Nourhashémi F, Andrieu S, Gillette-Guyonnet S, Vellas B, Albarède J L, Grandjean H
Service de Médecine Interne et de, Toulouse, France.
J Gerontol A Biol Sci Med Sci. 2001 Jul;56(7):M448-53. doi: 10.1093/gerona/56.7.m448.
A number of clinical conditions have been shown to be associated with frailty in elderly people. We hypothesized that incapacities on the Instrumental Activities of Daily Living (IADLs) scale could make it possible to identify this population. We investigated the associations between IADL incapacities and the various known correlates of frailty in a cohort of community-dwelling elderly women.
Cross-sectional analysis was carried out on the data from 7364 women aged over 75 years (EPIDOS Study). The IADL was the dependent variable. Sociodemographic, medical, and psychological performance measures were obtained during an assessment visit. Falls in the previous 6 months and fear of falling were also ascertained. Body composition was measured by dual-energy x-ray absorptiometry. The factors associated with disability in at least one IADL were included in a logistic regression model.
Thirty-two percent of the population studied had disability in at least one IADL item. This group was significantly older (81.7 +/- 4.1 yr vs 79.8 +/- 3.4 yr), had more frequent histories of heart disease, stroke, depression or diabetes, and was socially less active (p =.001). These associations persisted after multivariate analysis. Cognitive impairment as assessed by the Pfeiffer test (Pfeiffer score <8) was closely associated with disabilities on the IADL (OR 3.101, 95% confidence interval [CI] 2.19-4.38). Falls and fear of falling were also more frequent in the group of women with an abnormal IADL (p =.001) but only fear of falling remained significantly associated with incapacities on at least one IADL item after logistic regression (OR 1.47, 95% CI 1.28-1.69). Women with disability on at least one IADL item also had lower bone mineral density, this was independent of the other factors.
Our results confirmed that women with disability on at least one IADL item are frailer because they had more associated disorders, poorer cognitive function and more frequent falls. Disabilities on this scale could be a good tool for identifying individuals at risk of frailty among elderly persons living at home and in apparent good health. This finding requires confirmation by longitudinal studies.
多项临床情况已被证明与老年人的虚弱相关。我们假设日常生活活动能力量表（IADL）上的功能障碍可能有助于识别这一人群。我们在一组社区居住的老年女性队列中研究了IADL功能障碍与虚弱的各种已知相关因素之间的关联。
对来自7364名75岁以上女性的数据进行横断面分析（EPIDOS研究）。IADL为因变量。在评估访视期间获取社会人口统计学、医学和心理表现指标。还确定了过去6个月内的跌倒情况和跌倒恐惧。通过双能X线吸收法测量身体成分。将与至少一项IADL功能障碍相关的因素纳入逻辑回归模型。
研究人群中32%的人至少有一项IADL项目存在功能障碍。这一组年龄显著更大（81.7±4.1岁对79.8±3.4岁），有心脏病、中风、抑郁症或糖尿病病史的频率更高，社交活动更少（p = 0.001）。多变量分析后这些关联仍然存在。通过 Pfeiffer 测试评估的认知障碍（Pfeiffer 评分<8）与IADL功能障碍密切相关（比值比3.101，95%置信区间[CI]2.19 - 4.38）。IADL异常的女性组中跌倒和跌倒恐惧也更频繁（p = 0.001），但逻辑回归后只有跌倒恐惧与至少一项IADL项目的功能障碍仍显著相关（比值比1.47，95%CI 1.28 - 1.69）。至少有一项IADL项目存在功能障碍的女性骨密度也较低，这与其他因素无关。
我们的结果证实，至少有一项IADL项目存在功能障碍的女性更虚弱，因为她们有更多相关疾病、认知功能较差且跌倒更频繁。该量表上的功能障碍可能是识别居家且看似健康的老年人中虚弱风险个体的良好工具。这一发现需要纵向研究予以证实。
