Development of a clinical prediction model for the onset of functional decline in people aged 65–75 years: pooled analysis of four European cohort studies

BMC Geriatrics

  ^{1    1    2    2    3    3    4    5    5    6    7    8    9    1,10    1,11    1,12    1,12    1,12} 

[1] 0000 0001 1516 2393, grid.5947.f, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway;0000 0004 0435 165X, grid.16872.3a, Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands;0000 0004 0603 4965, grid.416008.b, Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany;0000 0004 1936 9748, grid.6582.9, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;0000 0004 1754 9227, grid.12380.38, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;0000 0004 0435 165X, grid.16872.3a, Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands;0000 0004 1754 9227, grid.12380.38, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, Amsterdam, BT, The Netherlands;0000 0004 1754 9227, grid.12380.38, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, Amsterdam, BT, The Netherlands;Faculty of Medicine Dentistry and Health Sciences, Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia;0000 0004 1757 1758, grid.6292.f, Department of Computer Science and Engineering, University of Bologna, Bologna, Italy;0000 0004 1936 9748, grid.6582.9, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;0000 0004 1936 9748, grid.6582.9, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;Geriatric Research Unit Ulm University and Geriatric Center, Agaplesion Bethesda Hospital Ulm, Ulm, Germany;0000000121662407, grid.5379.8, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK;0000000121662407, grid.5379.8, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK;0000 0004 0417 0074, grid.462482.e, Manchester Academic Health Science Centre and Manchester University NHS Foundation Trust, Manchester, UK;Laboratory of Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Firenze, Italy;

关键词: Functioning;    Individual patient data;    Middle aged;    Personalised care;    Preventive medicine;    Active aging;   

DOI  :  10.1186/s12877-019-1192-1

来源: publisher

【 摘 要 】

BackgroundIdentifying those people at increased risk of early functional decline in activities of daily living (ADL) is essential for initiating preventive interventions. The aim of this study is to develop and validate a clinical prediction model for onset of functional decline in ADL in three years of follow-up in older people of 65–75 years old.MethodsFour population-based cohort studies were pooled for the analysis: ActiFE-ULM (Germany), ELSA (United Kingdom), InCHIANTI (Italy), LASA (Netherlands). Included participants were 65–75 years old at baseline and reported no limitations in functional ability in ADL at baseline. Functional decline was assessed with two items on basic ADL and three items on instrumental ADL. Participants who reported at least some limitations at three-year follow-up on any of the five items were classified as experiencing functional decline. Multiple logistic regression analysis was used to develop a prediction model, with subsequent bootstrapping for optimism-correction. We applied internal-external cross-validation by alternating the data from the four cohort studies to assess the discrimination and calibration across the cohorts.ResultsTwo thousand five hundred sixty community-dwelling people were included in the analyses (mean age 69.7 ± 3.0 years old, 47.4% female) of whom 572 (22.3%) reported functional decline at three-year follow-up. The final prediction model included 10 out of 22 predictors: age, handgrip strength, gait speed, five-repeated chair stands time (non-linear association), body mass index, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, arthritis, and depressive symptoms. The optimism-corrected model showed good discrimination with a C statistic of 0.72. The calibration intercept was 0.06 and the calibration slope was 1.05. Internal-external cross-validation showed consistent performance of the model across the four cohorts.ConclusionsBased on pooled cohort data analyses we were able to show that the onset of functional decline in ADL in three years in older people aged 65–75 years can be predicted by specific physical performance measures, age, body mass index, presence of depressive symptoms, and chronic conditions. The prediction model showed good discrimination and calibration, which remained stable across the four cohorts, supporting external validity of our findings.

【 授权许可】

CC BY