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Associations of life’s crucial 9 with mortality among older adults with frailty: a prospective cohort study from the NHANES 2007 to 2018

Year: 2025

Type: article

Abstract: BACKGROUND: Frailty among the elderly represents a considerable public health issue linked to increased vulnerability and adverse outcomes. The Life's Crucial 9 (LC9) score, which includes mental health assessments alongside traditional cardiovascular health metrics, may offer a more comprehensive prediction of mortality risk in frail elderly populations. METHODS: This prospective cohort study leveraged data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Participants aged ≥ 60 years were included, and frailty was assessed as Frailty index ≥ 0.21. The LC9 score combined eight physical health metrics with a mental health component focused on depression. Mortality follow-up information was acquired until December 2019. The study employed cox proportional hazards regression to assess the relationship between LC9 scores and mortality and additionally applied restricted cubic spline models to investigate dose-response associations. RESULTS: The analysis encompassed a total of 2,690 participants. Each 10-point increase in LC9 score was associated with a 13% decrease in mortality risk (HR: 0.87; 95% CI: 0.80-0.95; p = 0.002) after full adjustment. Participants in the highest tertile of LC9 scores demonstrated a 23-28% reduction in mortality risk compared to the lowest tertile. An L-shaped relationship was observed, with higher LC9 scores associated with lower mortality risk. CONCLUSION: The LC9 score represents an important advancement in assessing mortality risk among frail older adults. This study highlights the need for holistic approaches in aging health assessments and suggests that integrating mental health within cardiovascular metrics may enhance the accuracy of risk predictions.

Source: BMC Geriatrics

DOI: 10.1186/s12877-025-05996-5