title: Predictors of decline in manual performance in older adults.
abstract: OBJECTIVE
  To determine factors that predict decline in manual performance using a multivariate model of determinants of functional limitation.
  
  
  METHODS
  Longitudinal observational study.
  
  
  METHODS
  Ambulatory general medicine clinics, residences of homebound individuals, and a continuing care retirement community.
  
  
  METHODS
  Subjects were 485 persons more than 60 years of age and included continuing care retirement community (CCRC) residents (n = 215), chronically homebound older persons (n = 65), and ambulatory older adults (n = 205). Mean age at baseline was 78 years.
  
  
  METHODS
  Independent variables included demographics, physician measures of upper-extremity joint impairment, comorbidities derived from physical examination and chart abstract, self-assessed arthritis pain, depression, and anxiety. The major dependent variable was 2-year decline in timed manual performance below a threshold associated with need for long-term care services.
  
  
  RESULTS
  The proportion of subjects who exceed a Timed Manual Performance Test threshold of 350 seconds increased slowly from baseline through Year 4 for all age groups but rose rapidly from Year 4 to Year 6 for the oldest group (> 85 years at baseline). Using a discrete survival model, we found that age, education, grip strength, and psychological status predicted crossing the manual performance threshold within a 2-year period.
  
  
  CONCLUSIONS
  The findings, coupled with earlier findings that upper extremity joint impairment predicted both grip strength and manual performance, suggest that joint impairment may be an important risk factor for future functional limitation. Since diminished hand function has been shown to predict dependency, development and testing of interventions to maintain or restore upper extremity joint function and reduce pain would appear to be a high research priority.
authors.affiliation: Prevention Research Center, School of Public Health, University of Illinois at Chicago 60607-3025, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hughes
authors.forename: J
authors.initials: J
authors.lastname: Gibbs
authors.forename: D
authors.initials: D
authors.lastname: Dunlop
authors.forename: P
authors.initials: P
authors.lastname: Edelman
authors.forename: R
authors.initials: R
authors.lastname: Singer
authors.forename: R W
authors.initials: RW
authors.lastname: Chang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D001007:Anxiety / Q000503:physiopathology; D001132:Arm / Q000502:physiology; D001168:Arthritis / Q000503:physiopathology; D015331:Cohort Studies; D003863:Depression / Q000503:physiopathology; D004522:Educational Status; D005260:Female; D005544:Forecasting; D006225:Hand / Q000502:physiology; D018737:Hand Strength / Q000502:physiology; D006301:Health Services Needs and Demand; D018577:Homebound Persons; D016852:Housing for the Elderly; D006801:Humans; D007596:Joints / Q000502:physiology; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records; D008603:Mental Health; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D010146:Pain / Q000503:physiopathology; D010808:Physical Examination; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology