Gait speed as a predictor of outcomes in post-acute transitional care for older people

Abstract

Aims: Gait speed has been advocated as a marker of vulnerability, but its discriminatory utility and predictive ability in frail older people in a post-acute community-based rehabilitation program has not been extensively investigated. The aims of this research were to examine whether there was a meaningful improvement in gait speed in post-acute care patients, and to determine whether gait speed predicted outcomes at 6-month follow up. Methods: In a prospective cohort study, 351 older persons admitted to a transition care program were comprehensively assessed using the interRAI Home Care instrument. This included a timed 4-m walk at admission and discharge. A telephone interview 6 months after admission determined functional independence, living status and readmissions to hospital. Results: Mean (SD) gait speed was 0.34m/s (0.21m/s) at admission and 0.54m/s (0.33m/s) at discharge. The improvement in gait speed over the program was significant (P<0.001), and represents a clinically meaningful change. At 6 months postadmission to transition care, a majority of patients (86.9%) were living in the community and 40.5% had at least one readmission to hospital. Higher gait speed at admission was associated with increased likelihood of living in the community (OR 1.34, P=0.015) and being functionally independent (OR 1.19 P=0.017) at follow up, as well as a reduced risk of hospital readmissions (OR 1.18, P=0.006). Conclusions: Gait speed is an inexpensive, feasible and objective measure of physical performance in frail older people. It could be a useful tool in community-based transition care settings to predict outcomes.