Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Gerontology. 2018;64(3):212-221. doi: 10.1159/000485135. Epub 2017 Dec 13.
Early identification of people at risk of functional decline is essential for delivering targeted preventive interventions.
The aim of this study is to identify and predict trajectories of functional decline over 9 years in males and females aged 60-70 years.
We included 403 community-dwelling participants from the InCHIANTI study and 395 from the LASA study aged 60-70 years at baseline, of whom the majority reported no functional decline at baseline (median 0, interquartile range 0-1). Participants were included if they reported data on ≥2 measurements of functional ability during a 9-year follow-up. Functional ability was scored with 6 self-reported items on activities of daily living. We performed latent class growth analysis to identify trajectories of functional decline and applied multinomial regression models to develop prediction models of identified trajectories. Analyses were stratified for sex.
Three distinct trajectories were identified: no/little decline (219 males, 241 females), intermediate decline (114 males, 158 females), and severe decline (36 males, 30 females). Higher gait speed showed decreased risk of functional limitations in males (intermediate limitations, odds ratio [OR] 0.74, 95% CI 0.57-0.97; severe limitations, OR 0.42, 95% CI 0.26-0.66). The final model in males further included the predictors fear of falling and alcohol intake (no/little decline, area under the receiver operating curve [AUC] 0.68, 95% CI 0.62-0.73; intermediate decline, AUC 0.63, 95% CI 0.56-0.69; severe decline, AUC 0.79, 95% CI 0.71-0.87). In females, higher gait speed showed a decreased risk of intermediate limitations (OR 0.51, 95% CI 0.38-0.68) and severe limitations (OR 0.18, 95% CI 0.07-0.44). Other predictors in females were age, living alone, economic satisfaction, balance, physical activity, BMI, and cardiovascular disease (no/little decline, AUC 0.80, 95% CI 0.75-0.85; intermediate decline, AUC 0.74, 95% CI 0.69-0.79; severe decline, AUC 0.95, 95% CI 0.91-0.99).
Already in people aged 60-70 years, 3 distinct trajectories of functional decline were identified in these cohorts over a 9-year follow-up. Predictors of trajectories differed between males and females, except for gait speed. Identification of people at risk is the basis for targeting interventions.
早期识别有功能下降风险的人群对于实施有针对性的预防干预至关重要。
本研究旨在确定并预测 60-70 岁男性和女性在 9 年内的功能下降轨迹。
我们纳入了来自 InCHIANTI 研究的 403 名社区居住参与者和来自 LASA 研究的 395 名年龄在 60-70 岁的参与者，其中大多数在基线时没有报告功能下降（中位数为 0，四分位距为 0-1）。如果参与者在 9 年随访期间报告了≥2 次功能能力测量数据，则将其纳入研究。功能能力通过 6 项自我报告的日常生活活动项目进行评分。我们进行了潜在类别增长分析以确定功能下降轨迹，并应用多项回归模型来开发识别轨迹的预测模型。分析按性别分层。
确定了 3 种不同的轨迹：无/轻度下降（219 名男性，241 名女性）、中度下降（114 名男性，158 名女性）和严重下降（36 名男性，30 名女性）。较高的步行速度降低了男性发生功能障碍的风险（中度障碍，比值比 [OR] 0.74，95%置信区间 [CI] 0.57-0.97；严重障碍，OR 0.42，95%CI 0.26-0.66）。男性的最终模型还包括恐惧跌倒和饮酒摄入量这两个预测因子（无/轻度下降，受试者工作特征曲线 [ROC]下面积 [AUC] 0.68，95%CI 0.62-0.73；中度下降，AUC 0.63，95%CI 0.56-0.69；严重下降，AUC 0.79，95%CI 0.71-0.87）。在女性中，较高的步行速度降低了发生中度障碍（OR 0.51，95%CI 0.38-0.68）和严重障碍（OR 0.18，95%CI 0.07-0.44）的风险。女性的其他预测因子包括年龄、独居、经济满意度、平衡能力、身体活动、BMI 和心血管疾病（无/轻度下降，AUC 0.80，95%CI 0.75-0.85；中度下降，AUC 0.74，95%CI 0.69-0.79；严重下降，AUC 0.95，95%CI 0.91-0.99）。
在这两个队列中，60-70 岁的人群在 9 年的随访中已经出现了 3 种不同的功能下降轨迹。男性和女性的轨迹预测因子不同，除了步行速度。识别高危人群是确定干预目标的基础。
