Preclinical mobility limitations among community dwelling older adults using the National Health and Aging Trends Study.

BACKGROUND: Preclinical Mobility Limitations (PCML) represent an early transitional stage in which individuals compensate for functional decline, yet do not exhibit overt disability. Recognition of PCML may identify individuals at elevated risk for future disability. Despite its importance, PCML has been understudied using nationally representative datasets. The purpose of this study is to operationalize and validate PCML using the National Health and Aging Trends Study (NHATS) and to examine its prevalence among community dwelling older adults. METHODS: We analyzed 4,566 participants from NHATS 2022/2023. PCML was operationalized based on expert consensus, incorporating task modifications and reduction in frequency of tasks without overt difficulty. We examined the prevalence of PCML and its association with sociodemographic and health factors. Concurrent validity was assessed using the Short Physical Performance Battery (SPPB) measure and an assessment of participation restrictions. We evaluated whether PCML predicts incident manifest limitations one year later using logistic multivariate regression models. RESULTS: PCML was identified in 46.8% of older adults and was more prevalent among those that were between the ages of 75-84 years and women. The mean SPPB composite score for those with PCML was 9.7 out of 12 and 30.6% reported participation restrictions. Those with PCML had 1.8 times increased odds of developing manifest limitations within one year, compared to those without PCML. CONCLUSIONS: This PCML measure has strong criterion validity, highlighting its utility as an early marker of functional decline. Screening for PCML in primary care may provide opportunities to prevent mobility disability and improve quality of life among older adults.