Objective: to determine contributors to decline in functional capacity in elderly patients with known vascular risk factors or disease.
Design: secondary analysis of longitudinal data gathered over an average 3.2 years of follow-up.
Participants: 5,804 community-dwelling subjects aged 70-82 years with a history of, or risk factors for, ischaemic vascular disease.
Measurements: basic activities of daily living were measured serially through the study using the 20-point Barthel index and extended activities using a 14-point Instrumental Activities of Daily Living (IADL).
Results: over the period of study 896/5,661 (16%) subjects had deterioration in Barthel (mean reduction 0.35, SD 1.76) and 1,270/5,662 (22%) had a reduction in IADL score (mean 0.63, SD 2.15). Independent risk factors at baseline for a reduction in Barthel and IADL were age, female gender and diabetes mellitus. A history of vascular disease and smoking were also significant predictors of reduction in IADL. The development of a new cerebrovascular event was associated with a greatly increased risk of reduction in the Barthel and IADL score (multivariate OR 3.71 (95% CI 2.94, 4.69) and 3.71 (95% CI 2.96, 4.66), respectively). A similar pattern was seen for non-fatal myocardial infarction. Incident cerebrovascular events and non-fatal myocardial infarction accounted for 31 and 11%, respectively, of the population decline in Barthel, and 24 and 10% of the decline in IADL.
Conclusion: incident vascular events were important contributors to functional decline in this population, accounting for almost half of the observed deterioration in basic activities of daily living and approximately one-third of the reduction in IADL. Prevention of ischaemic vascular events over the short to medium term should reduce the burden of disability in high-risk older subjects.