Reported Slowing in Walking and Everyday Activities and Long-Term Mortality in Older Adults: The NEDICES...

Background: Objective gait speed, self-rated walking pace, and self-reported walking difficulty are consistently associated with mortality. Far less is known about the prognostic meaning of perceiving, or being told, that one has recently become slower in both walking and everyday activities. We examined whether reported slowing was associated with long-term all-cause mortality in older adults. Methods: The Neurological Disorders in Central Spain (NEDICES) study is a prospective population-based cohort of 5278 adults aged 65 years or older. At baseline (1994-1995), participants were asked whether they noticed, or had been told, that lately they walked or did things more slowly; the item was available for 3994 participants. Vital status was ascertained through 31 December 2017 by linkage to the Spanish National Population Register. Kaplan-Meier methods and Cox regression were used. The primary model included the Carey-based comorbidity score and adjusted for demographic, movement-disorder, musculoskeletal, and lifestyle covariates. Results: Reported slowing was present in 1516 participants (38.0%); 3426 deaths occurred. In the primary complete-case model (n = 3858; 3311 deaths), reported slowing was associated with mortality after multivariable adjustment (hazard ratio 1.10, 95% confidence interval 1.02-1.18; p = 0.012). The item changed Harrell's C-index from 0.7046 to 0.7048. The estimate was attenuated after excluding deaths within five years (1.08, 0.99-1.17; p = 0.087) and after exploratory adjustment for the Pfeffer Functional Activities Questionnaire score (1.08, 1.00-1.16; p = 0.055). Conclusions: Reported slowing in walking and everyday activities was associated with a modest increase in mortality after multivariable adjustment. It may serve as a simple indicator of slightly higher mortality risk, although its incremental contribution to individual-level prognostication was limited.