4 of 4: Study of Osteoporotic Fractures (SOF)

描述(申请人提供)：85岁及以上的成年人(年龄最大的)，其中大多数是妇女，构成了美国人口中快速增长的部分。这种快速增长的高龄成年人人口将给已经因成本上升而不堪重负的医疗体系带来压力。需要确定“成功”或“最佳”老龄化的有效生物和心理社会标记物，以指导未来干预研究的设计，目的是在老龄化过程的早期针对高危个体，并为旨在促进最佳老龄化的公共卫生倡议提供信息。在这项建议中，我们建议继续研究骨质疏松性骨折(SOF)，这是9岁和10岁的女性中规模最大、特征最好的队列。SOF已成为研究老龄化的国家资源，SOF数据已越来越多地被用于促进对包括最佳衰老模式在内的长寿决定因素的了解。1986-87年，共有7280名65岁及以上的妇女在3个临床中心参加SOF，1997-98年，随着480名非裔美国人的加入，队列扩大到7760人。在这些人中，超过2300人至少活到了90岁。参与者参加了最多9次临床检查，并完成了三年一次的接触(在22年的随访中完成了95%以上)，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年重复测量来定义与年龄相关的认知功能、体能表现、骨密度、体重和积极情绪的轨迹。然后，我们将使用新建立的SOF数据与联邦医疗保险索赔数据和SOF参与者的持续跟踪之间的联系来测试这些轨迹是否能够识别出达到最佳老龄化表型的女性，这些表型的定义是寿命、活动寿命(无重大残疾的存活率)、特殊的健康期限(无重大疾病事件的存活率)以及住院和住院医疗利用率较低的女性。我们建议的具体目标是：1)确定年龄相关参数轨迹与老年女性寿命和活动寿命的关联；2)确定年龄相关参数轨迹与老年女性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医疗保健使用的关联，包括住院天数、住院康复天数、在熟练护理机构的康复天数以及无需永久安置在熟练护理机构的生存时间；以及4)维持和积极使用SOF广泛的血清、尿液和DNA样本生物库。在设计旨在针对较早年龄的脆弱老年人的干预研究之前，确定预测存活率的轨迹、改善的功能、疾病和保健结果以及在下降之前产生的关于窗口的数据是关键的第一步。 公共卫生相关性：我们建议继续对骨质疏松性骨折(SOF)进行前瞻性研究，并将全面的SOF数据库与联邦医疗保险索赔数据联系起来，以确定认知功能、体能表现、骨密度、体重和积极情绪方面与年龄相关的轨迹是否可以预测最佳老龄化的表型，这些表型包括寿命(包括活到第10个十年)、活动寿命(无主要残疾的生存时间)、特殊健康时间(无重大疾病事件的生存时间)以及住院和住院医疗利用率。我们将研究参加SOF的7760名女性；其中超过2300人至少活到90岁。在设计干预研究之前，确定预测存活率并改善功能、疾病和医疗保健结果的轨迹是关键的第一步，目的是针对年龄较小的脆弱老年人。

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. PUBLIC HEALTH RELEVANCE: We propose to continue the prospective Study of Osteoporotic Fractures (SOF) and link the comprehensive SOF database with Medicare claims data to determine if age-related trajectories in cognitive function, physical performance, bone mineral density, body weight and positive affect predict phenotypes of optimal aging defined by longevity (including survivorship into the 10th decade of life), active lifespan (survival free of major disability), exceptional health span (survival free of major disease events) and rates of inpatient and residential health care utilization. We will study the 7760 women enrolled in SOF; of these over 2300 have survived to at least age 90. Identification of trajectories predicting survival with improved functional, disease and health care outcomes is a critical first step needed prior to the design of intervention studies aimed at targeting vulnerable older individuals at an earlier age.