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Predicting Mortality up to 14 Years Among Community-Dwelling Adults Aged 65 and Older.

ABSTRACT: Extended validation of an index predicting mortality among community-dwelling US older adults.Examination of the performance of a previously developed index in predicting 10- and 14-year mortality among respondents to the 1997-2000 National Health Interview Surveys (NHIS) using the original development and validation cohorts. Follow-up mortality data are now available through 2011.16,063 respondents from the original development cohort and 8,027 respondents from the original validation cohort. All participants were community dwelling and ?65 years old.We calculated risk scores for each respondent based on the presence or absence of 11 factors (function, illnesses, behaviors, demographics) that make up the index. Using the Kaplan Meier method, we computed 10- and 14-year mortality estimates for the development and validation cohorts to examine model calibration. We examined model discrimination using the c-index.Participants in the development and validation cohorts were similar. Participants with risk scores 0-4 had 23% risk of 14-year mortality whereas respondents with risk scores (13+) had 89% risk of 14-year mortality. The c-index of the model in both cohorts was 0.73 for predicting 10-year mortality and 0.72 for predicting 14-year mortality. Overall, 18.4% of adults 65-74 years and 60.2% of adults ?75 years have >50% risk of mortality in 10 years.Our index demonstrated excellent calibration and discrimination in predicting 10- and 14-year mortality among community-dwelling US adults ?65 years. Information on long-term prognosis is needed to help clinicians and older adults make more informed person-centered medical decisions and to help older adults plan for the future.

SUBMITTER: Schonberg MA

PROVIDER: S-EPMC5478427 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Predicting Mortality up to 14 Years Among Community-Dwelling Adults Aged 65 and Older.

Schonberg Mara A MA Li Vicky V Marcantonio Edward R ER Davis Roger B RB McCarthy Ellen P EP

Journal of the American Geriatrics Society 20170221 6

<h4>Objectives</h4>Extended validation of an index predicting mortality among community-dwelling US older adults.<h4>Design/setting</h4>Examination of the performance of a previously developed index in predicting 10- and 14-year mortality among respondents to the 1997-2000 National Health Interview Surveys (NHIS) using the original development and validation cohorts. Follow-up mortality data are now available through 2011.<h4>Participants</h4>16,063 respondents from the original development coho ...[more]

PMID: 28221669

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Project description:Sarcopenia is defined as the age-related decline in skeletal muscle mass and function. The risk factors and causes of sarcopenia must be identified to develop prevention and treatment strategies for this syndrome. Our aim was to examine the association between sarcopenia with lifestyle and family function among community-dwelling Chinese people aged 60 years and older.We conducted this study to evaluate sarcopenia among 834 community-dwelling Chinese individuals aged ≥60 years using the Asian Working Group for Sarcopenia (AWGS) criteria. The sociodemographic characteristics, food consumption patterns, habits of smoking, and alcohol consumption of the participants were collected using a general questionnaire, whereas physical activity was assessed using the International Physical Activity Questionnaire (IPAQ; long-form version). Family function was assessed using the Family APGAR scale. In addition, the association of sarcopenia with lifestyle and family function was examined using univariate and multivariate analyses.The total prevalence rate of sarcopenia was 10.6%. Female participants with sarcopenia had a lower frequency per week of nut consumption than those without sarcopenia (p < 0.05), whereas, for male participants, the differences in food consumption patterns of those with sarcopenia versus those without sarcopenia were not significant. Among the participants, the mean Family APGAR score was 8 (standard deviation [SD] = 0.92). For both sexes, participants with sarcopenia had lower family function scores than those without sarcopenia. In the multivariate model, after adjustment for all covariates, frequency per week of nut consumption (adjusted OR 0.724, 95% CI 0.532-0.985, P < 0.05) and Family APGAR score (adjusted OR 0.683, 95% CI 0.496-0.940, P = 0.019) were statistically significantly associated with sarcopenia. The relationship between other lifestyle habits and sarcopenia was not significant.There was significant association between sarcopenia with intake of nuts and family function. Further studies should evaluate if adequate intake of nuts and a well-functioning family may be effective in lowering the risk of sarcopenia.

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Project description:Importance:There is little understanding of the outcomes associated with active lifestyle interventions for sarcopenia among older persons. Objective:To determine the association of 6-month multidomain lifestyle interventions (physical exercise, nutritional enhancement, cognitive training, combined treatment, and standard care) with change in sarcopenia status and physical function among adults 65 years and older. Design, Setting, and Participants:Post hoc secondary analysis of a parallel-group randomized clinical trial conducted from September 1, 2012, to September 1, 2014, at community centers providing services to elderly individuals in Singapore. Participants included a subsample of 92 community-dwelling prefrail or frail older persons with sarcopenia aged 65 years and older. Data were analyzed from June 1, 2017, to January 1, 2018. Interventions:The 5 intervention groups were a 6-month duration of physical exercise that included resistance and balance training, nutritional enhancement with a commercial oral nutrition supplement formula, cognitive training, a combination of the preceding 3 interventions, and standard care (control). Main Outcomes and Measures:Primary outcomes were changes in sarcopenia status and its components, appendicular skeletal muscle index (ASMI), knee extension strength (KES), and gait speed (GS) at 3 months and 6 months following the intervention. Sarcopenia was defined as the presence of both low ASMI and low KES and/or GS. Results:In 92 participants with sarcopenia, the mean (SD) age was 70.0 (4.7) years and 59 (64.1%) were female. Seventy-eight participants received active interventions and 14 received standard care. Of 92 total participants, the number who remained sarcopenic was reduced to 48 (of 73) after 3 months and 51 (of 75) after 6 months of intervention, indicating that 25 of 92 participants (27.2%) experienced sarcopenia reduction at 3 months and 24 of 92 (26.1%) had sarcopenia reduction at 6 months. Low KES was present in 88 of 92 patients (95.6%), and low GS in 30 of 92 patients (32.6%) at baseline. Among the components of sarcopenia, GS had the greatest change associated with active interventions, with 22 of 30 participants (73.3%) free of low GS at 6 months; in comparison, 17 of 88 participants (19.3%) were free of low KES at 6 months and 7 of 92 participants (7.6%) were free of low ASMI at 6 months. Men experienced greater reduction in sarcopenia than women (?2?=?5.925; P?=?.02), as did those with younger age (t?=?-2.078; P?=?.04) or higher ASMI (mean [SD] ASMI, 5.74 [0.77] vs 5.14 [0.77] kg/m2; P?=?.002). Participants in the active intervention group experienced statistically significant decreases in sarcopenia score and its components at 3 months and 6 months from baseline (F?=?14.138; P?<?.001), but the intervention was not associated with significant differences in ASMI, KES, and GS vs standard care. Conclusions and Relevance:This study suggests that older persons with sarcopenia are responsive to the effects of multidomain lifestyle interventions. Sarcopenia reduction was most pronounced through improved gait speed, and occurred more among those who were male, were younger, or had greater muscle mass.

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Predicting Mortality up to 14 Years Among Community-Dwelling Adults Aged 65 and Older.

Publications

Predicting Mortality up to 14 Years Among Community-Dwelling Adults Aged 65 and Older.

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