社区体检老年人衰弱状态转换及其进展影响因素的队列研究

Frailty state transition and its influencing factors in community-dwelling elderly undergoing health check-up:a cohort study

目的调查社区体检老年人群衰弱状态的转换情况,并分析衰弱程度进展的影响因素。方法本研究为前瞻性队列研究。2016年9—10月,采用多阶段随机抽样法,选择上海市奉贤区西渡街道社区卫生服务中心3833名≥60岁体检居民为研究对象,使用Fried衰弱表型等调查其基线健康状况和衰弱状态。2020年6—7月,随访研究对象的衰弱状态,对比分析其衰弱状态转换情况,使用logistic回归分析与衰弱程度进展相关的影响因素。结果最终研究对象为3061人,中位年龄71.0岁,男性1256人(41.0%),基线时衰弱前期和衰弱者分别为1563人(51.1%)和156人(5.1%)。4年后,1304人(42.6%)的衰弱程度进展,395人(12.9%)改善。Logistic回归分析结果显示,衰弱程度进展的影响因素包括高龄(OR=1.170,95%CI:1.147~1.194)、婚姻状态(有配偶:OR=0.377,95%CI:0.292~0.486)、体育锻炼(以每天为参照,从不:OR=18.610,95%CI:14.461~23.950,有时:OR=4.210,95%CI:2.186~8.107)、基线衰弱状态(以衰弱为参照,健康:OR=20.464,95%CI:11.779~35.553,衰弱前期:OR=2.147,95%CI:1.270~3.632)、卒中史(OR=2.195,95%CI:1.454~3.313)和糖尿病(OR=1.811,95%CI:1.346~2.437)(均P<0.05)。结论衰弱状态的动态转换较为常见,高龄、无配偶、体育锻炼少、基线衰弱状态、卒中史和患糖尿病是发生进展的危险因素。应早期识别衰弱程度进展高危人群并对其采取相应的干预措施,以改善老年人预后。

Objective To investigate the frailty state transition in the community-dwelling elderly undergoing health check-up,and related influencing factors.Methods From September to October 2016,3833 residents aged≥60 years undergoing health check-up in Xidu Community Health Center were enrolled in this prospective cohort study by multistage random sampling.All participants completed a questionnaire survey,health examinations,and frailty assessments as measured with the Fried frailty phenotype.A second assessment of frailty status was conducted from June to July 2020,the frailty state transition was analyzed by comparison between two assessments of frailty states.Logistic regression was used to analyze the influencing factors related to frailty progression.Results The final cohort consisted of 3061 participants.At the entering of the study,the median age of participants was 71.0 years,41.0%were male,1563(51.1%)were prefrail,and 156(5.1%)were frail.At the follow-up,the frailty status of 1304(42.6%)participants was progressed and that of 395(12.9%)participants was improved from their baseline levels,respectively.Logistic regression showed that age(OR=1.170,95%CI:1.147-1.194),marital status(married:OR=0.377,95%CI:0.292-0.486),physical exercise(never vs.every day:OR=18.610,95%CI:14.461-23.950;sometimes vs.every day:OR=4.210,95%CI:2.186-8.107),baseline frailty state(robust vs.frail:OR=20.464,95%CI:11.779-35.553;prefrail vs.frail:OR=2.147,95%CI:1.270-3.632),stroke(OR=2.195,95%CI:1.454-3.313)and diabetes(OR=1.811,95%CI:1.346-2.437)were identified as independent factors influencing frailty progression(all P<0.05).Conclusions Frailty state progression is common among older adults,and its related factors include age,unmarried status,physical exercise,baseline frailty state,stroke and diabetes.It is necessary to identify elderly at high risk for frailty progression and implement medical interventions.