Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France; Unité Mixte de Recherche (UMR) Institut National de la Santé et de la recherche médicale (INSERM) 1027, University of Toulouse III, France.
Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France; Unité Mixte de Recherche (UMR) Institut National de la Santé et de la recherche médicale (INSERM) 1027, University of Toulouse III, France.
Am J Med. 2018 Nov;131(11):1382.e7-1382.e13. doi: 10.1016/j.amjmed.2018.06.002. Epub 2018 Jul 1.
The objective of this study was to investigate whether a long-term multidomain lifestyle intervention was associated with the severity and incidence of frailty in older adults.
A 3-year randomized controlled trial was conducted among 1637 French community dwellers age ≥70: 821 controls and 816 who received a multidomain lifestyle intervention (cognitive training, nutrition counseling, and advice on physical activity). The intervention involved 12 2-hour sessions (in the first 2 months) followed by a 1-hour session each month until the study end. Controls received the usual care but did not receive any personalized lifestyle intervention. A frailty index (FI; range = 0-1, higher is worse) composed of 32 items was calculated at baseline, 6 months, 1 year, 2 years, and 3 years and constituted our main endpoint. FI ≥ 0.25 defined frailty. The 4 outcomes were severity of frailty (continuous FI score), incident frailty, incidence of persistent frailty (frailty at 2 consecutive time points), and reversibility of frailty (from frailty to nonfrailty).
Mixed-effect linear regression did not find a significant effect of the multidomain intervention on FI score. Frailty incidence occurred in 241 of 1146 subjects (138 controls and 103 in the multidomain group), whereas incidence of persistent frailty occurred in 75 of 1042 subjects (48 controls and 27 in the multidomain group). Cox models adjusted for baseline FI scores showed that compared with controls, subjects in the multidomain group had a decreased risk of developing both frailty (hazard ratio 0.72; 95% confidence interval, 0.55-0.93) and persistent frailty (hazard ratio 0.53; 95% confidence interval, 0.33-0.85).
This multidomain lifestyle intervention was associated with a reduced risk of developing frailty but did not affect the severity of frailty in community-dwelling older adults.
本研究旨在探讨长期多领域生活方式干预是否与老年人虚弱的严重程度和发生有关。
对 1637 名居住在法国社区、年龄≥70 岁的老年人进行了一项为期 3 年的随机对照试验：821 名对照组和 816 名接受多领域生活方式干预（认知训练、营养咨询和体育活动建议）的患者。干预包括 12 次 2 小时的课程（前 2 个月），随后每月进行 1 次课程，直至研究结束。对照组接受常规护理，但未接受任何个性化的生活方式干预。基线时计算了由 32 项组成的虚弱指数（FI；范围=0-1，分数越高越差），并在 6 个月、1 年、2 年和 3 年时进行了测量，作为我们的主要终点。FI≥0.25 定义为虚弱。4 个结局分别为虚弱的严重程度（连续 FI 评分）、虚弱的发生、持续性虚弱的发生（连续 2 个时间点的虚弱）和虚弱的可逆性（从虚弱到非虚弱）。
混合效应线性回归未发现多领域干预对 FI 评分有显著影响。1146 名受试者中有 241 名（138 名对照组和 103 名多领域组）发生虚弱，1042 名受试者中有 75 名（48 名对照组和 27 名多领域组）发生持续性虚弱。调整基线 FI 评分的 Cox 模型显示，与对照组相比，多领域组发生虚弱（风险比 0.72；95%置信区间，0.55-0.93）和持续性虚弱（风险比 0.53；95%置信区间，0.33-0.85）的风险降低。
这种多领域生活方式干预与降低发生虚弱的风险有关，但对社区居住的老年人虚弱的严重程度没有影响。
