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Rockwood, K.

Publications and source records attributed to Rockwood, K..

2 recordsLinked to original sources

Probing the network structure of health deficits in human aging

Human aging leads to the stochastic accumulation of damage. We model an aging population using a stochastic network model. Individuals are modeled as a network of interacting nodes, representing health attributes. Nodes in the network stochastically damage and repair, with rates dependent on the state of their neighbors. Damaged nodes represent health deficits. The Frailty Index (FI) assesses age-related damage as the proportion of health deficits an individual has accumulated, from a selection of attributes. Here, we use computational, information-theoretic, and mean-field approaches to show that the degree distribution and degree correlations of the underlying network are important to the models ability to recover the behavior of observational health data. We use different measures of damage in the network to probe the structure of the network. We find that the behavior of different classes of observational health deficits (laboratory or clinical) is similar to the behavior of nodes of low or high degree in the model, respectively. This explains how damage can propagate within the network, leading towards individual mortality.

systems biology

Delirium, frailty and mortality: interactions in a prospective study of hospitalized older people

BackgroundIt is unknown if the association between delirium and mortality is consistent for individuals across the whole range of health states. A bimodal relationship has been proposed, where delirium is particularly adverse for those with underlying frailty, but may have a smaller effect (perhaps even protective) if it is an early indicator of acute illness in fitter people. We investigated the impact of delirium on mortality in a cohort simultaneously evaluated for frailty.\n\nMethodsWe undertook an exploratory analysis of a cohort of consecutive acute medical admissions aged [&ge;]70. Delirium on admission was ascertained by psychiatrists. A Frailty Index (FI) was derived according to a standard approach. Deaths were notified from linked national mortality statistics. Cox regression was used to estimate associations between delirium, frailty and their interactions on mortality.\n\nResultsThe sample consisted of 710 individuals. Both delirium and frailty were independently associated with increased mortality rates (delirium: HR 2.4, 95%CI 1.8-3.3, p<0.01; frailty (per SD): HR 3.5, 95%CI 1.2-9.9, p=0.02). Estimating the effect of delirium in tertiles of FI, mortality was greatest in the lowest tertile: tertile 1 HR 3.4 (95%CI 2.1-5.6); tertile 2 HR 2.7 (95%CI 1.5-4.6); tertile 3 HR 1.9 (95% CI 1.2-3.0).\n\nConclusionWhile delirium and frailty contribute to mortality, the overall impact of delirium on admission appears to be greater at lower levels of frailty. In contrast to the hypothesis that there is a bimodal distribution for mortality, delirium appears to be particularly adverse when precipitated in fitter individuals.

epidemiology