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内在能力和多种疾病预测残疾发生的情况-来自宜兰纵向老龄化研究的见解。

Intrinsic capacity and multimorbidity predicting incident disability-Insights from the I-Lan Longitudinal Aging Study.

机构信息

Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan.

Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

Arch Gerontol Geriatr. 2024 Jun;121:105357. doi: 10.1016/j.archger.2024.105357. Epub 2024 Feb 3.

Abstract

OBJECTIVES

This longitudinal cohort study aimed to examine the effect of intrinsic capacity (IC) and multimorbidity on the development of new disabilities.

METHODS

The study utilized data from 1,009 participants without disabilities from the I-Lan Longitudinal Aging Study. Multivariable logistic regressions were employed to assess the predictive capability of IC (ranging from 0 to 100) and multimorbidity for incident disability over a 7-year follow-up period.

RESULTS

Both low IC (OR 4.9, 95 % CI 2.1-11.1, p < 0.001) and multimorbidity (OR 4.5, 95 % CI 2.2-9.2, p < 0.001) significantly predicted incident disability over the 7-year period. A one-point increase in IC reduced the risk of incident disability by 10 % (OR 0.9, 95 % CI 0.8-0.9, p < 0.001). Among IC subdomains, both better locomotion (OR 0.96, 95 % CI 0.94-0.99, p = 0.014) and psychology (OR 0.97, 95 %CI 0.94-1.00, p = 0.049) significantly reduced the risk of incident disability. Rapid declines in IC significantly predicted incident disability (OR 4.1, 95 % CI 1.8-9.3, p = 0.001), whereas the onset of new multimorbidity or changes in the number of chronic conditions did not demonstrate a significant association with incident disability. The interaction terms between IC and multimorbidity, both categorically (low IC * multimorbidity, p = 0.959) and numerically (IC (per point) * multimorbidity, p = 0.660) were all statistically insignificant.

CONCLUSIONS

IC exhibited better predictive capacity for 7-year incident disability compared to multimorbidity, so health care services targeting older adults should adopt an integrated care approach that combines both function- and disease-centric strategies.

摘要

目的

本纵向队列研究旨在探讨内在能力(IC)和多种合并症对新残疾发展的影响。

方法

本研究使用了来自无残疾的 1009 名参与者的宜兰纵向老龄化研究的数据。采用多变量逻辑回归评估 IC(范围为 0 至 100)和多种合并症在 7 年随访期间对新发残疾的预测能力。

结果

低 IC(OR 4.9,95%CI 2.1-11.1,p < 0.001)和多种合并症(OR 4.5,95%CI 2.2-9.2,p < 0.001)均显著预测了 7 年内新发残疾。IC 每增加 1 分,新发残疾的风险降低 10%(OR 0.9,95%CI 0.8-0.9,p < 0.001)。在 IC 子领域中,更好的运动能力(OR 0.96,95%CI 0.94-0.99,p = 0.014)和心理状况(OR 0.97,95%CI 0.94-1.00,p = 0.049)均显著降低了新发残疾的风险。IC 的快速下降显著预测了新发残疾(OR 4.1,95%CI 1.8-9.3,p = 0.001),而新发多种合并症或慢性疾病数量的变化与新发残疾无显著相关性。IC 和多种合并症之间的交互项,无论是分类(低 IC*多种合并症,p = 0.959)还是数值(IC(每点)*多种合并症,p = 0.660),均无统计学意义。

结论

IC 对 7 年新发残疾的预测能力优于多种合并症,因此,针对老年人的医疗保健服务应采用一种综合护理方法,将功能和疾病为中心的策略相结合。

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