@article {article, title = {Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes}, journal = {International Journal of Chronic Obstructive Pulmonary Disease}, volume = {Volume 17}, year = {2022}, pages = {701-717}, abstract = {Rationale: Frailty prevalence estimates among individuals with COPD have varied widely, and few studies have investigated relationships between frailty and adverse outcomes in a COPD population. Objective(s): Describe frailty prevalence among individuals with and without COPD and examine associations between frailty and mortality and other adverse outcomes in the next two years. Methods: This was an observational cohort study using Health and Retirement Study data (2006{\textendash} 2018) of community living individuals ages 50{\textendash} 64 and >= 65 with and without COPD (non-COPD). Frailty (Fried phenotype [5 items], and a modified Frailty Index-Comprehensive Geriatric Assessment [Enhanced FI-CGA] [37 items], and debility (modified BODE Index [4 items]) were assessed. Two-year post-assessment outcomes (mortality, >= 1 inpatient stay, home health and skilled nursing facility (SNF) use) were reviewed in a population matched 3:1 (non-COPD: COPD) on age, sex, race, and year using univariate and multivariate logistic regression (adjusted for morbidities). Area-under-the-curve (AUC) was used to evaluate regressions. Results: The study included 18,979 survey observations for age 50{\textendash} 64, and 24,162 age >= 65; 7.8\% and 12.0\% respectively reporting a diagnosis of COPD. Fried phenotype frailty prevalence for age >= 65 was 23.1\% (COPD) and 9.4\% (non-COPD), and for the Enhanced FI-CGA, 45.9\% (COPD) and 22.4\% (non-COPD). Two-year mortality for COPD was more than double non-COPD for age 50{\textendash} 64 (95\% CI: 3.8{\textendash} 5.9\% vs 0.7{\textendash} 1.3\%) and age >= 65 (95\% CI: 11.9{\textendash} 14.3\% vs 5.6{\textendash} 6.6\%). Inpatient utilization, home health care use, or at least temporary SNF placement were also more frequent for COPD. Measures were predictive of adverse outcomes. In adjusted models, the Fried phenotype and modified BODE score performed similarly, and both performed better than the Enhanced FI-CGA index. AUC values were higher for morality regressions. Conclusion: Frailty prevalence among individuals with COPD in this national survey is substantially greater than without COPD, even at pre-retirement (50{\textendash} 64 years). These measures identify patients with increased risk of poor outcomes.}, keywords = {Cognition, Disability, home health, peak air flow, Survival}, doi = {10.2147/COPD.S348714}, author = {Roberts, Melissa and Mapel, Douglas and Ganvir, Nikhil and Dodd, Melanie} } @article {12270, title = {Long-term functional outcomes and mortality after hospitalization for extracranial hemorrhage}, journal = {Journal of Hospital Medicine}, volume = {17}, year = {2022}, pages = {235-242}, abstract = {Background The effects of extracranial hemorrhage (ECH), or bleeding outside the brain, are often considered transient. Yet, there are few data on the long-term and functional consequences of ECH. Objective Define the association of ECH hospitalization with functional independence and survival in a nationally representative cohort of older adults. Design Longitudinal cohort study. Settings and Participants Data from the Health and Retirement Study from 1995 to 2016, a nationally representative, biennial survey of older adults. Adults aged 66 and above with Medicare linkage and at least 12 months of continuous Medicare Part A and B enrollment. Intervention Hospitalization for ECH. Main Outcomes and Measures Adjusted odds ratios and predicted likelihood of independence in all activities of daily living (ADLs), independence in all instrumental activities of daily living (IADLs) and extended nursing home stay. Adjusted hazard ratio and predicted likelihood for survival. Results In a cohort of 6719 subjects (mean age 77, 59\% women) with average follow-up time of 8.3 years (55,767 person-years), 736 (11\%) were hospitalized for ECH. ECH was associated with a 15\% increase in ADL disability, 15\% increase in IADL disability, 8\% increase in nursing home stays, and 4\% increase in mortality. After ECH, subjects became disabled and died at the same annual rate as pre-ECH but never recovered to pre-ECH levels of function. In conclusion, hospitalization for ECH was associated with significant and durable declines in independence and survival. Clinical and research efforts should incorporate the long-term harms of ECH into decision-making and strategies to mitigate these effects.}, keywords = {extracranial hemorrhage, functional independence, Hospitalization, Mortality, Survival}, issn = {15535606}, doi = {10.1002/jhm.12799}, author = {Parks, Anna L. and Jeon, Sun Y. and Boscardin, W. John and Steinman, Michael A. and Smith, Alexander K. and Covinsky, Kenneth E. and Fang, Margaret C. and Shah, Sachin J.} } @inbook {12304, title = {Perceptions of Mortality: Individual assessment of longevity risk}, booktitle = {New Models for Managing Longevity Risk: Public-Private Partnerships}, year = {2022}, publisher = {Oxford University Press}, organization = {Oxford University Press}, chapter = {2}, keywords = {Life Expectancy, Mortality, Survival}, isbn = {978{\textendash}0{\textendash}19{\textendash}285980{\textendash}8}, doi = {10.1093/oso/9780192859808.001.0001}, author = {Kathleen McGarry and Olivia S. Mitchell} } @article {11279, title = {Development and validation of prediction model to estimate 10-year risk of all-cause mortality using modern statistical learning methods: a large population-based cohort study and external validation.}, journal = {BMC Medical Research Methodology}, volume = {21}, year = {2021}, pages = {8}, abstract = {

