Development and internal validation of a new life expectancy estimator for multimorbid older adults

Abstract Background Multimorbidity is highly prevalent among older adults and associated with a shorter life expectancy. Many guidelines recommend tailoring preventive care of multimorbid people according to life expectancy. Indeed, patients with a relatively short life expectancy might not have the time to benefit from a preventive care intervention. Our objective was therefore to develop and internally validate a life expectancy estimator for older multimorbid adults. Methods We analysed data of the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) cohort study in Bern, Switzerland. 822 hospitalized participants aged 70 years old or more, with multimorbidity (3 or more chronic medical conditions), and polypharmacy (use of 5 drugs or more for >30 days) were included. Our main outcome was time to all-cause mortality assessed during 3 years of follow-up. Candidate predictors included demographic variables (age, sex), clinical characteristics (Charlson-Comorbidity-Index, number of drugs, body mass index, weight loss), smoking, functional status variables (Barthel-Index, falls, nursing home residence), and hospitalization. We internally validated and optimism corrected the model using bootstrapping techniques. We transformed the 3-year mortality prognostic index into a life expectancy estimator using the Gompertz survival function. Results At baseline, the participants (58% men) had a median age of 79 years (min: 70; max: 99). They took daily a median of 10 chronic medications (min: 5; max 38). During 3 years of follow-up, 292 participants (36%) died. The analysis is ongoing and results will be presented at the congress. Conclusions A life expectancy estimator eventually helps personalising care to prevent under- and overuse of preventive care in the growing older population. Key messages We provide the first life expectancy estimator for older multimorbid adults. A life expectancy estimator eventually helps personalising care to prevent under- and overuse of preventive care in the growing older population.


Background:
While diseases in contemporary and past populations are thoroughly studied, the knowledge about disability and the risks of getting it is poor.Like diseases, disabilities increase with growing age affecting primarily elderly groups.Whether this notion holds historically and for other groups at risk for disability and differences over time is not known.This study estimates the disability risks in Swedish populations c. 1800-1959 by age, sex and disability type (sensory, physical, mental).

Methods:
We use data on two historical populations in the 1800s (N = 36,500; 550 with disability) and 1900-1959 (N = 194,500; 4,700 with disability) drawn from digitized parish registers reporting socio-economic and demographic characteristics over lifetime and on disabilities.Cox proportional regressions estimate disability risks across time by group (age, sex, disability type).

Results:
Our preliminary results based on unadjusted estimates from 1900-1959 suggest that the disability risks doubled or more.In the 1950s, women had 2.6 times higher risk than 50 years before, while it was 2.0 for men.The major rise started in the 1930s (Men 1.51; Women: 1.67), and grew in the 1940s (Men 1.80; Women: 2.14).Next, we will assess these risks by group and in the 1800s.

Background:
Multimorbidity is highly prevalent among older adults and associated with a shorter life expectancy.Many guidelines recommend tailoring preventive care of multimorbid people according to life expectancy.Indeed, patients with a relatively short life expectancy might not have the time to benefit from a preventive care intervention.Our objective was therefore to develop and internally validate a life expectancy estimator for older multimorbid adults.

Methods:
We analysed data of the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) cohort study in Bern, Switzerland.822 hospitalized participants aged 70 years old or more, with multimorbidity (3 or more chronic medical conditions), and polypharmacy (use of 5 drugs or more for >30 days) were included.Our main outcome was time to all-cause mortality assessed during 3 years of follow-up.Candidate predictors included demographic variables (age, sex), clinical characteristics (Charlson-Comorbidity-Index, number of drugs, body mass index, weight loss), smoking, functional status variables (Barthel-Index, falls, nursing home residence), and hospitalization.We internally validated and optimism corrected the model using bootstrapping techniques.We transformed the 3-year mortality prognostic index into a life expectancy estimator using the Gompertz survival function.

Results:
At baseline, the participants (58% men) had a median age of 79 years (min: 70; max: 99).They took daily a median of 10 chronic medications (min: 5; max 38).During 3 years of follow-up, 292 participants (36%) died.The analysis is ongoing and results will be presented at the congress.

Conclusions:
A life expectancy estimator eventually helps personalising care to prevent under-and overuse of preventive care in the growing older population.

Key messages:
We provide the first life expectancy estimator for older multimorbid adults.
A life expectancy estimator eventually helps personalising care to prevent under-and overuse of preventive care in the growing older population.

Conclusions:
There has been a steady and substantial increase in the incidence of thyroid cancer in England over the past four decades.The largest increase in incidence was observed in young people aged 0-49 years.Some of this increase is due to enhanced surveillance and sensitive diagnostic methods, but other factors (e.g., obesity and history of benign thyroid conditions) need to be considered.

Key messages:
The unexpected substantial increase in the incidence of thyroid cancer in young people aged 0-49 years needs further investigation.
It is important to determine what proportion of the cases are due to enhanced surveillance and what proportion are due to environmental exposures.Abstract citation ID: ckac130.054ATHLOS Healthy Ageing Scale score as the predictor of mortality in Poland and the Czech Republic Magdalena Kozela M Kozela 1 , A Paja k 1 , JL Ayuso-Mateo 2,3 , M Bobak 4 , W Lu 4 , H Pikhart 4,6 , M Polak 1 , A Sanchez-Niubo 2,5 , U Stepaniak 1 , JM Haro 2,7 cancer is 2-3 times more common in females and is currently the fastest growing cancer worldwide.Exposure to ionizing radiation is the only established risk factor for thyroid cancer.Other factors include obesity, history of benign thyroid conditions, and family history.We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of thyroid cancer in England during the past four decades.