Physiological Redundancy in Older Adults in Relation to the Change with Age in the Slope of a Frailty Index
Physiological Redundancy in Older Adults in Relation to the Change with Age in the Slope of a Frailty Index
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DOI：
10.1111/j.1532-5415.2009.02667.x
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发表时间：
2010-02-01
影响因子：
6.3
通讯作者：
Mitnitski, Arnold
中科院分区：
文献类型：
--
作者：
Rockwood, Kenneth;Rockwood, Michael R. H.;Mitnitski, Arnold
目的：使用常规可用的临床数据来检验缺陷累积导致冗余丧失的命题。根据老化的可靠性理论，这将通过脆弱指数（FI）随年龄的斜率衰减来量化。设计：前瞻性队列研究的横断面分析，5年死亡率数据。设置：加拿大健康与老龄化研究第二波的临床样本。参与者：2305名基线年龄在70岁及以上的人。测量：一个基于数据的综合老年评估（CGA）的FI，年龄和FI-CGA之间的关系的斜率，FI-CGA的限值，mortality.RESULTS：一个年龄不变的限制赤字积累证明;观察到的99%限度为0.66。在赤字累积的第25百分位数（FI-CGA类似于0.18），FI-CGA与年龄的斜率为0.044（范围0.038-0.049）。当赤字增加到最大值的75%时（FI-CGA类似于0.52），斜率下降到0.021（范围0.016-0.027）。到第85百分位数时（FI-CGA近似0.6），斜率在统计学上已与0无区别。结论：如衰老可靠性理论所预测的那样，随着虚弱程度的增加，缺陷积累的速度减慢。从作为CGA的一部分常规收集的数据中导出的FI可以以这种方式量化老年人的冗余损失。量化冗余损失可以帮助临床决策，其应用于临床样本中的个体识别值得进一步评价。J Am Geriatr Soc 58：318-323，2010.
OBJECTIVES: To test the proposition, using routinely available clinical data, that deficit accumulation results in loss of redundancy. In keeping with the reliability theory of aging, this would be quantitated by attenuation in the slope of a Frailty Index (FI) with age. The more deficits, the less steep the slope and the less redundancy.DESIGN: Cross-sectional analysis of a prospective cohort study, with 5-year mortality data.SETTING: The clinical sample of the second wave of the Canadian Study of Health and Aging.PARTICIPANTS: Two thousand three hundred five people aged 70 and older at baseline.MEASUREMENTS: A FI based on data used for a Comprehensive Geriatric Assessment (CGA), the slope of the relationship between age and the FI-CGA, the limit value of the FI-CGA, mortality.RESULTS: An age-invariant limit to deficit accumulation was demonstrated; the observed 99% limit was 0.66. At the 25th percentile of deficit accumulation (FI-CGA similar to 0.18), the slope of the FI-CGA in relation to age was 0.044 (range 0.038-0.049). When deficits had increased to 75% of the maximum value (FI-CGA similar to 0.52), the slope fell to 0.021 (range 0.016-0.027). By the 85th percentile (FI-CGA similar to 0.6), the slope had become statistically indistinguishable from 0.CONCLUSION: As predicted by the reliability theory of aging, the rate of deficit accumulation slows with increasing frailty. A FI derived from data routinely collected as part of a CGA can in this way quantify loss of redundancy in older adults. Quantifying loss of redundancy can aid clinical decision-making; its application to individual prognostication in clinical samples warrants further evaluation. J Am Geriatr Soc 58:318-323, 2010.