eCite Digital Repository

Prediction of disability-free survival in healthy older people


Neumann, JT and Thao, LTP and Murray, AM and Callander, E and Carr, PR and Nelson, MR and Wolfe, R and Woods, RL and Reid, CM and Shah, RC and Newman, AB and Williamson, JD and Tonkin, AM and McNeil, JJ, on behalf of the ASPREE investigators, Prediction of disability-free survival in healthy older people, GeroScience, 44, (3) pp. 1641-1655. ISSN 2509-2723 (2022) [Refereed Article]

Pending copyright assessment - Request a copy

DOI: doi:10.1007/s11357-022-00547-x


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.

Item Details

Item Type:Refereed Article
Keywords:Disability; Elderly; Healthy; Public Health; Risk prediction; Survival
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Aged health care
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Nelson, MR (Professor Mark Nelson)
ID Code:155658
Year Published:2022
Deposited By:Menzies Institute for Medical Research
Deposited On:2023-03-03
Last Modified:2023-03-03

Repository Staff Only: item control page