Risk Factors for 5-Year Mortality in Older Adults The Cardiovascular Health Study
Linda P. Fried,Richard A. Kronmal,Anne B. Newman,Diane E. Bild,Maurice B. Mittelmark,Joseph F. Polak,John A Robbins,Julius M. Gardin +7 more
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TLDR
Objective measures of subclinical disease and disease severity were independent and joint predictors of 5-year mortality in older adults, along with male sex, relative poverty, physical activity, smoking, indicators of frailty, and disability.Abstract:
Context—Multiple factors contribute to mortality in older adults, but the extent
to which subclinical disease and other factors contribute independently to
mortality risk is not knownObjective—To determine the disease, functional, and personal characteristics that
jointly predict mortality in community-dwelling men and women aged 65 years
or olderDesign—Prospective population-based cohort study with 5 years of follow-up
and a validation cohort of African Americans with 425-year follow-upSetting—Four US communitiesParticipants—A total of 5201 and 685 men and women aged 65 years or older in the
original and African American cohorts, respectivelyMain Outcome Measures—Five-year mortalityResults—In the main cohort, 646 deaths (12%) occurred within 5 years Using
Cox proportional hazards models, 20 characteristics (of 78 assessed) were
each significantly (P<05) and independently associated
with mortality: increasing age, male sex, income less than $50000 per year,
low weight, lack of moderate or vigorous exercise, smoking for more than 50
pack-years, high brachial (>169 mm Hg) and low tibial (≤127 mm Hg) systolic
blood pressure, diuretic use by those without hypertension or congestive heart
failure, elevated fasting glucose level (>72 mmol/L [130 mg/dL]), low albumin
level (≤37 g/L), elevated creatinine level (≥106 µmol/L [12 mg/dL]),
low forced vital capacity (≤206 mL), aortic stenosis (moderate or severe)
and abnormal left ventricular ejection fraction (by echocardiography), major
electrocardiographic abnormality, stenosis of internal carotid artery (by
ultrasound), congestive heart failure, difficulty in any instrumental activity
of daily living, and low cognitive function by Digit Symbol Substitution test
score Neither high-density lipoprotein cholesterol nor low-density lipoprotein
cholesterol was associated with mortality After adjustment for other factors,
the association between age and mortality diminished, but the reduction in
mortality with female sex persisted Finally, the risk of mortality was validated
in the second cohort; quintiles of risk ranged from 2% to 39% and 0% to 26%
for the 2 cohortsConclusions—Objective measures of subclinical disease and disease severity were
independent and joint predictors of 5-year mortality in older adults, along
with male sex, relative poverty, physical activity, smoking, indicators of
frailty, and disability Except for history of congestive heart failure, objective,
quantitative measures of disease were better predictors of mortality than
was clinical history of diseaseread more
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Journal ArticleDOI
Frailty in Older Adults Evidence for a Phenotype
Linda P. Fried,Catherine M. Tangen,Jeremy D. Walston,Anne B. Newman,Calvin H. Hirsch,John S. Gottdiener,Teresa E. Seeman,Russell P. Tracy,Willem J. Kop,B Gregory Burke,Mary Ann McBurnie +10 more
TL;DR: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition, and finds that there is an intermediate stage identifying those at high risk of frailty.
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Cardiovascular Health Study Collaborative Research Group : Frailty in older adults : evidence for a phenotype
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National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification
Andrew S. Levey,Josef Coresh,Ethan M Balk,Annamaria T. Kausz,Adeera Levin,Michael W. Steffes,Ronald J. Hogg,Ronald D. Perrone,Joseph Lau,Garabed Eknoyan +9 more
TL;DR: The goal is to disseminate the simple definition and five-stage classification system of Chronic kidney disease, to summarize the major recommendations on early detection of chronic kidney disease in adults, and to consider some of the issues associated with these recommendations.
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Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention.
Mark J. Sarnak,Andrew S. Levey,Anton C. Schoolwerth,Josef Coresh,Bruce F. Culleton,L. Lee Hamm,Peter A. McCullough,Bertram L. Kasiske,Ellie Kelepouris,Michael J. Klag,Patrick S. Parfrey,Marc A. Pfeffer,Leopoldo Raij,David J. Spinosa,Peter W.F. Wilson +14 more
TL;DR: There was a high prevalence of CVD in CKD and that mortality due to CVD was 10 to 30 times higher in dialysis patients than in the general population, and the task force recommended that patients with CKD be considered in the “highest risk group” for subsequent CVD events.
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Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care
TL;DR: A narrative review of current understanding of the definitions and distinguishing characteristics of each of these conditions, including their clinical relevance and distinct prevention and therapeutic issues, and how they are related is provided.
References
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“Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician
Marshal F. Folstein,Marshal F. Folstein,Susan E B Folstein,Susan E B Folstein,Paul R. McHugh,Paul R. McHugh +5 more
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
A practical method for grading the cognitive state of patients for the clinician
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Journal ArticleDOI
The cardiovascular health study: Design and rationale
Linda P. Fried,Nemat O. Borhani,Paul L. Enright,Curt D. Furberg,Julius M. Gardin,Richard A. Kronmal,Lewis H. Kuller,Teri A. Manolio,Maurice B. Mittelmark,Anne B. Newman,Daniel H. O'Leary,Bruce M. Psaty,Pentti M. Rautaharju,Russell P. Tracy,Philip G. Weiler +14 more
TL;DR: These examinations in CHS permit evaluation of CVD risk factors in older adults, particularly in groups previously under-represented in epidemiologic studies, such as women and the very old.
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The association of changes in physical-activity level and other lifestyle characteristics with mortality among men.
Ralph S. Paffenbarger,Robert T. Hyde,Alvin L. Wing,I-Min Lee,Dexter L. Jung,James B. Kampert +5 more
TL;DR: Starting moderately vigorous sports activity, quitting cigarette smoking, maintaining normal blood pressure, and avoiding obesity were separately associated with lower rates of death from all causes and from coronary heart disease among middle-aged and older men.
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The Effect of Age on the Association between Body-Mass Index and Mortality
TL;DR: In this paper, the effect of age on optimal body weight is controversial, and few studies have had adequate numbers of subjects to analyze mortality as a function of body-mass index across age groups.
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