Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae, Itabashi, Tokyo 173-0015, Japan.
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae, Itabashi, Tokyo 173-0015, Japan.
Prev Med. 2021 Aug;149:106620. doi: 10.1016/j.ypmed.2021.106620. Epub 2021 May 14.
This cluster nonrandomized controlled trial examined the effectiveness of a 2-year community-wide intervention (CWI) on population-level frailty and functional health among older adults. We allocated 18 districts in Ota City, Tokyo, Japan, to intervention (3 districts, A-C) and control (15 districts) groups. Of the 15,500 stratified randomly sampled residents aged 65-84 years, 11,701 (6009 in intervention and 5692 in control groups) gave valid responses to the baseline survey and were followed for 2 years. Using participatory action research framework, we developed an evidence-based CWI to promote frailty prevention. The outcomes were changes in frailty (primary), functional health (secondary, i.e., physical, nutritional, and psychosocial variables), and awareness. Primary analyses showed no significant group by time interactions in frailty prevalence (difference in multivariate-adjusted change between groups, 1.8 percentage points [PP] [95% CI, -0.1, 3.6]). Although changes in functional health were similar between groups, prespecified subgroup analyses showed a benefit for ≥150 min/week of walking (3.9 PP [1.9-5.8]) in district A, and for exercise ≥1 time/week (2.1 PP [0.1-4.0]), Motor Fitness Scale (0.10 points [0.01-0.20]), Dietary Variety Score (DVS) (0.10 points [0.01-0.18]), DVS of ≥7 (2.0 PP [0.01-4.1]), and going outdoors ≥1 time/day (2.1 PP [0.1-4.1]) in district C. Awareness of our CWI was significantly higher in the intervention group (multivariate-adjusted difference between groups, 5.8 PP [3.9-7.8]). This CWI increased awareness in intervention group and improved population-level functional health in intervention subgroups in the short term but was not effective for population-level frailty prevention at 2 years. Trial registration: UMIN-CTR (UMIN000026515).
本整群非随机对照试验旨在研究为期 2 年的社区范围干预（CWI）对老年人人口层面的虚弱和功能健康的效果。我们将日本东京大田市的 18 个区分配到干预（A-C 区）和对照组（15 个区）。在 15500 名分层随机抽样的 65-84 岁居民中，有 11701 人（干预组 6009 人，对照组 5692 人）对基线调查做出了有效回应，并随访了 2 年。我们采用参与式行动研究框架制定了一项基于证据的 CWI，以促进虚弱预防。主要结局为虚弱变化（主要结局）、功能健康变化（次要结局，即身体、营养和心理社会变量）和认知变化。主要分析显示，虚弱流行率方面无显著的组间时间交互作用（组间多变量调整变化差异，1.8 个百分点 [PP] [95%CI，-0.1，3.6]）。尽管两组间功能健康的变化相似，但预设的亚组分析显示，每周步行≥150 分钟（3.9 PP [1.9-5.8]）的 A 区和每周运动≥1 次（2.1 PP [0.1-4.0]）、运动能力量表（0.10 分 [0.01-0.20]）、饮食多样性评分（DVS）（0.10 分 [0.01-0.18]）、DVS≥7（2.0 PP [0.01-4.1]）和每天外出≥1 次（2.1 PP [0.1-4.1]）的 C 区存在获益。干预组对我们的 CWI 的认知明显更高（组间多变量调整差异，5.8 PP [3.9-7.8]）。该 CWI 在短期内增加了干预组的认知，并改善了干预亚组人群层面的功能健康，但在 2 年内对人群层面的虚弱预防无效。试验注册：UMIN-CTR（UMIN000026515）。
