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THE TIMED “UP & GO” TEST AND MANUAL BUTTON SCORE ARE USEFUL PREDICTORS OF FUNCTIONAL DECLINE IN BASIC AND INSTRUMENTAL ADL IN COMMUNITY‐DWELLING OLDER PEOPLE

1999; Wiley; Volume: 47; Issue: 4 Linguagem: Inglês

10.1111/j.1532-5415.1999.tb07252.x

1532-5415

Kiyohito Okumiya, Kozo Matsubayashi, Tomoko Nakamura, Michiko Fujisawa, Yasushi Osaki, Yoshinori Doi, Toshio Ozawa,

Cerebral Palsy and Movement Disorders

To the Editor: Cho et al. have reported that gait/balance disorders and depression are associated with significant decline in functional status in basic activities of daily living (BADL) and instrumental activities of daily living (IADL).1 In a longitudinal cohort study2 with a follow-up of 3 years (from 1995 to 1998) in Kahoku, a rural Japanese town, we now show that the timed “Up & Go” test assessing gait/balance3 and the Button score assessing manual dexterity are also useful and easy-to-administer predictors of declines in BADL and IADL. The timed “Up 8c Go” test measures, in seconds, the time it takes the subject to stand up from an armchair, walk a distance of 3 meters, turn, walk back to the chair, and sit down again. This test is a simple measure of gait/balance disorders.3 Button scores evaluate manual dexterity using a panel with combinations of 10 hooks, 10 big buttons, and 5 small buttons. There were three discrete measurements of time recorded for each participant (10 hook-ons, 10 big button-on-and-offs, and 5 small button-onand-offs). Total manual dexterity time in seconds, defined as the Button Score (Button-S), was calculated by adding the average times for one hook-on and one big or small button-on-and-off.4 The study population consisted of 360 subjects aged 75 years or older (131 men and 229 women; mean age in 1995, 79.0 years) who participated in the Kahoku Longitudinal Aging Study2 in 1995. Through the use of a self-administered questionnaire, the subjects were asked about eight items of BADL (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, grooming, and taking medicine),5 five items of IADL (going out by public means of transportation, shopping for groceries, preparing meals, making payment as requested by a bill, depositing and withdrawing money)6, frequency of falls, medical history (heart disease, stroke, and osteoarthritis), and visual and auditory function. The following measurements were also carried out in 1995: (1) Neurobehavioral functions as determined by the following tests: “Up & Go” test, Functional Reach,7 Button score, Mini-Mental State Exam (MMSE), and Visuospatial Cognitive Performance Test (VCP-test)4; (2) Body mass index and blood pressure measurements; and (3) Geriatric Depression Scale (shorter version) (GDS).8 In 1995, 328 (270) subjects were independent in every BADL (IADL) item, and these subjects were followed for 3 years. Thirty-one (fifty-five) subjects dropped out of the study during the 3-year period, making the final sample size of the study 297 (215) subjects, of which 245 (177) subjects remained independent in every BADL (IADL) item; 52 (38) subjects became dependent in one or more BADL (IADL) items during the follow-up period. Table 1 shows the longitudinal risk factors of declines in BADL or IADL obtained by two models of monovariate analysis and multiple logistic regression analysis. Independent variables included in the model for BADL (dependent variable) were those variables that were statistically significant in monovariate analysis (“Up 8c Go” test > 17 seconds and Button score > 17 seconds; age; and hypertension (SBP ≥ 160 or DBP ≥ 95)). The independent predictors of declines in BADL in the multivariate analysis were “Up & Go” test >17 seconds and Button score > 17 seconds (adjusted odds ratio: 5.2; 95% CI: 1.7–15.6) and no hypertension. Independent variables included in the model for IADL (dependent variable) were those variables (“Up & Go” test > 14 seconds and age). The independent predictor of declines in IADL in the multivariate analysis was “Up & Go” test > 14 seconds (adjusted odds ratio: 2.9; 95% CI: 1.3–6.2). In our study, not only were gait/balance disorders associated with declines in BADL, as in the report by Cho, but manual dexterity was also. “Up 8c Go” test was the independent predictor of declines in both BADL and IADL. Nonhy- pertension was associated with declines in BADL. In our cohort study we also showed a U-curve relation between home blood pressure and mortality (unpublished data) and a J-curve relation between blood pressure and decline in cognitive function.9 Not only hypertension, again as in the report by Cho, but hypotension as well may be associated with declines in BADL. Depression (GDS ≥ 5) was not associated with BADL or IADL in our study. We recently showed that the timed “Up & Go” test and Button score are also useful predictors of falls.10 In conclusion, the “Up & Go” test and Button score may be useful and easy-to-administer predictors of functional decline in basic and instrumental ADL in communitydwelling older people.