Physical performance is associated with long-term survival in adults 80 years and older: Results from the ilSIRENTE study
Stefano Cacciatore MD, Riccardo Calvani PhD, Emanuele Marzetti MD, PhD, Anna Picca PhD, Andrea Russo MD, PhD, Matteo Tosato MD, PhD, Francesco Landi MD, PhD
First published: 02 May 2024
INTRODUCTION
According to the World Health Organization, the worldwide population of persons 80 and older is expected to triple by 2050.1 This group, known as “oldest old,” shows substantial heterogeneity in health and functional abilities.2 While life expectancy has increased significantly over the last century due to advancements in public health, nutrition, education, and medicine, a corresponding extension of healthy, disability-free lifespan has not occurred. As a result, many older adults live with chronic illnesses, mobility limitations, and disabilities.3 Impaired mobility in old age is associated with increased health risks and mortality. However, how physical performance affects long-term survival in the oldest old is unclear. The present investigation explored the association between physical performance and up to 15-year survival in a cohort of community-dwelling octogenarians from the “Aging and Longevity in the Sirente geographic area” (ilSIRENTE) study.
METHODS
ilSIRENTE was a prospective cohort study designed by the Department of Geriatrics of the Università Cattolica del Sacro Cuore (Rome, Italy) and conducted in the Sirente area (L’Aquila, Italy) in collaboration with local authorities and healthcare professionals.4
From 429 eligible individuals born in the Sirente area before January 1, 1924 and present in the region during the initial survey, 65 opted not to participate, leaving 364 participants. Those ≥85 years at enrollment (n = 161) were excluded. Six individuals were removed due to unavailable survival information and two for missing physical performance data, leaving 195 participants for the current analysis.
The Minimum Data Set for Home Care (MDS–HC)5 and additional questionnaires and tests from the InCHIANTI study6 were used for baseline assessments (December 2003–September 2004). Physical performance was evaluated through the short physical performance battery (SPPB),7 comprising balance tests, a 4-m gait speed test, and a chair-stand test. According to SPPB scores, functional impairment was categorized into severe (0–2), moderate (3–7), mild (8 or 9), or absent (10–12). Long-term survival was defined as reaching the age of 95. Vital status was confirmed by general practitioners and the National Death Registry.
Participant characteristics were summarized using descriptive statistics according to survival categories. Continuous variables are presented as mean values ± standard deviation. Categorical variables are shown as absolute numbers and percentages. Between-group differences were assessed using unpaired t-tests and chi-squared statistics. Statistical significance was set at p < 0.05. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for long-term survival according to SPPB score and gait speed were calculated using Cox proportional hazard models. Kaplan–Meier curves were plotted to assess the impact of physical performance on 10-year survival, with comparisons made using the log-rank test and Holm adjustment method for pairwise comparisons. Analyses were conducted using R version 4.2.3.
RESULTS
Participant characteristics according to survival categories are listed in Table 1. Mean age at enrollment was 82.3 ± 1.4 years and 131 (67.2%) were women. Forty-five (21.1%) participants reached 95 years, while 150 (79.9%) died before 95 years. Long-term survivors were predominantly women, had lower levels of disability, and higher body mass index (BMI), SPPB scores and gait speed. No long-term survivor had heart failure, compared with 13 (8.7%) of those who died earlier. Long-term survivors took fewer medications, without difference in the frequency of polypharmacy, and had lower plasma interleukin 6 (IL6) levels. A greater percentage of patients who died earlier had severe functional impairment, while the long-term survivors had higher a proportion of robust individuals.TABLE 1. Characteristics of participants according to survival categories.
