Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea.
Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea.
Maturitas. 2018 Jan;107:50-55. doi: 10.1016/j.maturitas.2017.10.006. Epub 2017 Oct 9.
Frailty and cognitive impairment in late life increase the risk of mortality. Physical frailty is closely associated with cognitive impairment. The aim of the study was to examine the independent and interaction effects of frailty and cognitive impairment in predicting mortality.
A nationally representative sample of community-dwelling Koreans aged 65 years and older (n=11,266) was followed for 3 years.
Frailty was categorized using Fried's phenotype model. Cognitive impairment was defined as more than 1.5 standard deviations below the age-, gender-, and education-specific norm of the Mini-Mental State Examination. Cox proportional hazards regression was used to analyze the mortality risk by frailty status and the moderating effect of cognitive impairment.
Frailty was associated with cognitive impairment, with 922 (19.1%), 1609 (28.1%), and 392 (42.8%) of the nonfrail, prefrail, and frail group, respectively, being cognitively impaired. Compared with the nonfrail group, those who were prefrail (hazard ratio [HR]=1.38; 95% confidence interval [CI]: 1.10, 1.73) and frail (HR=1.78, 95% CI: 1.29, 2.46) had higher mortality rates, after adjusting for sociodemographic variables, health behaviors, and chronic conditions. Cognitive impairment was associated with a 30% increased mortality rate. A significant interaction between frailty and cognitive impairment was observed (p=0.003). Compared with those nonfrail and not cognitively impaired, frail persons with cognitive impairment had a lower survival rate (HR=1.92, 95% CI: 1.26, 2.93).
Frailty was a significant predictor of 3-year mortality in community-dwelling older adults, with the association being moderated by baseline cognitive status. Taking cognitive function into account may allow better prediction of adverse outcomes of frailty in later life.
老年人的虚弱和认知障碍会增加死亡率。身体虚弱与认知障碍密切相关。本研究旨在探讨虚弱和认知障碍对预测死亡率的独立和交互作用。
本研究对年龄在 65 岁及以上的韩国社区居民进行了一项全国代表性样本(n=11266)，随访 3 年。
使用 Fried 的表型模型对虚弱进行分类。认知障碍定义为简易精神状态检查的年龄、性别和教育特定标准以下超过 1.5 个标准差。采用 Cox 比例风险回归分析虚弱状态与死亡率的关系，以及认知障碍的调节作用。
虚弱与认知障碍相关，非虚弱、虚弱前期和虚弱组分别有 922(19.1%)、1609(28.1%)和 392(42.8%)存在认知障碍。与非虚弱组相比，虚弱前期(HR=1.38；95%置信区间[CI]：1.10，1.73)和虚弱组(HR=1.78，95% CI：1.29，2.46)的死亡率更高，调整了社会人口统计学变量、健康行为和慢性疾病后。认知障碍与死亡率增加 30%相关。虚弱和认知障碍之间存在显著的交互作用(p=0.003)。与非虚弱且无认知障碍的人群相比，虚弱且有认知障碍的人群生存率较低(HR=1.92，95% CI：1.26，2.93)。
虚弱是社区居住的老年人 3 年死亡率的重要预测因素，其与基线认知状态有关。考虑认知功能可能会更好地预测老年人虚弱的不良后果。
