Hyde Zoë, Flicker Leon, Smith Kate, Atkinson David, Fenner Stephen, Skeaf Linda, Malay Roslyn, Lo Giudice Dina
Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
Rural Clinical School of WA, University of Western Australia, Perth, Australia; Kimberley Aboriginal Medical Services, Broome, Australia.
Maturitas. 2016 May;87:89-94. doi: 10.1016/j.maturitas.2016.02.013. Epub 2016 Feb 26.
Frailty represents a loss of homeostasis, markedly increasing the risk of death and disability. Frailty has been measured in several ethnic groups, but not, to our knowledge, in Aboriginal Australians. We aimed to determine the prevalence and incidence of frailty, and associations with mortality and disability, in remote-living Aboriginal people.
Between 2004 and 2006, we recruited 363 Aboriginal people aged ≥ 45 years from 6 remote communities and one town in the Kimberley region of Western Australia (wave 1). Between 2011 and 2013, 182 surviving participants were followed-up (wave 2). We assessed frailty with an index, comprising 20 health-related items. Participants with ≥ 4 deficits (frailty index ≥ 0.2) were considered frail. Disability was assessed by family/carer report. Those unable to do ≥ 2 of 6 key or instrumental activities of daily living were considered disabled. We investigated associations between frailty, and disability and mortality, with logistic regression and Cox proportional hazards models.
At wave 1 (W1), 188 participants (65.3%) were frail, and of robust people at W1 who participated in wave 2, 38 (51.4%) had become frail. Frailty emerged at a younger age than expected. A total of 109 people died (30.0%), of whom 80 (73.4%) were frail at W1. Frailty at W1 was not associated with becoming disabled, but was associated with mortality (HR = 1.9; 95% CI 1.2, 3.0).
Frailty in remote-living Aboriginal Australians is highly prevalent; substantially higher than in other populations. Research to understand the underlying causes of frailty in this population, and if possible, reverse frailty, is urgently needed.
衰弱代表体内平衡的丧失，显著增加死亡和残疾风险。已在多个种族群体中对衰弱进行了测量，但据我们所知，尚未在澳大利亚原住民中进行过测量。我们旨在确定偏远地区居住的原住民中衰弱的患病率和发病率，以及与死亡率和残疾的关联。
2004年至2006年期间，我们从西澳大利亚金伯利地区的6个偏远社区和1个城镇招募了363名年龄≥45岁的原住民（第1波）。2011年至2013年期间，对182名存活参与者进行了随访（第2波）。我们使用一个包含20项与健康相关条目的指数来评估衰弱。有≥4项缺陷（衰弱指数≥0.2）的参与者被视为衰弱。残疾情况通过家庭/照顾者报告进行评估。无法完成6项关键或工具性日常生活活动中≥2项的人被视为残疾。我们使用逻辑回归和Cox比例风险模型研究衰弱与残疾和死亡率之间的关联。
在第1波（W1）时，188名参与者（65.3%）衰弱，而在参与第2波的W1时的非衰弱人群中，有38人（51.4%）变得衰弱。衰弱出现的年龄比预期的要小。共有109人死亡（30.0%），其中80人（73.4%）在W1时衰弱。W1时的衰弱与致残无关，但与死亡率相关（风险比=1.9；95%置信区间1.2，3.0）。
居住在偏远地区的澳大利亚原住民中衰弱非常普遍；大大高于其他人群。迫切需要开展研究以了解该人群衰弱的根本原因，并尽可能逆转衰弱。
