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Adverse Outcomes and Correlates of Change in the Short Physical Performance Battery Over 36 Months in the African American Health Project

¹ Center for Aging Research, Indiana University, and Regenstrief Institute, Inc., Indianapolis, Indiana.
² Iowa City VAMC and College of Public Health, University of Iowa, Iowa City.
³ Health Services R&D Service, Department of Veterans Affairs Medical Center and College of Public Health and Health Professions, University of Florida, Gainesville.
⁴ Department of Neurology and Psychiatry, School of Medicine, Saint Louis University, St. Louis, Missouri.
⁵ Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.

Address correspondence to Douglas K. Miller, MD, IU-Center for Aging Research, Suite 2000, 410 West 10th Street, 1050 Wishard Blvd., RG-6, Indianapolis, IN 46202-3012 (E-mail: dokmille{at}iupui.edu) or Theodore K. Malmstrom, PhD, Saint Louis University, Department of Neurology & Psychiatry, 1438 South Grand Boulevard, Room 306, St. Louis, MO 63104 (E-mail: malmsttk{at}slu.edu)

Background. The Short Physical Performance Battery (SPPB) is a well-established measure of lower body physical functioning in older persons but has not been adequately examined in African Americans or younger persons. Moreover, factors associated with changes in SPPB over time have not been reported.

Methods. A representative sample of 998 African Americans (49–65 years old at baseline) living in St. Louis, Missouri were followed for 36 months to examine the predictive validity of SPPB in this population and identify factors associated with changes in SPPB. SPPB was calibrated to this population, ranged from 0 (worst) to 12 (best), and required imputation for about 50% of scores. Adverse outcomes of baseline SPPB included death, nursing home placement, hospitalization, physician visits, incident basic and instrumental activity of daily living disabilities, and functional limitations. Changes in SPPB over 36 months were modeled.

Results. Adjusted for appropriate covariates, weighted appropriately, and using propensity scores to address potential selection bias, baseline SPPB scores were associated with all adverse outcomes except physician visits, and were marginally associated with hospitalization. Declines in SPPB scores were associated with low falls efficacy (b = –1.311), perceived income adequacy (–0.121), older age (–0.073 per year), poor vision (–0.754), diabetes mellitus (–0.565), refusal to report household income (1.48), ever had Medicaid insurance (–0.610), obesity (–0.437), hospitalization in the prior year (–0.521), and kidney disease (–.956).

Conclusions. The effect of baseline SPPB on adverse outcomes in this late middle-age African American population confirms reports involving older, primarily white participants. Alleviating deterioration in lower body physical functioning guided by the associated covariates may avoid or delay multiple age-associated adverse outcomes.

Key Words: Aging • Lower body physical functioning • Disability • African Americans • Mortality • Nursing home placement