Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
J Am Med Dir Assoc. 2019 Feb;20(2):208-212.e3. doi: 10.1016/j.jamda.2018.05.013. Epub 2018 Jul 10.
We aimed to quantify the increased risk of disability associated with cardiovascular risk factors among older adults, and to verify whether this risk may vary by age and functional status.
Longitudinal population-based cohort study.
Urban area of Stockholm, Sweden.
Community-dwelling and institutionalized adults ≥60 years in the Swedish National study on Aging and Care in Kungsholmen free of cardiovascular diseases and disability (n = 1756) at baseline (2001-2004).
Incident disability in activities of daily living (ADL) was ascertained over 9 years. Cardiovascular risk factors (physical inactivity, alcohol consumption, smoking, high blood pressure, diabetes, high body mass index, high levels of total cholesterol, and high C-reactive protein) and walking speed were assessed at baseline. Data were analyzed using Cox proportional hazards models, stratifying by younger-old (age 60-72 years) and older-old (≥78 years).
During the follow-up, 23 and 148 persons developed ADL-disability among the younger- and older-old, respectively. In the younger-old, the adjusted hazard ratio (HR) of developing ADL-disability was 4.10 (95% confidence interval [CI] 1.22-13.76) for physical inactivity and 5.61 (95% CI 1.17-26.82) for diabetes. In the older-old, physical inactivity was associated with incident ADL-disability (HR 1.99, 95% CI 1.36-2.93), and there was a significant interaction between physical inactivity and walking speed limitation (<0.8 m/s), showing a 6-fold higher risk of ADL-disability in those who were both physically inactive and had walking speed limitation than being active with no limitation, accounting for a population-attributable risk of 42.7%.
CONCLUSIONS/IMPLICATIONS: Interventions targeting cardiovascular risk factors may be more important for the younger-old in decreasing the risk of disability, whereas improving physical function and maintaining physical activity may be more beneficial for the older-old.
我们旨在量化心血管危险因素与老年人残疾风险增加的关系，并验证这种风险是否会因年龄和功能状态而有所不同。
基于人群的纵向队列研究。
瑞典斯德哥尔摩市区。
在基线时（2001-2004 年）无心血管疾病和残疾的居住在社区和机构中的≥60 岁的瑞典全国老龄化和 Kungsholmen 护理研究中的成年人（n=1756）。
在 9 年内确定日常生活活动（ADL）的新发残疾。在基线时评估心血管危险因素（身体不活动、饮酒、吸烟、高血压、糖尿病、高体重指数、总胆固醇水平升高和 C 反应蛋白升高）和行走速度。使用 Cox 比例风险模型进行数据分析，按年轻老年人（年龄 60-72 岁）和老年老年人（≥78 岁）进行分层。
在随访期间，年轻老年人和老年老年人中分别有 23 人和 148 人出现 ADL 残疾。在年轻老年人中，不活动的调整后风险比（HR）为 4.10（95%置信区间[CI] 1.22-13.76），糖尿病的 HR 为 5.61（95%CI 1.17-26.82）。在老年老年人中，不活动与 ADL 残疾的发生相关（HR 1.99，95%CI 1.36-2.93），身体不活动和行走速度受限之间存在显著交互作用（<0.8 m/s），表明身体不活动且行走速度受限的人发生 ADL 残疾的风险比没有限制的人高 6 倍，占人群归因风险的 42.7%。
结论/意义：针对心血管危险因素的干预措施可能对降低年轻老年人残疾风险更为重要，而改善身体功能和保持身体活动可能对老年老年人更为有益。
