Yang Mengjiao, Liu Yang, Watanabe Miura Kumi, Matsumoto Munenori, Jiao Dandan, Zhu Zhu, Li Xiang, Cui Mingyu, Zhang Jinrui, Qian Meiling, Huang Lujiao, Anme Tokie
Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan; Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan.
J Am Med Dir Assoc. 2025 Jan;26(1):105359. doi: 10.1016/j.jamda.2024.105359. Epub 2024 Nov 15.
Frailty is a heterogeneous syndrome with distinct patterns. This study aimed to identify frailty risk patterns and their predictive value for mortality in older adults.
Prospective longitudinal study.
Data were obtained from a 2017 survey of 609 independently mobile adults aged 65 years and older in suburban Japan, focusing on those at risk for at least 1 frailty dimension.
Frailty assessments were extracted from the Kihon checklist, and subgroups were identified using latent class analysis. Associations between frailty patterns and 3-year mortality were assessed using Kaplan-Meier survival analysis and Cox proportional hazards modeling.
Three frailty patterns were identified: "high risk of cognitive impairment" (76.0%), "moderate risk of cognitive, physical, and oral dysfunction" (14.3%), and "high risk of cognitive, physical, and functional decline" (9.7%). We recorded 52 deaths during a mean follow-up time of 25.7 months (standard deviation: 12.6) and a median follow-up time of 26.5 months. Kaplan-Meier analysis showed significant survival differences among the groups (log-rank: P < .001). Compared with the high risk of cognitive impairment group, the moderate risk of cognitive, physical, and oral dysfunction group had a 145% higher mortality risk (adjusted hazard ratio, 2.45; 95% confidence interval, 1.22-4.90), while the high risk of cognitive, physical, and functional decline group exhibited a 220% higher risk of mortality (adjusted hazard ratio, 3.20; 95% confidence interval, 1.53-6.70).
The findings reveal the heterogeneity of frailty among community-dwelling Japanese older adults, with a high prevalence of cognitive impairment risk. The subgroup with risk of cognitive, physical, and functional decline had the highest mortality risk, highlighting the need for multidimensional assessment and intervention.
衰弱是一种具有不同模式的异质性综合征。本研究旨在确定衰弱风险模式及其对老年人死亡率的预测价值。
前瞻性纵向研究。
数据来自2017年对日本郊区609名65岁及以上能够独立活动的成年人的调查，重点关注至少在一个衰弱维度上存在风险的人群。
从基準检查表中提取衰弱评估数据，并使用潜在类别分析确定亚组。使用Kaplan-Meier生存分析和Cox比例风险模型评估衰弱模式与3年死亡率之间的关联。
确定了三种衰弱模式：“认知障碍高风险”（76.0%）、“认知、身体和口腔功能中度风险”（14.3%）以及“认知、身体和功能衰退高风险”（9.7%）。在平均随访时间25.7个月（标准差：12.6）和中位随访时间26.5个月期间，共记录了52例死亡。Kaplan-Meier分析显示各组之间存在显著的生存差异（对数秩检验：P <.001）。与认知障碍高风险组相比，认知、身体和口腔功能中度风险组的死亡风险高145%（调整后的风险比，2.45；95%置信区间，1.22 - 4.90），而认知、身体和功能衰退高风险组的死亡风险高220%（调整后的风险比，3.20；95%置信区间，1.53 - 6.70）。
研究结果揭示了日本社区居住的老年人中衰弱的异质性，认知障碍风险患病率较高。认知、身体和功能衰退风险亚组的死亡风险最高，凸显了多维评估和干预的必要性。
