Community Mobility Among Older Adults With Reduced Kidney Function: A Study of Life-Space

• Type of Material: Article
• Authors: Barrett Bowling, Emory University; Paul Muntner, University of Alabama Birmingham; Patricia Sawyer, University of Alabama Birmingham; Paul W. Sanders, University of Alabama Birmingham; Nancy Kutner, Emory University; Richard Kennedy, University of Alabama Birmingham; Richard M. Allman, Department of Veterans Affairs Medical Center
• Language: English
• Date: 2014-03-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 by the National Kidney Foundation, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1053/j.ajkd.2013.07.022
• Title of Journal or Parent Work: American Journal of Kidney Diseases
• ISSN: 0272-6386
• Volume: 63
• Issue: 3
• Start Page: 429
• End Page: 436
• Grant/Funding Information: Funding provided by Atlantic Philanthropies, Inc, the John A. Hartford Foundation, the Association of Specialty Professors, the American Society of Nephrology, and the American Geriatrics Society.; Support was provided through the National Institute on Aging (Dr Bowling: grant R03AG042336-01) and the T. Franklin Williams Scholarship Award.; Additional support was provided by the Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center Special Fellowship in Advanced Geriatrics, the John A. Hartford Foundation/Southeast Center of Excellence in Geriatric Medicine, and the National Institutes of Health (Dr Allman: grants R01 AG16062, P30AG031054, and 5UL1 RR025777).
• Keywords: ALBUMINURIA; LIMITATION; ELDERLY ADULTS; life-space mobility; elderly; GLOMERULAR-FILTRATION-RATE; MORTALITY; ASSOCIATION; DISEASE; HEALTH; ALL-CAUSE; Science & Technology; Life Sciences & Biomedicine; AGE; Chronic kidney disease; Urology & Nephrology
• Research Categories: Health Sciences, General

Abstract

Background Life-Space Assessment captures community mobility and social participation and quantifies the distance, frequency, and independence obtained as an older adult moves through his or her environment. Reduced estimated glomerular filtration rate (eGFR) is associated with decline in activities of daily living among older adults, but less is known about the association of eGFR with restrictions in mobility. Study Design Prospective observational cohort study. Setting & Participants Community-dwelling Medicare beneficiaries from the University of Alabama at Birmingham Study of Aging who had serum creatinine measured during a baseline in-home study visit and completed at least one telephone follow-up (N = 390). Predictor eGFR ≥ 60, 45-59, and <45 mL/min/1.73 m2. Outcome Life-space mobility trajectory. Measurements Life-space mobility was evaluated by telephone every 6 months for up to 4.5 years using the previously validated Life-Space Assessment. Scores using this tool range from 0-120 (higher scores indicate greater mobility). Results Mean age of the 390 participants was 77.6 ± 5.8 (SD) years, 41% were African American, 50.5% were women; 30.0% had eGFR of 45-59 mL/min/1.73 m2, and 20.2% had eGFR < 45 mL/min/1.73 m2. Age-, race-, and sex-adjusted mean baseline life-space mobility scores were 64.8 (95% CI, 62.0-67.6), 63.8 (95% CI, 60.3-67.4), and 58.3 (95% CI, 53.8-62.7) among those with eGFR categories ≥ 60, 45-59, and <45 mL/min/1.73 m2, respectively. Compared with those with eGFRs ≥ 60 mL/min/1.73 m2, a more rapid decline in life-space mobility was found among those with eGFRs < 45 mL/min/1.73 m2, though this did not reach statistical significance (P = 0.06); a similar effect was not seen among those with eGFRs of 45-59 mL/min/1.73 m2 (P = 0.3). Limitations Urinary albumin or longitudinal measures of eGFR were not available. Conclusions eGFR < 45 mL/min/1.73 m2 was associated with a trend toward a more rapid decline in life-space mobility among community-dwelling older adults. Findings should be confirmed in a larger population.