Richard E Kennedy1,2, Patricia Sawyer1,2, Courtney P Williams1, Alexander X Lo2,3, Christine S Ritchie4,5, David L Roth6, Richard M Allman7, Cynthia J Brown1,2,8. 1. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 2. Comprehensive Center for Healthy Aging, Birmingham, Alabama. 3. Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 4. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California. 5. Jewish Home San Francisco, San Francisco, California. 6. Division of Geriatric Medicine and Gerontology, Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland. 7. Geriatrics and Extended Care Services, Office of Patient Care Services, Veterans Health Administration, Washington, District of Columbia. 8. Geriatric Research, Education, and Clinical Center, Birmingham/Atlanta Veterans Affairs, Birmingham, Alabama.
Abstract
OBJECTIVES: To examine 6-month change in life-space mobility as a predictor of subsequent 6-month mortality in community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: Community-dwelling older adults from five Alabama counties in the University of Alabama at Birmingham (UAB) Study of Aging. PARTICIPANTS: A random sample of 1,000 Medicare beneficiaries, stratified according to sex, race, and rural or urban residence, recruited between November 1999 and February 2001, followed by a telephone interview every 6 months for the subsequent 8.5 years. MEASUREMENTS: Mortality data were determined from informant contacts and confirmed using the National Death Index and Social Security Death Index. Life-space was measured at each interview using the UAB Life-Space Assessment, a validated instrument for assessing community mobility. Eleven thousand eight hundred seventeen 6-month life-space change scores were calculated over 8.5 years of follow-up. Generalized linear mixed models were used to test predictors of mortality at subsequent 6-month intervals. RESULTS: Three hundred fifty-four deaths occurred within 6 months of two sequential life-space assessments. Controlling for age, sex, race, rural or urban residence, and comorbidity, life-space score and life-space decline over the preceding 6-month interval predicted mortality. A 10-point decrease in life-space resulted in a 72% increase in odds of dying over the subsequent 6 months (odds ratio = 1.723, P < .001). CONCLUSIONS: Life-space score at the beginning of a 6-month interval and change in life-space over 6 months were each associated with significant differences in subsequent 6-month mortality. Life-space assessment may assist clinicians in identifying older adults at risk of short-term mortality.
OBJECTIVES: To examine 6-month change in life-space mobility as a predictor of subsequent 6-month mortality in community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: Community-dwelling older adults from five Alabama counties in the University of Alabama at Birmingham (UAB) Study of Aging. PARTICIPANTS: A random sample of 1,000 Medicare beneficiaries, stratified according to sex, race, and rural or urban residence, recruited between November 1999 and February 2001, followed by a telephone interview every 6 months for the subsequent 8.5 years. MEASUREMENTS: Mortality data were determined from informant contacts and confirmed using the National Death Index and Social Security Death Index. Life-space was measured at each interview using the UAB Life-Space Assessment, a validated instrument for assessing community mobility. Eleven thousand eight hundred seventeen 6-month life-space change scores were calculated over 8.5 years of follow-up. Generalized linear mixed models were used to test predictors of mortality at subsequent 6-month intervals. RESULTS: Three hundred fifty-four deaths occurred within 6 months of two sequential life-space assessments. Controlling for age, sex, race, rural or urban residence, and comorbidity, life-space score and life-space decline over the preceding 6-month interval predicted mortality. A 10-point decrease in life-space resulted in a 72% increase in odds of dying over the subsequent 6 months (odds ratio = 1.723, P < .001). CONCLUSIONS: Life-space score at the beginning of a 6-month interval and change in life-space over 6 months were each associated with significant differences in subsequent 6-month mortality. Life-space assessment may assist clinicians in identifying older adults at risk of short-term mortality.
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