Balance and Strength Measures are Associated With Mortality in Older Men

Jack Paterson; Michelle Trevenen; Keith Hill; Osvaldo P Almeida; Bu B Yeap; Jonathan Golledge; Graeme J Hankey; Leon Flicker

doi:10.1016/j.jamda.2023.03.038

Balance and Strength Measures are Associated With Mortality in Older Men

J Am Med Dir Assoc. 2023 Oct;24(10):1527-1532.e2. doi: 10.1016/j.jamda.2023.03.038. Epub 2023 May 12.

Authors

Jack Paterson¹, Michelle Trevenen², Keith Hill³, Osvaldo P Almeida², Bu B Yeap⁴, Jonathan Golledge⁵, Graeme J Hankey⁶, Leon Flicker⁷

Affiliations

¹ Medical School, University of Western Australia, Perth, Western Australia, Australia.
² Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia.
³ Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, School of Primary and Allied Health Care, Peninsula Campus, Frankston, Victoria, Australia.
⁴ Medical School, University of Western Australia, Perth, Western Australia, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia.
⁵ Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
⁶ Medical School, University of Western Australia, Nedlands, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia.
⁷ Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia. Electronic address: leon.flicker@uwa.edu.au.

PMID: 37187326
DOI: 10.1016/j.jamda.2023.03.038

Abstract

Objectives: As people age, rates of morbidity and mortality are heterogenous. Balance and strength performance may contribute to this, offering modifiable risk factors for mortality. We aimed to compare relationships of balance and strength performance with all-cause and cause-specific mortality.

Design: The Health in Men Study, a cohort study, using wave 4 as baseline for analyses (2011-2013).

Setting and participants: 1335 older men (>65 years old), initially recruited April 1996-January 1999 in Western Australia, were included.

Methods: Physical tests included a strength (knee extension test) and balance measure (modified Balance Outcome Measure for Elder Rehabilitation (mBOOMER) Score), derived from baseline physical assessments. Outcome measures included all-cause, cardiovascular, and cancer mortality, ascertained via the WADLS death registry. Data were analyzed using Cox proportional hazards regression models (age as analysis time, adjusted for sociodemographic data, health behaviors, and conditions).

Results: Four hundred seventy-three participants died before the end of follow-up (December 17, 2017). Better performance on both the mBOOMER score and knee extension test was associated with lower likelihood of all-cause [hazard ratio (HR) 0.83, 95% CI 0.80-0.87, and HR 0.96, 95% CI 0.95-0.98, respectively] and cardiovascular mortality (HR 0.82, 95% CI 0.77-0.87, and HR 0.96, 95% CI 0.94-0.98, respectively). Better mBOOMER score performance was associated with lower likelihood of cancer mortality (HR 0.90, 95% CI 0.83-0.98) only when including participants with prior cancer.

Conclusions and implications: In summary, this study demonstrates an association of poorer performance in both strength and balance with future all-cause and cardiovascular mortality. Notably, these results clarify the relationship of balance with cause-specific mortality, with balance equaling strength as a modifiable risk factor for mortality.

Keywords: Physical performance; cancer; cardiovascular disease; mortality.