Functional limitations during the transition to older age - Abstract Overview: We propose a competitive renewal of Coronary Artery Risk Development in Young Adults Function study (CARDIA Function; R01AG062502) at the Year 40 (Y40) in-person exam. The goals of this renewal are to capitalize on the initial funding support provided at Y35 to obtain longitudinal assessments of function, to validate novel measurement approaches (i.e., new composite physical performance score, remote performance testing), to extend our innovative work on multimorbidity and function, and to identify new risk factors for functional decline during the critical transition from midlife to early older age. Significance: Over the next three years, >10,000 U.S. adults will turn 65 years old every day. In addition to major life changes (i.e., retirement, insurance) that come with the transition to older age, declines in physical function may begin to occur in this life stage. To capture functional decline, we added the first measures of self-reported function and physical performance (speed, balance, upper/lower body strength, endurance) to the Y35 exam in order to identify functional decline in later exam cycles. Accomplishments of CARDIA Function include enrolling 2,030 participants (90% of Y35 in-person; mean age 60.1), establishing a Physical Function and Aging Workgroup, publishing analyses of >30 years of data characterizing early life course development and progression of multiple chronic conditions (i.e., multimorbidity), developing a new CARDIA Physical Performance (CAPP) composite score, and identifying the association of multimorbidity trajectories with midlife physical function. Continued funding will allow us to obtain repeat assessments of self-reported function and physical performance to address 3 new scientific Aims: (1) To characterize the prevalence and incidence of functional limitations, as well as the age of onset, progression, and severity of functional decline during the transition to older age, (2) To determine the association between multimorbidity progression and functional decline during the transition to older age, and (3) To identify cumulative, life-course risk factors and situational, life-stage risk factors for both multimorbidity progression and functional decline. An overarching aim of this renewal is to advance methods in measuring functional decline during the transition to older age including the use of remote-administered physical performance tests. Impact: The proposed renewal at the CARDIA Y40 exam coincides with the peak wave of the ‘baby boom’ generation who turn 65 years old through 2027. This renewal also provides the last opportunity to measure function among participants of a decades-long prospective cohort study during the transition from late midlife to early older age. Results will lead to new approaches to identify functional limitations, new strategies for measuring physical performance in the age of telehealth, and new life- stage specific targets for preventing functional decline during the transition to older age.
