Joint Impairment and Ambulation in the Elderly

Objective: To test the impact of joint impairment on ambulation in the elderly, using a multivariate model. Design: Cross‐sectional observational study (baseline data from an ongoing longitudinal study). Subjects: Five hundred thirty‐two persons over age 60, including continuing care retirement community (CCRC) (n = 222), homebound (n = 63), and ambulatory (n = 247) respondents. Mean age at assessment = 76.6 (SD = 6.6). Measurement: Independent variables included sociodemo‐graphics, physician measures of lower joint impairment, an index of cormorbidities derived from physical examination or chart abstract, self‐assessed arthritis pain, depression, and anxiety. The dependent variable, ambulation, was measured as walk‐rate, based on the time required to walk 50 feet. Main Results: For the total sample, 61% of the subjects were impaired in more than one lower joint group, with almost 50% of the homebound impaired in more than three joint groups. Demographics (particularly age and education) explained much of the variance in walk‐rate. After controlling for demographics and membership in the groups purposely sampled (CCRC, homebound, ambulatory), lower joint impairment accounted for an additional 7% of the variance in walk‐rate. Total amount of variance explained by the model was 56% (Adjusted R² = .56). A 3‐point change in lower joint impairment score, equivalent to the maximum impairment score for a single joint group, is associated with a 4‐second change in the mean time required to walk 50 feet. The knee and lower spine joints contributed most to the impact of the lower joint impairment measure. Conclusions: Among the elderly, age and education are strong predictors of performance on a walk‐rate test. Independent of demographics and non‐musculoskeletal conditions, joint impairment is associated with diminished walking ability in this population. 1993 The American Geriatrics Society