Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC - location VU University medical center, Amsterdam, the Netherlands.
Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain; CIBERFES, Ministerio de Economía y Competitividad, Spain.
J Am Med Dir Assoc. 2019 Sep;20(9):1105-1110. doi: 10.1016/j.jamda.2019.01.129. Epub 2019 Mar 8.
The aim of the current study was to investigate whether a new functional classification, based on basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with mortality in older adults during 10 years of follow-up.
Cohort study, with a follow-up of 10 years.
A total of 924 participants aged 70 and older from the Frailty and Dependence in Albacete (FRADEA) study, a population-based sample of Spanish older adults.
At baseline, a new functional classification of 8 categories was constructed with limitations in BADL using the Barthel Index, limitations in IADL using the Lawton IADL Index, and the criteria of the frailty phenotype. Associations with 10-year mortality were assessed using Kaplan-Meier curves and Cox proportional hazard models.
The risk of mortality gradually increased toward the less functionally independent end of the classification. The presence of mild, moderate, or severe BADL impairment was associated with mortality, in models adjusted for age, sex, comorbidity and institutionalization. The analyses also revealed that those who were BADL independent, IADL dependent and prefrail [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.22-4.20], and those who were BADL independent and frail (HR = 3.74, 95% CI = 1.88-7.42) had an increased risk of mortality.
CONCLUSIONS/IMPLICATIONS: A new functional classification composed of BADL, IADL, and frailty representing the functional continuum is effective in stratifying the risk for mortality in older adults. Frailty is a high-mortality-risk state close to subjects with mild disability in BADL, needing an intensive specialized approach. Prefrailty with any impairment in IADL has an intermediate mortality risk and should be offered primary care interventions.
本研究旨在探讨基于日常生活基本活动（BADL）和工具性日常生活活动（IADL）以及衰弱的新功能分类是否与 10 年随访期间老年人的死亡率相关。
队列研究，随访 10 年。
共纳入 924 名来自衰弱和依赖在阿瓦塞特（FRADEA）研究的 70 岁及以上老年人，该研究是西班牙老年人的一项基于人群的样本。
在基线时，使用 Barthel 指数构建了新的 8 类功能分类，用于 BADL 受限，使用 Lawton IADL 指数构建了 IADL 受限，以及衰弱表型的标准。使用 Kaplan-Meier 曲线和 Cox 比例风险模型评估与 10 年死亡率的关联。
随着分类中功能独立性逐渐降低，死亡率风险逐渐增加。轻度、中度或重度 BADL 受损与死亡率相关，调整年龄、性别、合并症和机构化后，模型仍然成立。分析还表明，那些 BADL 独立、IADL 依赖和虚弱前期的人（风险比[HR]2.27，95%置信区间[CI]1.22-4.20），以及那些 BADL 独立且虚弱的人（HR 3.74，95% CI 1.88-7.42）的死亡率风险增加。
结论/意义：由 BADL、IADL 和衰弱代表功能连续性的新功能分类能够有效分层老年人的死亡风险。衰弱是一种高死亡率风险状态，接近 BADL 轻度残疾的患者，需要强化专业治疗。任何 IADL 受损的虚弱前期具有中等死亡率风险，应提供初级保健干预措施。
