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. 2023 Apr;169:107449. doi: 10.1016/j.ypmed.2023.107449. Epub 2023 Feb 13.
Preventing frailty is crucial in aging societies. We examined the effectiveness of a community-based frailty-prevention program for delaying the onset of functional disability among community-dwelling older adults. From 2014 to 2019, 48 community-based frailty prevention classes (FPC, 60 min/session, once a week), comprising resistance exercise and nutritional or psychosocial programs, were established in Yabu City, Japan. We conducted a baseline survey in 2012 and followed up with participants for up to 6.8 years (4.8 years from establishing the first FPC). We analyzed data from 3350 older people. The primary and secondary outcomes were the onset of functional disability and cause-specific functional disability (including dementia and cardiovascular and orthopedic diseases), respectively. In addition to crude Cox proportional hazard regression, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM; 918 nonparticipants and 459 participants) were used to adjust for confounders. Participants were more likely to be female and have a healthy lifestyle than nonparticipants. During the follow-up, 690 individuals developed a functional disability. The hazard ratio of incident functional disability in the participants was significantly lower than that in nonparticipants in the IPTW (hazard ratio 0.53, 95% confidential interval 0.38-0.75) and PSM (0.52, 0.37-0.71) analyses. In age-stratified analysis, significant associations were observed only in the ≥75-year-old subgroup. In a cause-specific analysis, participation significantly and consistently reduced incident functional disability caused by dementia (IPTW 0.47, 0.25-0.86; PSM 0.45, 0.25-0.83). Community-based FPC may be effective for preventing functional disability, especially caused by dementia, in this population.
在老龄化社会中，预防虚弱至关重要。我们研究了一种基于社区的虚弱预防计划对延缓社区居住的老年人发生功能障碍的效果。2014 年至 2019 年，在日本八街市设立了 48 个基于社区的虚弱预防班（FPC，每次 60 分钟，每周一次），包括抗阻运动和营养或心理社会项目。我们在 2012 年进行了基线调查，并对参与者进行了长达 6.8 年的随访（从第一个 FPC 建立开始随访 4.8 年）。我们分析了 3350 名老年人的数据。主要和次要结局分别是功能障碍的发生和特定原因的功能障碍（包括痴呆症和心血管及骨科疾病）。除了粗 Cox 比例风险回归外，还使用逆概率治疗加权（IPTW）和倾向评分匹配（PSM；918 名非参与者和 459 名参与者）来调整混杂因素。与非参与者相比，参与者更有可能是女性，且生活方式更健康。在随访期间，690 人出现了功能障碍。在 IPTW（风险比 0.53，95%置信区间 0.38-0.75）和 PSM（0.52，0.37-0.71）分析中，参与者发生功能障碍的风险比显著低于非参与者。在年龄分层分析中，仅在≥75 岁亚组中观察到显著关联。在特定原因分析中，参与显著且一致地降低了由痴呆引起的新发功能障碍（IPTW 0.47，0.25-0.86；PSM 0.45，0.25-0.83）。基于社区的 FPC 可能对预防该人群的功能障碍，特别是由痴呆引起的功能障碍有效。
