title: Slow Gait Speed and Risk of Long-Term Nursing Home Residence in Older Women, Adjusting for Competing Risk of Mortality: Results from the Study of Osteoporotic Fractures.
abstract: To determine whether slow gait speed increases the risk of costly long-term nursing home residence when accounting for death as a competing risk remains unknown.
  
  
  
  Longitudinal cohort study using proportional hazards models to predict long-term nursing home residence and subdistribution models with death as a competing risk.
  
  
  
  Community-based prospective cohort study.
  
  
  
  Older women (mean age 76.3) participating in the Study of Osteoporotic Fractures who were also enrolled in Medicare fee-for-service plans (N = 3,755).
  
  
  
  Gait speed was measured on a straight 6-m course and averaged over two trials. Long-term nursing home residence was defined using a validated algorithm based on Medicare Part B claims for nursing home-related care.
  
  
  
  Participants were followed until long-term nursing home residence, disenrollment from Medicare plan, death, or December 31, 2010. Over the follow-up period (median 11 years), 881 participants (23%) experienced long-term nursing home residence, and 1,013 (27%) died before experiencing this outcome. Slow walkers (55% of participants with gait speed <1 m/s) were significantly more likely than fast walkers to reside in a nursing home long-term (adjusted hazards ratio (aHR) = 1.79, 95% confidence interval (CI) = 1.54-2.09). Associations were attenuated in subdistribution models (aHR = 1.52, 95% CI = 1.30-1.77) but remained statistically significant.
  
  
  
  Older community-dwelling women with slow gait speed are more likely to experience long-term nursing home residence, as well as mortality without long-term residence. Ignoring the competing mortality risk may overestimate long-term care needs and costs.
authors.affiliation: Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Lyons
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, Minnesota.|Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.|Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.affiliation: Park Nicollet Institute for Research and Education, Health Partners, Minneapolis, Minnesota.|Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, Minnesota.|Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.|Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.affiliation: Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Heeren
authors.affiliation: Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts.
authors.forename: Sherri O
authors.initials: SO
authors.lastname: Stuver
authors.affiliation: Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fredman
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D006278:Medicare; D009026:Mortality / Q000639:trends*; D009735:Nursing Homes; D058866:Osteoporotic Fractures / Q000453:epidemiology; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D000072797:Walking Speed
keywords: Medicare; aging; competing risk; gait speed; nursing home