内在能力下降预测中国老年人的长期死亡率：北京老龄化纵向研究。

Declined intrinsic capacity predicts long-term mortality in Chinese older adults: Beijing Longitudinal Study of Aging.

机构信息

Department of Geriatrics, Xuanwu Hospital, Capital Medical University, China National Clinical Research Center for Geriatric Medicine, Beijing 100053, China.

Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing Institute of Geriatrics, Beijing 100053, China.

出版信息

Maturitas. 2024 Oct;188:108082. doi: 10.1016/j.maturitas.2024.108082. Epub 2024 Jul 27.

DOI:10.1016/j.maturitas.2024.108082

PMID:39089049

Abstract

BACKGROUND

Intrinsic capacity reflects an individual's functions and capacities across their lifetime. There are few studies on whether the level of intrinsic capacity can predict long-term mortality in Chinese populations.

OBJECTIVE

To explore the effects of intrinsic capacity on long-term outcomes in older Chinese adults.

METHODS

Data were obtained from the Beijing Longitudinal Study of Aging. Overall, 1699 community-dwelling adults aged ≥60 years were included and followed up for 8 years. Intrinsic capacity was determined according to the World Health Organization definition. The predictive ability for adverse outcomes was assessed using the age- and sex-adjusted Cox proportional hazards model.

RESULTS

A decline in intrinsic capacity domains was observed in 729 (42.9 %) participants. Declines in the mobility, cognition, vitality, sensory and psychology domains were observed in 21.8 %, 15.1 %, 11.4 %, 9.10 %, and 14.2 % of the participants, respectively. Low intrinsic capacity was associated with worse physical performance, frailty, social frailty, chronic diseases, fracture, and falls. A greater decline in intrinsic capacity predicted an elevated 8-year mortality rate (decline in overall intrinsic capacity hazard ratio 2.91, 95 % confidence interval 2.44-3.47, P < 0.001; decline in one domain hazard ratio 2.11, 95 % confidence interval 1.71-2.61, P < 0.001; decline in two domains hazard ratio 3.54, 95 % confidence interval 2.81-4.45, P < 0.001; decline in three or more domains hazard ratio 5.30, 95 % confidence interval 4.09-6.87, P < 0.001); adjusted models did not affect prediction performance. Among the five domains of intrinsic capacity, cognition was the strongest predictor of mortality (hazard ratio 3.17, 95 % confidence interval 2.63-3.81, P < 0.001).

CONCLUSIONS

Intrinsic capacity is useful in identifying older adults at higher risk of adverse outcomes, presenting significant implications for healthcare policies in China.

摘要

背景

内在能力反映了个体一生中的各项功能和能力。关于内在能力水平能否预测中国人群的长期死亡率，相关研究较少。

目的

探讨内在能力对中国老年人群长期结局的影响。

方法

数据来自北京老龄化纵向研究。共纳入 1699 名年龄≥60 岁的社区居住成年人，随访 8 年。根据世界卫生组织的定义确定内在能力。使用年龄和性别调整的 Cox 比例风险模型评估不良结局的预测能力。

结果

729 名（42.9%）参与者的内在能力域下降。21.8%、15.1%、11.4%、9.10%和 14.2%的参与者分别出现移动性、认知、活力、感觉和心理域下降。低内在能力与较差的身体表现、虚弱、社交虚弱、慢性疾病、骨折和跌倒有关。内在能力较大程度下降预示着 8 年死亡率升高（整体内在能力下降的风险比 2.91，95%置信区间 2.44-3.47，P<0.001；一个域下降的风险比 2.11，95%置信区间 1.71-2.61，P<0.001；两个域下降的风险比 3.54，95%置信区间 2.81-4.45，P<0.001；三个或更多域下降的风险比 5.30，95%置信区间 4.09-6.87，P<0.001）；调整后的模型并未影响预测性能。在内在能力的五个域中，认知是死亡的最强预测因子（风险比 3.17，95%置信区间 2.63-3.81，P<0.001）。