The telephone interview included verbal consent, medical history, and cognitive screening tests. Potential subjects were contacted by letter explaining the purpose and nature of the study and then contacted by telephone. 14, 15 Exclusion criteria for the Einstein Aging Study included severe audiovisual loss, being bed-bound, or institutionalization. 14, 15 Subjects were recruited from Medicare lists of older adults in Bronx County as previously described. Participants were community-residing adults age 70 and over participating in a gait and mobility substudy of the Einstein Aging Study. The aims of this study were 3-fold: (1) to examine commonalities and differences in clinical conditions associated with self-reported difficulties in climbing up and down stairs (2) to establish the reliability for self-reported difficulties in climbing up and down stairs and (3) to examine whether there was a risk gradient for activity limitations associated with stair negotiation difficulty. We examined the clinical and functional correlates of self-reported difficulty in climbing up and climbing down stairs separately in a community-residing sample of nondisabled and nondemented older adults. Poor characterization of stair negotiation has been identified as a major limitation in functional assessment in previous reviews. 7, 13 Hence, asking older adults about difficulty only in climbing up stairs or stair negotiation difficulty overall may not be optimal in assessing functional status and in identifying clinical correlates of limitations in these 2 activities that may be amenable to intervention.

7, 12 Accidents occur about 3 times more frequently while climbing down stairs than up stairs. 8 However, the neurologic, cardiovascular, and musculoskeletal demands differ between climbing up and climbing down stairs. Most functional assessment instruments inquire about difficulty only in climbing up stairs or combined difficulty in climbing up and down stairs. 7 - 9 In hospital settings, stair-climbing ability is often assessed to help make decisions about whether a patient should be sent home or to a nursing facility. Stair negotiation (climbing up and down stairs) was among the top 5 tasks that community-residing older adults rated as being most difficult due to “old age.” 6, 7 Self-reported ability to climb stairs is considered a key marker of functional independence in older adults. 3 - 5 However, the reliability and validity of many individual activities, such as stair climbing, that are used to assess ADLs and function are not well established. 2 Among nondisabled subjects, activity limitations (able to perform ADLs with some difficulty) are considered a marker of the early stages of the disablement process. Disability In Basic Activities of daily living (ADLs) is common among older adults, 1 and is assessed in clinical settings by asking older adults about inability or requiring assistance from another person to perform activities such as bathing, climbing stairs, or walking.

Up down stairs