BACKGROUND: In increasingly ageing populations, there is an emergent need to develop a robust prediction model for estimating an individual absolute risk for all-cause mortality, so that relevant assessments and interventions can be targeted appropriately. The objective of the study was to derive, evaluate and validate (internally and externally) a risk prediction model allowing rapid estimations of an absolute risk of all-cause mortality in the following 10 years.

METHODS: For the model development, data came from English Longitudinal Study of Ageing study, which comprised 9154 population-representative individuals aged 50-75 years, 1240 (13.5\%) of whom died during the 10-year follow-up. Internal validation was carried out using Harrell{\textquoteright}s optimism-correction procedure; external validation was carried out using Health and Retirement Study (HRS), which is a nationally representative longitudinal survey of adults aged >=50 years residing in the United States. Cox proportional hazards model with regularisation by the least absolute shrinkage and selection operator, where optimisation parameters were chosen based on repeated cross-validation, was employed for variable selection and model fitting. Measures of calibration, discrimination, sensitivity and specificity were determined in the development and validation cohorts.

RESULTS: The model selected 13 prognostic factors of all-cause mortality encompassing information on demographic characteristics, health comorbidity, lifestyle and cognitive functioning. The internally validated model had good discriminatory ability (c-index=0.74), specificity (72.5\%) and sensitivity (73.0\%). Following external validation, the model{\textquoteright}s prediction accuracy remained within a clinically acceptable range (c-index=0.69, calibration slope β=0.80, specificity=71.5\% and sensitivity=70.6\%). The main limitation of our model is twofold: 1) it may not be applicable to nursing home and other institutional populations, and 2) it was developed and validated in the cohorts with predominately white ethnicity.

CONCLUSIONS: A new prediction model that quantifies absolute risk of all-cause mortality in the following 10-years in the general population has been developed and externally validated. It has good prediction accuracy and is based on variables that are available in a variety of care and research settings. This model can facilitate identification of high risk for all-cause mortality older adults for further assessment or interventions.

}, keywords = {Absolute risk, Mortality, Population-based longitudinal study, Prognostic factors, Statistical learning, Survival}, issn = {1471-2288}, doi = {10.1186/s12874-020-01204-7}, author = {Ajnakina, Olesya and Agbedjro, Deborah and Ryan J McCammon and Jessica Faul and Murray, Robin M and Stahl, Daniel and Andrew Steptoe} } @article {11116, title = {Grandparenthood and risk of mortality: Findings from the Health and Retirement Study.}, journal = {Social Science \& Medicine}, volume = {268}, year = {2021}, pages = {113371}, abstract = {

Grandparenthood constitutes a significant role for older adults and may have important health implications. Our study examines the grandparenthood-mortality nexus, controlling for an array of potentially confounding variables. Longitudinal survey data from the Health and Retirement Study (HRS) were used, comprising twelve biennial waves from 1992 to 2014 with linked data on vital status derived from the National Death Index. The sample included 27,463 participants aged >=51 years with at least one child. Cox proportional hazard models tested the association between grandparenthood and mortality risk with adjustment for socio-demographic variables, for social variables including characteristics of and contact with children, and for health variables, including measures of general, functional and mental health. Grandparenthood overall was unassociated with mortality risk in both women and men. However, the subpopulation of younger, partnered grandmothers with a larger number of grandchildren tended to exhibit a substantial increase in mortality risk as compared to women without grandchildren.

