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This thesis investigates the predictive value of respiratory function for adverse health outcomes in adults aged 80 and over, the fastest growing age-group worldwide. Using the dataset of BELFRAIL, a population-based, prospective cohort of adults aged 80 and over in Belgium, we found that the majority of participants performed quality spirometry for the interpretation of forced expiratory volume in 1 second (FEV1); FEV1 expressed in different ways was associated with mortality, hospitalization, mental and physical decline independent of respiratory diseases, smoking and co-morbidities; FEV1/Ht3, a FEV1 expression that is independent of reference values, performed as good as or even better than the traditional FEV1 percent over predicted value, and its short-term decline was associated with adverse outcomes beyond respiratory diseases. Additionally, moderate-severe exertional dyspnea was found an independent predictor of adverse outcomes in this cohort. Further research should study how to integrate FEV1 and dyspnea in the general health assessments of older adults, as they provide valuable clinical information for improving the care of the growing population of adults aged 80 and over.