Impaired mobility a 'geriatric biomarker' for decline after heart attack

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By Reuters Staff

NEW YORK (Reuters Health) - Mobility impairment, measured during hospitalization, is a "geriatric biomarker" for functional decline in adults 65 and older who suffer acute myocardial infarction, a new study suggests.

In a report online October 7 in JAMA Internal Medicine, the authors say a "brief and easy-to-administer mobility assessment may be useful in the inpatient setting to identify older patients with acute myocardial infarction who are at risk for functional decline."

Dr. Alexandra Hajduk of Yale School of Medicine, in New Haven, Connecticut, and colleagues assessed mobility using the Timed Up and Go (TUG) test in more than 2,500 older adults (mean age 81, 57% male) hospitalized with AMI at 94 academic community hospitals.

TUG scores were categorized as preserved mobility (15 to 25 seconds to complete), and severe impairment (unable to complete).

More than half of the cohort had impaired mobility during their hospital stay; 22% had mild impairment, 16% moderate impairment and 15% severe impairment.

A quarter of adults reported functional decline at six months after discharge (compared with one month before admission), 13% reported a decline in activities of daily living (ADL) and 17% reported a decline in ability to walk 0.4-km from baseline.

While only about 4% of participants with preserved mobility reported ADL decline at six months after discharge, the rate was close to 7% in those with mild impairment (adjusted odds ratio, 1.24), 19% in those with moderate impairment (aOR, 2.67) and 35% in those with severe impairment (aOR, 5.45). Only the latter two results were statistically significant.

Eleven percent of those with preserved mobility declined in ability to walk 0.4 km, compared with 15% of those with mild impairment (aOR, 1.51), 19% of those with moderate impairment (aOR, 2.03) and 25% of those with severe impairment (aOR, 3.25). All three results were significant.

"We found that mobility impairment was associated with decline in all activities we evaluated, including the essential ADLs and neighborhood-level mobility. Mobility impairment showed the greatest risk in its association with declines in bathing and dressing; this finding is important because the loss of ability to independently perform these ADLs may signal a critical transition for older adults from independence to dependence," write Dr. Hajduk and colleagues.

They conclude, "Because most older adults value function and independence as health outcomes of greater priority than longevity, clinicians caring for older adults with AMI must recognize and address threats to these important patient-centered outcomes. Our findings suggest that mobility assessment during hospitalization may be useful for evaluating risk of functional decline among older patients with AMI. The TUG is a brief, freely available, and easy assessment that can be administered by clinicians or support staff without extensive training."

The study had no commercial funding and the authors have declared no relevant conflicts of interest.

SOURCE: https://bit.ly/2LSIZHi

JAMA Intern Med 2019.

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