Okabe Daichi, Tsuji Taishi, Kondo Katsunori
Advanced Preventive Medical Sciences, Chiba University Graduate School of Medical and Pharmaceutical Sciences.
Chiba University Center for Preventive Medical Sciences.
Nihon Ronen Igakkai Zasshi. 2018;55(3):367-377. doi: 10.3143/geriatrics.55.367.
In Japan, the Kihon checklist, which a useful part of the Comprehensive Geriatric Assessment (CGA), is performed using questionnaire. On the other hand, specific health checkup screens are available for some basic diseases, such as diabetes and dyslipidemia, which can cause stroke, the largest cause of long-term care need. However, to date, no report has compared CGA and health checkups in older people for their ability to predict healthy life expectancy; therefore, this study was undertaken to do that.
Data from the Japan Gerontological Evaluation Study (JAGES) 2010, a self-administered mail survey of independent people aged 65 years or older, were used. A total of 9,756 participants in six cities responded to the questionnaire, underwent a health check, and were followed up for 3 years.Cox proportional hazards models were used to estimate hazard ratios (HR) for the eventual need for long-term care level 2 or more or death, adjusting for sex, age, drinking or smoking habits, educational years, and equivalent income. Explanatory variables in the Kihon checklist included seven risks, namely, general frailty, functional disability, malnutrition, oral dysfunction, seclusion, cognitive impairment, and depression, and in specific health checkups, 15 required items including metabolic syndrome.
The incident rate of long-term care level 2 or more or death was 19.4/1,000 person-years. All risks in the Kihon checklist, excluding oral dysfunction, were significant (range of HRs: 1.44-3.63). Six items in the specific health checkups (urine protein, low BMI, AST, HDL, FPG, and HbA1c) were significant (range of HRs: 1.37-2.07). Metabolic syndrome was not significant (HR: 1.05).
Therefore, CGA performed using questionnaire predicts healthy life expectancy better than a health checkup based on a blood test.
在日本，作为综合老年评估（CGA）有用组成部分的基本检查表是通过问卷调查来进行的。另一方面，针对一些可能导致中风（长期护理需求的最大原因）的基础疾病，如糖尿病和血脂异常，有特定的健康检查项目。然而，迄今为止，尚无报告比较CGA和健康检查对老年人预测健康预期寿命的能力；因此，开展本研究以进行此项比较。
使用来自日本老年学评估研究（JAGES）2010的数据，这是一项对65岁及以上独立人群的自填式邮件调查。六个城市的9756名参与者回复了问卷，接受了健康检查，并随访3年。采用Cox比例风险模型估计最终需要二级及以上长期护理或死亡的风险比（HR），并对性别、年龄、饮酒或吸烟习惯、受教育年限和等效收入进行调整。基本检查表中的解释变量包括七个风险因素，即一般身体衰弱、功能残疾、营养不良、口腔功能障碍、社交隔离、认知障碍和抑郁，而在特定健康检查中，包括代谢综合征在内的15项必查项目。
二级及以上长期护理或死亡的发生率为19.4/1000人年。基本检查表中除口腔功能障碍外的所有风险因素均具有统计学意义（HR范围：1.44 - 3.63）。特定健康检查中的六项指标（尿蛋白、低体重指数、谷草转氨酶、高密度脂蛋白、空腹血糖和糖化血红蛋白）具有统计学意义（HR范围：1.37 - 2.07）。代谢综合征无统计学意义（HR：1.05）。
因此，通过问卷调查进行的CGA比基于血液检查的健康检查能更好地预测健康预期寿命。
