PREDICTORS OF DECLINE IN MANUAL PERFORMANCE IN OLDER ADULTS

OBJECTIVE: To determine factors that predict decline in manual perform ance using a multivariate model of determinants of functional limitati on. DESIGN: Longitudinal observational study. SETTINGS: Ambulatory gen eral medicine clinics, residences of homebound individuals, and a cont inuing care retirement community. PARTICIPANTS: Subjects were 485 pers ons more than 60 years of age and included continuing care retirement community (CCRC) residents (n = 215), chronically homebound older pers ons (n = 65), and ambulatory older adults (n = 205). Mean age at basel ine was 78 years. MEASUREMENT: Independent variables included demograp hics, physician measures of upper-extremity joint impairment, comorbid ities derived from physical examination and chart abstract, self-asses sed arthritis pain, depression, and anxiety. The major dependent varia ble was 2-year decline in timed manual performance below a threshold a ssoci ated with need for long-term care services. RESULTS: The proport ion of subjects who exceed a Timed Manual Performance Test threshold o f 350 seconds increased slowly from baseline through Year 4 for all ag e groups but rose rapidly from Year 4 to Year 6 for the oldest group ( >85 years at baseline). Using a discrete survival model, we found that age, education, grip strength, and psychological status predicted cro ssing the manual performance threshold within a 2-year period. CONCLUS IONS: The findings, coupled with earlier findings that upper extremity joint impairment predicted both grip strength and manual performance, suggest that joint impairment may be an important risk factor for fut ure functional limitation. Since diminished hand function has been sho wn to predict dependency, development and testing of interventions to maintain or restore upper extremity joint function and reduce pain wou ld appear to be a high research priority.