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A home health bulletin distributed to our physicians on December 29, 2008

Improvement in Gait Speed Predicts 36% Better Survival for Seniors

Susan Hardy, MD and colleagues recruited 439 adults age 65 and older to assess multiple possible predictors of mortality that could be used in primary care.(1)  Their results were published recently in the Journal of the American Geriatric Society.  They performed physical assessments on all participants at baseline.  Seniors who showed no improvement in habitual gait speed after one year experienced an eight-year mortality rate of 49.3%.  Participants who showed a gain in gait speed during a quarterly assessment but lost the gains by the one-year assessment experienced a mortality rate of 41.2% over the next eight years.  Seniors who showed only a 0.1 meter per second improvement in gait speed after one year experienced a much improved mortality rate of 31.6% over the next eight years.  Hardy et al. state that their findings support the recommendations that primary care practitioners should assess gait speed as part of annual geriatric exams.  Hardy et al. also suggest that these findings may underscore the importance of prescribing interventions that affect habitual gait speed. 

Therapeutic exercise can improve habitual gait speed in older adults.(2)  Not all seniors who might benefit  from gait training qualify for Medicare certified home health.  Some will need to use facility-based therapy under their Medicare Part B benefits.  However, when patients do qualify for home health, the convenience of home visits coupled with the fact that Medicare pays 100% of home health may help motivate your patients to participate.  Furthermore, physical therapy and occupational therapy from AbleCare Home Health will train your patients in a customized home exercise program that will remove barriers to future exercise (i.e. the need for special equipment, the need to travel to a gym, the need to go outside, fear of self-injury).

To qualify for home health, patients must meet homebound criteria (call if you would like more information).  In addition, Medicare’s skilled need requirement generally looks for a recent occurrence to justify skilled services (i.e. a new diagnosis, recent exacerbation, recent illness, recent injury, problems with the Timed-Up-and-Go-Test).  Interventions for conditions such as congestive heart failure, arthritis, and COPD have shown positive effects on walking speed.(3-5)  The Timed-Up-and-Go-Test incorporates usual gait speed as part of the screening, and considerable research correlates times greater than 14 seconds with a high risk of future falls.(6-11)  Generally speaking, homebound patients will qualify for home health when a recent evaluation discovers a high risk of future falls.  When your patients’ gait speed suggests that they have not fully recovered from a recent injury or illness or when your patients’ gait suggests a high risk of future falls, please consider a referral to AbleCare.  AbleCare may be able to progress your patient into the group that experiences 36% better survival. 

Hardy et al recruited patients from two primary care practices serving Medicare populations – making these results particularly relevant to primary care.  We encourage primary care practitioners to make referrals directly from their offices.  Patients using walking aides were included.  Patients who were cognitively intact and patients who were mildly impaired but with a caregiver were included.  Improvement in gait speed proved to be a strong predictor of mortality regardless of whether a patient had been hospitalized during the year.

Your Friendliest
Home Health Option

Your patients frequently write on satisfaction surveys that AbleCare caregivers feel like part of their family.  We feel the same way, and it shows.  AbleCare caregivers commonly pick up medications for patients, find community solutions to non-medical challenges at home, and are just plain caring and nice.  Embodying our caring hearts value is a requirement of all AbleCare team members.  You and your staff probably notice the difference, too.

References

1. Hardy S, Perera S, Foumani Y, et al. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc. 2007; 55 (11): 1727-1734.
2. Lopopolo R, Greco M, Sulliivan D, et al. Effect of therapeutic exercise on gait speed in community-dwelling elderly people: A meta-analysis. Phys Ther 2006; 86:520-540.
3. Boxall A, Barclay L, Sayers A, et al. Managing chronic obstructive pulmonary disease in the community. A randomized controlled trial of home-based pulmonary rehabilitation for elderly housebound patients. J Cardiopulm Rehabil 2005; 25: 378-385.
4. Ettinger W, Burns R, Messier S, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997; 277: 25-31.
5. Olsson L, Swedberg K, Clark A, et al. Six minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: A systematic review. Eur Heart J 2005; 26: 778-793.
6. Whitney J, Lord S, Close J. “Streamlining assessment and intervention in a falls clinic using the Timed Up and Go Test and Physiological Profile Assessments.” Age and Ageing. 2005; 34 (6): 567-571.
7. Podsiadlo D, Richardson S. “The times ‘up and go’ a test of basic functional mobility for frail elderly persons.” J Am Geriatr Soc 1991; 39: 142-8.
8. Bischoff H, Stahelin H, Monsch A, et al. “Identifying a cut-off point for normal mobility: a comparison of the timed up and go test in community-dwelling and institutionalized elderly women.” Age Ageing 2003; 32: 315-20.
9. Shumway-Cook A, Brauer S, Woollacott M. “Predicting the probability of falls in community-dwelling older adults using the times up and go test.” Phys Ther 2000; 80: 896-903.
10. Rose DJ, Jones CJ, Lucchese N. “Predicting the probability of falls in community-residing older adults using the 8-foot up-and-go: a new measure of functional mobility.” J Phys Activity Aging 2002; 10: 466-75.
11. Gunter B, White N, Hayes W, et al. “Functional mobility discriminates nonfallers from one-time and frequent fallers.” J Gerontol Med Sci 2000; 55A: M672-6.