Transitions in Functional Status of Community Dwelling Older Adults: Impact of Physical Performance, Depression and Cognition

Objectives: The aim of this study is to identify transitions in the functional status (FS) of older adults and to assess the influence of physical performance, depression, and cognitive impairment at baseline, and their changes over time, on FS decline.Methods: This is a population-based cohort with 4 years of follow-up (2008-2011) in "Penaagrande cohort'' (Madrid) in Primary care centres, composed of 607 persons aged >= 65 years. Transition in FS was classified as no disability, mobility disability and activities of daily living disability based on FS in 2008 and 2011. FS decline was considered as transition to decline, continued disability or death. The Short physical performance battery (SPPB), gait speed (GS), depression and cognitive impairment at baseline and as time-dependent variables (TDVs), were the principal independent variables in logistic regression analysis.Results: Some 43.3% (95% CI: 39.3-47.4) of the study population experienced FS decline. Low SPPB and depression at baseline were associated with FS decline (odds ratio [OR] 5.79, 95% CI: 3.39-9.90 and OR 2.92, 95% CI: 1.71-5.02, respectively). The OR of FS decline (fully adjusted) were: 2.90 (95% CI: 1.59-5.29) for decrease in SPPB over time, 5.73 (95% CI: 3.36-9.77) for worsening depression, and 1.93 (95% CI: 1.13-3.29) for worsening of cognitive impairment. GS was also associated with FS decline when used as an alternative indicator of physical performance both at baseline (OR 3.26 [95% CI: 2.08-5.11]) and as TDV (OR 5.60 [95% CI: 3.17-9.89]).Conclusion: The presence of low physical performance, depression and cognitive impairment predicts FS decline. Evaluation of these factors could be helpful in early diagnosis of FS decline. (C) 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.