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The relationship between age, gender and cognitive performance in the very old: the effect of selective survival.

Abstract

OBJECTIVE

To determine the prevalence of cognitive disability as a function of advanced age and gender in elderly nursing home and community-dwelling populations. Since cognitive dysfunction is associated with increased mortality, we hypothesized that selective survival results in a decreased prevalence of cognitive disability in the oldest old.

DESIGN

Cohort study. An analysis of 6-month longitudinal data obtained from a national probability sample of older persons in 260 nursing homes (n = 1951) and 2-year-longitudinal data obtained from a sample of community-dwelling older persons (n = 2947).

MEASURES

In the nursing home sample, the primary outcome measure was cognitive performance score. In the community sample, cognitive performance was determined using the results of three orientation questions and assessment of decision-making ability. Cognitive performance and subsequent survival, controlling for various disease states and demographic factors, were examined in three age cohorts of men and women (ages 65-79, 80-89, 90-99).

RESULTS

In the nursing home sample, the cognitive performance of very old men (> or = 90 years) was better than that of younger men (aged 80-89 years, P < 0.05) and very old women (age > or = 90 years, P = 0.001). Among 80-89-year-olds with poor cognitive performance, the 6-month mortality rate was higher in men than in women (38% vs 19%, P = 0.001). However, the mortality rates of men and women with good cognitive performance were not statistically different in any age group. Proportional-hazards regression analysis demonstrated that poor cognitive performance remained a powerful predictor of death among men aged 80-89 years with a relative risk of 2.7 (95% Cl, 1.19-3.17; P = 0.0006) after controlling for covariates. Results from the community sample lent support to our findings: within each age group, mortality rates for men and women with intact cognitive performance were not statistically different. However, in the two older age groups, the mortality rates of subjects with impaired cognitive performance were significantly greater for men than for women (P < 0.01 for both age groups).

CONCLUSIONS

Decreased cognitive performance is significantly associated with mortality among elderly men. Survival by men who have relatively intact cognitive function results in a population of oldest men, those aged 90-99 years, with cognitive performance scores better than younger men or similarly-aged women. The same selective survival phenomenon was not observed among women. Thus, there may be less cognitive disability among very old men than previously expected.

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  • Authors+Show Affiliations

    ,

    Hebrew Rehabilitation Center for Aged, Beth Israel Hospital, Boston, MA 02131.

    , ,

    Source

    MeSH

    Age Factors
    Aged
    Cognition Disorders
    Cohort Studies
    Decision Making
    Educational Status
    Female
    Geriatric Assessment
    Homes for the Aged
    Humans
    Longevity
    Male
    Mental Status Schedule
    Nursing Homes
    Orientation
    Pilot Projects
    Prevalence
    Proportional Hazards Models
    Sampling Studies
    Selection, Genetic
    Sex Factors
    Survival Rate

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    8227893

    Citation

    Perls, T T., et al. "The Relationship Between Age, Gender and Cognitive Performance in the Very Old: the Effect of Selective Survival." Journal of the American Geriatrics Society, vol. 41, no. 11, 1993, pp. 1193-201.
    Perls TT, Morris JN, Ooi WL, et al. The relationship between age, gender and cognitive performance in the very old: the effect of selective survival. J Am Geriatr Soc. 1993;41(11):1193-201.
    Perls, T. T., Morris, J. N., Ooi, W. L., & Lipsitz, L. A. (1993). The relationship between age, gender and cognitive performance in the very old: the effect of selective survival. Journal of the American Geriatrics Society, 41(11), pp. 1193-201.
    Perls TT, et al. The Relationship Between Age, Gender and Cognitive Performance in the Very Old: the Effect of Selective Survival. J Am Geriatr Soc. 1993;41(11):1193-201. PubMed PMID: 8227893.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The relationship between age, gender and cognitive performance in the very old: the effect of selective survival. AU - Perls,T T, AU - Morris,J N, AU - Ooi,W L, AU - Lipsitz,L A, PY - 1993/11/1/pubmed PY - 1993/11/1/medline PY - 1993/11/1/entrez SP - 1193 EP - 201 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 41 IS - 11 N2 - OBJECTIVE: To determine the prevalence of cognitive disability as a function of advanced age and gender in elderly nursing home and community-dwelling populations. Since cognitive dysfunction is associated with increased mortality, we hypothesized that selective survival results in a decreased prevalence of cognitive disability in the oldest old. DESIGN: Cohort study. An analysis of 6-month longitudinal data obtained from a national probability sample of older persons in 260 nursing homes (n = 1951) and 2-year-longitudinal data obtained from a sample of community-dwelling older persons (n = 2947). MEASURES: In the nursing home sample, the primary outcome measure was cognitive performance score. In the community sample, cognitive performance was determined using the results of three orientation questions and assessment of decision-making ability. Cognitive performance and subsequent survival, controlling for various disease states and demographic factors, were examined in three age cohorts of men and women (ages 65-79, 80-89, 90-99). RESULTS: In the nursing home sample, the cognitive performance of very old men (> or = 90 years) was better than that of younger men (aged 80-89 years, P < 0.05) and very old women (age > or = 90 years, P = 0.001). Among 80-89-year-olds with poor cognitive performance, the 6-month mortality rate was higher in men than in women (38% vs 19%, P = 0.001). However, the mortality rates of men and women with good cognitive performance were not statistically different in any age group. Proportional-hazards regression analysis demonstrated that poor cognitive performance remained a powerful predictor of death among men aged 80-89 years with a relative risk of 2.7 (95% Cl, 1.19-3.17; P = 0.0006) after controlling for covariates. Results from the community sample lent support to our findings: within each age group, mortality rates for men and women with intact cognitive performance were not statistically different. However, in the two older age groups, the mortality rates of subjects with impaired cognitive performance were significantly greater for men than for women (P < 0.01 for both age groups). CONCLUSIONS: Decreased cognitive performance is significantly associated with mortality among elderly men. Survival by men who have relatively intact cognitive function results in a population of oldest men, those aged 90-99 years, with cognitive performance scores better than younger men or similarly-aged women. The same selective survival phenomenon was not observed among women. Thus, there may be less cognitive disability among very old men than previously expected. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/8227893/The_relationship_between_age_gender_and_cognitive_performance_in_the_very_old:_the_effect_of_selective_survival_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0002-8614&amp;date=1993&amp;volume=41&amp;issue=11&amp;spage=1193 DB - PRIME DP - Unbound Medicine ER -