Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults

• Autores: Jason L. Sanders, Alice M. Arnold, Calvin H. Hirsch, Stephen Thielke, Dae Kim, Kenneth J. Mukamal, Jorge R. Kizer, Joachim H. Ix--, Robert C. Kaplan, Stephen B. Kritchevsky, Anne B. Newman
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 64, Nº. 6, 2016, págs. 1242-1249
• Idioma: inglés
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• Resumen

  • Objectives To ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity).

    Design Prospective, community-based cohort study in four U.S. cities.

    Setting Cardiovascular Health Study.

    Participants Individuals aged 65 and older.

    Measurements Participants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty—reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self-reported healthy life (YHL), and mortality using multivariable regression and survival analysis.

    Results After adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60–1.33) more YAL and 0.54 (95% CI = 0.19–0.90) more YHL than expected agers, and those who were prematurely frail had −0.99 (95% CI = −1.36 to −0.62) fewer YAL and −0.53 (95% CI = −0.89 to −0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P < .001). Adapters spent 55% of their remaining life able and healthy, those who were prematurely frail spent 37%, and of expected agers spent 47% (P < .001).

    Conclusion Despite similar levels of disease burden, older adults who were more vigorous appeared to compress morbidity and live longer. Older adults with higher frailty lengthened morbidity and had greater mortality. Adaptive factors may compress morbidity and decrease mortality.