ORIGINAL RESEARCH
Frank H. Lawler, MD, MSPH; James W. Mold, MD, MPH; Xiaolan Liao, PhD; David E. Bard, PhD
Corresponding Author: Frank H. Lawler, MD, MSPH; Department of Family and Preventive Medicine - University of Oklahoma Health Sciences Center.
Email: franklawler@hotmail.com
DOI: 10.3122/jabfm.2022.220306R1
Keywords: Aged, Geriatrics, Mortality, Peripheral Nervous System Diseases, Peripheral Neuropathies, Primary Health Care, Prognosis
Dates: Submitted: 09-09-2022; Revised: 01-18-2023; Accepted: 01-20-2023
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INTRODUCTION: We analyzed data from a prospective cohort of 799 older primary care patients recruited in 1999 to determine whether the presence of peripheral neuropathy (PN) discovered by physical examination was associated with premature mortality and to investigate potential mechanisms.
METHODS: PN was defined as the presence of one or more bilateral lower extremity sensory deficits detectable by physical examination. Mortality was determined from key contacts and internet sources. Statistical models were used to evaluation the association between PN and mortality. Structural equation modeling (SEM) was used to explore direct and indirect relationships between PN and survival time.
RESULTS: Bilateral lower extremity neurological deficits were common, reaching 54% in those 85 and older. PN was strongly associated with earlier mortality after controlling for age, male gender, being unmarried, poorer self-reported health, and cigarette use. Mean survival time for those with PN was 10.8 (SD 6.5) years, compared with 13.9 (SD 6.5) years for subjects without PN (p<.0001). PN was also indirectly associated through impaired balance.
CONCLUSIONS: In this relatively healthy cohort of older primary care patients, PN detectable by physical examination was extremely common and strongly associated with earlier mortality. One possible mechanism involves loss of balance, though our data were insufficient to determine whether poor balance led to injurious falls or to less-specific declines in health. Nevertheless, these findings may warrant further studies to determine the causes of age-associated PN and the potential impact of early detection and balance improvement and other fall prevention strategies in individuals with PN detected by physical examination.