Rodríguez-Laso Ángel, García-García Francisco José, Rodríguez-Mañas Leocadio
CIBERFES, ISCIII, Madrid, Spain.
CIBERFES, ISCIII, Madrid, Spain; Geriatric Department, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain.
J Am Med Dir Assoc. 2023 Jan;24(1):57-64. doi: 10.1016/j.jamda.2022.10.010. Epub 2022 Nov 17.
We aimed to explore predictors of sustained transitions (those that are maintained for an extra follow-up) between robustness and prefrailty in both directions.
Longitudinal population-based cohort.
Community-dwelling Spaniards 65 years or older from the Toledo Study of Healthy Ageing.
The Fried's frailty phenotype was measured over 3 waves (2006-2009, 2011-2013, and 2014-2017). Multiple logistic regressions compared individuals following the pattern robust-prefrail-prefrail with those who remained robust across waves, and those following the pattern prefrail-robust-robust with those who remained prefrail, for sociodemographic, clinical, life-habits, dependency for activities of daily living, upper and lower extremities' strength variables. The Fried's items of those who remained prefrail and those who became robust were compared.
Mean age was 72.3 years (95% CI: 71.8-72.8) and 57.9% (52.7%-63.0%) were women. After multivariate adjustment, predictors (apart from age) of the sustained transition robustness-prefrailty were as follows: number of drugs taken (odds ratio: 1.37; 95% CI: 1.14-1.65), not declaring the amount of alcohol consumed (8.32; 1.78-38.88), and grip strength (0.92 per kg; 0.86-0.99). Predictors of the sustained transition prefrailty-robustness were as follows: drinking alcohol (0.2; 0.05-0.83), uricemia (0.67; 0.49-0.93), number of chair stands in 30 seconds (1.14; 1.01-1.28), and grip strength (1.12; 1.05-1.2). Low grip strength was associated with a lower probability of regaining robustness.
Prediction of sustained transitions between the first stages of frailty development can be achieved with a reduced number of variables and noting whether the Fried's item leading to a diagnosis of prefrailty is low grip strength. Our results suggest the need to intensify interventions on deprescription, quitting alcohol, and strengthening of upper and lower limbs.
我们旨在探索在稳健状态和衰弱前期之间双向持续转变（即在额外随访期间保持的转变）的预测因素。
基于人群的纵向队列研究。
来自托莱多健康老龄化研究的65岁及以上居住在社区的西班牙人。
在三个时间段（2006 - 2009年、2011 - 2013年和2014 - 2017年）测量弗里德衰弱表型。多元逻辑回归比较了呈现稳健-衰弱前期-衰弱前期模式的个体与在各时间段均保持稳健的个体，以及呈现衰弱前期-稳健-稳健模式的个体与始终保持衰弱前期的个体，比较内容涉及社会人口统计学、临床、生活习惯、日常生活活动依赖程度、上下肢力量变量。对始终保持衰弱前期和变得稳健的个体的弗里德项目进行了比较。
平均年龄为72.3岁（95%置信区间：71.8 - 72.8），女性占57.9%（52.7% - 63.0%）。经过多变量调整后，稳健-衰弱前期持续转变的预测因素（年龄除外）如下：所服用药物数量（优势比：1.37；95%置信区间：1.14 - 1.65）、未申报酒精摄入量（8.32；1.78 - 38.88）以及握力（每千克0.92；0.86 - 0.99）。衰弱前期-稳健持续转变的预测因素如下：饮酒（0.2；0.05 - 0.83）、血尿酸血症（0.67；0.49 - 0.93）、30秒内起坐次数（1.14；1.01 - 1.28）以及握力（1.12；1.05 - 1.2）。低握力与恢复到稳健状态的可能性较低相关。
通过减少变量数量并注意导致衰弱前期诊断的弗里德项目是否为低握力，可以实现对衰弱发展第一阶段之间持续转变的预测。我们的结果表明需要加强关于减少用药、戒酒以及增强上下肢力量的干预措施。
