Comparison of physical and social risk-reducing factors for the development of disability in older adults: a population-based cohort study
Comparison of physical and social risk-reducing factors for the development of disability in older adults: a population-based cohort study
复制标题
DOI：
10.1136/jech-2019-212372
复制
发表时间：
2019-10-01
影响因子：
6.3
通讯作者：
Steptoe, Andrew
中科院分区：
文献类型：
--
作者：
Fancourt, Daisy;Steptoe, Andrew
传统上，对老年残疾发展的可改变危险因素的考虑主要集中在身体活动上。然而，越来越多的证据表明，心理、社会和认知因素也有助于维持功能独立性。这项研究比较了身体和社会活动与残疾发病之间的保护性联系。方法分析了2004/2005年至2016/2017年每两年追踪一次的5434名50岁以上成年人的数据，测量了自我报告的进行任何基本日常生活活动（adl）或工具性adl的困难。暴露包括轻度、中度和剧烈的身体活动，与朋友/家人的社交频率，文化参与（例如，去剧院/博物馆/音乐会），以及参加社区团体。结果在12年的随访中，1945名成人出现残疾。使用Cox比例风险回归模型对所有确定的人口统计学和健康相关变量进行调整后发现，剧烈运动或活动每月一次或以上（HR 0.82, 95% CI 0.71至0.96）、中度运动或活动每周超过一次（HR 0.81, 95% CI 0.67至0.97）或文化活动每年一次或两次或以上（HR 0.84, 95% CI 0.73至0.97）与发生残疾的风险较低相关。其他暴露没有显示出独立的保护关联。考虑到反向因果关系和探索时不变因素（如社会经济地位）的潜在混淆作用，结果对敏感性分析是稳健的。这些结果表明，开发多模式干预措施以预防残疾和促进健康老龄化或促进老年人更多地参与现有社区活动和社会活动的重要性。
Background Considerations of modifiable risk factors for the development of disability in older age have traditionally focused on physical activity. However, there is increasing evidence that psychological, social, and cognitive factors also help to maintain functional independence. This study compared the protective associations between physical and social activities and disability onset. Methods We analysed data from 5434 adults aged 50+ years tracked biennially from 2004/2005 to 2016/2017, measuring self-reported difficulty in carrying out any basic activities of daily living (ADLs) or instrumental ADLs. Exposures included mild, moderate and vigorous physical activity, frequency of socialising with friends/family, cultural engagement (eg, going to the theatre/museums/concerts), and participation in community groups. Results Over the 12-year follow-up, 1945 adults developed disability. Using Cox proportional hazards regression models adjusted for all identified demographic and health-related variables, vigorous exercise or activity once a month or more (HR 0.82, 95% CI 0.71 to 0.96), moderate exercise or activity more than once a week (HR 0.81, 95% CI 0.67 to 0.97) or cultural engagement once or twice a year or more (HR 0.84, 95% CI 0.73 to 0.97) were associated with a lower hazard of developing disability. Other exposures did not show independent protective associations. Results were robust to sensitivity analyses considering reverse causality and exploring the potential confounding role of time-invariant factors, such as socioeconomic status. Conclusion These results suggest the importance of either developing multimodal interventions to protect against disability and promote healthy ageing or promoting greater physical and social engagement with existing community activities among older adults.