Prediction of disability-free survival in healthy older people.

Neumann, JT; Thao, LTP; Murray, AM; Callander, E; Carr, PR; Nelson, MR; Wolfe, R; Woods, RL; Reid, CM; Shah, RC; Newman, AB; Williamson, JD; Tonkin, AM; McNeil, JJ; ASPREE investigators,

Prediction of disability-free survival in healthy older people.

Neumann, JT Thao, LTP Murray, AM Callander, E

Carr, PR Nelson, MR Wolfe, R Woods, RL Reid, CM Shah, RC Newman, AB Williamson, JD Tonkin, AM McNeil, JJ ASPREE investigators,

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Publisher:: Springer Nature
Publication Type:: Journal Article
Citation:: Geroscience, 2022, 44, (3), pp. 1641-1655
Issue Date:: 2022-06

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Field	Value	Language
dc.contributor.author	Neumann, JT
dc.contributor.author	Thao, LTP
dc.contributor.author	Murray, AM
dc.contributor.author	Callander, E https://orcid.org/0000-0001-7233-6804
dc.contributor.author	Carr, PR
dc.contributor.author	Nelson, MR
dc.contributor.author	Wolfe, R
dc.contributor.author	Woods, RL
dc.contributor.author	Reid, CM
dc.contributor.author	Shah, RC
dc.contributor.author	Newman, AB
dc.contributor.author	Williamson, JD
dc.contributor.author	Tonkin, AM
dc.contributor.author	McNeil, JJ
dc.contributor.author	ASPREE investigators,
dc.date.accessioned	2023-02-13T03:31:34Z
dc.date.available	2022-03-16
dc.date.available	2023-02-13T03:31:34Z
dc.date.issued	2022-06
dc.identifier.citation	Geroscience, 2022, 44, (3), pp. 1641-1655
dc.identifier.issn	2509-2715
dc.identifier.issn	2509-2723
dc.identifier.uri	http://hdl.handle.net/10453/166072
dc.description.abstract	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).
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Springer Nature
dc.relation.ispartof	Geroscience
dc.relation.isbasedon	10.1007/s11357-022-00547-x
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject.mesh	Aged
dc.subject.mesh	Aspirin
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Healthy Aging
dc.subject.mesh	Healthy Life Expectancy
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Risk Factors
dc.subject.mesh	Humans
dc.subject.mesh	Aspirin
dc.subject.mesh	Risk Factors
dc.subject.mesh	Aged
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Healthy Aging
dc.subject.mesh	Healthy Life Expectancy
dc.subject.mesh	Aged
dc.subject.mesh	Aspirin
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Healthy Aging
dc.subject.mesh	Healthy Life Expectancy
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Risk Factors
dc.title	Prediction of disability-free survival in healthy older people.
dc.type	Journal Article
utslib.citation.volume	44
utslib.location.activity	Switzerland
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
dc.date.updated	2023-02-13T03:31:31Z
pubs.issue	3
pubs.publication-status	Published
pubs.volume	44
utslib.citation.issue	3

Abstract:

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).

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http://hdl.handle.net/10453/166072