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Peripheral arterial disease and loss of physical function: Just two old friends?

      Life expectancy in the United States and Europe has increased during the last decade, resulting in a higher proportion of older citizens [
      • Beard J.
      • Officer A.
      • Cassels A.
      World Report on Ageing and Health.
      ]. This change shifts medical attention to the multi-dimensional needs of the older population, with a new paradigm towards the impact of functionality and independent living [
      • Beard J.
      • Officer A.
      • Cassels A.
      World Report on Ageing and Health.
      ]. Given data, around 10% of people older than 65 years will be living with frailty, a distinctive health state related to aging and disease, with multiple body systems gradually loosing function and reserves and diminished resilience towards minor events [
      • Beard J.
      • Officer A.
      • Cassels A.
      World Report on Ageing and Health.
      ]. In this context, preservation of stability and mobility, as well as fall prevention, becomes paramount for individualized care planning. Older and elderly individuals are especially prone to the development of peripheral arterial disease (PAD) as “key element” in the context of multi-morbidity [
      • Dormandy J.A.
      • Rutherford R.B.
      Management of peripheral arterial disease (PAD). TASC working group. TransAtlantic inter-society consensus (TASC).
      ]. It is suspected that peripheral arterial disease (PAD) affects more than 200 million people across the globe. Several studies documented the physical impairment of patients suffering from peripheral arterial disease (PAD) [
      • McDermott M.M.
      • Greenland P.
      • Liu K.
      • Guralnik J.M.
      • Celic L.
      • Criqui M.H.
      • Chan C.
      • Martin G.J.
      • Schneider J.
      • Pearce W.H.
      • Taylor L.M.
      • Clark E.
      The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study.
      ,
      • McDermott M.M.
      • Liu K.
      • Greenland P.
      • Guralnik J.M.
      • Criqui M.H.
      • Chan C.
      • Pearce W.H.
      • Schneider J.R.
      • Ferrucci L.
      • Celic L.
      • Taylor L.M.
      • Vonesh E.
      • Martin G.J.
      • Clark E.
      Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms.
      ]. Most surprisingly, even asymptomatic PAD subjects are at risk for greater functional decline compared to subjects without PAD [
      • McDermott M.M.
      • Liu K.
      • Greenland P.
      • Guralnik J.M.
      • Criqui M.H.
      • Chan C.
      • Pearce W.H.
      • Schneider J.R.
      • Ferrucci L.
      • Celic L.
      • Taylor L.M.
      • Vonesh E.
      • Martin G.J.
      • Clark E.
      Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms.
      ]. Clinical judgment based on a taxonomy in chronic care management, including knowledge on the impact of single diseases and clusters of diseases on physical function, will help predict individual as well as population based health trajectories. Thus, discriminating between a stabilization of PAD (reduction in claudication symptoms) and a functional decline of physical performance in various domains of daily living may be crucial for health care development [
      • Schäfer I.
      • Kaduszkiewicz H.
      • Wagner H.O.
      • Schön G.
      • Scherer M.
      • van den Bussche H.
      Reducing complexity: a visualisation of multimorbidity by combining disease clusters and triads.
      ].

      Keywords

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