Physical function trends and their association with mortality in postmenopausal women.

Laddu DR, Saquib N, Manson JE, Arena R, Shadyab AH, Weitlauf JC, Hovey KM, Andrews C, Banack H, Stefanick ML, LaMonte MJ, Women’s Health Initiative Investigators. Physical function trends and their association with mortality in postmenopausal women. Menopause (New York, N.Y.). 2022 Jul 1; 29(7):823-831.

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Abstract:

OBJECTIVE: Research is limited regarding the predictive utility of the RAND-36 questionnaire and physical performance tests in relation to all-cause, cardiovascular disease (CVD), and total-cancer mortality in older women. METHODS: Data on the RAND-36 questionnaire, gait speed, and chair stand performance were assessed in 5,534 women aged = 65 years at baseline. A subset (n = 298) had physical function assessments additionally at follow-up (years 1, 3, or 6). Multivariable Cox proportional hazards regression models estimated associations (HR) for a 1-standard deviation (SD) difference in baseline RAND-36 scores and performance tests (alone and combined) with mortality outcomes in the overall cohort and in models stratified by enrollment age ( < 70 and = 70 y). The relative prognostic value of each physical function exposure was assessed using the Uno concordance statistic. RESULTS: A total of 1,186 deaths from any cause, 402 deaths from CVD, and 382 deaths from total-cancer were identified during a mean follow-up of 12.6 years. Overall, each 1-SD unit higher baseline RAND-36 score was associated with significantly lower all-cause mortality (HR = 0.90) and discriminatory capacity (Uno = 0.65) that was comparable to each performance exposure (HRs 0.88-0.91; Uno = 0.65). These findings were consistent in women aged < 70 and = 70 years. The associations of RAND-36 and performance measures with CVD mortality and total-cancer mortality were not significant in multivariable models nor in age-stratified models. CONCLUSIONS: The RAND-36 questionnaire is a reasonable substitute for tracking physical functioning and estimating its association with all-cause mortality in older adults when clinical performance testing is not feasible.