Frailty in older adults: Evidence for a phenotype
Frailty in older adults: Evidence for a phenotype
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DOI：
10.1093/gerona/56.3.m146
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发表时间：
2001-03-01
影响因子：
5.1
通讯作者：
McBurnie, MA
中科院分区：
文献类型：
--
作者：
Fried, LP;Tangen, CM;McBurnie, MA
背景：虚弱被认为在老年人中非常普遍，并具有较高的跌倒、残疾、住院和死亡风险。虚弱一直被认为是残疾、合并症和其他特征的同义词，但人们认识到它可能有生物学基础，是一种独特的临床综合征。标准化的定义尚未建立。为了开发和操作老年人的虚弱表型并评估并发和预测有效性，该研究使用了心血管健康研究的数据。参与者为5317名65岁及以上的男性和女性（4735名来自1989-90年招募的原始队列，582名来自1992-93年招募的非裔美国人队列）。两个队列分别接受了几乎相同的基线评估和7年和4年的随访，并进行了年度检查和监测，包括突发疾病、住院、跌倒、残疾和死亡率。结果，虚弱被定义为一种临床综合征，其中存在以下三个或更多标准：非故意体重减轻（过去一年10磅），自我报告的疲惫，虚弱（握力），步行速度慢，体力活动少。该社区居民的总体虚弱患病率为6.9%，随年龄增长而增加，女性高于男性。四年发病率为7.2%。脆弱与非裔美国人有关。受教育程度和收入较低，健康状况较差，同时患有慢性疾病和残疾的比例较高。在虚弱、合并症和残疾的共同发生方面有重叠，但不一致。这种虚弱表型独立预测了3年内发生跌倒、活动能力恶化或ADL残疾、住院。死亡风险比为1.82 - 4.46（未经调整），1.29-2.24（根据健康、疾病和预测5年死亡率的社会特征进行调整）。中度虚弱状态，如存在一个或两个标准所示，显示出这些结果的中度风险，以及在31年的随访中变得虚弱的风险增加（与基线时没有虚弱标准的人相比，事件虚弱的优势比为未经调整的4.51和调整后的2.63）。本研究为社区居住老年人虚弱提供了一个潜在的标准化定义，并为该定义提供了并发和预测效度。研究还发现，有一个中间阶段可以识别出那些脆弱的高风险人群。最后，它提供的证据表明，虚弱既不是合并症也不是残疾的同义词，但合并症是一个病因危险因素，残疾是虚弱的结果。这为那些虚弱或有风险的人的临床评估提供了潜在的基础，并为未来的研究开发基于虚弱的标准化确定的虚弱干预措施提供了潜在的基础。
Background Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and he a distinct clinical syndrome. A standardized definition has not yet been established.Methods. To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality.Results, Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9% it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American. having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive lover 3 years) of incident falls, worsening mobility or ADL disability, hospitalization. and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming Frail over 31 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline).Conclusion. This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, bur comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.