Sanders Jason L, Arnold Alice M, Hirsch Calvin H, Thielke Stephen M, Kim Dae, Mukamal Kenneth J, Kizer Jorge R, Ix Joachim H, Kaplan Robert C, Kritchevsky Stephen B, Newman Anne B
Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts.
Department of Biostatistics, University of Washington, Seattle, Washington.
J Am Geriatr Soc. 2016 Jun;64(6):1242-9. doi: 10.1111/jgs.14163.
To ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity).
Prospective, community-based cohort study in four U.S. cities.
Cardiovascular Health Study.
Individuals aged 65 and older.
Participants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty-reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self-reported healthy life (YHL), and mortality using multivariable regression and survival analysis.
After adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60-1.33) more YAL and 0.54 (95% CI = 0.19-0.90) more YHL than expected agers, and those who were prematurely frail had -0.99 (95% CI = -1.36 to -0.62) fewer YAL and -0.53 (95% CI = -0.89 to -0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P < .001). Adapters spent 55% of their remaining life able and healthy, those who were prematurely frail spent 37%, and of expected agers spent 47% (P < .001).
Despite similar levels of disease burden, older adults who were more vigorous appeared to compress morbidity and live longer. Older adults with higher frailty lengthened morbidity and had greater mortality. Adaptive factors may compress morbidity and decrease mortality.
确定患有广泛性疾病但相对有活力的老年人（适应者）是否会缩短临终前伴有发病情况的生存期（压缩发病期）。
在美国四个城市开展的前瞻性、基于社区的队列研究。
心血管健康研究。
65岁及以上的个体。
根据疾病程度（通过非侵入性评估）、活力和虚弱程度，将参与者分为三组（预期年龄者（n = 3528，疾病程度与活力和虚弱程度参考组相似）、适应者（n = 882，疾病程度较高但有活力）和过早虚弱者（n = 855，疾病程度较低但虚弱）），并使用多变量回归和生存分析，根据有能力生活的年限（YAL）、自我报告的健康生活年限（YHL）和死亡率进行比较。
调整后，适应者比预期年龄者多0.97年的有能力生活年限（95%置信区间（CI）= 0.60 - 1.33）和多0.54年的自我报告健康生活年限（95% CI = 0.19 - 0.90），而过早虚弱者比预期年龄者少0.99年的有能力生活年限（95% CI = -1.36至 -0.62）和少0.53年的自我报告健康生活年限（95% CI = -0.89至 -0.17）。适应者比预期年龄者的总寿命多0.9年，过早虚弱者比预期年龄者少1.5年（P <.001）。适应者在剩余生命中有55%的时间有能力且健康，过早虚弱者为37%，预期年龄者为47%（P <.001）。
尽管疾病负担水平相似，但活力更强的老年人似乎能压缩发病期并活得更长。虚弱程度较高的老年人发病期延长且死亡率更高。适应性因素可能会压缩发病期并降低死亡率。
