Strandberg Timo E, Lindström Linda, Jyväkorpi Satu, Urtamo Annele, Pitkälä Kaisu H, Kivimäki Mika
University of Helsinki, Clinicum, and Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland.
Center for Life Course Health Research, University of Oulu, Oulu, Finland.
Eur Geriatr Med. 2021 Oct;12(5):953-961. doi: 10.1007/s41999-021-00472-w. Epub 2021 Mar 4.
Multimorbidity, prefrailty, and frailty are frequent in ageing populations, but their independent relationships to long-term prognosis in home-dwelling older people are not well recognised.
In the Helsinki Businessmen Study (HBS) men with high socioeconomic status (born 1919-1934, n = 3490) have been followed-up from midlife. In 2000, multimorbidity (≥ 2 conditions), phenotypic prefrailty and frailty were determined in 1365 home-dwelling men with median age of 73 years). Disability was assessed as a possible confounder. 18-year mortality follow-up was established from registers and Cox regression used for analyses.
Of the men, 433 (31.7%) were nonfrail and without multimorbidity at baseline (reference group), 500 (36.6%) and 82 (6.0%) men had prefrailty or frailty, respectively, without multimorbidity, 84 (6.2%) men had multimorbidity only, and 201 (14.7%) and 65 (4.8%) men had prefrailty or frailty together with multimorbidity. Only 30 (2.2%) and 86 (6.3%) showed signs of ADL or mobility disability. In the fully adjusted analyses (including ADL disability, mental and cognitive status) of 18-year mortality, frailty without multimorbidity (hazard ratio 1.62, 95% confidence interval 1.13-2.31) was associated with similar mortality risk than multimorbidity without frailty (1.55, 1.17-2.06). The presence of both frailty and multimorbidity indicated a strong mortality risk (2.93, 2.10-4.07).
Although multimorbidity is generally considered a substantial health problem, our long-term observational study emphasises that phenotypic frailty alone, independently of disability, may be associated with a similar risk, and a combination of multimorbidity and frailty is an especially strong predictor of mortality.
多种疾病共存、衰弱前期和衰弱在老年人群中很常见，但它们与居家老年人长期预后的独立关系尚未得到充分认识。
在赫尔辛基商人研究（HBS）中，对社会经济地位较高的男性（出生于1919年至1934年，n = 3490）从中年期开始进行随访。2000年，在1365名中位年龄为73岁的居家男性中确定了多种疾病共存（≥2种疾病）、表型衰弱前期和衰弱情况。将残疾作为可能的混杂因素进行评估。通过登记建立了18年的死亡率随访，并使用Cox回归进行分析。
在这些男性中，433人（31.7%）在基线时无衰弱且无多种疾病共存（参照组），500人（36.6%）和82人（6.0%）分别有衰弱前期或衰弱但无多种疾病共存，84人（6.2%）仅有多种疾病共存，201人（14.7%）和65人（4.8%）有衰弱前期或衰弱且伴有多种疾病共存。只有30人（2.2%）和86人（6.3%）表现出日常生活活动能力或行动能力残疾的迹象。在对18年死亡率进行的完全调整分析（包括日常生活活动能力残疾、精神和认知状态）中，无多种疾病共存的衰弱（风险比1.62，95%置信区间1.13 - 2.31）与无衰弱的多种疾病共存（1.55，1.17 - 2.06）的死亡风险相似。衰弱和多种疾病共存表明死亡风险很高（2.93，2.10 - 4.07）。
尽管多种疾病共存通常被认为是一个重大的健康问题，但我们的长期观察性研究强调，仅表型衰弱，独立于残疾，可能与类似风险相关，并且多种疾病共存和衰弱的组合是死亡率的一个特别强的预测因素。
