老年人握力、功能与死亡率：一种时变分析方法。
Handgrip Strength, Function, and Mortality in Older Adults: A Time-varying Approach.
机构信息
Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND.
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
出版信息
Med Sci Sports Exerc. 2018 Nov;50(11):2259-2266. doi: 10.1249/MSS.0000000000001683.
PURPOSE
To determine the time-varying associations between 1) decreased handgrip strength and disabilities in each activity of daily living (ADL) function, and 2) disaggregated ADL limitations and time to mortality in older adults.
METHODS
A United States nationally representative sample of 17,747 older adults from the Health and Retirement Study were followed up for 8 yr. Maximal handgrip strength was measured with a hand-held dynamometer. Ability to perform ADL was self-reported. Date of death was identified by the National Death Index and exit interviews. Separate covariate-adjusted hierarchical logit models were used to examine the time-varying associations between decreased handgrip strength and each ADL outcome. Distinct covariate-adjusted Cox models were used to analyze the time-varying associations between disaggregated ADL limitations and time to mortality.
RESULTS
Every 5-kg decrease in handgrip strength was associated with increased odds for the following ADL limitations: 20% for eating, 14% for walking, 14% for bathing, 9% for dressing, 8% for transferring, and 6% for toileting. The presence of a bathing, walking, toileting, eating, and dressing ADL disability was associated with a 47%, 43%, 32%, 30%, and 19% higher hazard for mortality, respectively. A transferring ADL disability was not significantly associated with mortality.
CONCLUSIONS
Decreased handgrip strength was associated with increased odds for each ADL limitation, and in turn, most individual ADL impairments were associated with a higher hazard for mortality in older adults. These findings provide insights into the disabling process by identifying which ADL limitations are most impacted by decreased handgrip strength and the subsequent time to mortality for each ADL disability.
目的
确定握力下降与日常生活活动（ADL）功能障碍之间的时变关联 1），以及 2）ADL 受限的细分与老年人的死亡时间。
方法
使用手持测力计测量了来自健康与退休研究的 17747 名美国全国代表性老年人样本的最大握力。ADL 能力通过自我报告进行评估。通过国家死亡指数和离职面谈确定死亡日期。分别使用经过协变量调整的层次逻辑模型来检验握力下降与每项 ADL 结果之间的时变关联。使用经过区分的经过协变量调整的 Cox 模型来分析 ADL 受限细分与死亡时间之间的时变关联。
结果
握力每下降 5 公斤，以下 ADL 受限的几率就会增加：进食受限增加 20%，行走受限增加 14%，洗澡受限增加 14%，穿衣受限增加 9%，转移受限增加 8%，如厕受限增加 6%。存在洗澡、行走、如厕、进食和穿衣 ADL 残疾的人，其死亡的风险分别增加了 47%、43%、32%、30%和 19%。转移 ADL 残疾与死亡率无显著关联。
结论
握力下降与每项 ADL 受限的几率增加有关，而反过来，大多数 ADL 损伤都与老年人死亡的风险增加有关。这些发现通过确定哪些 ADL 受限受握力下降影响最大以及每种 ADL 残疾的随后死亡时间，深入了解了致残过程。
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