title: Predictors of functional change: a longitudinal study of nondemented people aged 65 and older.
abstract: OBJECTIVE
  To identify factors associated with functional change in an older population and investigate interactions among selected potential risk factors.
  
  
  METHODS
  A population-based prospective cohort study.
  
  
  METHODS
  A random sample was selected from the Group Health Cooperative members in the Seattle area from 1994 to 1996 and followed biennially.
  
  
  METHODS
  Two thousand five hundred eighty-one people aged 65 and older, cognitively intact at baseline.
  
  
  METHODS
  Functional status was measured by activities of daily living, instrumental activities of daily living, and performance-based physical function testing.
  
  
  RESULTS
  The cohort status at the time of these analyses was: deceased, 391; withdrawn, 179; dementia, 152; and on study, 1,873. The mean follow-up time was 3.4 years. Using linear regressions with Generalized Estimating Equation, selected medical conditions (diabetes mellitus, hypertension, coronary heart disease, cerebrovascular disease (CVD), osteoporosis, arthritis, and cancer), low cognitive function, depression, and smoking were associated with worse functional outcomes. Exercise and moderate alcohol use were associated with better functional outcomes. Over the follow-up period, coronary heart disease, CVD, and depression were associated with increased rates of functional decline. Exercise and moderate alcohol consumption were associated with decreased rates of functional decline. Significant interactions were observed between exercise and coronary heart disease, moderate alcohol use and CVD, and cognition and CVD.
  
  
  CONCLUSIONS
  Our study has identified not only risk factors associated with functional decline but also the interactions among these factors. These observations, along with other published research, add to the growing understanding of the underlying process of functional change and could provide a basis to design effective strategies to delay functional decline.
authors.affiliation: Departments of Medicine, Biostatistics, and Epidemiology, University of Washington, Seattle, Washington, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Gerald
authors.initials: G
authors.lastname: van Belle
authors.forename: Walter B
authors.initials: WB
authors.lastname: Kukull
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged / Q000502:physiology*; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D001168:Arthritis / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000503:physiopathology; D003071:Cognition; D015331:Cohort Studies; D003327:Coronary Disease / Q000503:physiopathology; D003863:Depression / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000503:physiopathology; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000503:physiopathology; D010024:Osteoporosis / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking