Woods Nancy Fugate, LaCroix Andrea Z, Gray Shelly L, Aragaki Aaron, Cochrane Barbara B, Brunner Robert L, Masaki Kamal, Murray Anne, Newman Anne B
Seattle Clinical Center, Seattle, Washington 98195, USA.
J Am Geriatr Soc. 2005 Aug;53(8):1321-30. doi: 10.1111/j.1532-5415.2005.53405.x.
To define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability.
Prospective study, the Women's Health Initiative Observational Study.
Forty U.S. clinical centers.
Forty thousand six hundred fifty-seven women aged 65 to 79 at baseline.
Components of frailty included self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow-up.
Baseline frailty was classified in 16.3% of participants, and incident frailty at 3-years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self-reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48-1.97), hip fracture (HR=1.57, 95% CI=1.11-2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47-4.02), and hospitalizations (OR=1.95, 95% CI=1.72-2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions.
These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.
使用简单指标定义衰弱；识别衰弱的风险因素作为预防目标；并研究这种衰弱分类对死亡、住院、髋部骨折和日常生活活动（ADL）残疾的预测效度。
前瞻性研究，即妇女健康倡议观察性研究。
美国40个临床中心。
基线时40657名年龄在65至79岁之间的女性。
衰弱的组成部分包括自我报告的肌肉无力/行走障碍、疲惫、低体力活动以及基线至随访3年期间意外体重减轻。在平均5.9年的随访期间确定死亡、髋部骨折、ADL残疾和住院情况。
16.3%的参与者被分类为基线衰弱，3年时的新发衰弱率为14.8%。年龄较大、慢性病、吸烟和抑郁症状评分与新发衰弱呈正相关，而收入、适度饮酒、独居和自我报告的健康状况与之呈负相关。体重过轻、超重或肥胖者发生衰弱的风险均显著高于正常体重者。在对人口统计学特征、健康行为、残疾和合并症进行调整后，基线衰弱独立预测死亡风险（风险比（HR）=1.71，95%置信区间（CI）=1.48 - 1.97）、髋部骨折（HR = 1.57，95% CI = 1.11 - 2.20）、ADL残疾（比值比（OR）= 3.15，95% CI = 2.47 - 4.02）和住院（OR = 1.95，95% CI = 1.72 - 2.22）。
这些结果支持衰弱概念作为一种老年综合征的稳健性，该综合征可预测老年女性的几种不良结局。体重过轻、肥胖、吸烟和抑郁症状与衰弱的发生密切相关，是重要的预防目标。
