Mathis Lindsey M, Sun Na, Ho Simon K, White Lane S, Addison Odessa, Savin Douglas N, Falvey Jason R
Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Baltimore Geriatric Research, Education, and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2025 Jan 11. doi: 10.1111/jgs.19367.
Community mobility is a vital patient-centered outcome for older adults living in the community. These deficits in mobility are linked to social isolation, increased hospitalizations, and higher mortality rates. Impaired pulmonary function may be a modifiable risk factor for mobility decline, with existing inequities in lung health potentially contributing disproportionately to mobility loss among Black older adults.
MATERIALS/METHODS: A cohort of 4742 community-dwelling older adults (weighted n = 29,180,893) with self-reported ability to walk 3 or more blocks in their community was drawn from the National Health and Aging Trends Study (NHATS). Pulmonary function was measured by PEF in NHATS. Community mobility loss was defined as self-reported inability to walk ≥ 3 blocks in the 1-year follow-up assessment. Hierarchical multivariable logistic regression was used and adjusted for demographics, comorbidities, pain, and assistive device use.
Overall, 73.7% of the sample had normal PEF, 18.6% had moderate impairment, and 7.7% had severe impairment. Those with severe impairment were more likely to be male and identify as Black. In unadjusted analyses, 8.8% of older adults with normal PEF experienced mobility loss, compared with 12.7% of those with moderate impairment, and 19.7% with severe impairment. Odds of mobility loss were 111% higher for those with severe PEF impairment as compared to those with normal PEF (OR = 2.1, 95% CI 1.2-3.7) in fully adjusted models, with weaker relationships being observed for those with moderately impaired PEF (OR = 1.2, 95% CI 0.8-1.8).
Nearly 8%, or an estimated 1 million community-ambulating U.S. older adults, had severe impairments in peak expiratory flow in 2015; these older adults have a substantially higher risk of losing the ability to ambulate community distances over the subsequent year.
社区活动能力是社区中老年人以患者为中心的重要结局。这些活动能力缺陷与社会隔离、住院率增加和死亡率上升有关。肺功能受损可能是活动能力下降的一个可改变的风险因素，现有的肺部健康不平等可能对黑人老年人的活动能力丧失造成不成比例的影响。
材料/方法：从国家健康与老龄化趋势研究（NHATS）中选取了4742名社区居住的老年人队列（加权n = 29180893），他们自我报告在社区中能够行走3个或更多街区。在NHATS中通过呼气峰流速（PEF）测量肺功能。社区活动能力丧失定义为在1年的随访评估中自我报告无法行走≥3个街区。使用分层多变量逻辑回归，并对人口统计学、合并症、疼痛和辅助设备使用情况进行了调整。
总体而言，73.7%的样本PEF正常，18.6%有中度受损，7.7%有重度受损。重度受损者更可能为男性且为黑人。在未调整的分析中，PEF正常的老年人中有8.8%经历了活动能力丧失，而中度受损者为12.7%，重度受损者为19.7%。在完全调整的模型中，与PEF正常者相比，PEF重度受损者活动能力丧失的几率高111%（OR = 2.1，95%CI 1.2 - 3.7），而PEF中度受损者的关系较弱（OR = 1.2，95%CI 0.8 - 1.8）。
2015年，近8%（约100万）能够在社区行走的美国老年人呼气峰流速严重受损；这些老年人在接下来的一年中失去在社区行走能力的风险显著更高。
