Defining Health Trajectories in Older Adults With Five Clinical Indicators.
BACKGROUND
People age differently, challenging the identification of those more at risk of rapid health deterioration. This study aimed to explore the heterogeneity in the health of older adults by using five clinical indicators to detect age-related variation and individual health trajectories over time.


METHODS
Health of 3,363 people aged 60+ from the Swedish National study on Aging and Care-Kungsholmen (SNAC-K) assessed at baseline and at 3- and 6-year follow-ups. Number of chronic diseases, physical and cognitive performance, personal and instrumental activities of daily living were integrated in a health assessment tool (HAT). Interindividual health differences at baseline and follow-ups were assessed with logistic quantile regression. Intraindividual health trajectories were traced with quantile mixed-effect models.


RESULTS
The HAT score ranges from 0 (poor health) to 10 (good health); each score corresponds to a specific clinical profile. HAT was reliable over time and accurately predicted adverse health outcomes (receiver-operating characteristic areas: hospitalization = 0.78; 95% confidence interval = 0.74-0.81; mortality = 0.85; 95% confidence interval = 0.83-0.87; similar areas obtained for gait speed). Before age 85, at least 90% of participants were free of severe disability, and at least 50% were functionally independent despite chronic disorders. Age- and sex-related variation and high heterogeneity in health were detected at baseline and confirmed by intraindividual health trajectories.


CONCLUSIONS
This study provides a positive picture of the health status of people 60+. Despite the complexity and heterogeneity of health in this age group, we could identify age- and sex-specific health trajectories using an integrated HAT. HAT is potentially useful in clinical practice and public health interventions.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.
Giola
G
Santoni
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.|Department of Clinical and Experimental Sciences, University of Brescia, Italy.
Alessandra
A
Marengoni
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.|EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute, Sweden.
Amaia
A
Calderón-Larrañaga
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.
Sara
S
Angleman
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.
Debora
D
Rizzuto
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.|Stockholm Gerontology Research Center, Sweden.
Anna-Karin
AK
Welmer
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.
Francesca
F
Mangialasche
Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
Nicola
N
Orsini
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Sweden.|Stockholm Gerontology Research Center, Sweden.
Laura
L
Fratiglioni
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology / Q000523:psychology; D003071:Cognition; D004185:Disability Evaluation; D005260:Female; D005684:Gait; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D000071069:Multiple Chronic Conditions / Q000453:epidemiology*; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology
Cognition; Gait; Multimorbidity; Physical function