Dementia, Comorbidity, and Physical Function in the Program of All-Inclusive Care for the Elderly.
Jason R Falvey, Allison M Gustavson, Lisa Price and 2 others
PMID 28437317WHAT IT FOUND
PACE participants had gait speeds of 0.64 m/s and over 20 seconds on TUG.
More chronic conditions related to slower walking, and in people with dementia each additional condition was linked to 3.5% worse TUG time. Without dementia, conditions were not linked to TUG time.
Key findings
01Among 525 PACE participants with gait speed and TUG data, each additional Functional Comorbidity Index point was associated with 0.015 m/s slower gait speed, while dementia was not significantly associated with gait speed in the fully adjusted model.
02For TUG time, dementia interacted with comorbidity count: participants with dementia had 3.5% worse TUG time for each additional comorbidity, while participants without dementia had no significant contribution of comorbidities to TUG time.
03In the gait speed model, each additional point on the SPPB balance and chair rise tests was associated with 0.10 m/s and 0.12 m/s greater gait speed, respectively, and FCI score was also independently associated with lower gait speed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Cross-sectional chart review cannot show whether dementia or comorbidity burden caused changes in function, or which came first. Only 525 of 671 consecutive participants had gait speed and TUG data; 84 missing were non-ambulatory, so results apply mainly to ambulatory participants with recorded tests. Dementia was recorded only as present or absent, without type or severity. Participants came from four clinics in one metropolitan area, so findings may not apply elsewhere. Comorbidity data came from chart review and ICD-9 codes, and the Functional Comorbidity Index had limited psychometric data. Assistive devices were allowed, and the fastest of two trials was used, which may affect how results compare with other settings.
Declared interests
The article lists NIH and non-U.S. government research support. The authors reported no relevant financial conflicts of interest.
The easy way to misread this
Do not read these associations as proof that dementia or comorbidities caused slower function. The study was cross-sectional, and dementia was not independently associated with adjusted gait speed; its effect appeared as an interaction with comorbidity count for TUG time.