Ruane Robert, Lampert Oliver, Larsson Maria, Vetrano Davide Liborio, Laukka Erika J, Ekström Ingrid
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden.
Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
JAMA Otolaryngol Head Neck Surg. 2025 Apr 10. doi: 10.1001/jamaoto.2025.0174.
Olfactory deficits are associated with higher mortality in older adults, but the mechanisms remain unclear. Further understanding this relationship could inform interventions to improve survival and quality of life for those with olfactory deficits.
To investigate the association of olfactory deficits with all-cause and cause-specific mortality and to explore potential mediating factors.
DESIGN, SETTING, AND PARTICIPANTS: The Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), is an ongoing population-based, longitudinal cohort study with baseline between 2001 and 2004. Eligible participants were residents of Kungsholmen, Stockholm, Sweden, and aged between 60 and 99 years from March 21, 2001, to August 30, 2004. Twelve-year follow-up was completed in February 2013. Data analysis took place between February 2024 and July 2024.
Olfactory ability was tested with the 16-item Sniffin' Sticks Odor Identification task. Mortality was determined through the Swedish National Cause of Death Register. Cox proportional hazards models examined the associations between olfaction and mortality over 6 years and 12 years. Competing hazard risks regression analyses assessed the olfactory-mortality association for specific death causes. Generalized structural equation models investigated mediators, including incident dementia, baseline chronic diseases, frailty, and malnutrition. The tested hypotheses were formulated after data collection.
Among 2524 participants (baseline mean [SD] age, 71.9 [10.0] years; 1545 [61.2%] female), 445 (17.6%) had died at 6 and 969 (38.4%) at 12 years of follow-up. Each additional incorrect answer on the odor identification test was associated with a 6% increased all-cause mortality risk at 6 years (hazard ratio [HR], 1.06 [95% CI, 1.03-1.08]) and 5% increased risk at 12 years (HR, 1.05 [95% CI, 1.03-1.08]) in multiadjusted models. In cause-specific models, the olfaction-mortality association had the greatest risk in relation to neurodegenerative death causes. Meaningful mediators for death at 6 years included dementia (23% of total association), frailty (11% of total association), and malnutrition (5% of total association). At 12 years, frailty remained a mediator (9% of total association).
The results of this cohort study underscore the importance of olfactory function as a mortality risk marker in older adults and highlight the evolving influence of neurodegeneration and frailty on this relationship. Further research is needed to assess the clinical utility of olfactory assessments in identifying individuals at risk of adverse health outcomes.
嗅觉减退与老年人较高的死亡率相关，但机制尚不清楚。进一步了解这种关系可为改善嗅觉减退者的生存率和生活质量的干预措施提供依据。
研究嗅觉减退与全因死亡率和特定原因死亡率的关联，并探讨潜在的中介因素。
设计、背景和参与者：瑞典 Kungsholmen 地区老年与护理国家研究（SNAC-K）是一项正在进行的基于人群的纵向队列研究，基线时间为 2001 年至 2004 年。符合条件的参与者为瑞典斯德哥尔摩 Kungsholmen 地区的居民，年龄在 60 至 99 岁之间，时间跨度为 2001 年 3 月 21 日至 2004 年 8 月 30 日。2013 年 2 月完成了 12 年的随访。数据分析于 2024 年 2 月至 2024 年 7 月进行。
使用 16 项嗅觉棒气味识别任务测试嗅觉能力。通过瑞典国家死亡原因登记册确定死亡率。Cox 比例风险模型检验了 6 年和 12 年期间嗅觉与死亡率之间的关联。竞争风险回归分析评估了特定死亡原因的嗅觉-死亡率关联。广义结构方程模型研究了中介因素，包括新发痴呆、基线慢性疾病、虚弱和营养不良。所检验的假设是在数据收集后制定的。
在 2524 名参与者中（基线平均[标准差]年龄为 71.9[10.0]岁；1545 名[61.2%]为女性），445 名（17.6%）在随访 6 年时死亡，969 名（38.4%）在随访 12 年时死亡。在多因素调整模型中，气味识别测试中每增加一个错误答案，6 年时全因死亡率风险增加 6%（风险比[HR]，1.06[95%置信区间，1.03 - 1.08]），12 年时风险增加 5%（HR，1.05[95%置信区间，1.03 - 1.08]）。在特定原因模型中，嗅觉与死亡率的关联在神经退行性死亡原因方面风险最大。6 年时死亡的有意义中介因素包括痴呆（占总关联的 23%）、虚弱（占总关联的 11%）和营养不良（占总关联的 5%）。在 12 年时，虚弱仍然是一个中介因素（占总关联的 9%）。
这项队列研究的结果强调了嗅觉功能作为老年人死亡率风险标志物的重要性，并突出了神经退行性变和虚弱对这种关系不断演变的影响。需要进一步研究来评估嗅觉评估在识别有不良健康结局风险个体中的临床效用。
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