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（最年长的老年人），其中大多数是女性，构成了美国人口中禁食增长的部分。老龄人口的迅速增长将使本已因成本上升而不堪重负的医疗保健系统更加紧张。需要确定“成功”或“最佳”老龄化的有效生物学和社会心理标志，以指导未来针对老龄化过程早期高风险个体的干预研究的设计，并为旨在促进最佳老龄化的公共卫生举措提供信息。在这项建议中，我们建议继续骨质疏松性骨折（SOF）的研究，这是最大和最具特征的女性在她们生命的第9和第10个十年的队列。sofs已成为老龄化研究的国家资源，sofs数据已越来越多地用于推进对寿命决定因素的理解，包括最佳衰老模式。1986-87年，共有7280名65岁及以上的妇女在3个临床中心入组SOF， 1997-98年，纳入480名非洲裔美国人，队列扩大到7760人。其中2300多人活到了90岁以上。参与者参加了多达9次临床检查，并完成了三年一次的接触（超过95%在22年的随访期间完成），提供了全面有力的测量档案。我们现在建议使用独特的20年的重复测量来定义认知功能、身体表现、骨密度、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，并对SOF参与者进行持续随访，以测试这些轨迹是否确定了达到最佳衰老表型的女性，该表型由长寿、活跃寿命（无重大残疾的生存期）、特殊健康期（无重大疾病事件的生存期）和较低的住院和住院医疗保健使用率定义。我们建议的具体目的是：1)确定年龄相关参数轨迹与老年妇女寿命和活动寿命的关联；2)确定年龄相关参数轨迹与老年妇女异常健康跨度的关系；3)确定年龄相关参数轨迹与住院和住院医疗服务使用的关系，包括住院天数、住院机构康复天数、熟练护理机构康复天数和熟练护理机构永久安置的生存；4)维持和积极使用广泛的SOF生物库，包括血清、尿液和DNA标本。确定预测功能、疾病和保健结果改善的生存轨迹，以及关于衰退前窗口期的数据，是设计旨在针对较早年龄的脆弱老年人的干预研究所需的关键第一步。

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.