Kashtanova Daria A, Erema Veronika V, Gusakova Maria S, Sutulova Ekaterina R, Yakovchik Anna Yu, Ivanov Mikhail V, Taraskina Anastasiia N, Terekhov Mikhail V, Matkava Lorena R, Rumyantseva Antonina M, Yudin Vladimir S, Akopyan Anna A, Strazhesko Irina D, Kordiukova Irina S, Akinshina Alexandra I, Makarov Valentin V, Tkacheva Olga N, Kraevoy Sergey A, Yudin Sergey M
Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Moscow, Russia.
Russian Clinical Research Center for Gerontology, Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
Front Med (Lausanne). 2023 Mar 2;10:1132476. doi: 10.3389/fmed.2023.1132476. eCollection 2023.
Aging puts the human body under an immense stress and makes it extremely susceptible to many diseases, often leading to poor outcomes and even death. Long-living individuals represent a unique group of people who withstood the stress of time and offer an abundance of information on the body's ability to endure the pressure of aging. In this study, we sought to identify predictors of overall one-year mortality in 1641 long-living individuals. Additionally, we analyzed risk factors for COVID-19-related morality, since statistics demonstrated an extreme vulnerability of older adults.
We conducted a two-stage evaluation, including a comprehensive geriatric assessment for major aging-associated: frailty, cognitive impairment, frontal lobe dysfunction, chronic pain, anxiety, risk of falls, sensory deficit, depression, sarcopenia, risk of malnutrition, fecal and urinary incontinence, dependence in Activities of Daily Living, dependence in Instrumental Activities of Daily Living, polypragmasia, and orthostatic hypotension; extensive blood testing, a survey, and a one-year follow-up interview.
The most reliable predictors of overall mortality were cognitive impairment, malnutrition, frailty, aging-associated diseases and blood markers indicating malnutrition-induced metabolic dysfunctions (decreased levels of protein fractions, iron, 25-hydroxyvitamin D, and HDL), and aging biomarkers, such as IGF-1 and N-terminal pro b-type natriuretic peptide. In post-COVID 19 participants, the most significant mortality predictors among geriatric syndromes were depression, frontal lobe dysfunction and frailty, and similar to overall mortality blood biomarkers - 25-hydroxyvitamin D, IGF-1, HDL as well as high white blood cell, neutrophils counts and proinflammatory markers. Based on the results, we built a predictive model of overall mortality in the long-living individuals with f-score=0.76.
The most sensitive and reliable predictors of mortality were modifiable. This is another evidence of the critical importance of proper geriatric care and support for individuals in their "golden years". These results could facilitate geriatric institutions in their pursuit for providing improved care and could aid physicians in detecting early signs of potentially deadly outcomes. Additionally, our findings could be used in developing day-to-day care guidelines, which would greatly improve prevention statistics.
衰老使人体承受巨大压力，使其极易患上多种疾病，常常导致不良后果甚至死亡。长寿个体是一群独特的人，他们经受住了时间的考验，并提供了大量有关身体承受衰老压力能力的信息。在本研究中，我们试图确定1641名长寿个体一年总体死亡率的预测因素。此外，我们分析了与COVID-19相关死亡率的风险因素，因为统计数据表明老年人极其脆弱。
我们进行了两阶段评估，包括对主要衰老相关因素进行全面的老年综合评估：虚弱、认知障碍、额叶功能障碍、慢性疼痛、焦虑、跌倒风险、感觉缺陷、抑郁、肌肉减少症、营养不良风险、粪便和尿失禁、日常生活活动依赖、工具性日常生活活动依赖、多症状行为和直立性低血压；广泛的血液检测、一项调查以及为期一年的随访访谈。
总体死亡率最可靠的预测因素是认知障碍、营养不良、虚弱、衰老相关疾病以及表明营养不良引起的代谢功能障碍的血液标志物（蛋白质组分、铁、25-羟基维生素D和高密度脂蛋白水平降低），以及衰老生物标志物，如胰岛素样生长因子-1（IGF-1）和N末端B型脑钠肽原。在感染COVID-19后的参与者中，老年综合征中最显著的死亡率预测因素是抑郁、额叶功能障碍和虚弱，与总体死亡率相似的血液生物标志物——25-羟基维生素D、IGF-1、高密度脂蛋白以及高白细胞、中性粒细胞计数和促炎标志物。基于这些结果，我们构建了f值为0.76的长寿个体总体死亡率预测模型。
死亡率最敏感和可靠的预测因素是可改变的。这是适当的老年护理和对处于“黄金岁月”的个体提供支持至关重要的又一证据。这些结果有助于老年机构追求提供更好的护理，并有助于医生检测潜在致命后果的早期迹象。此外，我们的研究结果可用于制定日常护理指南，这将大大改善预防统计数据。
