PhenoAge and PhenoAgeAccel do not outperform chronological age in predicting physical performance decline or mortality in community-dwelling older adults

Dec 27, 2025The journals of gerontology. Series A, Biological sciences and medical sciences

Phenoage measures do not predict physical decline or death better than actual age in older adults living in the community

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Abstract

Chronological age is associated with a β = -0.41 decline in physical function among older adults.

All three age metrics—chronological age, PhenoAge, and PhenoAgeAccel—show statistically significant positive associations with both physical function decline and mortality.
Chronological age has the strongest correlation with decline in physical function and mortality compared to PhenoAge and PhenoAgeAccel.
The hazard ratio for mortality related to chronological age is 2.78, indicating a significant increase in risk.
PhenoAge and PhenoAgeAccel show weaker associations with physical function decline and mortality than chronological age.
Chronological age outperforms PhenoAge and PhenoAgeAccel in predicting declines in physical function, with an area under the curve (AUC) of 0.71.

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BACKGROUND: Chronological age inadequately captures inter-individual variability in aging-related functional decline. Biological age metrics such as PhenoAge and PhenoAgeAccel, based on clinical biomarkers, have shown associations with frailty and mortality in clinical populations, but their utility in predicting physical performance decline in community-dwelling older adults remains uncertain.

METHODS: We used data from 979 participants aged ≥65 years in the InCHIANTI study, with complete baseline biomarker and physical performance data. Associations of standardized (z-scores) chronological age, PhenoAge, and PhenoAgeAccel with longitudinal changes in physical function (rescaled SPPB) and 10-year all-cause mortality were analyzed using linear mixed and Cox models respectively. A secondary analysis in 504 participants with normal baseline physical performance (SPPB ≥10) assessed the predictive value of each rescaled metric for the onset of compromised function (SPPB ≤9) at 6 years. Model performance was evaluated using AIC and AUC.

RESULTS: All three metrics showed statistically significant positive associations with physical function decline and mortality. Chronological age showed the strongest associations with rSPPB decline (β = -0.41, AIC = 3793) and mortality (HR = 2.78). PhenoAge (β = -0. 32, AIC 4338, HR = 2.57) and PhenoAgeAccel (β = -0.14, AIC 4642, HR = 1.71) showed weaker effects. Chronological age also outperformed PhenoAge and PhenoAgeAccel in predicting SPPB decline (AUC = 0.71 vs. 0.69 and 0.55, respectively).

CONCLUSION: While PhenoAge and PhenoAgeAccel are associated with adverse functional outcomes, they do not add predictive value over chronological age in a general older population.

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PhenoAge and PhenoAgeAccel do not outperform chronological age in predicting physical performance decline or mortality in community-dwelling older adults

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