Functional aging, or disability-free survival, becomes increasingly exceptional as older adults reach age 80 and beyond. In the long- term survivors of the Cardiovascular Health Study (CHS) cohort, we will determine the likelihood of maintaining function, identify the trajectories that distinguish those destined to do well, and define the importance, independence and interactions of physiologic predictors of function. The CHS cohort is now aged 80 to 100+ with over 12 years of follow-up, but have not been examined for 4 years. With the long term, longitudinal data and a reassessment of functional status, we can identify critical targets and time points that could lead to potential intervention to extend functional years of life. We have shown that subclinical cardiovascular disease alone, in the absence of any clinically recognized CVD event, predicts impaired physical and cognitive function. However, CVD does not fully explain the very strong effect of age itself on decline in function. We can also determine the potential for maintaining function in the presence of CVD. We have noted that many participants over age 80 have maintained physical and cognitive function in spite of extensive subclinical CVD.
The aims of this application are: 1) to identify and characterize CHS participants who have remained functional after age 80, specifically to determine the trajectories of CVD risk factors and behavioral factors, especially physical activity and CVD treatment that lead to functional aging, 2) to determine whether low levels of IL-6 and TNF-alpha, as well as CRP, high levels of adrenal androgens, and insulin-like growth factor-1 and adiponectin, and lower fasting insulin and glucose will predict continued functioning independently of cardiovascular disease, 3) to identify individuals who have maintained functional aging in the presence of a large atherosclerotic burden and to examine factors that may promote function in spite of CVD, 4) to determine whether the predictors of a functional aging predict continuous parameters of function including leg muscle strength, grip strength, gait speed, and cognitive processing speed. With longitudinal data collected over many years, the CHS is now uniquely positioned to answer these questions about aging. This study is a critical step towards the identification of the targets and the time points for intervention to preserve function in old age. ? ?
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