Prognostic value of short-term decline of forced expiratory volume in 1 s over height cubed (FEV1/Ht3) in a cohort of adults aged 80 and over

Forced expiratory volume in 1 s over height cubed (FEV1/Ht(3)) is an FEV1 expression that uses no reference values and is independently associated with adverse outcomes in older adults. No studies have reported on the prognostic value of its decline over time in adults aged 80 and over.Query date: 2019-12-23 16:38:43status: publishe

Predictive value of different expressions of forced expiratory volume in 1 second (FEV1) for adverse outcomes in a cohort of adults aged 80 and older

OBJECTIVES: Forced expiratory volume in 1 second (FEV1) is proposed as a marker of healthy ageing and FEV1 expressions that are independent of reference values have been reported to be better at predicting mortality in older adults. We assess and compare the predictive value of different FEV1 expressions for mortality, hospitalization, and physical and mental decline in adults aged 80 and older. DESIGN: Population-based, prospective, cohort study. SETTING: The BELFRAIL study, Belgium. PARTICIPANTS: A total of 501 community-dwelling adults aged 80 and older (mean age 84.7 years). MEASUREMENTS: Baseline FEV1 expressed as percent predicted (FEV1PP) and z-score (FEV1Z) using the Global Lung Function Initiative 2012 reference values; over lowest sex-specific percentile (FEV1Q), and height squared (FEV1/Ht2) and cubed (FEV1/Ht3). Mortality data until 5.1 ± 0.2 years from baseline; hospitalization data until 3.0 ± 0.25 years. Activities of daily living, battery of physical performance tests, Mini-Mental State Examination, and 15-item Geriatric Depression Scale at baseline and after 1.7 ± 0.2 years. RESULTS: Individuals in the lowest quartile of FEV1 expressions had higher adjusted risk than the rest of study population for all-cause mortality (highest hazard ratio 2.05 [95% Confidence Interval 1.50-2.80] for FEV1Q and 2.01 [1.47-2.76] for FEV1/Ht3), first hospitalization (highest hazard ratio 1.63 [1.21-2.16] for FEV1/Ht2 and 1.61[1.20-2.16] for FEV1/Ht3), mental decline (highest odds ratio 2.80 [1.61-4.89] for FEV1Q) and physical decline (only FEV1/Ht3 with odds ratio 1.93 [1.13-3.30]). Based on risk classification improvement measures, FEV1/Ht3 and FEV1Q performed better than FEV1PP. CONCLUSION: In a cohort of adults aged 80 and older, FEV1 expressions that are independent of reference values (FEV1/Ht3 and FEV1Q) were better at predicting adverse health outcomes than traditional expressions that depend on reference values, and should be used in further research on FEV1 and aging.Query date: 2019-12-23 16:38:43status: publishe

Do commonly used frailty models predict mortality, loss of autonomy and mental decline in older adults in northwestern Russia? A prospective cohort study

Frailty prevalence differs across countries depending on the models used to assess it that are based on various conceptual and operational definitions. This study aims to assess the clinical validity of three frailty models among community-dwelling older adults in north-western Russia where there is a higher incidence of cardiovascular disease and lower life expectancy than in European countries.status: publishe

Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study

Objectives To test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers.Design Cross- validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85- plus Study.setting General practice, Belgium and The Netherlands.Participants The BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85- plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD.Outcome measures The model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3- year CV morbidity and mortality. A competing- risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models.results Traditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N- terminal pro- B- type natriuretic peptide (NT- pro- BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT- pro- BNP and high- sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT- pro- BNP performed well as a stand- alone predictor (NRI 0.32 (95% CI −0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)).Conclusions This study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT- pro- BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults

The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing.

International audienc

The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing.

International audienceSeventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs