Autonomic function parameters are associated to incident limitations in advanced activities of daily living after 2 years follow-up in adults aged 80 and over

BACKGROUND: Neurogenic orthostatic hypotension and blood pressure variability (BPV) may be considered as additional clinical parameters to evaluate preventive interventions. This is particularly relevant if these parameters predict difficulties in performing activities of daily living (ADL).

AIM: To explore the predictive value of autonomic function parameters (AFPs) for incident limitations in ADL mediated by changes in locomotor function in relatively robust older adults over 2 years.

METHODS: This prospective longitudinal study included 267 participants (aged 83 ± 3 years) from the BUTTERFLY study. Data were collected at baseline and after 6, 12 and 24 months. Both direct and indirect associations of autonomic function with the onset of limitations in ADL after 2 years follow-up, mediated by changes in locomotor function, were assessed using PROCESS macro mediating logistic regression analysis.

RESULTS: High systolic supine-to-stand BPV was associated with increased limitations in advanced ADL (aADL) [unstandardised beta (B) = 0.160, P < .001] after a 2-year follow-up. Increased visit-to-visit systolic BPV indirectly predicted incident limitations of aADL, mediated by changes in gait speed during year 1 (B = 0.018, 95% CI: 0.001-0.054). No direct or indirect association between autonomic function and basic or instrumental ADL was observed.

CONCLUSION: Our prospective study demonstrated that various AFPs predict incident limitations in aADL among adults aged 80+ after a 2-year follow-up period. These results are important because aADL represent a complex level of ADL that often deteriorates first. Therefore, monitoring BPV in clinical settings becomes crucial because it potentially affects long-term independence.