机构养老老年人的衰弱与死亡率或新发残疾：FINAL研究
Frailty and mortality or incident disability in institutionalized older adults: the FINAL study.
作者信息
de la Rica-Escuín Marisa, González-Vaca Julia, Varela-Pérez Rosana, Arjonilla-García María Dolores, Silva-Iglesias Marta, Oliver-Carbonell José Luis, Abizanda Pedro
机构信息
Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
出版信息
Maturitas. 2014 Aug;78(4):329-34. doi: 10.1016/j.maturitas.2014.05.022. Epub 2014 Jun 2.
BACKGROUND
Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic.
OBJECTIVES
To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults.
DESIGN
Concurrent cohort study.
SETTING
Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain.
PARTICIPANTS
Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data.
MEASUREMENTS
Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3).
RESULTS
287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p<0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7-6.6) adjusted for all study covariables.
CONCLUSION
In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.
背景
对于机构养老的老年人的衰弱情况知之甚少，关于这一主题的纵向研究也很少。
目的
确定西班牙机构养老的老年人中衰弱与死亡率或日常生活基本活动（BADL）中发生残疾之间的关联。
设计
同期队列研究。
地点
西班牙阿尔瓦塞特的两家养老院，即瓦斯科·努涅斯·德·巴尔沃亚养老院和古巴大道养老院。
参与者
在基线时纳入的324名65岁以上的机构养老成年人中，有21人（5.5%）在一年的随访期间失访。在剩下的303人中，63人（20.8%）死亡，91人（30.0%）出现新发残疾，140人（49.2%）未发生这两种情况。16名参与者因数据不完整而不适合进行分析。
测量方法
衰弱定义为存在三个或更多弗里德标准：非故意体重减轻、精力不足、疲惫、行动迟缓以及身体活动量低。当通过巴氏指数检测到在洗澡、修饰、如厕、穿衣、进食或转移方面出现新发残疾时，视为BADL中发生残疾。构建逻辑回归模型，并对年龄、性别、体重指数（BMI）、先前的巴氏指数和简易精神状态检查表（MMSE）以及高合并症（查尔森指数≥3）进行调整。
结果
287名参与者有有效数据。平均年龄84.2岁（标准差6.8），其中187名（65.2%）为女性。199名（69.3%）衰弱，72名（25.1%）有高合并症。平均BMI为27.6（标准差5.2），巴氏指数为53.4（标准差37.1），MMSE为14.2（标准差9.7）。在随访中，43名（21.6%）衰弱参与者和15名（17.0%）非衰弱参与者死亡。73名（46.8%）衰弱参与者和16名（21.9%）非衰弱参与者在BADL中出现新发残疾（p<0.001）。在对所有研究协变量进行调整后，衰弱与新发残疾或死亡率相关（比值比3.3；95%置信区间1.7 - 6.6）。
结论
在一组机构养老的老年人中，衰弱与死亡率或BADL中发生残疾相关。
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