}, keywords = {Aging, Longitudinal research, Social Relationships, Survival, Well-being}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2020.113371}, author = {Ellwardt, Lea and Hank, Karsten and Carlos F. Mendes de Leon} } @article {10858, title = {Perceptions of Mortality: Individual Assessments of Longevity Risk }, number = {678}, year = {2020}, institution = {University of Pennsylvania}, address = {Philadelphia}, abstract = {Financially successful retirement depends in large part on managing longevity risk: individuals need to save during their working lives to cover expenses in retirement, and then they must spend down those savings carefully so as not to outlive their assets. Despite the centrality of individuals{\textquoteright} expectations regarding life expectancy, little is known about how longevity expectations are formed and how they evolve as individuals age. This paper assesses the evolution of subjective survival probabilities, defined as the probabilities that people believe they will live to at least 75 or 85 years of age. I examine the correlates of these reported probabilities when initially measured, how they change over time, and in particular, how they change with major life course events like the death of a parent, in-law, spouse, or sibling. I also examine how the subjective probabilities change in response to health shocks such as a heart attack or diagnosis of diabetes. }, keywords = {Health Shocks, longevity risk, Survival}, url = {https://repository.upenn.edu/cgi/viewcontent.cgi?article=1680\&context=prc_papers}, author = {Kathleen McGarry} } @article {9739, title = {The well-being of long-term cancer survivors.}, journal = {American Journal of Managed Care}, volume = {24}, year = {2018}, pages = {188-195}, abstract = {

OBJECTIVES: To compare the well-being of long-term cancer survivors with that of US residents of similar age and demographic characteristics, patients recently diagnosed with cancer, and individuals with chronic illness.

STUDY DESIGN: Retrospective observational study.

METHODS: Using the Health and Retirement Study, a survey of US residents older than 50 years, we defined 4 cohorts: long-term cancer survivors (>4 years post diagnosis), individuals recently diagnosed with cancer (<=4 years post diagnosis), individuals with chronic illness, and US residents older than 50 years ("nationally representative cohort"). Well-being measures included self-reported health, utility, happiness, medical utilization and spending, employment, and earnings, and these measures were compared across cohorts, adjusting for survey year, demographic characteristics, smoking, and number of comorbidities. We imputed medical spending using the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey.

RESULTS: Long-term cancer survivors fared significantly better than those recently diagnosed with cancer, those with chronic illness, and individuals in the nationally representative cohort in the majority of well-being measures (P~<.05), including fewer doctor visits, hospitalizations, and hospital nights; better utility and self-reported health; and greater likelihood of employment. Long-term cancer survivors had lower healthcare spending than those recently diagnosed with cancer (P~<.01) and significantly greater happiness than the nationally representative cohort and those with chronic illness (P~<.05).

CONCLUSIONS: Although patients with cancer experience diminished well-being in the short term across a variety of measures, in the long term, cancer survivors do as well as or better than US residents of similar age and demographic characteristics. This finding is striking given that one might expect long-term cancer survivors to do worse than similar individuals without a history of cancer.

}, keywords = {Cancer, Long-term Care, Longevity, Survival}, issn = {1936-2692}, author = {Jeffrey Sullivan and Thornton Snider, Julia and van Eijndhoven, Emma and Okoro, Tony and Batt, Katharine and Thomas DeLeire} } @article {8787, title = {Differential Mortality in Europe and the U.S.: Estimates Based on Subjective Probabilities of Survival}, journal = {SSRN Electronic Journal}, year = {2008}, abstract = {Estimates of differential mortality by socioeconomic status play an important role in several domains: in public policy for assessing distributional effects of public programs; in financial markets for the design of life insurance and annuities; and in individual decision making when figuring out how much to save for retirement. Traditionally, reliable estimates of differential mortality require rich panel data with large sample size. This paper proposes a new, less data-intensive approach relying on just a single cross-section of data. Rather than using observations on actual mortality in panel over time, the authors propose relating individuals{\textquoteright} subjective probabilities of survival to variables of socioeconomic status in cross-section. They formulate the method in a model of survey response and provide an empirical validation based on data from the Health and Retirement Study comparing the alternative estimates to the traditional estimates of differential mortality for the same sample of baseline respondents. They present two applications. First, they document an increase in differential mortality in the U.S. over time, and second, they produce comparable estimates of differential mortality for 10 European countries and the U.S. based on subjective probabilities of survival.}, keywords = {Cross-National, Longevity, Mortality, NDI, Older Adults, Survival}, doi = {10.2139/ssrn.1265705}, author = {Delavande, Adeline and Susann Rohwedder} }