Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundarció Sant Joan de Déu, Dr Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5. Pabellón 11, 28029 Madrid, Spain; Visiting Fellow at Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, mSuite 600, Seattle, WA 98121, USA.
Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5. Pabellón 11, 28029 Madrid, Spain; Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Exp Gerontol. 2018 Jun;106:137-144. doi: 10.1016/j.exger.2018.02.028. Epub 2018 Feb 27.
Frailty is characterized by several deficits in multiple health related domains. Although cognition is among the important components of frailty, there is lack of evidence on the role of specific neuro-cognitive dimensions. The primary aim of the present work was to evaluate the multidimensional definition of frailty, and to assess whether neuro-cognitive function is a constituent of the frailty syndrome among adults aged ≥50 years living in three European countries. As a secondary aim, the construct validity of the created frailty index was tested (with inpatient and outpatient hospitalization), as well as its determinants.
Data were obtained from a cross-sectional, community-based, nationally-representative survey conducted in Finland, Poland and Spain (n = 7987 individuals aged ≥50 years). Socio-demographic, clinical, lifestyle and social factors were assessed using validated procedures. Cognitive function was assessed with the following tests: learning and short-term memory, working memory and verbal fluency. A frailty index was constructed based on 31 frailty attributes. Principal component analysis was used to identify the components of the frailty index. Logistic and Poisson regression analysis was also conducted.
The factor analysis on the components of the index extracted three main dimensions for frailty (disability and daily functioning, cognitive function, chronic health conditions), confirming the multiple dimensions of frailty. Various socio-demographic (e.g., financial status, education level) and lifestyle habits (alcohol consumption) were related with frailty. The presence of frailty was associated with 3.1 times higher odds for inpatient hospitalization (95%CI 2.75 to 3.51). Frailty was also related with higher frequency of outpatient visits.
These findings suggest that frailty is a multidimensional concept with three major dimensions. Neuro-congitive function seems to be a separate dimension of the frailty syndrome. Smoking habits and alcohol intake were positively related with frailty while inpatient and outpatient hospitalization were found to be associated to the level of frailty.
衰弱的特征是在多个健康相关领域存在多种缺陷。尽管认知是衰弱的重要组成部分之一，但缺乏关于特定神经认知维度作用的证据。本研究的主要目的是评估衰弱的多维定义，并评估神经认知功能是否是三个欧洲国家≥50 岁成年人衰弱综合征的一个组成部分。其次，测试了创建的衰弱指数的结构效度（包括住院和门诊住院）及其决定因素。
数据来自于一项在芬兰、波兰和西班牙进行的横断面、基于社区的、全国代表性调查（n=7987 名≥50 岁的个体）。使用经过验证的程序评估社会人口统计学、临床、生活方式和社会因素。认知功能通过以下测试进行评估：学习和短期记忆、工作记忆和语言流畅性。基于 31 个衰弱属性构建衰弱指数。使用主成分分析确定衰弱指数的组成部分。还进行了逻辑和泊松回归分析。
对指数组成部分的因子分析提取了衰弱的三个主要维度（残疾和日常功能、认知功能、慢性健康状况），证实了衰弱的多维性。各种社会人口统计学因素（如财务状况、教育水平）和生活方式习惯（饮酒）与衰弱有关。衰弱的存在与住院治疗的可能性增加 3.1 倍相关（95%CI 2.75 至 3.51）。衰弱也与门诊就诊频率增加有关。
这些发现表明衰弱是一个具有三个主要维度的多维概念。神经认知功能似乎是衰弱综合征的一个独立维度。吸烟习惯和饮酒与衰弱呈正相关，而住院和门诊就诊与衰弱程度有关。
