Associations of Multidomain Lifestyle Intervention with Frailty: Secondary Analysis of a Randomized Controlled Trial
Associations of Multidomain Lifestyle Intervention with Frailty: Secondary Analysis of a Randomized Controlled Trial
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DOI：
10.1016/j.amjmed.2018.06.002
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发表时间：
2018-11-01
影响因子：
5.9
通讯作者：
Vellas, Bruno
中科院分区：
文献类型：
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作者：
Barreto, Philipe de Souto;Rolland, Yves;Vellas, Bruno
背景：本研究的目的是调查长期多领域生活方式干预是否与老年人衰弱的严重程度和发生率相关。方法：在 1637 名年龄 >= 70 岁的法国社区居民中进行了一项为期 3 年的随机对照试验：821 名对照者和 816 名接受多领域生活方式干预（认知训练、营养咨询和身体活动建议）的人。干预包括 12 次 2 小时的课程（前 2 个月），随后每月进行 1 小时的课程，直至研究结束。对照组接受常规护理，但没有接受任何个性化的生活方式干预。在基线、6个月、1年、2年和3年计算由32个项目组成的衰弱指数（FI；范围= 0-1，越高越差），构成我们的主要终点。 FI >= 0.25 定义为衰弱。 4 个结果是衰弱严重程度（连续 FI 评分）、偶发衰弱、持续衰弱发生率（连续 2 个时间点衰弱）和衰弱可逆性（从衰弱到非衰弱）。 结果：混合效应线性回归未发现多领域干预对 FI 评分有显着影响。 1146 名受试者中有 241 名发生衰弱（对照组 138 名，多域组 103 名），而 1042 名受试者中有 75 名发生持续性衰弱（对照组 48 名，多域组 27 名）。根据基线 FI 评分调整的 Cox 模型显示，与对照组相比，多领域组的受试者出现衰弱（风险比 0.72；95% 置信区间，0.55-0.93）和持续衰弱（风险比 0.53；95% 置信区间，0.33-0.85）的风险降低。结论：这种多领域生活方式干预与减少 出现衰弱的风险，但不影响社区老年人衰弱的严重程度。 (C) 2018 Elsevier Inc. 保留所有权利。
BACKGROUND: The objective of this study was to investigate whether a long-term multidomain lifestyle intervention was associated with the severity and incidence of frailty in older adults.METHODS: A 3-year randomized controlled trial was conducted among 1637 French community dwellers age >= 70: 821 controls and 816 who received a multidomain lifestyle intervention (cognitive training, nutrition counseling, and advice on physical activity). The intervention involved 12 2-hour sessions (in the first 2 months) followed by a 1-hour session each month until the study end. Controls received the usual care but did not receive any personalized lifestyle intervention. A frailty index (FI; range = 0-1, higher is worse) composed of 32 items was calculated at baseline, 6 months, 1 year, 2 years, and 3 years and constituted our main endpoint. FI >= 0.25 defined frailty. The 4 outcomes were severity of frailty (continuous FI score), incident frailty, incidence of persistent frailty (frailty at 2 consecutive time points), and reversibility of frailty (from frailty to nonfrailty).RESULTS: Mixed-effect linear regression did not find a significant effect of the multidomain intervention on FI score. Frailty incidence occurred in 241 of 1146 subjects (138 controls and 103 in the multidomain group), whereas incidence of persistent frailty occurred in 75 of 1042 subjects (48 controls and 27 in the multidomain group). Cox models adjusted for baseline FI scores showed that compared with controls, subjects in the multidomain group had a decreased risk of developing both frailty (hazard ratio 0.72; 95% confidence interval, 0.55-0.93) and persistent frailty (hazard ratio 0.53; 95% confidence interval, 0.33-0.85).CONCLUSIONS: This multidomain lifestyle intervention was associated with a reduced risk of developing frailty but did not affect the severity of frailty in community-dwelling older adults. (C) 2018 Elsevier Inc. All rights reserved.