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. 2007 Jun;55(6):935-40.
doi: 10.1111/j.1532-5415.2007.01155.x.

Cumulative index of health deficiencies as a characteristic of long life

Alexander M Kulminski  1 , Svetlana V Ukraintseva, Igor V Akushevich, Konstantin G Arbeev, Anatoli I Yashin
Affiliations

Cumulative index of health deficiencies as a characteristic of long life

Alexander M Kulminski et al. J Am Geriatr Soc. 2007 Jun.

Abstract

Objectives: To describe the accumulation of aging-associated health disorders using a cumulative measure known as a frailty index (FI) and to evaluate its ability to differentiate long- and short-life phenotypes as well as the FI's connection to aging-associated processes in older people.

Design: Retrospective cross-sectional and longitudinal studies.

Setting: The National Long-Term Care Survey (NLTCS) data that assessed health and functioning of U.S. older individuals (> or =65) in 1982, 1984, 1989, 1994, and 1999 were analyzed. The NLTCS sample in each survey represents a mixture of longitudinal and cross-sectional components.

Participants: Approximately 5,000 individuals in each survey.

Measurements: A cumulative index of health and well-being deficiencies (disabilities, signs, diseases) was calculated as a count of deficits observed in an individual divided by the total number of all considered deficits.

Results: Men and women who died before the age of 75 and those who died after the age of 85 exhibited remarkably similar FI frequency patterns despite the 10-year age difference between age profiles in these samples. Long life is consistently characterized in longitudinal analyses by lower FIs. FI dynamics are found to be strongly sex sensitive.

Conclusion: The FI appears to be a sensitive age-independent indicator of sex-specific physiological decline in aging individuals and a sex-specific discriminator of survival chances. The FI is a promising characteristic suitable for improving sex-sensitive forecasts of risks of adverse health outcomes in older people.

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Figures

Figure 1
Figure 1
The sex-specific frailty index (measured in percentages) frequency distributions for the (a) short-livers (SL), (b) individuals who died at age 85+ (LLD), (c) sub-sample of the LLD group with individuals aged 85+ years at the date of interview (LLD85+), and (d) long-living individuals aged 85+ years at the date of interview (LLA). Bars show 95% confidence intervals. Insets show statistical characteristics of the respective groups. SD means standard deviation. Numbers in parentheses show standard errors.
Figure 2
Figure 2
Longitudinal changes of the mean frailty index (theoretical range is between 0 and 1) for the deceased (SL and LLD) and living (LLA) females and males from the 1984 cohort. Bars show 95% confidence intervals.
Figure 3
Figure 3
(a-b) Time behavior of the frailty index for the males’ and females’ subgroups of the deceased (SL: short-dashed line; LLD: dashed line) and living (LLA: solid line) individuals who participated in early surveys (1984–1994 for LLA and LLD and 1984–1989 for SL; denoted by filled symbols) and later surveys (1989–1999 for LLA and LLD and 1989–1994 for SL; denoted by open symbols). Bars show 95% confidence intervals. (c-d) The same as in (ab) but only for the early surveys and 10-year age groups (shown in the figures along with sample sizes) as defined on April 1, 1984.
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