Even single-domain decline in physical performance predicts short- and long-term mortality in older adults

BACKGROUND: Age-related decline in physical performance may reflect early loss of physiological reserve and increased vulnerability to adverse outcomes. We examined whether longitudinal decline across one or multiple physical performance domains predicts short- and long-term mortality in older adults. METHODS: We analysed data from 1967 community-dwelling participants in the Progetto Veneto Anziani (Pro.V.A.) cohort. Physical functional decline between baseline and first follow-up was defined across three domains (handgrip strength, gait speed, chair stand performance) and categorized as decline in 0, 1, or ≥ 2 domains. Landmark Cox models estimated 2- and 8-year mortality risk, adjusting for sociodemographic, clinical, cognitive and baseline functional parameters. RESULTS: During follow-up, decline in one domain was associated with increased mortality at both 2 years (HR 1.73, 95% CI 1.20-2.51) and 8 years (HR 1.49, 95% CI 1.26-1.78). Decline in ≥2 domains conferred similar risk estimates (2-year HR 1.77; 8-year HR 1.78). No significant interaction by sex was observed. Sensitivity analyses excluding early deaths yielded consistent results. CONCLUSIONS: These results suggest that even decline confined to a single physical performance domain may signal an early transition toward increased vulnerability. Monitoring trajectories of physical performance may therefore help identify older adults at increased mortality risk before more widespread functional deterioration becomes apparent.