School of Cultural Heritage and Information Management, Shanghai University, Shanghai, China.
Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Shanghai Institute of Pancreatic Diseases, The First Affiliated Hospital of Naval Medical University/Changhai Hospital, Naval Medical University, Shanghai, China.
JMIR Public Health Surveill. 2024 Oct 11;10:e50617. doi: 10.2196/50617.
Aging, a significant public health issue, is associated with multiple concurrent chronic diseases and aging-related conditions (geriatric syndromes).
This study aims to investigate the impact of age and chronic conditions on geriatric syndromes and the intercorrelations between multiple geriatric syndromes and quality of life (QoL) in older adults (aged ≥65 years) at the population level.
A large representative sample was randomly selected from a county in China, Feidong, with 17 towns and 811,867 residents. Multiple chronic conditions, geriatric syndromes (frailty, polypharmacy, and malnutrition), and QoL were assessed and compared. Associations of demographic information and chronic conditions with geriatric conditions and QoL in older adults were assessed using multivariable-adjusted logistic regression. Intercorrelations between age, multiple geriatric syndromes, and QoL were investigated using both correlation analysis and restricted cubic splines-based multivariable-adjusted dose-response analysis.
Older adults comprised 43.42% (3668/8447) of the entire study population. The prevalence of frailty, premalnutrition or malnutrition, polypharmacy, and impaired QoL (median age 73, IQR 69-78 years; 1871/3668, 51% men) was 8.26% (303/3668), 15.59% (572/3668), 3.22% (118/3668), and 10.8% (396/3668), respectively. Different age and sex subgroups mostly had similar prevalence of geriatric syndromes (except that frailty occurred more often with older age). Premalnutrition or malnutrition were associated with a lower frequency of obesity and a higher frequency of constipation, polypharmacy with a higher frequency of diabetes and constipation, frailty with a higher frequency of constipation and hernia, and impaired QoL with a higher frequency of hypertension, diabetes, physical disability, and constipation. Mini Nutritional Assessment-Short Form, Groningen Frailty Indicator, and EQ-5D-5L scores, as well as the number of medications used, mostly predicted each other and QoL. Impaired QoL was associated with a higher frequency of frailty, premalnutrition or malnutrition, and polypharmacy, and frailty with a higher frequency of premalnutrition or malnutrition and polypharmacy. At a 1.5-year follow-up, impaired QoL was linked to polypharmacy and frailty at baseline, premalnutrition or malnutrition and polypharmacy were associated with frailty at baseline, and frailty was linked to both premalnutrition or malnutrition and polypharmacy at baseline. Causal mediation analyses showed that frailty mediated the link between polypharmacy and worse QoL and that polypharmacy mediated the link between frailty and worse QoL.
In this large population-based study of older adults, multiple chronic conditions were associated with ≥1 of the investigated geriatric syndromes. Geriatric syndromes were mostly intercorrelated with, and well predictive of, each other and QoL; and causal relationships existed between geriatric syndromes and QoL, with other geriatric syndromes being mediators. The findings might be biased by residual confounding factors. It is important to perform personalized geriatric syndrome assessments stratified by chronic condition; active prevention of, or intervention for, any syndrome might help to reduce the others and improve QoL.
老龄化是一个重大的公共卫生问题，与多种并存的慢性疾病和与衰老相关的疾病（老年综合征）有关。
本研究旨在探讨年龄和慢性疾病对老年综合征的影响，以及在人群水平上，老年综合征与生活质量（QoL）之间的相互关系。
从中国肥东县的一个县随机抽取一个大的代表性样本，该县有 17 个镇和 811867 名居民。评估了多种慢性疾病、老年综合征（虚弱、多重用药和营养不良）和 QoL，并进行了比较。使用多变量调整后的逻辑回归评估了年龄和慢性疾病与老年人老年综合征和 QoL 的关联。使用相关性分析和基于受限立方样条的多变量调整剂量-反应分析，研究了年龄、多种老年综合征和 QoL 之间的相互关系。
本研究共纳入 3668 名（占总研究人群的 43.42%）老年人。虚弱、营养不良或营养不足、多重用药和 QoL 受损的患病率（中位年龄 73 岁，IQR 69-78 岁；1871/3668 例，51%为男性）分别为 8.26%（303/3668）、15.59%（572/3668）、3.22%（118/3668）和 10.8%（396/3668）。不同年龄和性别亚组的老年综合征患病率相似（除了虚弱与年龄增长有关）。营养不良与肥胖的频率较低和便秘的频率较高有关，多重用药与糖尿病和便秘的频率较高有关，虚弱与便秘和疝气的频率较高有关，QoL 受损与高血压、糖尿病、身体残疾和便秘的频率较高有关。迷你营养评估-简短表格、格罗宁根虚弱指数和 EQ-5D-5L 评分，以及使用的药物数量，大多可以相互预测和预测 QoL。QoL 受损与虚弱、营养不良或营养不足和多重用药的频率较高有关，而虚弱与营养不良或营养不足和多重用药的频率较高有关。在 1.5 年的随访中，QoL 受损与基线时的多重用药和虚弱有关，营养不良或营养不足和多重用药与基线时的虚弱有关，而虚弱与基线时的营养不良或营养不足和多重用药有关。因果中介分析表明，虚弱中介了多重用药与较差 QoL 之间的联系，而多重用药中介了虚弱与较差 QoL 之间的联系。
在这项针对老年人的大型基于人群的研究中，多种慢性疾病与≥1 种所研究的老年综合征有关。老年综合征大多相互关联，并与彼此和 QoL 高度相关；老年综合征和 QoL 之间存在因果关系，其他老年综合征是中介。研究结果可能受到残余混杂因素的影响。对患有慢性疾病的老年人进行个性化老年综合征评估很重要；积极预防或干预任何综合征都可能有助于减少其他综合征并改善 QoL。
