New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Massachusetts.
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, Massachusetts.
J Gerontol A Biol Sci Med Sci. 2019 Jul 12;74(8):1257-1264. doi: 10.1093/gerona/gly232.
Frailty is a key determinant of clinical outcomes. We sought to describe frailty among U.S. Veterans and its association with mortality.
Nationwide retrospective cohort study of regular Veterans Affairs (VA) users, aged at least 65 years in 2002-2012, followed through 2014, using national VA administrative and Medicare and Medicaid data. A frailty index (FI) for VA (VA-FI) was calculated using the cumulative deficit method. Thirty-one age-related deficits in health from diagnostic and procedure codes were included and were updated biennially. Survival analysis assessed associations between VA-FI and mortality.
A VA-FI was calculated for 2,837,152 Veterans over 10 years. In 2002, 35.5% were non-frail (FI = 0-0.10), 32.6% were pre-frail (FI = 0.11-0.20), 18.9% were mildly frail (FI = 0.21-0.30), 8.7% were moderately frail (FI = 0.31-0.40), and 4.3% were severely frail (FI > 0.40). From 2002 to 2012, the prevalence of moderate frailty increased to 12.7%and severe frailty to 14.1%. Frailty was strongly associated with survival and was independent of age, sex, race, and smoking; the VA-FI better predicted mortality than age alone. Although prevalence of frailty rose over time, compared to non-frail Veterans, 2 years' hazard ratios (95% confidence intervals) for mortality declined from a peak in 2004 of 2.01 (1.97-2.04), 3.49 (3.44-3.55), 5.88 (5.79-5.97), and 10.39 (10.23-10.56) for pre-frail, mildly, moderately, and severely frail, respectively, to 1.51 (1.49-1.53), 2.36 (2.33-2.39), 3.68 (3.63-3.73), 6.62 (6.53-6.71) in 2012. At every frailty level, risk of mortality was lower for women versus men and higher for blacks versus whites.
Frailty affects at least 3 of every 10 U.S. Veterans aged 65 years and older, and is strongly associated with mortality. The VA-FI could be used to more accurately estimate life expectancy and individualize care for Veterans.
衰弱是临床结局的关键决定因素。我们旨在描述美国退伍军人的衰弱情况及其与死亡率的关系。
这是一项全国性的退伍军人事务部（VA）患者回顾性队列研究，2002 年至 2012 年间年龄至少 65 岁，随访至 2014 年，使用国家 VA 行政和医疗保险和医疗补助数据。使用累积缺陷法计算 VA 衰弱指数（VA-FI）。包括 31 种与年龄相关的健康缺陷，每两年更新一次。生存分析评估了 VA-FI 与死亡率之间的关系。
10 年间计算了 2837152 名退伍军人的 VA-FI。2002 年，35.5%的人非衰弱（FI=0-0.10），32.6%的人衰弱前期（FI=0.11-0.20），18.9%的人轻度衰弱（FI=0.21-0.30），8.7%的人中度衰弱（FI=0.31-0.40），4.3%的人严重衰弱（FI>0.40）。从 2002 年到 2012 年，中度衰弱的患病率增加到 12.7%，严重衰弱的患病率增加到 14.1%。衰弱与生存密切相关，与年龄、性别、种族和吸烟无关；VA-FI 比年龄更能准确预测死亡率。尽管衰弱的患病率随着时间的推移而上升，但与非衰弱的退伍军人相比，2004 年死亡率的 2 年风险比（95%置信区间）分别下降至 2.01（1.97-2.04）、3.49（3.44-3.55）、5.88（5.79-5.97）和 10.39（10.23-10.56），分别为衰弱前期、轻度衰弱、中度衰弱和严重衰弱，2012 年分别下降至 1.51（1.49-1.53）、2.36（2.33-2.39）、3.68（3.63-3.73）、6.62（6.53-6.71）。在每个衰弱水平，女性的死亡率风险低于男性，黑人的死亡率风险高于白人。
衰弱影响了至少每 10 名 65 岁及以上美国退伍军人中的 3 名，与死亡率密切相关。VA-FI 可用于更准确地估计预期寿命并为退伍军人提供个性化护理。
