Prediction of disability-free survival in healthy older people
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Prediction of disability-free survival in healthy older people. / Neumann, Johannes Tobias; Thao, Le T P; Murray, Anne M; Callander, Emily; Carr, Prudence R; Nelson, Mark R; Wolfe, Rory; Woods, Robyn L; Reid, Christopher M; Shah, Raj C; Newman, Anne B; Williamson, Jeff D; Tonkin, Andrew M; McNeil, John J; ASPREE investigators.
in: GEROSCIENCE, Jahrgang 44, Nr. 3, 06.2022, S. 1641-1655.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prediction of disability-free survival in healthy older people
AU - Neumann, Johannes Tobias
AU - Thao, Le T P
AU - Murray, Anne M
AU - Callander, Emily
AU - Carr, Prudence R
AU - Nelson, Mark R
AU - Wolfe, Rory
AU - Woods, Robyn L
AU - Reid, Christopher M
AU - Shah, Raj C
AU - Newman, Anne B
AU - Williamson, Jeff D
AU - Tonkin, Andrew M
AU - McNeil, John J
AU - ASPREE investigators
N1 - © 2022. The Author(s).
PY - 2022/6
Y1 - 2022/6
N2 - Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6-77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people.Trial registration Clinicaltrials.gov (NCT01038583).
AB - Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6-77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people.Trial registration Clinicaltrials.gov (NCT01038583).
KW - Aged
KW - Aspirin
KW - Australia
KW - Female
KW - Healthy Aging
KW - Healthy Life Expectancy
KW - Humans
KW - Male
KW - Risk Factors
U2 - 10.1007/s11357-022-00547-x
DO - 10.1007/s11357-022-00547-x
M3 - SCORING: Journal article
C2 - 35420334
VL - 44
SP - 1641
EP - 1655
JO - GEROSCIENCE
JF - GEROSCIENCE
SN - 2509-2715
IS - 3
ER -