Folsom Aaron R, Boland Lori L, Cushman Mary, Heckbert Susan R, Rosamond Wayne D, Walston Jeremy D
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second St., Minneapolis, MN 55454-1015, USA.
J Gerontol A Biol Sci Med Sci. 2007 Jan;62(1):79-82. doi: 10.1093/gerona/62.1.79.
Frailty is a common risk factor for morbidity and mortality in elderly persons. Recent evidence links frailty to activation of coagulation and inflammatory pathways. We aimed to determine whether frailty in community-dwelling older adults is a risk factor for venous thromboembolism (VTE).
We conducted a prospective cohort study in four U.S. communities involving 4859 participants 65 years old and older. At baseline, in 1989-1993, we assessed frailty based on weight loss, grip strength, feelings of exhaustion, walk time, and physical activity. Incident VTE (deep vein thrombosis or pulmonary embolus) through 2002 was identified by review of hospital records.
Fifty-two percent of the sample was classified as having intermediate or definite frailty. After adjustment for age, race, sex, body mass index, and diabetes, the relative risk of total VTE (n = 150) for people who were frail compared with no frailty was 1.31 (95% confidence interval [CI], 0.93-1.84). The comparably adjusted relative risk for idiopathic VTE (n = 58) was 1.79 (95% CI, 1.02-3.13).
The incidence rates of idiopathic VTE was higher in community-dwelling older adults with baseline frailty compared with no frailty. Further studies of the clotting process in frailty may allow the development of an improved strategy to determine VTE risk in this vulnerable subset of older adults.
衰弱是老年人发病和死亡的常见风险因素。最近的证据将衰弱与凝血和炎症途径的激活联系起来。我们旨在确定社区居住的老年人中的衰弱是否是静脉血栓栓塞（VTE）的风险因素。
我们在美国四个社区进行了一项前瞻性队列研究，涉及4859名65岁及以上的参与者。在1989 - 1993年的基线时，我们根据体重减轻、握力、疲惫感、步行时间和身体活动来评估衰弱情况。通过查阅医院记录确定截至2002年的VTE（深静脉血栓形成或肺栓塞）发病情况。
52%的样本被分类为具有中度或明确的衰弱。在对年龄、种族、性别、体重指数和糖尿病进行调整后，衰弱者与非衰弱者相比，总的VTE（n = 150）的相对风险为1.31（95%置信区间[CI]，0.93 - 1.84）。特发性VTE（n = 58）经类似调整后的相对风险为1.79（95%CI，1.02 - 3.13）。
与非衰弱的社区居住老年人相比，基线衰弱的社区居住老年人中特发性VTE的发病率更高。对衰弱中凝血过程的进一步研究可能有助于制定一种改进的策略，以确定这一脆弱老年亚组中的VTE风险。
