Physical Frailty and Cognitive Impairment in Older Adults in United States Nursing Homes.
Physical Frailty and Cognitive Impairment in Older Adults in United States Nursing Homes.
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DOI：
10.1159/000515140
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发表时间：
2021
影响因子：
2.4
通讯作者：
Ulbricht CM
中科院分区：
文献类型：
--
作者：
Yuan Y;Lapane KL;Tjia J;Baek J;Liu SH;Ulbricht CM
在美国老年养老院的居民中，关于老年人在养老院居住的前六个月身体虚弱的患病率、潜在的动态变化及其与认知障碍的关系的研究有限。最小数据集（MDS） 3.0是关于美国医疗保险/医疗补助认证疗养院居民的国家数据库。MDS 3.0用于识别年龄≥65岁、2014年1月1日至2016年6月30日期间新入住NHs、入院时预期寿命≥6个月、住院时间≥6个月的老年人（n=571,139）。采用入院时、3个月和6个月的MDS 3.0评估。在每次评估中，采用frail - nh（健壮；虚弱前；虚弱）测量身体虚弱，采用精神状态和认知表现量表简短访谈（无/轻度；中度；重度）测量认知障碍。入院时测量人口统计学特征和诊断条件，每次评估时都记录疼痛和接受精神药物治疗的情况。描述了身体虚弱的分布及其随时间的认知障碍的变化。采用广义估计方程拟合非比例优势模型，纵向考察身体虚弱与认知功能障碍之间的关系，并根据人口学和临床特征进行调整。大约60%的老年居民在头6个月身体虚弱。观察到身体虚弱程度的改善和恶化。特别是那些入院时身体虚弱的人，23%的人在3个月后变得健壮。入院时，3个月和6个月时，超过37%的老年居民有严重的认知障碍，约70%的认知障碍患者身体虚弱。入院时，有中度认知障碍的老年居民比无/轻度认知障碍的老年人体弱/强壮的可能性高35%[调整优势比（aOR）： 1.35, 95%置信区间（CI）： 1.33-1.37]，严重认知障碍的老年人体弱/强壮的可能性比无/轻度认知障碍的老年人高74% （aOR: 1.74, 95%CI: 1.72-1.77）。这两种情况之间的联系仍然是积极的，并且随着时间的推移而持续增加。身体虚弱在NHs中普遍存在，有改善的潜力，并且与认知障碍密切相关。身体虚弱可能是一个可修改的目标，干预措施可能包括努力解决认知障碍。
In older U.S. nursing home residents, there is limited research on the prevalence of physical frailty, its potential dynamic changes, and its association with cognitive impairment in older adults’ first six months of nursing home stay. Minimum Data Set (MDS) 3.0 is the national database on residents in U.S. Medicare-/Medicaid-certified nursing homes. MDS 3.0 was used to identify older adults aged ≥65 years, newly-admitted to NHs during 2014/01/01 and 2016/06/30, with life expectancy ≥6 months at admission and NH length of stay ≥6 months (n=571,139). MDS 3.0 assessments at admission, 3 months and 6 months were used. In each assessment, physical frailty was measured by FRAIL-NH (robust; pre-frail; frail) and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale (none/mild; moderate; severe). Demographic characteristics and diagnosed conditions were measured at admission, while presence of pain and receipt of psychotropic medications were at each assessment. Distribution of physical frailty and its change over time by cognitive impairment were described. Non-proportional odds model was fitted with generalized estimation equation to longitudinally examine the association between physical frailty and cognitive impairment, adjusting for demographic and clinical characteristics. Around 60% of older residents were physically frail in the first 6 months. Improvement and worsening across physical frailty levels were observed. Particularly, in those who were pre-frail at admission, 23% improved to robust by 3 months. At admission, 3 months and 6 months, over 37% of older residents had severe cognitive impairment, and about 70% of those with cognitive impairment were physically frail. At admission, older residents with moderate cognitive impairment were 35% more likely [adjusted odds ratio (aOR): 1.35, 95% confidence interval (CI): 1.33-1.37] and those with severe impairment 74% more likely (aOR: 1.74, 95%CI: 1.72-1.77) to be frail than pre-frail/robust, compared to those with none/mild impairment. The association between the two conditions remained positive and consistently increased over time. Physical frailty was prevalent in NHs with potential to improve and was strongly associated with cognitive impairment. Physical frailty could be a modifiable target and interventions may include efforts to address cognitive impairment.
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影响因子：
3.9
作者：
Doba, Nobutaka;Tokuda, Yasuharu;Hinohara, Shigeaki
通讯作者：
Hinohara, Shigeaki
DOI：
10.1016/j.jamda.2017.06.014
发表时间：
2018-01-01
影响因子：
7.6
作者：
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通讯作者：
Bruyere, Olivier
DOI：
10.1111/j.1532-5415.2008.02136.x
发表时间：
2009-03-01
影响因子：
6.3
作者：
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通讯作者：
Dartigues, Jean-Francois
DOI：
10.1016/j.jamda.2013.12.002
发表时间：
2014-04-01
影响因子：
7.6
作者：
Lee, Jenny S. W.;Auyeung, Tung-Wai;Woo, Jean
通讯作者：
Woo, Jean
影响因子：
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作者：
Gill, TM;Gahbauer, EA;Han, L
通讯作者：
Han, L