New diagnosis of ‘dismobility’ brings impaired mobility to the forefront of clinical practice and establishes the predictive power of slow gait speed

California Pacific CURRENTS: The online journal of CPMC Research Institute

April 24, 2014 (San Francisco, CA)

Impaired mobility in adults over age 65—many of whom are unable to walk more than three blocks—adds billions of dollars to annual healthcare costs in the U.S. Slow gait speed, commonly overlooked in medical practice and rarely recorded in patient follow-up, limits independence and is associated with the progression of chronic illnesses.

The  diagnosis of ‘dismobility’ (defined as gait speed of 0.6 meters per second or less)   arises from  two decades of  research on the consequences of slow walking speed from  the  collaborative Mobility Working Group  and other scientists, as published online today in The Journal of the American Medical Association.

“Establishing diagnoses based on cut-points for measurements have enabled clinical diagnoses and new treatments for hypertension, osteoporosis, and other conditions characterized by graded associations of markers with relevant outcomes,” said Steven R. Cummings, MD, Senior Scientist at California Pacific Medical Center Research Institute (CPMCRI), Director of the San Francisco Coordinating Center (SFCC) and lead study author.  “Making gate speed a vital sign with a diagnosis of dismobility for extremely slow walking will bring attention to impaired mobility in clinical practice.”

Dr. Cummings and colleagues’ research suggests that patients with dismobility should be screened for treatable, contributing medical conditions including osteoarthritis, pulmonary disease, and neurologic illnesses such as Parkinson's disease.  Furthermore, diagnosing dismobility may spark improved and earlier treatment of the primary condition, and specific subsequent treatment for slow gait.

“A diagnosis of dismobility should prompt clinicians to improve or maintain physical performance in their patients to reduce the risk of poor outcomes,” said Peggy Cawthon (PhD, MPH), Scientist at CPMCRI and the SFCC, study co-author and a leading expert in mobility. “Older patients should be counseled about participating in a program of regular exercise proven to prevent declining gait speed and impaired mobility.”

The new research suggests that gait speed—which is highly reproducible and widely used in clinical and epidemiologic research—should be measured annually beginning at age 70, when the prevalence of dismobility substantially rises.

By 2040, it is projected that the U.S. will have more than 81 million adults over age 65, with 15.4 million unable to walk more than three blocks.