Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.
Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine in St. Louis, Missouri.
J Gerontol A Biol Sci Med Sci. 2020 Apr 17;75(5):899-905. doi: 10.1093/gerona/glz124.
The Long Life Family Study (LLFS) enrolled families exhibiting exceptional longevity. The goal of this article was to determine the prevalence and predictors of remaining independent after 7 years in the oldest generation.
We examined 7-year change in physical (free of activities of daily living difficulty), cognitive (Mini-Mental State Examination score ≥ 24), and overall independence (physically/cognitively independent) in adults aged 90.3 ± 6.3 from LLFS's oldest generation. Potential predictors (n = 28) of remaining independent included demographics, diseases, biomarkers, anthropometrics, and physical and cognitive performance tasks and were determined using generalized estimating equations (α: p < .05). This was a discovery/exploratory analysis, so no multiple testing correction was employed and the results require independent replication.
At baseline (n = 1442), 67.3%, 83.8%, and 79.7% were overall, physically, and cognitively independent, respectively. After 7 years, 66% died, 7.5% were lost to follow-up, and the prevalence of overall independence decreased to 59.1% in survivors (-8.2%, 95% confidence interval: -14.1%, 2.2%). Of those with baseline independence, 156/226 (69.0%) remained independent. Predictors of remaining physically independent included younger age, better Short Physical Performance Battery score and lung function, smaller waist circumference, and lower soluble receptor for advanced glycation end-product levels (p < .05). Predictors of remaining cognitively independent included no cancer history, better Digit Symbol Substitution Test performance, and higher body weight (p < .05).
The prevalence of independence decreased by only 8.2% after 7 years, demonstrating the close correspondence between disability and mortality. Further, despite a mean baseline age of 90 years, a large proportion of survivors remained independent, suggesting this exceptional subgroup may harbor protective mechanisms.
长寿家庭研究（LLFS）招募了表现出异常长寿的家庭。本文的目的是确定在最年长一代中 7 年后保持独立的患病率和预测因素。
我们研究了来自 LLFS 最年长一代的 90.3±6.3 岁成年人在 7 年内身体（无日常生活活动困难）、认知（简易精神状态检查得分≥24）和整体独立性（身体/认知独立）的变化。使用广义估计方程（α：p<0.05）确定了 28 个潜在的预测因素（n=28），包括人口统计学、疾病、生物标志物、人体测量学以及身体和认知表现任务。这是一项发现/探索性分析，因此没有进行多次检验校正，结果需要独立复制。
基线时（n=1442），分别有 67.3%、83.8%和 79.7%的人整体、身体和认知上独立。7 年后，66%的人死亡，7.5%的人失访，幸存者的整体独立性患病率降至 59.1%（-8.2%，95%置信区间：-14.1%，2.2%）。在基线时独立的人群中，有 156/226（69.0%）人仍然独立。保持身体独立的预测因素包括年龄较小、较短的简易体能状况量表和肺功能评分、较小的腰围和较低的可溶性晚期糖基化终产物受体水平（p<0.05）。保持认知独立的预测因素包括无癌症病史、数字符号替代测试表现更好和更高的体重（p<0.05）。
7 年后，独立性的患病率仅下降了 8.2%，这表明残疾和死亡率之间存在密切的对应关系。此外，尽管平均基线年龄为 90 岁，但很大一部分幸存者仍然保持独立，这表明这个特殊的亚组可能具有保护机制。
