The association between multimorbidity and mobility disability-free life expectancy in adults aged 85 years and over: A modelling study in the Newcastle 85+ cohort.
The association between multimorbidity and mobility disability-free life expectancy in adults aged 85 years and over: A modelling study in the Newcastle 85+ cohort.
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DOI：
10.1371/journal.pmed.1004130
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发表时间：
2022-11
期刊：
影响因子：
15.8
通讯作者：
中科院分区：
文献类型：
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行动不便预示着进一步的功能衰退，本身就可能损害老年人独立生活的能力（和偏好）。世界人口也在老龄化，85岁以上的老年人多发病是常态。在这一年龄组中尚不清楚的是，多项运动对（a）移动残疾的转变和（B）无移动残疾预期寿命（mobDFLE）的影响。在714名85岁的老年人的初始队列中使用多状态建模，随访10年（2006年85岁至2016年95岁），我们调查了长期疾病数量增加与（1）行动不便发生率，（2）行动不便恢复和（3）死亡之间的关系，然后探讨这是如何影响85岁时没有行动障碍的剩余预期寿命的。模型根据年龄、性别、疾病组计数、BMI和教育进行调整。我们根据参与者自我报告的在房子周围走动、上下楼梯/台阶以及步行至少400码的能力来定义行动能力残疾;如果参与者在一项或多项活动中遇到困难或无法执行这些活动，则将其定义为行动能力残疾。数据来自纽卡斯尔85+研究：一项纵向人群队列研究，招募来自泰恩和北泰恩赛德全科诊所的纽卡斯尔社区居民和机构化个人。我们观察到，每增加一种疾病，（风险比（HR）1.16，95%置信区间（CI）：1.07至1.25，p <0.001），从这种状态恢复的机会减少26%（HR 0.74，95% CI：0.63至0.86，p <0.001），以及12%的移动性残疾死亡风险增加（HR：1.12，95% CI：1.07至0.17，p <0.001）。这转化为随着长期条件数量的增加而减少的mobDFLE。然而，不能从这些分析中排除剩余和未测量的混杂因素，并且在访谈之间和死亡之前可能存在未观察到的向/从活动能力残疾的转变。我们建议从这项工作的两个影响。(1)我们的研究结果支持呼吁更多地关注预防人口老龄化的多发性硬化症。(2)由于更多的时间花在行动能力残疾可能会导致更大的护理需求，随着年龄的增长保持独立性也应该是卫生/社会护理和康复服务的一个关键重点。在纽卡斯尔的一项模拟研究中，劳里戴维斯博士及其同事探索了85岁及以上成年人的多项运动与无运动障碍预期寿命之间的关系。在不断增长的老年人口中，多次死亡是常态。行动不便也对健康、福祉和独立生活产生深远影响。然而，在85岁以上的人群中，缺乏探索多重抑郁症与行动能力障碍之间关系的研究，尽管现在的注意力更多地集中在剩余预期寿命的质量上。在一个85岁的人群中，我们研究了多项运动与运动障碍转变之间的关系，然后研究了这与无运动障碍预期寿命（mobDFLE）之间的关系。我们发现，在年龄≥ 85岁的患者中，没有阈值可以使多发病成为残疾;相反，每增加一种疾病，发生移动性残疾的风险增加16%。这意味着随着长期条件数量的增加，mobDFLE减少。我们的研究结果表明，在那些年龄≥ 85岁的人中，多项运动是行动能力残疾和与之生活的年数的重要决定因素。由于行动能力残疾可能导致更大的护理需求，预防多项运动和保持独立性（包括从生命早期开始）可能是有益的。
Mobility disability is predictive of further functional decline and can itself compromise older people’s capacity (and preference) to live independently. The world’s population is also ageing, and multimorbidity is the norm in those aged ≥85. What is unclear in this age group, is the influence of multimorbidity on (a) transitions in mobility disability and (b) mobility disability-free life expectancy (mobDFLE). Using multistate modelling in an inception cohort of 714 85-year-olds followed over a 10-year period (aged 85 in 2006 to 95 in 2016), we investigated the association between increasing numbers of long-term conditions and (1) mobility disability incidence, (2) recovery from mobility disability and (3) death, and then explored how this shaped the remaining life expectancy free from mobility disability at age 85. Models were adjusted for age, sex, disease group count, BMI and education. We defined mobility disability based on participants’ self-reported ability to get around the house, go up and down stairs/steps, and walk at least 400 yards; participants were defined as having mobility disability if, for one or more these activities, they had any difficulty with them or could not perform them. Data were drawn from the Newcastle 85+ Study: a longitudinal population-based cohort study that recruited community-dwelling and institutionalised individuals from Newcastle upon Tyne and North Tyneside