Common chronic diseases and general impairments as determinants of walking disability in the oldest-old population.
OBJECTIVE
Walking disability affects older people's autonomy and well-being. We investigated the relative effect of common chronic diseases and general impairments on walking disability in the general oldest-old population.


METHODS
Population-based cohort study.


METHODS
Leiden 85-plus Study, the Netherlands.


METHODS
Five hundred ninety-nine persons aged 85, response rate 87%.


METHODS
Walking disability was assessed using a 6-meter walking test. Persons with a walking time below the 25th percentile and those who were physically unable to perform the walking test were categorized as having a walking disability. Information on common chronic diseases was obtained from records of subjects' general practitioners and pharmacies. General impairments were assessed with functional tests and standardized questions during face-to-face interviews. We expressed the effect of common chronic diseases and general impairments as the population attributable risk (PAR), indicating how much disability can be prevented when the identified risk factor is eliminated from the population.


RESULTS
One hundred ninety-two persons (33%) had a walking disability. This disability was highly associated with poor mobility in daily life, recurrent falls, and poor well-being (all P <.001). Of the common chronic diseases, stroke, angina pectoris, diabetes mellitus, and hip fracture but not arthritis contributed most (PARs from 6% to 15%) to walking disability in the population at large. General impairments had higher prevalence rates and higher PARs than common chronic diseases. Cognitive impairment, depressive symptoms, and dizziness upon rising contributed most (PARs between 22 to 27%) to walking disability. In multivariate regression analyses of all common chronic diseases and general impairments, associations remained significant.


CONCLUSIONS
Within the general oldest-old population, general impairments contribute more substantially to walking disability than do common chronic diseases. The diagnosed diseases did not explain the impairments that led to walking disability. Especially in the oldest old, clinicians should focus not merely on common chronic diseases but particularly on general impairments as targets for diagnostic analysis and treatment to decrease walking disability.
Bootsma-van der Wiel
Annetje
A
Departent of General Internal Medicine, Leiden University Medical Center, The Netherlands.
Gussekloo
Jacobijn
J
De Craen
Anton J M
AJ
Van Exel
Eric
E
Bloem
Bastiaan R
BR
Westendorp
Rudi G J
RG
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003072:Cognition Disorders; D015331:Cohort Studies; D003863:Depression; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004244:Dizziness; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D016138:Walking