Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese
Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese
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DOI：
10.1093/gerona/gly024
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发表时间：
2019-02-01
影响因子：
5.1
通讯作者：
Shinkai, Shoji
中科院分区：
文献类型：
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作者：
Taniguchi, Yu;Kitamura, Akihiko;Shinkai, Shoji
高水平的功能能力是晚年独立生活的重要组成部分。我们使用重复测量分析来确定更高级别功能能力的老化轨迹。然后，我们确定这些轨迹是否与全因死亡率，并研究了医疗和长期护理费用的差异之间的轨迹社区居住的老年人Japanese.Methods 2,675名年龄在65-90岁的成年人参加了年度老年健康评估和两年一次的健康监测调查期间，从2001年10月至2011年8月。平均随访评估次数为4.0次，观察总数为10，609次。更高层次的功能能力，这对应于劳顿的分层模型的第四和第五子级别，进行了评估与东京都老年学研究所的能力指数（TMIG-IC）。结果我们确定了四个不同的轨迹模式（高稳定，晚发性下降，早发性下降，低下降）的TMIG-IC通过年龄65-90岁。与高稳定轨迹组相比，晚发性降低、早发性降低和低降低TMIG-IC轨迹组的受试者的死亡率校正风险比分别为1.22（95%置信区间：1.01-1.47）、1.90（1.53-2.36）和2.87（2.14-3.84）。具有高稳定性和迟发性降低的高水平功能能力轨迹的参与者具有较低的平均每月医疗费用和长期护理费用。相比之下，平均总成本较高的那些低下降的轨迹，排除了大量的增加后，这种成本在年底的life.Conclusions低下降的老龄化轨迹在较高水平的功能能力的人有较高的死亡风险，并有较高的每月总成本。
Background Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese.Methods 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC).Results We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life.Conclusions People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.