营养风险和体重指数预测社区居住的老年人住院、入住养老院和死亡：UAB 老龄化研究 8.5 年随访结果。
Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up.
机构信息
Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
Department of Medicine, University of California at San Francisco.
出版信息
J Gerontol A Biol Sci Med Sci. 2014 Sep;69(9):1146-53. doi: 10.1093/gerona/glu024. Epub 2014 Mar 3.
BACKGROUND
Nutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years.
METHODS
Data are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures.
RESULTS
In adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models.
CONCLUSIONS
Nutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults.
背景
营养风险和低 BMI 在社区居住的老年人中很常见，但尚不清楚这些因素与长期随访期间的卫生服务利用和死亡率有何关联。本研究旨在评估营养风险和 BMI 与全因、非手术和手术住院治疗、入住养老院和 8.5 年内死亡的前瞻性关联。
方法
数据来自阿拉巴马大学伯明翰分校老龄化研究的 1000 名参与者，这是一项针对阿拉巴马州年龄在 65 岁及以上的黑人和白人居民的纵向观察性研究。使用与 DETE R MINE 清单相关的问题评估营养风险。BMI 分为体重不足（<18.5）、正常体重（18.5-24.9）、超重（25.0-29.9）、I 级肥胖（30.0-34.9）和 II 级和 III 级肥胖（≥35.0）。使用 Cox 比例风险模型评估全因、非手术和手术住院治疗、入住养老院和死亡率的风险。协变量包括社会支持、社会孤立、合并症和人口统计学指标。
结果
在调整后的模型中，营养风险高的人全因住院的风险增加 51%（95%置信区间：1.14-2.00），非手术住院的风险增加 50%（95%置信区间：1.11-2.01；参照：低营养风险）。营养风险中度的人死亡风险增加 54%（95%置信区间：1.19-1.99）。调整后的模型中 BMI 与任何结局均无关。
结论
营养风险与全因住院、非手术住院和死亡率有关。营养风险可能会影响导致卫生服务利用和死亡的失能过程。这些发现表明，需要更加关注社区居住的老年人的营养评估、干预和服务。
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