A comprehensive prognostic tool for older adults: Predicting death, ADL disability, and walking disability simultaneously
Background Many clinical and financial decisions for older adults depend on the future risk of disability and mortality. Prognostic tools for long‐term disability risk in a general population are lacking. We aimed to create a comprehensive prognostic tool that predicts the risk of mortality, of acti...
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Published in | Journal of the American Geriatrics Society (JAGS) Vol. 70; no. 10; pp. 2884 - 2894 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, USA
John Wiley & Sons, Inc
01.10.2022
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Many clinical and financial decisions for older adults depend on the future risk of disability and mortality. Prognostic tools for long‐term disability risk in a general population are lacking. We aimed to create a comprehensive prognostic tool that predicts the risk of mortality, of activities of daily living (ADL) disability, and walking disability simultaneously using the same set of variables.
Methods
We conducted a longitudinal analysis of the nationally‐representative Health and Retirement Study (HRS). We included community‐dwelling adults aged ≥70 years who completed a core interview in the 2000 wave of HRS, with follow‐up through 2018. We evaluated 40 predictors encompassing demographics, diseases, physical functioning, and instrumental ADLs. We applied novel methods to optimize three models simultaneously while prioritizing variables that take less time to ascertain during backward stepwise elimination. The death prediction model used Cox regression and both the models for walking disability and for ADL disability used Fine and Gray competing‐risk regression. We examined calibration plots and generated optimism‐corrected statistics of discrimination using bootstrapping. To simulate unavailable patient data, we also evaluated models excluding one or two variables from the final model.
Results
In 6646 HRS participants, 2662 developed walking disability, 3570 developed ADL disability, and 5689 died during a median follow‐up of 9.5 years. The final prognostic tool had 16 variables. The optimism‐corrected integrated area under the curve (iAUC) was 0.799 for mortality, 0.685 for walking disability, and 0.703 for ADL disability. At each percentile of predicted mortality risk, there was a substantial spread in the predicted risks of walking disability and ADL disability. Discrimination and calibration remained good even when missing one or two predictors from the model. This model is now available on ePrognosis (https://eprognosis.ucsf.edu/alexlee.php)
Conclusions
Given the variability in disability risk for people with similar mortality risks, using individualized risks of disabilities may inform clinical and financial decisions for older adults. |
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Bibliography: | Funding information National Institute on Aging, Grant/Award Numbers: K24AG066998, K24AG068312, R01AG047897, T32AG212000, U01AG009740 Alexander K. Smith and Sei J. Lee contributed equally to this work as senior authors. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Dr. A. Lee made substantial contributions to the interpretation of data and drafting the manuscript, and gave final approval of the version to be published. Ms. Diaz-Ramirez and Dr. Boscardin made substantial contributions to the design of the study, the analysis and interpretation of data, revising the article critically for important intellectual content, and they both gave final approval of the version to be submitted. As co-last authors, Dr. S. Lee and Dr. Smith conceived and designed the study, made substantial contributions to the interpretation of data, and revised the article for important intellectual content; they both gave final approval of the version to be published. Author Contributions Dr. A.K. Smith and Dr. S.J. Lee both contributed equally to this work as senior authors. |
ISSN: | 0002-8614 1532-5415 |
DOI: | 10.1111/jgs.17932 |