Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults.
To ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity).



Prospective, community-based cohort study in four U.S. cities.



Cardiovascular Health Study.



Individuals aged 65 and older.



Participants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty-reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self-reported healthy life (YHL), and mortality using multivariable regression and survival analysis.



After adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60-1.33) more YAL and 0.54 (95% CI = 0.19-0.90) more YHL than expected agers, and those who were prematurely frail had -0.99 (95% CI = -1.36 to -0.62) fewer YAL and -0.53 (95% CI = -0.89 to -0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P < .001). Adapters spent 55% of their remaining life able and healthy, those who were prematurely frail spent 37%, and of expected agers spent 47% (P < .001).



Despite similar levels of disease burden, older adults who were more vigorous appeared to compress morbidity and live longer. Older adults with higher frailty lengthened morbidity and had greater mortality. Adaptive factors may compress morbidity and decrease mortality.
Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts.
Jason L
JL
Sanders
Department of Biostatistics, University of Washington, Seattle, Washington.
Alice M
AM
Arnold
Department of Medicine, University of California Davis, Sacramento, California.
Calvin H
CH
Hirsch
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.|Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington.
Stephen M
SM
Thielke
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Dae
D
Kim
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Kenneth J
KJ
Mukamal
Department of Medicine, Yeshiva University, Bronx, New York.
Jorge R
JR
Kizer
Department of Medicine, University of California San Diego, San Diego, California.
Joachim H
JH
Ix
Department of Epidemiology and Population Health, Yeshiva University, Bronx, New York.
Robert C
RC
Kaplan
Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Stephen B
SB
Kritchevsky
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Anne B
AB
Newman
D000222:Adaptation, Physiological; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009017:Morbidity; D009026:Mortality; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
adaptation; frailty; function; longevity; morbidity