Geriatric Unit, Campus Bio-Medico University of Rome, Rome.
Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.
Geriatr Gerontol Int. 2018 May;18(5):685-691. doi: 10.1111/ggi.13226. Epub 2017 Dec 28.
To date, there is no consensus on which set of variables should be used to identify older persons at risk of disability in activities of daily living. The present study aimed to: (i) evaluate how different deficits cluster in a population of community-dwelling older persons; and (ii) investigate whether the discriminative capacity of physical performance measures towards the development of disability might be improved by adding psychological, social and environmental indicators.
Data are from 709 non-disabled older persons participating in the "Invecchiare in Chianti" study. We carried out a cluster analysis of 12 deficits in multiple functional domains, selected from the available frailty assessment instruments. Then, participants were assigned to a group, based on the obtained clusters of variables. For each group, we measured the prognostic capacity and the predictive ability for 6-year disability.
The analysis showed a "physical" cluster (including weight loss, reduced grip strength/gait speed/physical activity, impaired balance, environmental barriers) and a "psychosocial" cluster (e.g. living alone, depression, low income). Thus, participants were classified into four groups according to the presence of a physical and/or psychosocial cluster. Compared with the "fit" group, the relative risks of becoming disabled in the "physical," "psychosocial" and "mixed" deficit groups were 2.23 (95% CI 0.71-7.00), 1.52 (95% CI 0.62-3.75) and 6.37 (95% CI 2.83-14.33), respectively. The positive and negative predictive values for the "physical," "psychosocial" and "mixed" deficit groups were, respectively, 9% and 87%, 6% and 83%, and 27% and 94%.
As expected, physical and psychosocial deficits cluster predominantly into different groups. Even when both are considered simultaneously, the ability to predict incident disability is still insufficient. Geriatr Gerontol Int 2018; 18: 685-691.
迄今为止，对于应使用哪些变量集来识别日常生活活动中存在残疾风险的老年人，尚无共识。本研究旨在：（i）评估不同缺陷在社区居住的老年人人群中如何聚集；（ii）研究通过添加心理、社会和环境指标，是否可以提高身体机能测量对残疾发展的鉴别能力。
数据来自于参加“Invecchiare in Chianti”研究的 709 名非残疾老年人。我们对来自可用的衰弱评估工具的多个功能领域的 12 个缺陷进行了聚类分析。然后，根据获得的变量聚类，将参与者分配到一个组。对于每个组，我们测量了 6 年残疾的预后能力和预测能力。
分析显示了一个“身体”聚类（包括体重减轻、握力/步速/身体活动减少、平衡受损、环境障碍）和一个“心理社会”聚类（例如独居、抑郁、低收入）。因此，根据是否存在身体和/或心理社会聚类，参与者被分为四组。与“健康”组相比，“身体”、“心理社会”和“混合”缺陷组发生残疾的相对风险分别为 2.23（95%CI 0.71-7.00）、1.52（95%CI 0.62-3.75）和 6.37（95%CI 2.83-14.33）。“身体”、“心理社会”和“混合”缺陷组的阳性和阴性预测值分别为 9%和 87%、6%和 83%以及 27%和 94%。
正如预期的那样，身体和心理社会缺陷主要聚集在不同的组中。即使同时考虑这两者，预测事件性残疾的能力仍然不足。老年医学与老年病学杂志 2018；18：685-691。
