Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.
Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
Age Ageing. 2017 Nov 1;46(6):994-1000. doi: 10.1093/ageing/afx095.
adults aged 80 and over, a fast growing age-group, with increased co-morbidity and frailty have not been the focus of previous research on dyspnoea. We investigate the correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over.
about 565 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had assessment of Medical Research Council dyspnoea scale (MRC), forced expiratory volume in 1 s (FEV1), N-terminal pro-brain natriuretic peptide (NT-proBNP), physical performance tests, grip strength, 15 items geriatric depression scale, activities of daily living (ADL), body mass index (BMI) and demographics data. Kaplan-Meier survival curves, Cox and logistic multivariable regression, classification and regression tree (CART) analysis assessed association of dyspnoea (MRC 3-5) with time-to-cardiovascular and all-cause death (5 years), time to first hospitalisation (3 years), new/worsened ADL disability (2 years), and its correlates.
participants with dyspnoea MRC 3-5 (29.9%) had increased hazard ratios for cardiovascular mortality 2.85 (95% confidence interval 1.93-4.20), all-cause mortality 2.04 (1.58-2.64), first hospitalisation 1.72 (1.35-2.19); and increased odds ratio for new/worsened disability 2.49 (1.54-4.04), independent of age, sex and smoking status. Only FEV1, physical performance, BMI and NT-proBNP (in order of importance) were selected in the tree-based classification model for dyspnoea.
in a cohort of adults aged 80 and over, dyspnoea was common and an independent predictor of adverse outcomes, with cardio-respiratory and physical performance impairments as key independent correlates. Its routine and comprehensive evaluation in primary care could be very valuable in caring for this age-group.
80 岁及以上的成年人是一个快速增长的年龄群体，他们合并症和虚弱的发生率更高，但之前的呼吸困难研究并未关注这一年龄群体。我们调查了该队列中 80 岁及以上成年人呼吸困难的相关因素及其与不良结局的关系。
大约 565 名居住在社区的 80 岁及以上的 BELFRAIL 前瞻性队列研究的成年人接受了医学研究委员会呼吸困难量表（MRC）、1 秒用力呼气量（FEV1）、N 端脑利钠肽前体（NT-proBNP）、身体机能测试、握力、15 项老年抑郁量表、日常生活活动（ADL）、身体质量指数（BMI）和人口统计学数据的评估。Kaplan-Meier 生存曲线、Cox 和逻辑多变量回归、分类和回归树（CART）分析评估了呼吸困难（MRC 3-5）与心血管和全因死亡（5 年）、首次住院（3 年）、新发/加重 ADL 残疾（2 年）时间的相关性，及其相关因素。
呼吸困难 MRC 3-5 组（29.9%）的参与者发生心血管死亡的风险比为 2.85（95%置信区间 1.93-4.20），全因死亡率为 2.04（1.58-2.64），首次住院的风险比为 1.72（1.35-2.19）；新发/加重残疾的比值比为 2.49（1.54-4.04），独立于年龄、性别和吸烟状况。仅 FEV1、身体机能、BMI 和 NT-proBNP（按重要性顺序）被选入基于树的呼吸困难分类模型。
在 80 岁及以上的成年人队列中，呼吸困难很常见，是不良结局的独立预测因素，心肺功能和身体机能损害是关键的独立相关因素。在初级保健中常规和全面评估呼吸困难可能对这一年龄组的护理非常有价值。
