine convergent and known-groups validity. Participants' health outcomes were tracked for a year to evaluate predictive validity.

RESULTS

Sixty participants completed the baseline assessment and 52 completed the second assessment. Participants reported an overall positive experience with the test. Intraclass correlation coefficients for reliability ranged from 0.79 to 0.90. For convergent validity, correlations >0.30 were found predominantly for usual gait speed with self-report mobility measures. Both the usual- and fast-gait speed were able to discriminate between difficulty walking and gait aid use. Usual gait speed was able to predict specialist and family doctor visits and fast gait speed was able to predict rehabilitation specialist visits over 1 year.

CONCLUSIONS AND IMPLICATIONS

Our findings demonstrate support for the acceptability, reliability, and validity of virtually administered gait speed tests for community-dwelling older adults. Although future studies are needed to examine the validity of virtual gait speed tests in larger and more diverse samples to improve generalizability of results, clinicians and researchers can virtually administer 3-m gait speed tests with confidence that scores are trustworthy and reflect older adults' mobility.

Measurement properties of the usual and fast gait speed tests in community-dwelling older adults: a COSMIN-based systematic review

OBJECTIVE

The gait speed test is one of the most widely used mobility assessments for older adults. We conducted a systematic review to evaluate and compare the measurement properties of the usual and fast gait speed tests in community-dwelling older adults.

METHODS

Three databases were searched: MEDLINE, EMBASE and CINAHL. Peer-reviewed articles evaluating the gait speed test's measurement properties or interpretability in community-dwelling older adults were included. The Consensus-based Standards for the selection of health Measurement Instruments guidelines were followed for data synthesis and quality assessment.

RESULTS

Ninety-five articles met our inclusion criteria, with 79 evaluating a measurement property and 16 reporting on interpretability. There was sufficient reliability for both tests, with intraclass correlation coefficients (ICC) generally ranging from 0.72 to 0.98, but overall quality of evidence was low. For convergent/discriminant validity, an overall sufficient rating with moderate quality of evidence was found for both tests. Concurrent validity of the usual gait speed test was sufficient (ICCs = 0.79-0.93 with longer distances) with moderate quality of evidence; however, there were insufficient results for the fast gait speed test (e.g. low agreement with longer distances) supported by high-quality studies. Responsiveness was only evaluated in three articles, with low quality of evidence.

CONCLUSION

Findings from this review demonstrated evidence in support of the reliability and validity of the usual and fast gait speed tests in community-dwelling older adults. However, future validation studies should employ rigorous methodology and evaluate the tests' responsiveness.