Associations Between Peak Expiratory Flow and Community Mobility Loss Among Older Adults in the United States

Background: Community mobility is a vital patient-centered outcome for older adults living in the community. These deficits in mobility are linked to social isolation, increased hospitalizations, and higher mortality rates. Impaired pulmonary function may be a modifiable risk factor for mobility decline, with existing inequities in lung health potentially contributing disproportionately to mobility loss among Black older adults.

Materials/methods: A cohort of 4742 community-dwelling older adults (weighted n = 29,180,893) with self-reported ability to walk 3 or more blocks in their community was drawn from the National Health and Aging Trends Study (NHATS). Pulmonary function was measured by PEF in NHATS. Community mobility loss was defined as self-reported inability to walk ≥ 3 blocks in the 1-year follow-up assessment. Hierarchical multivariable logistic regression was used and adjusted for demographics, comorbidities, pain, and assistive device use.

Results: Overall, 73.7% of the sample had normal PEF, 18.6% had moderate impairment, and 7.7% had severe impairment. Those with severe impairment were more likely to be male and identify as Black. In unadjusted analyses, 8.8% of older adults with normal PEF experienced mobility loss, compared with 12.7% of those with moderate impairment, and 19.7% with severe impairment. Odds of mobility loss were 111% higher for those with severe PEF impairment as compared to those with normal PEF (OR = 2.1, 95% CI 1.2-3.7) in fully adjusted models, with weaker relationships being observed for those with moderately impaired PEF (OR = 1.2, 95% CI 0.8-1.8).

Conclusions: Nearly 8%, or an estimated 1 million community-ambulating U.S. older adults, had severe impairments in peak expiratory flow in 2015; these older adults have a substantially higher risk of losing the ability to ambulate community distances over the subsequent year.