Kojima Gotaro
a Japan Green Medical Centre , London , UK.
Disabil Rehabil. 2017 Sep;39(19):1897-1908. doi: 10.1080/09638288.2016.1212282. Epub 2016 Aug 24.
Frailty has been shown to be associated with disability in the previous studies. However, it is not clear how consistently or to how much degree frailty is actually associated with the future disability risks.
A systematic review of the literature was conducted using Embase, MEDLINE, CINAHL, PsycINFO, and the Cochrane Library for any prospective studies published from 2010 to September 2015 examining associations between baseline frailty status and subsequent risk of developing or worsening disabilities among community-dwelling older people. A meta-analysis was performed to synthesize pooled estimates.
Of 7012 studies identified through the systematic review, 20 studies were included in the meta-analysis. Twelve studies examined activities of daily living (ADL) disability risks, two studies examined instrumental activities of daily living (IADL) disability risks, and six studies examined both ADL and IADL disability risks. Overall, frail older people were more likely to develop or worsen disabilities in ADL (12 studies, pooled OR = 2.76, 95% CI = 2.23-3.44, p < 0.00001; 5 studies, pooled HR = 2.23, 95% CI = 1.42-3.49, p < 0.00001) and IADL (6 studies, pooled OR = 3.62, 95% CI = 2.32-5.64, p < 0.00001; 2 studies, pooled HR = 4.24, 95% CI = 0.85-21.28, p = 0.08). Prefrailty was also associated with incident or worsening disability risks to a lesser degree in most pooled analyses. High heterogeneity observed among 12 studies with OR of ADL disability risks for frailty was explored using subgroup analyses, which suggested methodological quality and mean age of the cohort were the possible causes.
This systematic review meta-analysis quantitatively showed that frail older people are at higher risks of disabilities. These results are important for all related parties given population aging worldwide. Interventions for frailty are important to prevent disability and preserve physical functions, autonomy, and quality of life. Implications for Rehabilitation Although frailty has been shown to be associated with disability and considered as a precursor of disability, it is not clear how consistently or to how much degree frailty is actually associated with the future disability risks. This systematic review and meta-analysis quantitatively shows frailty is a significant predictor of incident and worsening ADL and IADL disabilities. It is a pressing priority to develop interventions for frailty to prevent disability and preserve older people's physical functions, autonomy, and quality of life.
在以往研究中，衰弱已被证明与残疾有关。然而，目前尚不清楚衰弱与未来残疾风险之间的关联有多一致，或在多大程度上相关。
利用Embase、MEDLINE、CINAHL、PsycINFO和Cochrane图书馆对2010年至2015年9月发表的任何前瞻性研究进行文献系统综述，这些研究考察了社区居住老年人基线衰弱状态与随后发生或残疾恶化风险之间的关联。进行荟萃分析以综合汇总估计值。
通过系统综述确定的7012项研究中，有20项研究纳入了荟萃分析。12项研究考察了日常生活活动（ADL）残疾风险，2项研究考察了工具性日常生活活动（IADL）残疾风险，6项研究同时考察了ADL和IADL残疾风险。总体而言，衰弱的老年人更有可能出现ADL残疾或使其恶化（12项研究，合并比值比[OR]=2.76，95%置信区间[CI]=2.23-3.44，p<0.00001；5项研究，合并风险比[HR]=2.23，95%CI=1.42-3.49,p<0.00001）以及IADL残疾（6项研究，合并OR=3.62，95%CI=2.32-5.64，p<0.00001；2项研究，合并HR=4.24，95%CI=0.85-21.28，p=0.08）。在大多数汇总分析中，衰弱前期与残疾发生或恶化风险的关联程度也较低。使用亚组分析探讨了12项关于衰弱的ADL残疾风险OR的研究中观察到的高异质性，这表明方法学质量和队列的平均年龄可能是原因。
这项系统综述荟萃分析定量显示，衰弱的老年人残疾风险更高。鉴于全球人口老龄化，这些结果对所有相关方都很重要。针对衰弱的干预措施对于预防残疾和维持身体功能、自主性及生活质量很重要。康复治疗的意义尽管衰弱已被证明与残疾有关，并被视为残疾的先兆，但目前尚不清楚衰弱与未来残疾风险之间的关联有多一致，或在多大程度上相关。这项系统综述和荟萃分析定量显示，衰弱是ADL和IADL残疾发生及恶化的重要预测因素。开发针对衰弱的干预措施以预防残疾并维持老年人的身体功能、自主性及生活质量是当务之急。
