Robyn L Woods1, Sara Espinoza2,3, Le T P Thao1, Michael E Ernst4, Joanne Ryan1, Rory Wolfe1, Raj C Shah5, Stephanie A Ward1,6, Elsdon Storey1, Mark R Nelson7, Christopher M Reid8, Jessica E Lockery1, Suzanne G Orchard1, Ruth E Trevaks1, Sharyn M Fitzgerald1, Nigel P Stocks9, Jeff D Williamson10, John J McNeil1, Anne M Murray11,12, Anne B Newman13. 1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 2. Division of Geriatrics, Gerontology and Palliative Medicine, Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, USA. 3. Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, USA. 4. Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, USA. 5. Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA. 6. Centre for Healthy Brain Ageing, The University of New South Wales, Sydney, Australia. 7. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. 8. School of Public Health, Curtin University, Perth, Western Australia, Australia. 9. Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia. 10. Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. 11. Berman Center for Clinical Outcomes and Research, Minneapolis Medical Research Foundation, Hennepin Healthcare Research Institute, Minneapolis, USA. 12. Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, USA. 13. Center for Aging and Population Health, University of Pittsburgh, Pennsylvania, USA.
Abstract
BACKGROUND: Cerebrovascular events, dementia, and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin's effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults. METHODS: The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100 mg aspirin versus placebo recruited 19 114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the United States. Six basic ADLs were assessed every 6 months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after 6 months. Proportional hazards modeling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk. RESULTS: Over a median of 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing, and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 vs 5.3 events/1000 py; hazard ratio [HR] = 0.81, 95% confidence interval [CI]: 0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability, there were more deaths in the aspirin group (24 vs 12). DISCUSSION: Low-dose aspirin in initially healthy older people did not reduce the risk of incident ADL disability, although there was evidence of reduced persistent ADL disability.
BACKGROUND: Cerebrovascular events, dementia, and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin's effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults. METHODS: The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100 mg aspirin versus placebo recruited 19 114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the United States. Six basic ADLs were assessed every 6 months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after 6 months. Proportional hazards modeling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk. RESULTS: Over a median of 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing, and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 vs 5.3 events/1000 py; hazard ratio [HR] = 0.81, 95% confidence interval [CI]: 0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability, there were more deaths in the aspirin group (24 vs 12). DISCUSSION: Low-dose aspirin in initially healthy older people did not reduce the risk of incident ADL disability, although there was evidence of reduced persistent ADL disability.
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: John J McNeil; Rory Wolfe; Robyn L Woods; Andrew M Tonkin; Geoffrey A Donnan; Mark R Nelson; Christopher M Reid; Jessica E Lockery; Brenda Kirpach; Elsdon Storey; Raj C Shah; Jeff D Williamson; Karen L Margolis; Michael E Ernst; Walter P Abhayaratna; Nigel Stocks; Sharyn M Fitzgerald; Suzanne G Orchard; Ruth E Trevaks; Lawrence J Beilin; Colin I Johnston; Joanne Ryan; Barbara Radziszewska; Michael Jelinek; Mobin Malik; Charles B Eaton; Donna Brauer; Geoff Cloud; Erica M Wood; Suzanne E Mahady; Suzanne Satterfield; Richard Grimm; Anne M Murray Journal: N Engl J Med Date: 2018-09-16 Impact factor: 91.245
Authors: Jo Wrigglesworth; Nurathifah Yaacob; Phillip Ward; Robyn L Woods; John McNeil; Elsdon Storey; Gary Egan; Anne Murray; Raj C Shah; Sharna D Jamadar; Ruth Trevaks; Stephanie Ward; Ian H Harding; Joanne Ryan Journal: Neurobiol Aging Date: 2021-10-20 Impact factor: 4.673
Authors: A R M Saifuddin Ekram; Robyn L Woods; Joanne Ryan; Sara E Espinoza; Julia F M Gilmartin-Thomas; Raj C Shah; Raaj Mehta; Bharati Kochar; Judy A Lowthian; Jessica Lockery; Suzanne Orchard; Mark Nelson; Michelle A Fravel; Danny Liew; Michael E Ernst Journal: Arch Gerontol Geriatr Date: 2022-03-23 Impact factor: 4.163
Authors: Sara E Espinoza; Robyn L Woods; A R M Saifuddin Ekram; Michael E Ernst; Galina Polekhina; Rory Wolfe; Raj C Shah; Stephanie A Ward; Elsdon Storey; Mark R Nelson; Christopher M Reid; Jessica E Lockery; Suzanne G Orchard; Ruth Trevaks; Sharyn M Fitzgerald; Nigel P Stocks; Andy Chan; John J McNeil; Anne M Murray; Anne B Newman; Joanne Ryan Journal: J Gerontol A Biol Sci Med Sci Date: 2022-10-06 Impact factor: 6.591
Authors: Suzanne G Orchard; Galina Polekhina; Joanne Ryan; Raj C Shah; Elsdon Storey; Trevor T-J Chong; Jessica E Lockery; Stephanie A Ward; Rory Wolfe; Mark R Nelson; Christopher M Reid; Anne M Murray; Sara E Espinoza; Anne B Newman; John J McNeil; Taya A Collyer; Michele L Callisaya; Robyn L Woods Journal: Alzheimers Dement (Amst) Date: 2022-09-22
Authors: Joanne Ryan; Sara Espinoza; Michael E Ernst; A R M Saifuddin Ekram; Rory Wolfe; Anne M Murray; Raj C Shah; Suzanne G Orchard; Sharyn Fitzgerald; Lawrence J Beilin; Stephanie A Ward; Jeff D Williamson; Anne B Newman; John J McNeil; Robyn L Woods Journal: J Gerontol A Biol Sci Med Sci Date: 2022-01-07 Impact factor: 6.591