| Died before 95 years (n = 150) | Survived 95 years or more (n = 45) | Total sample (n = 195) | p | |
|---|---|---|---|---|
| Personal characteristics | ||||
| Age, years | 82.3 (1.4) | 82.3 (1.3) | 82.3 (1.4) | 0.942 |
| Sex, female | 95 (63.3%) | 36 (80.0%) | 131 (67.2%) | 0.037 |
| Education, years | 5.3 (1.6) | 5.1 (1.7) | 5.3 (1.6) | 0.434 |
| Living alone | 48 (32.0%) | 17 (37.8%) | 65 (33.3%) | 0.517 |
| BMI, kg/m2 | 25.8 (4.6) | 27.4 (4.2) | 26.2 (4.5) | 0.033 |
| Alcohol abuse | 20 (13.3%) | 3 (6.7%) | 23 (11.8%) | 0.224 |
| Active smoking | 4 (2.7%) | 1 (2.2%) | 5 (2.6%) | 0.869 |
| Cognition and functional status | ||||
| CPS score | 0.79 (1.54) | 0.31 (0.87) | 0.68 (1.4) | 0.051 |
| ADL score | 0.99 (2.04) | 0.04 (0.21) | 0.77 (1.84) | 0.002 |
| IADL score | 2.51 (2.47) | 1.27 (1.50) | 2.22 (2.34) | 0.002 |
| SPPB summary score | 7.1 (3.6) | 9.2 (2.3) | 7.6 (3.5) | <0.001 |
| SPPB 0–2 | 22 (14.7) | 1 (2.2) | 23 (11.8) | 0.032 |
| SPPB 3–7 | 48 (32.0) | 9 (20.0) | 57 (29.3) | 0.120 |
| SPPB 8 or 9 | 31 (20.7) | 11 (24.5) | 42 (21.5) | 0.589 |
| SPPB 10–12 | 49 (32.6) | 24 (53.3) | 73 (37.4) | 0.019 |
| Gait speed, m/s | 0.78 (0.34) | 0.88 (0.29) | 0.80 (0.33) | <0.001 |
| Clinical characteristics | ||||
| Coronary artery disease | 22 (14.7%) | 5 (11.1%) | 27 (13.8%) | 0.545 |
| Heart failure | 13 (8.7%) | 0 (0%) | 13 (6.7%) | 0.041 |
| Diabetes mellitus | 33 (22.0%) | 8 (17.8%) | 41 (21.0%) | 0.516 |
| COPD | 20 (13.3%) | 6 (13.3%) | 26 (13.3%) | 1.000 |
| Dementia | 17 (11.3%) | 1 (2.2%) | 18 (9.2%) | 0.079 |
| Parkinson’s disease | 4 (2.7%) | 0 (0%) | 4 (2.1%) | 0.268 |
| Cancer | 6 (4.0%) | 2 (4.4%) | 8 (4.1%) | 0.895 |
| Osteoarthritis | 38 (25.3%) | 6 (13.3%) | 44 (22.6%) | 0.091 |
| Depression | 44 (29.3%) | 8 (17.8%) | 52 (26.7%) | 0.124 |
| Number of diseases | 2.41 (1.42) | 2.02 (1.14) | 2.32 (1.37) | 0.098 |
| Multimorbidity | 107 (71.3%) | 27 (60.0%) | 134 (68.7%) | 0.150 |
| Number of medications | 3.51 (2.36) | 2.51 (1.80) | 3.27 (2.27) | 0.009 |
| Polypharmacy | 45 (30.0%) | 7 (15.6%) | 52 (26.7%) | 0.055 |
| Inflammatory markers | ||||
| CRP, mg/dL | 4.07 (3.55) | 3.09 (3.02) | 3.84 (3.45) | 0.096 |
| IL6, pg/mL | 2.58 (2.10) | 1.64 (1.33) | 2.37 (1.99) | 0.005 |
| TNF-α, pg-mL | 1.80 (1.60) | 1.74 (3.20) | 1.78 (2.07) | 0.857 |
- Note: Data are reported as means (standard deviations) and absolute numbers (%) for continuous and categorical variables, respectively.
- Abbreviations: ADL, activities of daily living; BMI, body mass index; CPS, cognitive performance scale; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; IADL, instrumental activities of daily living; IL6, interleukin 6; SPPB, short physical performance battery; TNF-α, tumor necrosis factor alpha.
Cox regression showed that a higher SPPB score and gait speed were independently associated with lower HRs of dying before 95 years (Figure 1A,B). Female sex, higher BMI, and lower plasma IL6 levels were further significant predictors of long-term survival.
Ten-year mortality differed significantly according to physical performance (p < 0.001; Figure 1C). Pairwise comparison showed significant differences between all categories and SPPB 0–2 (p < 0.001 vs. SPPB 10–12 and 8–9; p = 0.011 vs. SPPB 3–7) and between SPPB 3–7 and 10–12 (p = 0.011).
DISCUSSION
The present analysis indicates that physical performance is independently associated with long-term survival in very old adults living in the community. Consistent with literature,7 physical performance is as a reliable metric for assessing mortality risk in octogenarians. Neither the number of diseases nor any specific disease predicted long-term survival. Our findings, together with available evidence,3, 8–10 support the view that physical performance is a primary target for interventions to enhance longevity and extend health span.
AUTHOR CONTRIBUTIONS
Conceptualization: Stefano Cacciatore, Riccardo Calvani, Emanuele Marzetti, and Francesco Landi; methodology: Stefano Cacciatore and Riccardo Calvani; validation: Anna Picca and Matteo Tosato; investigation: Andrea Russo; writing—original draft preparation: Stefano Cacciatore; writing—review and editing: Riccardo Calvani and Emanuele Marzetti; funding acquisition: Emanuele Marzetti and Francesco Landi; and supervision: Francesco Landi.
ACKNOWLEDGMENTS
This study was supported by the Italian Ministry of Health—Ricerca Corrente 2023. The “Invecchiamento e Longevità nel Sirente” (ilSIRENTE) study was supported by the “Comunità Montana Sirentina” (Secinaro, L’Aquila, Italy). We thank all participants for their enthusiasm in engaging in the project and their patience during assessments. We are grateful to volunteers of the “Protezione Civile” and the Italian Red Cross of the Abruzzo Region for their support. Finally, we thank the “Comunità Montana Sirentina” and its President who promoted and strongly supported the development of the project. Members of the ilSIRENTE Study Group are listed in Reference [4].
