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Objectives To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life. Design Community-based cohort study of older adults followed from 1989 to 2015. Setting Four U.S. communities. Participants Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline. Measurements Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index ( BMI), social networks, and social support, were measured at baseline. Activities of daily living ( ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life ( YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period. Results The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval ( CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%. Conclusion The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between kidney function and all-cause mortality in octogenarians. Design Retrospective analysis of prospectively collected data. Setting Community. Participants Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study ( CHS) All Stars participants. Measurements Estimated glomerular filtration rate (e GFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (e GFRCR) and cystatin C one-variable (e GFRCYS) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models. Results Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between e GFRCR and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m2), the highest (≥75 mL/min per 1.73 m2) and lowest (≤43 mL/min per 1.73 m2) quintiles of e GFRCR were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36-4.55; HR = 2.28, 95% CI = 1.26-4.10, respectively). The association between e GFRCYS and all-cause mortality was linear in those with e GFRCYS of less than 60 mL/min per 1.73 m2, and in the multivariate analyses, the lowest quintile of e GFRCYS (<52 mL/min per 1.73 m2) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m2). Conclusion Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between e GFRCR and all-cause mortality differed from that observed with e GFRCYS; the relationship was U-shaped for e GFRCR, whereas the risk was primarily present in the lowest quintile for e GFRCYS. [ABSTRACT FROM AUTHOR]