Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults

Jason L. Sanders, Alice M. Arnold, Calvin H. Hirsch, Stephen M. Thielke, Dae Kim, Kenneth J. Mukamal, Jorge Kizer, Joachim H. Ix, Robert C. Kaplan, Stephen B. Kritchevsky, Anne B. Newman

Research output: Contribution to journalArticle

11 Scopus citations


Objectives: To ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity). Design: Prospective, community-based cohort study in four U.S. cities. Setting: Cardiovascular Health Study. Participants: Individuals aged 65 and older. Measurements: Participants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty—reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self-reported healthy life (YHL), and mortality using multivariable regression and survival analysis. Results: After adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60–1.33) more YAL and 0.54 (95% CI = 0.19–0.90) more YHL than expected agers, and those who were prematurely frail had −0.99 (95% CI = −1.36 to −0.62) fewer YAL and −0.53 (95% CI = −0.89 to −0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P 

Original languageEnglish (US)
Pages (from-to)1242-1249
Number of pages8
JournalJournal of the American Geriatrics Society
Issue number6
StatePublished - Jun 1 2016



  • adaptation
  • frailty
  • function
  • longevity
  • morbidity

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Sanders, J. L., Arnold, A. M., Hirsch, C. H., Thielke, S. M., Kim, D., Mukamal, K. J., Kizer, J., Ix, J. H., Kaplan, R. C., Kritchevsky, S. B., & Newman, A. B. (2016). Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults. Journal of the American Geriatrics Society, 64(6), 1242-1249. https://doi.org/10.1111/jgs.14163