髋部骨折后男性和女性身体虚弱及其组成部分的纵向特征。
Longitudinal characteristics of physical frailty and its components in men and women post hip fracture.
机构信息
Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, Maryland, USA.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
出版信息
J Am Geriatr Soc. 2024 Jan;72(1):170-180. doi: 10.1111/jgs.18595. Epub 2023 Sep 19.
BACKGROUND
Frailty is an important geriatric syndrome predicting adverse health outcomes in older adults. However, the longitudinal characteristics of frailty components in post-hip fracture patients are less understood. Adopting the Fried frailty definition, we examined the longitudinal trends and sex trajectory differences in frailty and its components over 1 year post-fracture.
METHODS
Three hundred and twenty-seven hip fracture patients (162 men and 165 women with mean age 80.1 and 81.5) from Baltimore Hip Studies 7th cohort with measurements at 22 days after admission, and months 2, 6, and 12 post-fracture were analyzed. Frailty components included: grip strength, gait speed, weight, total energy expenditure, and exhaustion. Longitudinal analysis used mixed effect models.
RESULTS
At baseline, men were sicker with worse cognitive status, and had higher weight and grip strength, but lower total energy expenditure than women (p < 0.001). The prevalence of frailty was 31.5%, 30.2%, and 28.2% at months 2, 6, and 12 respectively, showing no longitudinal trends or sex differences. However, its components showed substantial recovery trends over the post-fracture year after confounding adjustments, including increasing gait speed, reducing risk of exhaustion, and stabilized weight loss and energy expenditure over time. Particularly, while men's grip strength tended to remain stable over first year post surgery within patients, women's grip strength reduced significantly over time within patients. On average over time within patients, women were more active with higher energy expenditures but lower grip strength and weight than men.
CONCLUSION
Significant recovery trends and sex differences were observed in frailty components during first year post-fracture. Overall frailty status did not show those trends over months 2-12 since a summary measure might obscure changes in components. Therefore, frailty components provided important multi-dimensional information on the complex recovery process of patients, indicating targets for intervention beyond the global binary measure of frailty.
背景
衰弱是一种重要的老年综合征，可预测老年人的不良健康结局。然而，髋部骨折后衰弱成分的纵向特征尚不清楚。采用 Fried 衰弱定义，我们研究了骨折后 1 年内衰弱及其各成分的纵向趋势和性别轨迹差异。
方法
来自巴尔的摩髋部研究 7 期的 327 例髋部骨折患者（162 例男性和 165 例女性，平均年龄为 80.1 和 81.5 岁），在入院后第 22 天、骨折后 2、6 和 12 个月进行了测量。衰弱的组成部分包括握力、步态速度、体重、总能量消耗和疲惫。纵向分析使用混合效应模型。
结果
基线时，男性的病情更严重，认知状态更差，体重和握力更高，但总能量消耗较低（p<0.001）。衰弱的患病率分别为骨折后 2、6 和 12 个月的 31.5%、30.2%和 28.2%，无纵向趋势或性别差异。然而，在混杂调整后，其各组成部分在骨折后一年内显示出明显的恢复趋势，包括步态速度加快、减少疲惫风险以及体重和能量消耗随时间稳定。特别是，虽然男性患者的握力在手术后的第一年基本保持稳定，但女性患者的握力在患者内随时间显著下降。平均而言，女性患者在患者内的活动量更高，能量消耗更高，但握力和体重比男性低。
结论
在骨折后 1 年内，衰弱各组成部分出现了显著的恢复趋势和性别差异。在 2-12 个月内，总体衰弱状态并未显示出这些趋势，因为综合衡量可能会掩盖各组成部分的变化。因此，衰弱的各组成部分提供了关于患者复杂康复过程的重要多维信息，表明除了衰弱的整体二元衡量标准外，还有干预目标。
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