4 of 4: Study of Osteoporotic Fractures (SOF)

描述（由申请人提供）：85岁及以上的成年人（年龄最大的老年人），其中大多数是女性，构成了美国人口的快速增长部分。老年人口的迅速增长将使已经因成本上升而不堪重负的医疗保健系统不堪重负。识别有效的生物和心理标记的“成功”或“最佳”的老化需要指导未来的干预研究的设计，旨在针对高风险的个人在老化过程的早期，并告知公共卫生举措，旨在促进最佳老化。 在这项提案中，我们建议继续进行骨质疏松性骨折（SOF）的研究，这是最大和最具特征的9岁和10岁女性队列研究。SOF已成为老龄化研究的国家资源，SOF数据已越来越多地用于促进对寿命决定因素的理解，包括最佳老龄化模式。共有7280名65岁及以上的妇女最初在1986-87年在3个临床中心参加了SOF，1997-98年该队列扩大到7760名，其中480名非裔美国人参加。其中，超过2300人至少活到了90岁。参与者参加了多达9次临床检查，并完成了三年一次的联系（超过95%在22年的随访期间完成），提供了全面而强大的测量档案。 我们现在建议使用SOF中独特的20年重复测量来定义认知功能，身体表现，骨矿物质密度，体重和积极影响的年龄相关轨迹。然后，我们将使用新建立的SOF数据与医疗保险索赔数据的联系，并继续随访SOF参与者，以测试这些轨迹是否识别出达到最佳衰老表型的女性，这些表型由长寿，活跃寿命（无重大残疾的生存），特殊的健康跨度（无重大疾病事件的生存）以及较低的住院和住院医疗保健利用率定义。我们的建议的具体目标是：1）确定与年龄相关的参数轨迹与老年妇女的寿命和活跃寿命的关联; 2）确定与年龄相关的参数轨迹与老年妇女的特殊健康跨度的关联; 3）确定年龄相关参数轨迹与住院和住宅卫生保健使用的关联，其特征在于住院天数，在住院设施中的康复天数、在专业护理设施中的康复天数以及在专业护理设施中无永久安置的存活率;以及4）维持并积极使用血清、尿液和DNA标本的广泛SOF生物储存库。确定预测功能、疾病和保健结果得到改善的生存轨迹，以及关于衰退前窗口期的数据，是设计针对年龄较早的脆弱老年人的干预研究之前所需的关键的第一步。

DESCRIPTION (provided by applicant): Adults 85 years and older (the oldest old), the majority of whom are women, comprise the fasting growing segment of the United States population. This rapidly expanding population of very elderly adults will strain a health care system already overburdened by rising costs. Identification of valid biologic and psychosocial markers of "successful" or "optimal" aging is needed to direct the design of future intervention studies aimed at targeting high risk individuals early on in the aging process and to inform public health initiatives aimed at promoting optimal aging. In this proposal, we propose to continue the Study of Osteoporotic Fractures (SOF) the largest and best characterized cohort of women in their 9th and 10th decade of life. SOF has become a national resource for studies of aging and SOF data have been increasingly utilized to advance understanding of the determinants of longevity including patterns of optimal aging. A total of 7280 women aged 65 years and older were originally enrolled in SOF at 3 clinical centers in 1986-87, with expansion of the cohort to 7760 with the enrollment of 480 African Americans in 1997-98. Of these, over 2300 have survived to at least age 90. Participants have attended up to 9 clinical examinations and completed tri-annual contacts (over 95% completed during 22 years of follow-up) providing a comprehensive powerful archive of measurements. We now propose to use the unique 20 years of repeated measurements in SOF to define age-related trajectories of cognitive function, physical performance, bone mineral density, body weight and positive affect. We will then use the newly established linkage of SOF data with Medicare claims data and continued follow-up of SOF participants to test whether these trajectories identify women who have attained the phenotype of optimal aging as defined by longevity, active lifespan (survival free of major disability), exceptional health span (survival free of major disease events), and lower rates of inpatient and residential health care utilization. The specific aims of our proposal are to: 1) Determine the association of age-related parameter trajectories with longevity and active lifespan in older women; 2) Determine the association of age-related parameter trajectories with exceptional health span in older women; 3) Determine the association of age-related parameter trajectories with inpatient and residential health care use as characterized by inpatient hospitalization days, rehabilitation days in inpatient facility, rehabilitation days in skilled nursing facility, and survival free of permanent placement in skilled nursing facility; and 4) Sustain and actively use the extensive SOF biologic repository of serum, urine and DNA specimens. Identification of trajectories predicting survival with improved functional, disease and health care outcomes and the data generated regarding the window prior to decline is a critical first step needed prior to the design of intervention studies aimed at targeting vulnerable older individuals at an earlier age.