Restricted Activity: Key Indicator of Decline or “Just Having a Bad Day”?

• Pathological conditions, signs and symptoms
• Disabled
• Aged
• Activities of daily living
• Quality of life

As most older persons age, quality of life becomes increasingly important relative to quantity of life. The good news is that the average 65-year-old person will be functionally independent for the next 15 to 20 years of life (1). Disability is much more of a problem for persons 85 years of age or older; in this group, which is expanding most rapidly, almost 50% of people require assistance in basic activities of daily living (bathing, dressing, using the toilet, ambulation, and eating) (2, 3). However, the transition from independence to dependence is highly heterogeneous. No age or set of medical conditions is pathognomonic for disability. As the population continues to age, we need a better understanding of what causes disability in older people so that we may develop more effective strategies to prevent decline.

In this issue, Gill and colleagues (4) present data on restricted activity in a cohort of community-dwelling elderly persons. The concept of restricted activity has prima facie appeal as a measure of functional disability (5). Restricted activity has been a key outcome measure in several multifactorial geriatrics interventional trials designed to prevent or reduce disability (6-8). However, it is rarely measured in more disease-focused intervention studies or by clinicians in general. Clearly, a better understanding of the epidemiology and significance of restricted activity is a worthy goal.

The methods that Gill and colleagues used are rigorous and represent a significant advance over previous studies in this field. The investigators drew participants …