Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study.
Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study.
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DOI：
10.1136/bmj.n1743
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发表时间：
2021-08-04
期刊：
影响因子：
--
通讯作者：
Singh-Manoux A
中科院分区：
文献类型：
--
作者：
Landré B;Fayosse A;Ben Hassen C;Machado-Fragua MD;Dumurgier J;Kivimaki M;Sabia S;Singh-Manoux A
研究多目标和自我报告的运动功能测量与死亡率的关系。前瞻性队列研究。英国白厅II队列研究，1985-88年招募了35-55岁的参与者; 2007-09年增加了运动功能部分。2007-09年（平均年龄65.6岁，SD 5.9）、2012-13年和2015-16年，6194名参与者进行了运动功能测量。2007年至2019年期间与运动功能的客观指标（步行速度、握力和定时升椅）和自我报告指标（SF-36的身体成分汇总评分以及基本和工具性日常生活活动（ADL）限制）相关的全因死亡率。2007- 2009年运动功能较差的一个性别特异性标准差（例/总数，610/5645）与22%的死亡风险增加相关（95%置信区间为12%至33%），步行速度为15%在平均10.6年的随访中，握力为6%至25%，定时椅子上升为14%（7%至23%），身体成分总评分为17%（8%至26%）。具有基本/工具性ADL限制与30%（7%至58%）的死亡风险增加相关。当从2012-13年（平均随访6.8年）和2015-16年（平均随访3.7年）进行测量时，这些相关性逐渐增强。轨迹分析显示，死亡者（n=484）的运动功能比存活者（n=6194）差，直到死亡前10年，定时椅子上升（标准化差异0.35，95%置信区间0.12至0.59;相当于1.2（男性）和1.3（女性）秒差），9年步行速度（0.21，0.05至0.36; 5.5（男性）和5.3（女性）cm/s差异），6年握力（0.10，0.01 - 0.20; 0.9（男性）和0.6（女性）kg差异），7年时身体成分总评分（0.15，0.05至0.25; 1.2（男性）和1.6（女性）评分差异），和4年的基本/工具性ADL限制（患病率差异2%，0%至4%）。这些差异在导致死亡的时间内增加了定时椅子上升，身体成分总分和ADL限制。老年早期的运动功能与死亡率有很强的相关性，晚期下降的证据出现在整体运动功能（定时椅子上升和身体成分汇总评分）的测量早期和基本/工具ADL限制的晚期。
To examine multiple objective and self-reported measures of motor function for their associations with mortality. Prospective cohort study. UK based Whitehall II cohort study, which recruited participants aged 35-55 years in 1985-88; motor function component was added at the 2007-09 wave. 6194 participants with motor function measures in 2007-09 (mean age 65.6, SD 5.9), 2012-13, and 2015-16. All cause mortality between 2007 and 2019 in relation to objective measures (walking speed, grip strength, and timed chair rises) and self-reported measures (physical component summary score of the SF-36 and limitations in basic and instrumental activities of daily living (ADL)) of motor function. One sex specific standard deviation poorer motor function in 2007-09 (cases/total, 610/5645) was associated with an increased mortality risk of 22% (95% confidence interval 12% to 33%) for walking speed, 15% (6% to 25%) for grip strength, 14% (7% to 23%) for timed chair rises, and 17% (8% to 26%) for physical component summary score over a mean 10.6 year follow-up. Having basic/instrumental ADL limitations was associated with a 30% (7% to 58%) increased mortality risk. These associations were progressively stronger when measures were drawn from 2012-13 (mean follow-up 6.8 years) and 2015-16 (mean follow-up 3.7 years). Analysis of trajectories showed poorer motor function in decedents (n=484) than survivors (n=6194) up to 10 years before death for timed chair rises (standardised difference 0.35, 95% confidence interval 0.12 to 0.59; equivalent to a 1.2 (men) and 1.3 (women) second difference), nine years for walking speed (0.21, 0.05 to 0.36; 5.5 (men) and 5.3 (women) cm/s difference), six years for grip strength (0.10, 0.01 to 0.20; 0.9 (men) and 0.6 (women) kg difference), seven years for physical component summary score (0.15, 0.05 to 0.25; 1.2 (men) and 1.6 (women) score difference), and four years for basic/instrumental ADL limitations (prevalence difference 2%, 0% to 4%). These differences increased in the period leading to death for timed chair rises, physical component summary score, and ADL limitations. Motor function in early old age has a robust association with mortality, with evidence of terminal decline emerging early in measures of overall motor function (timed chair rises and physical component summary score) and late in basic/instrumental ADL limitations.
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