Taking BPWe are accustomed to the routine measurement of blood pressure, heart rate, respiratory rate, and temperature at every visit to the doctor’s office.  We are not surprised by 4:00 am awakenings for obligatory vital sign monitoring in a hospital.  Since 2001, the Joint Commission on Accreditation of Healthcare Organizations has required pain assessment in healthcare settings (1).  Thus, pain is commonly referred to as a 5th vital sign.  What will be the 6th vital sign?  Some suggestions include:  health-related quality of life (2), distress (3), health literacy (4), urinary incontinence (5), mental status (6), fall risk (7), and gait speed (8).  All of these factors are particularly relevant to aging adults.  I will elaborate on gait speed, and perhaps future bloggers will be inspired to explore other potential 6th vital signs.

Gait speed (a.k.a. gait velocity, walking speed, walking velocity) is a reliable and valid functional measure that has predictive value for important health outcomes.  This simple measure is associated with physical and cognitive decline, future hospitalizations, discharge destination, mortality, falls, and quality of life (8,9).  All you need is a patient with the ability to walk (with or without and assistive device), a stopwatch, a measurable clear straight pathway (> 4 meters), and either a calculator or basic math skills (distance/time).  Gait speed is commonly measured with the patient’s self selected or usual pace, which can also be compared with a fast pace.  Ability to increase gait speed beyond usual pace is an important indicator of functional reserve.  A systematic review of studies with average participant age > 70 years estimated usual gait speed of 0.46 m/s in acute care, 0.53 m/s in subacute care, and 0.74 m/s in outpatient (9).  Normal gait speed for community-dwelling older adults is 1.2 – 1.4 m/s.8  These findings suggest “the need for ongoing rehabilitation to attain levels sufficient for reintegration in the community (9).”

Discussion question – what measure do you recommend as a 6th vital sign for geriatric patients?

This week’s Guest Blogger is Rebecca Galloway, PT, PhD, GCS, CEEAA, Assistant Professor, Department of Physical Therapy, UTMB School of Health Professions.

Reference List

  1. The Joint Commission. Facts about pain management. http://www.jointcommission.org/pain_management/ .Updated 2013. Accessed 8-22-2013.
  2. Feeny D. Health-related quality-of-life data should be regarded as a vital sign. J Clin Epidemiol Feet in the sand2013;66:706-709.
  3. Waller A, Garland SN, Bultz BD. Using screening for distress, the sixth vital sign, to advance patient care with assessment and targeted interventions. Support Care Cancer 2012;20:2246.
  4. Heinrich C. Health literacy: The sixth vital sign. J Am Acad Nurse Pract 2012;24:223.
  5. Joseph AC. Is urinary incontinence as the sixth vital sign part of your practice? Urol Nurs 2009;29:146.
  6. Flaherty JH, Rudolph J, Shay K et al. Delirium is a serious and under-recognized problem: why assessment of mental status should be the sixth vital sign. J Am Med Dir Assoc 2007;8:273-275.
  7. Younce AB, Hinton D, Hayes DD, Berg J. Make fall risk the sixth vital sign. Nursing 2011;41:64.
  8. Fritz S, Lusardi M. White paper:  “walking speed:  the sixth vital sign”. J Geriatr Phys Ther 2009;32:49.
  9. Peel NM, Kuys SS, Klein K. Gait speed as a measure in geriatric assessment in clinical settings:  a systematic review. J Gerontol A Biol Sci Med Sci 2012;68:39-46.

Join us for a real-time discussion about ideas raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.