Mortality and survival in nonagenarians during the COVID-19 pandemic: Unstable equilibrium of aging

Daria A Kashtanova; Veronika V Erema; Maria S Gusakova; Ekaterina R Sutulova; Anna Yu Yakovchik; Mikhail V Ivanov; Anastasiia N Taraskina; Mikhail V Terekhov; Lorena R Matkava; Antonina M Rumyantseva; Vladimir S Yudin; Anna A Akopyan; Irina D Strazhesko; Irina S Kordiukova; Alexandra I Akinshina; Valentin V Makarov; Olga N Tkacheva; Sergey A Kraevoy; Sergey M Yudin

doi:10.3389/fmed.2023.1132476

Mortality and survival in nonagenarians during the COVID-19 pandemic: Unstable equilibrium of aging

Front Med (Lausanne). 2023 Mar 2:10:1132476. doi: 10.3389/fmed.2023.1132476. eCollection 2023.

Authors

Daria A Kashtanova¹, Veronika V Erema¹, Maria S Gusakova¹, Ekaterina R Sutulova¹, Anna Yu Yakovchik¹, Mikhail V Ivanov¹, Anastasiia N Taraskina¹, Mikhail V Terekhov¹, Lorena R Matkava¹, Antonina M Rumyantseva¹, Vladimir S Yudin¹, Anna A Akopyan², Irina D Strazhesko², Irina S Kordiukova², Alexandra I Akinshina¹, Valentin V Makarov¹, Olga N Tkacheva², Sergey A Kraevoy¹, Sergey M Yudin¹

Affiliations

¹ Federal State Budgetary Institution "Centre for Strategic Planning and Management of Biomedical Health Risks" of the Federal Medical Biological Agency, Moscow, Russia.
² Russian Clinical Research Center for Gerontology, Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia.

Abstract

Introduction: Aging puts the human body under an immense stress and makes it extremely susceptible to many diseases, often leading to poor outcomes and even death. Long-living individuals represent a unique group of people who withstood the stress of time and offer an abundance of information on the body's ability to endure the pressure of aging. In this study, we sought to identify predictors of overall one-year mortality in 1641 long-living individuals. Additionally, we analyzed risk factors for COVID-19-related morality, since statistics demonstrated an extreme vulnerability of older adults.

Methods: We conducted a two-stage evaluation, including a comprehensive geriatric assessment for major aging-associated: frailty, cognitive impairment, frontal lobe dysfunction, chronic pain, anxiety, risk of falls, sensory deficit, depression, sarcopenia, risk of malnutrition, fecal and urinary incontinence, dependence in Activities of Daily Living, dependence in Instrumental Activities of Daily Living, polypragmasia, and orthostatic hypotension; extensive blood testing, a survey, and a one-year follow-up interview.

Results: The most reliable predictors of overall mortality were cognitive impairment, malnutrition, frailty, aging-associated diseases and blood markers indicating malnutrition-induced metabolic dysfunctions (decreased levels of protein fractions, iron, 25-hydroxyvitamin D, and HDL), and aging biomarkers, such as IGF-1 and N-terminal pro b-type natriuretic peptide. In post-COVID 19 participants, the most significant mortality predictors among geriatric syndromes were depression, frontal lobe dysfunction and frailty, and similar to overall mortality blood biomarkers - 25-hydroxyvitamin D, IGF-1, HDL as well as high white blood cell, neutrophils counts and proinflammatory markers. Based on the results, we built a predictive model of overall mortality in the long-living individuals with f-score=0.76.

Conclusion: The most sensitive and reliable predictors of mortality were modifiable. This is another evidence of the critical importance of proper geriatric care and support for individuals in their "golden years". These results could facilitate geriatric institutions in their pursuit for providing improved care and could aid physicians in detecting early signs of potentially deadly outcomes. Additionally, our findings could be used in developing day-to-day care guidelines, which would greatly improve prevention statistics.

Keywords: COVID-19; COVID-19 mortality; aging; inflammaging; longevity; mortality; mortality predictors; nonagenarians.

Copyright © 2023 Kashtanova, Erema, Gusakova, Sutulova, Yakovchik, Ivanov, Taraskina, Terekhov, Matkava, Rumyantseva, Yudin, Akopyan, Strazhesko, Kordiukova, Akinshina, Makarov, Tkacheva, Kraevoy and Yudin.