Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Medical Informatics Center, Peking University, Beijing, China.
J Am Geriatr Soc. 2021 Oct;69(10):2877-2887. doi: 10.1111/jgs.17311. Epub 2021 Jun 10.
BACKGROUND/OBJECTIVES: To identify visual trajectories and examine their relationships with physical and cognitive function in older Chinese adults. DESIGN: Population-based longitudinal study. SETTING: The Chinese Longitudinal Healthy Longevity Survey. PARTICIPANTS: A total of 16,151 participants aged ≥65 years. MEASUREMENTS: Visual, physical (including activities of daily living [ADL] and instrumental ADL [IADL]), and cognitive function were assessed at baseline and subsequently every 3 years. ADI disability and IADL disability were defined as needing any help in any item of the Katz scale and a modified Lawton's scale, respectively. Cognitive impairment was defined as a Chinese version of the Mini-Mental State Examination score below 24. A group-based trajectory model was used to determine visual trajectories adjusted for age, sex, and education. Associations of visual trajectories with ADL disability, IADL disability, and cognitive impairment were evaluated using generalized estimating equation models adjusted for potential confounders. RESULTS: This study identified three distinct visual trajectories, including no decline (32.4%), moderate decline (48.3%), and progressive decline (19.3%) during the follow-up period. Compared with the no decline trajectory, both the moderate decline (ADL disability: OR = 2.75, 95% CI: 2.30-3.28; IADL disability: OR = 3.01, 95% CI: 2.74-3.31; cognitive impairment: OR = 3.37, 95% CI: 3.02-3.76) and the progressive decline (ADL disability: OR = 8.50, 95% CI: 6.55-11.02; IADL disability: OR = 12.96, 95% CI: 9.95-16.87; cognitive impairment: OR = 10.84, 95% CI: 8.89-13.23) trajectories were significantly associated with an increased risk of functional impairment. Compared with the moderate decline trajectory, the progressive decline trajectory was significantly associated with an increased risk of ADL disability (OR = 3.09, 95% CI: 2.46-3.89), IADL disability (OR = 4.30, 95% CI: 3.29-5.61), and cognitive impairment (OR = 3.22, 95% CI:2.63-3.93). CONCLUSION: Older Chinese adults exhibit three distinct visual trajectories and those with decline trajectories in vision have an increased risk of functional impairment than those with a trajectory of no decline in vision.
背景/目的：识别中国老年人的视觉轨迹，并研究其与身体和认知功能的关系。 设计：基于人群的纵向研究。 地点：中国长寿纵向研究。 参与者：共 16151 名年龄≥65 岁的参与者。 测量：在基线和随后每 3 年评估一次视觉、身体（包括日常生活活动[ADL]和工具性日常生活活动[IADL]）和认知功能。ADI 残疾和 IADL 残疾定义为在 Katz 量表和 Lawton 量表的任何一项中需要任何帮助。认知障碍定义为中文版简易精神状态检查评分低于 24 分。使用基于群组的轨迹模型来确定经过年龄、性别和教育调整后的视觉轨迹。使用广义估计方程模型调整潜在混杂因素后，评估视觉轨迹与 ADL 残疾、IADL 残疾和认知障碍的关系。 结果：本研究确定了三种不同的视觉轨迹，包括在随访期间没有下降（32.4%）、中度下降（48.3%）和渐进性下降（19.3%）。与没有下降轨迹相比，中度下降（ADL 残疾：OR=2.75，95%CI：2.30-3.28；IADL 残疾：OR=3.01，95%CI：2.74-3.31；认知障碍：OR=3.37，95%CI：3.02-3.76）和渐进性下降（ADL 残疾：OR=8.50，95%CI：6.55-11.02；IADL 残疾：OR=12.96，95%CI：9.95-16.87；认知障碍：OR=10.84，95%CI：8.89-13.23）轨迹与功能受损风险增加显著相关。与中度下降轨迹相比，渐进性下降轨迹与 ADL 残疾（OR=3.09，95%CI：2.46-3.89）、IADL 残疾（OR=4.30，95%CI：3.29-5.61）和认知障碍（OR=3.22，95%CI：2.63-3.93）风险增加显著相关。 结论：中国老年人存在三种不同的视觉轨迹，与没有视觉轨迹下降的老年人相比，视觉轨迹下降的老年人功能障碍风险增加。
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