general practices. We observed that each additional disease was associated with a 16% increased risk of incident mobility disability (hazard ratio (HR) 1.16, 95% confidence interval (CI): 1.07 to 1.25, p < 0.001), a 26% decrease in the chance of recovery from this state (HR 0.74, 95% CI: 0.63 to 0.86, p < 0.001), and a 12% increased risk of death with mobility disability (HR: 1.12, 95% CI: 1.07- to .17, p < 0.001). This translated to reductions in mobDFLE with increasing numbers of long-term conditions. However, residual and unmeasured confounding cannot be excluded from these analyses, and there may have been unobserved transitions to/from mobility disability between interviews and prior to death. We suggest 2 implications from this work. (1) Our findings support calls for a greater focus on the prevention of multimorbidity as populations age. (2) As more time spent with mobility disability could potentially lead to greater care needs, maintaining independence with increasing age should also be a key focus for health/social care and reablement services. In a modelling study from Newcastle, Dr Laurie Davies and colleagues explore the association between multimorbidity and mobility disability-free life expectancy in adults aged 85 years and over. Multimorbidity is the norm in growing older populations. Mobility disability also has profound consequences for health, well-being and independent living. However, there is a dearth of research exploring the relationship between multimorbidity and mobility disability in those aged ≥85, even though attention is now more focussed on the quality of remaining life expectancy. In an inception cohort of 85-year-olds followed over 10 years (age 85 to 95), we explored the association between multimorbidity and transitions in mobility disability, and then examined how this was associated with mobility disability-free life expectancy (mobDFLE). We found that there is no threshold beyond which multimorbidity becomes disabling in those aged ≥85; rather, each additional disease is associated with a 16% increased risk of incident mobility disability. This translates to reductions in mobDFLE with increasing numbers of long-term conditions. Our findings suggest that, in those aged ≥85, multimorbidity is an important determinant of mobility disability and the number of years spent living with it. As mobility disability can lead to greater care needs, preventing multimorbidity and maintaining independence including from earlier in the life course could be beneficial.
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影响因子：
--
作者：
Collerton J;Jagger C;Yadegarfar ME;Davies K;Parker SG;Robinson L;Kirkwood TB
通讯作者：
Kirkwood TB
影响因子：
7.2
作者：
Fried, LP;Bandeen-Roche, K;Guralnik, JM
通讯作者：
Guralnik, JM
DOI：
10.1111/j.1532-5415.2005.00586.x
发表时间：
2006-02-01
影响因子：
6.3
作者：
Gill, TM;Allore, HG;Guo, ZC
通讯作者：
Guo, ZC
多个长期条件对在二十年中无残障预期寿命的不平等的贡献：使用认知功能和衰老研究对两个人群进行纵向分析。
影响因子：
15.1
作者：
Bennett HQ;Kingston A;Lourida I;Robinson L;Corner L;Brayne CE;Matthews FE;Jagger C
通讯作者：
Jagger C
影响因子：
4.1
作者：
Jagger C;Collerton JC;Davies K;Kingston A;Robinson LA;Eccles MP;von Zglinicki T;Martin-Ruiz C;James OF;Kirkwood TB;Bond J
通讯作者：
Bond J