Predicting Adverse Outcomes in Healthy Aging Community-Dwelling Early-Old Adults with the Timed Up and Go Test
Received 31 March 2020
Accepted for publication 26 June 2020
Published 31 July 2020 Volume 2020:15 Pages 1263—1270
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Agnieszka Batko-Szwaczka,1 Krzysztof Wilczyński,1 Beata Hornik,2 Magdalena Janusz-Jenczeń,2 Iwona Włodarczyk,2 Bartosz Wnuk,3 Joanna Szołtysek,3 Jacek Durmała,3 Karolina Szuster-Kowolik,1 Katarzyna Antoniak-Sobczak,1 Jan Dulawa,4 Jan Szewieczek1
1Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland; 2Department of Internal Nursing, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland; 3Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland; 4Department of Internal Medicine and Metabolic Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Correspondence: Agnieszka Batko-Szwaczka
Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, GCM, Ul. Ziolowa 45/47, Katowice 40-635, Poland
Background: Simple, easy-to-perform, safe and cost-effective methods for the prediction of adverse outcomes in older adults are essential for the identification of patients who are most likely to benefit from early preventive interventions.
Methods: The study included 160 community-dwelling individuals aged 60– 74 years, with 44.4% women. A comprehensive geriatric assessment was performed in all participants. Bioimpedance body composition analysis included 149 subjects. Among other tests, functional assessment included the Barthel Index of Activities of Daily Living (Barthel Index), Mini-Mental State Examination (MMSE), Timed Up and Go (TUG) and Fried frailty phenotype. Follow-up by telephone was made after at least 365 days. The composite endpoint (CE) included fall, hospitalization, institutionalization and death.
Results: Cohort characteristics: age 66.8± 4.2 years (mean±SD), 3.81± 2.23 diseases, 4.29± 3.60 medications or supplements, and good functional status (MMSE 29.0± 1.5, Barthel Index 98.1± 8.2, prevalence of Fried frailty phenotype 2.5%). During one-year follow-up, 34 subjects (21.3%; 95% confidence interval [CI] =14.9− 27.6%) experienced CE: hospitalizations (13.8%; 95% CI=8.41− 19.1), falls (9.38%; 95% CI=4.86− 13.9), death (0.63%; 95% CI=0− 1.85) and no institutionalization. A higher probability of CE was associated with age ≥ 70 years (P=0.018), taking any medication or supplements (P=0.007), usual pace gait speed ≤ 0.8 m/s (P=0.028) and TUG > 9 s (P< 0.002). TUG was the only independent measure predicting one-year CE occurrence (OR=1.22, 95% CI=1.07− 1.40, P=0.003) in multivariate logistic regression. However, its predictive power was poor; the area under the receiver operating characteristic curve was 0.659 (95% CI 0.551− 0.766, P=0.004) and Youden’s J statistic for a TUG cut-off of 9.0 s was 0.261 (sensitivity 0.618 and specificity 0.643).
Conclusion: The TUG test was superior to frailty phenotype measures in predicting one-year incidence of a CE consisting of fall, hospitalization, institutionalization and death in a cohort of healthy-aging community-dwelling early-old adults, although its value as a stand-alone test was limited.
Keywords: frailty phenotype, community-dwelling older adults, healthy aging, comprehensive geriatric assessment, Timed Up and Go test
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