de Breij Sascha, Rijnhart Judith J M, Schuster Noah A, Rietman M Liset, Peters Mike J L, Hoogendijk Emiel O
Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands.
Department of Life Course and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Prev Med Rep. 2021 Oct 7;24:101589. doi: 10.1016/j.pmedr.2021.101589. eCollection 2021 Dec.
Frailty is associated with a higher risk of mortality, but not much is known about underlying pathways of the frailty-mortality association. In this study, we explore a wide range of possible mediators of the relation between frailty and mortality. Data were used from the Longitudinal Aging Study Amsterdam (LASA). We included 1477 older adults aged 65 years and over who participated in the study in 2008-2009 and linked their data to register data on mortality up to 2015. We examined a range of lifestyle, social, psychological, cognitive, and physical factors as potential mediators. All analyses were stratified by sex. We used causal mediation analyses to estimate the indirect effects in single-mediator analyses. Statistically significant mediators were then included in multiple-mediator analyses to examine their combined effect. The results showed that older men (OR = 2.79, 95% CI = 1.23;6.34) and women (OR = 2.31, 95% CI = 1.24;4.30) with frailty had higher odds of being deceased 6 years later compared to those without frailty. In men, polypharmacy (indirect effect OR = 1.21, 95% CI = 1.03;1.50) was a statistically significant mediator in this association. In women, polypharmacy, self-rated health, and multimorbidity were statistically significant mediators in the single-mediator models, but only the indirect effect of polypharmacy remained in the multiple-mediator model (OR = 1.16, 95% CI = 1.03;1.38). In conclusion, of many factors that were considered, we identified polypharmacy as explanatory factor of the association between frailty and mortality in older men and women. This finding has important clinical implications, as it suggests that targeting polypharmacy in frail older adults could reduce their risk of mortality.
衰弱与较高的死亡风险相关，但对于衰弱与死亡之间关联的潜在途径了解不多。在本研究中，我们探讨了一系列衰弱与死亡关系的可能中介因素。数据来自阿姆斯特丹纵向衰老研究（LASA）。我们纳入了1477名65岁及以上的老年人，他们在2008 - 2009年参与了该研究，并将他们的数据与截至2015年的死亡登记数据相联系。我们考察了一系列生活方式、社会、心理、认知和身体因素作为潜在中介因素。所有分析均按性别分层。我们使用因果中介分析来估计单中介分析中的间接效应。然后将具有统计学意义的中介因素纳入多中介分析，以检验它们的综合效应。结果显示，与非衰弱老年人相比，衰弱的老年男性（OR = 2.79，95%CI = 1.23；6.34）和女性（OR = 2.31，95%CI = 1.24；4.30）在6年后死亡的几率更高。在男性中，多重用药（间接效应OR = 1.21，95%CI = 1.03；1.50）是该关联中具有统计学意义的中介因素。在女性中，多重用药、自评健康状况和多种疾病并存是单中介模型中具有统计学意义的中介因素，但在多中介模型中只有多重用药的间接效应仍然显著（OR = 1.16，95%CI = 1.03；1.38）。总之，在众多被考虑的因素中，我们确定多重用药是老年男性和女性衰弱与死亡关联的解释因素。这一发现具有重要的临床意义，因为它表明针对衰弱老年人的多重用药问题可能会降低他们的死亡风险。
