Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Mov Disord. 2021 Aug;36(8):1871-1878. doi: 10.1002/mds.28561. Epub 2021 Mar 23.
Frailty is a geriatric syndrome with negative health impacts not captured by comorbidity and disability alone. The prevalence of frailty in Parkinson's disease (PD) has been described, but data on frailty-associated outcomes are limited.
To describe the level of frailty and investigate the association between frailty and outcomes in a Medicare sample of persons diagnosed with PD.
We used the claims-based frailty index to assess frailty in a cohort of Medicare beneficiaries with PD in 2013. Frailty was categorized as non-frail/pre-frail, mildly frail, moderately frail, and severely frail. Adjusted logistic regression models examined the relationship between frailty and mortality, hospitalization, emergency department visits, and fall-related injuries through 2014.
Of 62,786 beneficiaries with PD in 2013, 55.3% were frail. Frail individuals were more likely to be female, older, Black, metropolitan dwelling, without neurologist care, nursing facility residents, or multimorbid. The average daily levodopa equivalent dose initially increased, then decreased from the pre-frail to the severely frail groups. Compared to non-frail/pre-frail persons, severely frail persons had higher adjusted odds of 1-year mortality (AOR 2.74, 95% CI 1.98, 3.78), hospitalization (AOR 2.34, 95% CI 1.74, 3.14), emergency department visits (AOR 2.97, 95% CI 2.14, 4.13), and fall-related injury (AOR 1.43, 95% CI 0.90, 2.26).
Frailty is common and differentially distributed among older adults with PD. Frailty in PD is associated with adverse health outcomes and death. Observational study analyses may benefit from adjustment for frailty; claims-based frailty surveillance may identify vulnerable PD patients in health system, registry, or administrative data. © 2021 International Parkinson and Movement Disorder Society.
衰弱是一种老年综合征，其健康影响不仅限于合并症和残疾。帕金森病（PD）患者的衰弱患病率已被描述，但与衰弱相关结局的数据有限。
描述医疗保险样本中 PD 患者的衰弱水平，并研究衰弱与结局之间的关系。
我们使用基于索赔的衰弱指数评估 2013 年医疗保险受益人群中 PD 患者的衰弱情况。将衰弱分为非衰弱/衰弱前期、轻度衰弱、中度衰弱和重度衰弱。调整后的逻辑回归模型通过 2014 年的死亡率、住院率、急诊就诊率和与跌倒相关的伤害来检查衰弱与这些结局之间的关系。
在 2013 年的 62786 名 PD 受益人群中，55.3%为衰弱。衰弱患者更可能为女性、年龄较大、黑人、居住在大都市、未接受神经科医生治疗、居住在护理机构或多病共存。左旋多巴等效日剂量最初增加，然后从衰弱前期到严重衰弱组逐渐减少。与非衰弱/衰弱前期人群相比，严重衰弱人群的 1 年死亡率（调整比值比 2.74，95%可信区间 1.98，3.78）、住院率（调整比值比 2.34，95%可信区间 1.74，3.14）、急诊就诊率（调整比值比 2.97，95%可信区间 2.14，4.13）和与跌倒相关的伤害（调整比值比 1.43，95%可信区间 0.90，2.26）风险更高。
衰弱在 PD 老年患者中较为常见且分布不均。PD 中的衰弱与不良健康结局和死亡有关。观察性研究分析可能受益于衰弱的调整；基于索赔的衰弱监测可能会在医疗保健系统、登记处或行政数据中识别出易受影响的 PD 患者。 © 2021 国际帕金森病和运动障碍学会。
