The Fountain of Youth

In honor of this week’s NICHQ Forum for Improving Children’s Health Care, I wanted to do a piece on the importance of preventive care. Integrative pediatricians strive to help children develop healthy lifestyles so that they can lead optimally healthy lives. A recent article in the Journal of the American Medical Association (JAMA) provides us with intriguing clues as to which factors predict long (and healthy?) lives.

Researchers in San Francisco surveyed nearly 20,000 adults ages 60 and above, developing a scale that would predict mortality over the next four years. They identified twelve independent predictors of mortality: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point). Of interest is the focus on these functional variables, for, after all, what good is a long life if it’s spent in miserable health?

Totaling the points results in a “Risk Index,” and scores on the risk index were strongly associated with 4-year mortality (death within a four-year prospective time frame), with 0 to 5 points predicting a less than 4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points predicting a 42% risk, and 14 or more points predicting a 64% risk. The power of this study is that we have some indicators of relative risk for death within a fairly short time period. What is the utility of this Risk Index for children’s health? Perhaps we can focus on lifestyle factors such as those in the comorbid condition list as well as on facilitating “functional” health. These factors may indeed be the keys to not only long life, but optimally functional longevity.