CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France.
Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France.
BMC Geriatr. 2021 Feb 26;21(1):142. doi: 10.1186/s12877-021-02063-7.
Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people's independence trajectories and associated risk factors would enable the develop early intervention strategies.
Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011-November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the "Functional Autonomy Measurement System (Système de Mesure de l'Autonomie Fonctionnelle (SMAF))". Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory.
Three distinct trajectories of independence were identified including a "Stable functional autonomy (SFA) trajectory" (53% of patients), a "Stable then decline functional autonomy decline (SDFA) trajectory" (33% of patients) and a "Constantly functional autonomy decline (CFAD) trajectory" (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD.
Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.
独立性与衰老过程有关。丧失独立性的定义是指无法做出决策和参与日常生活活动（ADLs）。独立性与身体、心理、生物和社会经济因素有关。增强对老年人独立轨迹和相关风险因素的理解，将能够制定早期干预策略。
在 Unité de Prévention de Suivi et d'Analyse du Vieillissement（UPSAV）数据库中识别的患者中进行了独立轨迹分析。UPSAV 队列是一项前瞻性观察性研究。参与者为 2011 年 7 月至 2013 年 11 月期间 221 名年龄≥75 岁的社区居住者，随访 24 个月，并受益于预防策略。数据使用问卷进行前瞻性收集。独立性使用“功能性自主测量系统（Système de Mesure de l'Autonomie Fonctionnelle (SMAF)）”进行评估。采用基于群体的轨迹建模（GBTM）来识别独立性轨迹，并将结果与 k-均值和层次升序分类进行比较。采用多项逻辑回归分析识别独立性轨迹的预测因素。
确定了三种不同的独立性轨迹，包括“稳定的功能独立性（SFA）轨迹”（53%的患者）、“稳定然后下降的功能独立性下降（SDFA）轨迹”（33%的患者）和“持续下降的功能独立性下降（CFAD）轨迹”（14%的患者）。不属于协会成员和以前跌倒与 SDFA 轨迹显著相关（P<0.01）。缺乏经济和人力援助、没有爱好和认知障碍与 CFAD 轨迹显著相关（P<0.01）。以前的职业和多种疾病是 SDFA 和 CFAD 两种下降轨迹的预测因素。
社区居住的老年人表现出不同的独立性轨迹和预测因素。这项研究的证据表明，应该预期对老年人的独立性丧失进行预防和筛查，以维持自主性。
