Abstract
Recent research has shown that markers of biological age, such as leukocyte telomere length (LTL), epigenetic clocks and the frailty index (FI) are predictive of mortality and age-related diseases. However, whether these markers associate with the need for care in old age, thereby having utility in reflecting dependency, is unclear. This study was undertaken to analyze whether LTL, two epigenetic clocks—the DNA methylation age (DNAmAge) and DNAm PhenoAge—and the FI are associated with the need for regular care in up to 604 individuals (aged 48–94 years) participating in the Swedish Adoption/Twin Study of Aging. Need for regular care was defined as receiving formal or informal help in daily routines at least once per week. Logistic regression adjusted for age, sex and education was used in the analysis. The predictive accuracies, assessed as the area under the curve (AUC) for the significant biological age measures were further compared to the accuracies of the limitations in activities of daily living (ADL) and instrumental ADL (IADL). Neither LTL nor the epigenetic clocks were associated with the need for care, whereas the FI was; odds ratio for 10% increase in FI 3.54 (95% confidence interval 2.32–5.41). The FI also demonstrated higher predictive accuracy than the ADL score (FI AUC 0.80 vs. ADL score AUC 0.62; p < 0.001 for equality of the AUCs), whereas the difference between FI AUC (0.80) and IADL score AUC (0.75) was not significant (p = 0.238). The FI might thus be a useful marker for the need for care.
Highlights
A central feature of aging is loss of function and independence in performing daily routines
Neither leukocyte telomere length (LTL) nor the epigenetic clocks were associated with the need for care, whereas the frailty index (FI) was; odds ratio for 10% increase in FI 3.54 (95% confidence interval 2.32–5.41)
As the epigenetic clock data were available for a smaller sample than the FI and LTL, the left hand side of Table 1 presents the sample characteristics separately for those with the epigenetic clocks available
Summary
A central feature of aging is loss of function and independence in performing daily routines. Several markers of biological age, such as leukocyte telomere length (LTL), the frailty index (FI) and composite markers of DNA methylation sites, termed epigenetic clocks, have demonstrated utility in predicting mortality and other age-related outcomes independent of chronological age and other risk factors (Chen et al 2016; Horvath and Raj 2018; Jylhava et al 2017; Vermeiren 2016) These biological age markers have been associated with clinical biomarkers and functional performance measures (Horvath and Raj 2018; Hubbard et al 2009; Jylhava et al 2017; Levine et al 2018). We sought to evaluate the predictive accuracies of the significant markers and compare with the predictive accuracies of the ADL and instrumental ADL (IADL) scores—two scales that are commonly used in assessing the need of formal social care
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