虚弱指数的变化及其与死亡率的关系。
Changes in a Frailty Index and Association with Mortality.
机构信息
Hinda and Arthur Marcus Institute for Aging, Hebrew Senior Life, Boston, Massachusetts, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
J Am Geriatr Soc. 2021 Apr;69(4):1057-1062. doi: 10.1111/jgs.17002. Epub 2020 Dec 29.
BACKGROUND
Although frailty status is dynamic, whether improvements in frailty predict mortality is unknown.
OBJECTIVE
Describe 1-year changes in a frailty index (FI) and association with 48-month mortality.
DESIGN
Secondary analysis of the National Health in Aging Trends Study.
SETTING
Community.
PARTICIPANTS
Five thousand six hundred and seventy two Medicare beneficiaries 65 and older (3,267 (55.8%) females).
MEASUREMENTS
A 40-item deficit accumulation FI was measured in 2011 and 2012, based on multidomain assessment including comorbidities, activities of daily living, physical tasks, cognition, and performance testing. We categorized 2011 FI into robust (FI < 0.15), pre-frail (FI = 0.15-0.24), mild frailty (FI = 0.25-0.34), and moderate to severe frailty (FI ≥ 0.35). Change in frailty was calculated as the FI change from 2011 to 2012, categorized as either absolute (>0.045 decrease, 0.015-0.045 decrease, ±0.015 change, 0.015-0.045 increase, >0.045 increase) or proportional change (>20% decrease, 5-20% decrease, ±5% change, 5-20% increase, 20% increase). We measured the association of FI change with 4-year mortality using Cox regression.
RESULTS
From 2011 to 2012, mean FI increased by 0.02 (standard deviation 0.07), with 58.6% having an increase. Over 4 years, 1,039 participants (13.6%) died. After adjusting for age and sex, compared to stable frailty (±0.015), both absolute (>0.045) and proportional (>20%) increases in frailty were associated with higher mortality among pre-frail participants (hazard ratio (HR) = 2.35, 95% confidence interval (CI) = (1.45-3.79) and HR (95% CI) = 3.32 (1.76-6.26), respectively), participants with mild frailty (HR (95% CI) = 1.96 (1.35-2.85) and 2.03 (1.37-3.02)) and moderate or severe frailty (HR (95% CI) = 1.99 (1.48-2.67) and 1.94 (1.43-2.63)) but not robust participants (HR (95% CI)= 1.48 (0.86-2.54), HR (95% CI) = 1.62 (0.80-3.28)). However, decreases in FI were not significantly associated with decreased risk of mortality.
CONCLUSIONS
Increasing deficit accumulation FI over 1 year is associated with increased mortality risk. While decreasing FI occurs, we did not find evidence to support reduced mortality risk.
背景
衰弱状态是动态的，但是改善衰弱状态是否可以预测死亡率尚不清楚。
目的
描述衰弱指数（FI）在一年内的变化情况，并探讨其与 48 个月死亡率的关系。
设计
国家老龄化趋势研究的二次分析。
地点
社区。
参与者
5672 名 65 岁及以上的医疗保险受益人（3267 名女性，占 55.8%）。
测量方法
根据包括合并症、日常生活活动、体力任务、认知和性能测试在内的多领域评估，于 2011 年和 2012 年测量了 40 项缺陷累积 FI。我们将 2011 年 FI 分为健康（FI<0.15）、衰弱前期（FI=0.15-0.24）、轻度衰弱（FI=0.25-0.34）和中重度衰弱（FI≥0.35）。衰弱变化的计算方法为 2011 年至 2012 年的 FI 变化，分为绝对变化（>0.045 下降、0.015-0.045 下降、±0.015 变化、0.015-0.045 增加、>0.045 增加）或比例变化（>20%下降、5-20%下降、±5%变化、5-20%增加、20%增加）。我们使用 Cox 回归分析 FI 变化与 4 年死亡率之间的关系。
结果
从 2011 年到 2012 年，FI 平均增加了 0.02（标准差 0.07），其中 58.6%的人增加了 FI。在 4 年期间，有 1039 名参与者（13.6%）死亡。调整年龄和性别后，与稳定的衰弱（±0.015）相比，衰弱前期参与者的 FI 绝对增加（>0.045）和比例增加（>20%）均与更高的死亡率相关（危险比（HR）=2.35，95%置信区间（CI）为（1.45-3.79）和 HR（95%CI）=3.32（1.76-6.26）），轻度衰弱（HR（95%CI）=1.96（1.35-2.85）和 2.03（1.37-3.02））和中度或重度衰弱（HR（95%CI）=1.99（1.48-2.67）和 1.94（1.43-2.63））参与者，但健康参与者（HR（95%CI）=1.48（0.86-2.54），HR（95%CI）=1.62（0.80-3.28））没有显著相关性。然而，FI 的下降与死亡率风险降低没有显著关联。
结论
在 1 年内，缺陷累积 FI 的增加与死亡率风险的增加相关。虽然 FI 有所下降，但我们没有发现死亡率风险降低的证据。
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