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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., and others. (2022) Prediction of disability-free survival in healthy older people. GeroScience, 44 . pp. 1641-1655. ISSN 2509-2715. (doi:10.1007/s11357-022-00547-x) (KAR id:111145)

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)

Item Type: Article
DOI/Identification number: 10.1007/s11357-022-00547-x
Uncontrolled keywords: Risk prediction, Disability, Survival, Elderly, Healthy, Public Health
Subjects: H Social Sciences
Institutional Unit: Schools > School of Psychology > Tizard Centre
Former Institutional Unit:
There are no former institutional units.
Funders: National Institutes of Health (https://ror.org/01cwqze88)
Depositing User: Glynis Murphy
Date Deposited: 03 Sep 2025 10:34 UTC
Last Modified: 08 Sep 2025 06:56 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/111145 (The current URI for this page, for reference purposes)

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