Heterogeneity in the Health and Functional Capacity of Adults Aged 85+ as Risk for Mortality

OBJECTIVES: To examine whether older adults aged 85+, with different health and functional capacities, cluster in different ways and to demonstrate whether individuals within particular clusters report differential mortality risk. DESIGN: Retrospective cohort study. SETTING: The Dynamic Analyses to Optimize Aging (DYNOPTA) project is a harmonization project of nine Australian longitudinal surveys of health and well-being in adults aged 50+ between 1991 and 2006. PARTICIPANTS: Participants were 685 older adults (female = 52%) living in the community and aged 85 to 103 at baseline who were followed until death or December 31, 2006, for survivors. MEASUREMENT: Latent class analysis (LCA) analyzed self-reported information on physical health, mental health, and functional capacity to define homogeneous classes based on probable cognitive impairment and depression status, medical conditions, and number of activities of daily living and instrumental activities of daily living. RESULTS: LCA discriminated four classes reflecting two main survival patterns. Two classes reported half the median survival days; differences between these classes were related to high vs moderate depression and extent of functional limitations. Two classes reported better survival; differences between these classes were related to functional limitations, but both had low proportions with depression and dementia. The classes with shorter survival were associated with substantively higher rates of depression and dementia. CONCLUSION: Higher rates of baseline depression and dementia were unique characteristics of those individuals in the clusters that reported shorter survival. However, a substantial proportion of very old adults experience good mental health with better survival outcomes. J Am Geriatr Soc 67:1036–1042, 2019.