title: How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over.
abstract: OBJECTIVE
  To determine the speed at which the Grim Reaper (or Death) walks.
  
  
  METHODS
  Population based prospective study.
  
  
  METHODS
  Older community dwelling men living in Sydney, Australia.
  
  
  METHODS
  1705 men aged 70 or more participating in CHAMP (Concord Health and Ageing in Men Project).
  
  
  METHODS
  Walking speed (m/s) and mortality. Receiver operating characteristics curve analysis was used to calculate the area under the curve for walking speed and determine the walking speed of the Grim Reaper. The optimal walking speed was estimated using the Youden index (sensitivity + specificity-1), a common summary measure of the receiver operating characteristics curve, and represents the maximum potential effectiveness of a marker.
  
  
  RESULTS
  The mean walking speed was 0.88 (range 0.15-1.60) m/s. The highest Youden index (0.293) was observed at a walking speed of 0.82 m/s (2 miles (about 3 km) per hour), corresponding to a sensitivity of 63% and a specificity of 70% for mortality. Survival analysis showed that older men who walked faster than 0.82 m/s were 1.23 times less likely to die (95% confidence interval 1.10 to 1.37) than those who walked slower (P = 0.0003). A sensitivity of 1.0 was obtained when a walking speed of 1.36 m/s (3 miles (about 5 km) per hour) or greater was used, indicating that no men with walking speeds of 1.36 m/s or greater had contact with Death.
  
  
  CONCLUSIONS
  The Grim Reaper's preferred walking speed is 0.82 m/s (2 miles (about 3 km) per hour) under working conditions. As none of the men in the study with walking speeds of 1.36 m/s (3 miles (about 5 km) per hour) or greater had contact with Death, this seems to be the Grim Reaper's most likely maximum speed; for those wishing to avoid their allotted fate, this would be the advised walking speed.
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Fiona F
authors.initials: FF
authors.lastname: Stanaway
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Blyth
authors.forename: David G
authors.initials: DG
authors.lastname: Le Couteur
authors.forename: Vasi
authors.initials: V
authors.lastname: Naganathan
authors.forename: Louise
authors.initials: L
authors.lastname: Waite
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Seibel
authors.forename: David J
authors.initials: DJ
authors.lastname: Handelsman
authors.forename: Philip N
authors.initials: PN
authors.lastname: Sambrook
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017079:Exercise Tolerance / Q000502:physiology; D015577:Geriatric Assessment; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008136:Longevity; D008297:Male; D054526:Men's Health / Q000706:statistics & numerical data*; D010809:Physical Fitness / Q000502:physiology*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D016138:Walking / Q000502:physiology*