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基线固有能力及其子领域对多领域干预促进社区居住老年人健康老龄化总体效果的作用:一项全国性整群随机对照试验的分析。

Roles of Baseline Intrinsic Capacity and its Subdomains on the Overall Efficacy of Multidomain Intervention in Promoting Healthy Aging among Community-Dwelling Older Adults: Analysis from a Nationwide Cluster-Randomized Controlled Trial.

机构信息

Liang-Kung Chen, MD, PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan. E-mail addresses:

出版信息

J Prev Alzheimers Dis. 2024;11(2):356-365. doi: 10.14283/jpad.2024.20.


DOI:10.14283/jpad.2024.20
PMID:38374742
Abstract

BACKGROUND: Impaired intrinsic capacity (IC), which affects approximately 90% of older adults, is associated with a significantly heightened risk of frailty and cognitive decline. Existing evidence suggests that multidomain interventions have the potential to enhance cognitive performance and yield positive effects on physical frailty. OBJECTIVE: To examine roles of baseline IC and its subdomains on the efficacy of multidomain interventions in promoting healthy aging in older adults. DESIGN: a cluster-randomized controlled trial. SETTING AND PARTICIPANTS: 1,054 community-dwelling older adults from 40 community-based clusters across Taiwan. INTERVENTION: A 12-month pragmatic multidomain intervention of exercise, cognitive training, nutritional counseling and chronic condition management. MEASUREMENTS: Baseline IC was measured by 5 subdomains, including cognition (Montreal Cognitive Assessment, MoCA), sensory (visual and hearing impairment), vitality (handgrip strength or Mini-Nutritional Assessment-short form), psychological well-being (Geriatric Depression Scale-5), and locomotion (6m gait speed). Outcomes of interest were cognitive performance (MoCA scores) and physical frailty (CHS frailty score) over a follow-up period of 6 and 12 months. RESULTS: Of all participants (mean age:75.1±6.4 years, 68.6% female), about 90% participants had IC impairment at baseline (2.0±1.2 subdomains). After covariate adjustment using a generalized linear mixed model (GLMM), the multidomain intervention significantly prevented cognitive declines and physical frailty, particularly in those with IC impairment ≥ 3 subdomains (MoCA: coefficient: 1.909, 95% CI: 0.736 ~ 3.083; CHS frailty scores: coefficient = -0.405, 95% CI: -0.715 ~ -0.095). To assess the associations between baseline poor capacity in each IC subdomain and MoCA/CHS frailty scores over follow-up, a 3-way interaction terms (timeinterventioneach poorer IC subdomains) were added to GLMM models. Significant improvements in MoCA scores were shown for participants with poorer baseline cognition (coefficient= 1.138, 95% CI: 0.080 ~ 2.195) and vitality domains (coefficient= 1.651, 95% CI: 0.541 ~ 2.760). The poor vitality domain also had a significant modulating effect on the reduction of CHS frailty score after the 6- and 12-month intervention period (6 months: coefficient= -0.311, 95% CI: -0.554 ~ -0.068; 12 months: coefficient= -0.257, 95% CI: -0.513 ~ -0.001). CONCLUSION AND IMPLICATIONS: A multidomain intervention in community-dwelling older adults improves cognitive decline and physical frailty, with its effectiveness influenced by baseline IC, highlighting the importance of personalized strategies for healthy aging.

摘要

背景:内在能力(IC)受损影响了大约 90%的老年人,与虚弱和认知能力下降的风险显著增加有关。现有证据表明,多领域干预有可能提高认知表现,并对身体虚弱产生积极影响。

目的:研究基线 IC 及其子领域在促进老年人健康老龄化方面对多领域干预效果的作用。

设计:一项整群随机对照试验。

地点和参与者:来自台湾 40 个社区的 1054 名社区居住的老年人。

干预措施:为期 12 个月的实用多领域干预,包括运动、认知训练、营养咨询和慢性病管理。

测量:基线 IC 通过 5 个子领域进行测量,包括认知(蒙特利尔认知评估,MoCA)、感觉(视觉和听力障碍)、活力(握力或迷你营养评估-简短形式)、心理幸福感(老年抑郁量表-5)和运动能力(6m 步行速度)。在 6 个月和 12 个月的随访期间,感兴趣的结果是认知表现(MoCA 评分)和身体虚弱(CHS 虚弱评分)。

结果:在所有参与者中(平均年龄:75.1±6.4 岁,68.6%为女性),大约 90%的参与者在基线时存在 IC 损伤(2.0±1.2 个子领域)。使用广义线性混合模型(GLMM)进行协变量调整后,多领域干预显著预防了认知下降和身体虚弱,特别是在 IC 损伤≥3 个子领域的参与者中(MoCA:系数:1.909,95%CI:0.7363.083;CHS 虚弱评分:系数=-0.405,95%CI:-0.715-0.095)。为了评估基线时每个 IC 子领域较差的能力与随访期间 MoCA/CHS 虚弱评分之间的关联,在 GLMM 模型中添加了 3 个交互项(时间干预每个较差的 IC 子领域)。对于基线认知和活力较差的参与者,MoCA 评分有显著改善(认知较差:系数=1.138,95%CI:0.0802.195;活力较差:系数=1.651,95%CI:0.5412.760)。活力较差的子领域也对 6 个月和 12 个月干预后 CHS 虚弱评分的降低有显著的调节作用(6 个月:系数=-0.311,95%CI:-0.554-0.068;12 个月:系数=-0.257,95%CI:-0.513-0.001)。

结论和意义:在社区居住的老年人中进行多领域干预可以改善认知能力下降和身体虚弱,其效果受到基线 IC 的影响,突出了个性化健康老龄化策略的重要性。

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[2]
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