老年人衰弱综合征与不良结局风险的前瞻性队列研究

Prospective cohort study of frailty syndrome and its associated risk for adverse outcomes in elderly Chinese residents

目的探讨老年人衰弱综合征对老年人日常生活能力及不良结局风险的影响。方法采用中国健康与养老追踪调查全国开放数据,应用年龄60岁及以上社区老年人的一般信息、健康危险因素、慢性疾病、各种能力评估及Fried衰弱评估标准资料,以2011年作为基线调查,进行随访资料分析,使用经协变量调整的Logistic回归模型对衰弱综合征与不良结局风险进行分析。结果2011年基线人群5630例老年人中无衰弱、衰弱前期和衰弱者分别占34.9%(1963例)、57.4%(3236例)和7.7%(431例)。第3、5和8年随访结果显示,衰弱人群组跌倒、髋骨骨折、住院以及死亡发生率均高于衰弱前期和无衰弱人群。随访至2015年,研究人群经协变量校正后Logistic回归分析结果显示,衰弱组比非衰弱组的跌倒风险(OR=1.738,95%CI:1.292~2.338,P<0.001),髋骨骨折风险(OR=2.672,95%CI:1.365~5.233,P=0.004),住院风险(OR=1.670,95%CI:1.224~2.277,P=0.001),死亡风险(OR=1.599,95%CI:1.256~2.035,P<0.001),上肢活动能力下降风险(OR=2.769,95%CI:2.101~3.650,P<0.001),工具性日常生活能力下降风险(OR=2.567,95%CI:1.941~3.395,P<0.001),基本日常生活能力下降风险(OR=2.790,95%CI:2.110~3.689,P<0.001)均增加。结论衰弱综合征会增加老年人生活能力下降、跌倒、髋关节骨折、住院以及死亡的风险,衰弱筛查是预测社区老年人群不良结局风险的有效工具。

Objective To explore the effects of frailty syndrome on activities of daily living and its associated risk for adverse outcomes among elderly residents in China.Methods Using open data from"China Health and Retirement Longitudinal Survey",the 2011 baseline survey was conducted on general information,health risk factors,chronic disease,data obtained from various ability assessments and Fried frailty criteria assessments for community elderly aged 60 years and over.The follow-up data were used to analyze the adverse outcomes of frailty syndrome using a covariation-adjusted Logistic regression model.Results Among the 5630 people in the baseline population,34.9%(1963/5630 cases)were non-frailty,57.4%(3236 cases)were pre-frailty,and 7.7%(431 cases)were frailty.The frailty group had higher rates of falls,hip fractures,hospitalizations,and death than the pre-frail and non-frail groups at the 3rd,5th,and 8th years of follow-up.At follow up to 2015,the covariate-adjusted analysis of the study population showed that as compared with the non-frail group,the frail group had increased risks of falling(OR=1.738,95%CI:1.292-2.338,P<0.001),increased risks of hip fracture(OR=2.672,95%CI:1.365-5.233,P=0.004),increased risks of hospitalization(OR=1.670,95%CI:1.224-2.277,P=0.001),increased risk of death(OR=1.599,95%CI:1.256-2.035,P<0.001),increased risks of declined upper limb activity(OR=2.769,95%CI:2.101-3.650,P<0.001),of declined instrumental activity of daily living(OR=2.567,95%CI:1.941-3.395,P<0.001),and of declined basic activities of daily living(OR=2.790,95%CI:2.110-3.689,P<0.001).Conclusions Frailty syndrome increases the risk of decreased ability to live,falls,hip fractures,hospitalization and death in older adults.Frailty screening is an effective tool for predicting the risk of adverse outcomes in elderly community populations.