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Actuarial Approach01:20

Actuarial Approach

The actuarial approach, a statistical method originally developed for life insurance risk assessment, is widely used to calculate survival rates in clinical and population studies. This method accounts for participants lost to follow-up or those who die from causes unrelated to the study, ensuring a more accurate representation of survival probabilities.
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Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...
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The Kaplan-Meier estimator is a non-parametric method used to estimate the survival function from time-to-event data. In medical research, it is frequently employed to measure the proportion of patients surviving for a certain period after treatment. This estimator is fundamental in analyzing time-to-event data, making it indispensable in clinical trials, epidemiological studies, and reliability engineering. By estimating survival probabilities, researchers can evaluate treatment effectiveness,...
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Published on: October 23, 2020

Predicting survival in oldest old people.

Diana G Taekema1, J Gussekloo, Rudi G J Westendorp

  • 1Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands. d.g.taekema@lumc.nl

The American Journal of Medicine
|September 29, 2012
PubMed
Summary

In individuals aged 85 and older, slow gait speed and difficulty with Instrumental Activities of Daily Living predict survival. Instrumental Activities of Daily Living assessment may offer better prognostication for this age group.

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Area of Science:

  • Gerontology
  • Epidemiology
  • Clinical Medicine

Background:

  • Physical performance measures are valuable for estimating survival in the elderly.
  • Older adults aged 85+ are often unable to perform standard functional tests.
  • This study investigates gait speed and Instrumental Activities of Daily Living (IADL) as prognostic markers in the oldest old.

Purpose of the Study:

  • To examine the association between gait speed and survival in individuals aged 85 years and older.
  • To assess Instrumental Activities of Daily Living (IADL) as an alternative prognostic marker for survival in the oldest old.
  • To determine appropriate gait speed cutoffs for survival prediction in this demographic.

Main Methods:

  • Utilized the prospective, population-based Leiden 85-plus Study with a 12-year follow-up.
  • Included 599 participants all aged 85 at baseline.
  • Measured survival rate as the primary outcome, alongside gait speed and IADL questionnaire data.

Main Results:

  • At age 85, 12.2% could not perform the walking test; only 1.9% walked faster than 1.0 m/s.
  • Slow gait speed was associated with higher mortality risk (HR 2.66 at 2 years, HR 2.04 at 12 years), though significance was lost after confounder adjustment.
  • Poor IADL ability significantly increased mortality risk (HR 6.11 at 2 years, HR 2.75 at 12 years), with the association remaining significant after adjustment.

Conclusions:

  • Gait speed cutoffs require reevaluation for the oldest old population.
  • Slow gait speed (≤0.40 m/s women, ≤0.45 m/s men) and IADL disability predict survival in 85-year-olds.
  • IADL assessment may be a superior tool for short- and long-term survival prognostication in the oldest old.