Determining a person's risk for death is much more complicated than looking at their medical history. Their age, sex, income, lifestyle, disabilities, and physical measurements for disease also play a significant role, according to an article in the Feb. 25 issue of The Journal of the American Medical Association (JAMA).

Linda P. Fried, M.D., M.P.H., from The Johns Hopkins Medical Institutions, Baltimore, Md., and colleagues determined the disease, functional and personal characteristics that jointly predict mortality in community-dwelling men and women aged 65 years or older.

The researchers found that mortality was associated with 20 diverse and interrelated characteristics including:

• Demographics (such as age, sex, income)
• Lifestyle (such as smoking, exercise)
• Physical measures of disease (such as blood glucose, electrocardiographic abnormalities, forced vital capacity)
• Disability (such as difficulties with activities of daily living and cognitive function)

The study included 5,201 men and women aged 65 years or older participating in the Cardiovascular Health Study (CHS).

The researchers concluded that objective measures of subclinical disease and disease severity were independent and joint predictors of five-year mortality in older adults. They add that except for history of congestive heart failure, objective, quantitative measures of disease were better predictors of mortality than was clinical history of disease.

For example, they found: men had a 2.3-fold higher risk for death compared with women; that people with income of less than $50,000 per year had a higher risk for death compared with those making more money; and that smoking, lack of exercise and high blood pressure were also associated with higher mortality.

The authors write: "These findings identify clinical levels of risk that are associated with higher mortality and, therefore, should be considered in setting treatment goals or monitoring their effects."

They add: "To our knowledge, this study is the first to provide insight into the multiple disease characteristics that jointly, as well as independently, contribute to mortality in older adults."

Study can provide important information

In an accompanying editorial in the Feb. 25 JAMA, Elizabeth Barrett-Connor, M.D., and Cynthia A. Stuenkel, M.D., from the University of California, San Diego, School of Medicine, La Jolla, write: "How should these findings alter clinical practice? Among the 20 variables that predicted mortality, at least 12 are modifiable. But, except for smoking cessation, exercise and blood pressure control, there is little evidence that modifying these variables will improve outcome in old age. Important considerations involve whether interventions are equally appropriate at age 65 and 85 years, and whether interventions should vary by chronological age or physiological age. Moreover, it is unclear whether the CHS findings can be extrapolated to other populations.

They continue: "Everyone dies too early or too late. For the elderly, the predictors of death are perhaps less important than the quality of life before death. The CHS investigators have the opportunity to use their rich database and considerable skills to study the variables that predict a healthy old age."