Impact of frailty and metabolic syndrome on the incidence of loss of independence in community-dwelling older Japanese: the Kusatsu-town study
Impact of frailty and metabolic syndrome on the incidence of loss of independence in community-dwelling older Japanese: the Kusatsu-town study
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虚弱和代谢综合征对社区居住的日本老年人失去独立的发生率的影响：草津镇研究
DOI：
10.11236/jph.64.10_593
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
藤原 佳典
中科院分区：
文献类型：
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作者：
北村 明彦;新開 省二;谷口 優;天野 秀紀;清野 諭;横山 友里;西 真理子;藤原 佳典
目的调查日本社区老年人中，虚弱、代谢综合征（MetS）和丧失独立能力导致残疾或死亡的关系。方法在2002年至2011年期间，我们进行了一项为期7年的前瞻性研究，涉及1，453名65岁及以上的居民，最初没有残疾，他们在草津市进行了全面的老年医学评估。对具有完整值的受试者进行统计分析，从而导致每个数据点的受试者数量可变。1，335名受试者的虚弱定义为以下三个或更多标准：体重减轻（在过去六个月内> 2-3 kg），虚弱（男性握力< 26 kg，女性< 18 kg），疲惫（对问题“你感觉充满活力吗？”回答“否”）。“）、缓慢（通常的步态速度< 1.0 m/s）和低体力活动（对”您通常多久去一次户外？").根据日本定义，对1，450例受试者进行MetS定义。使用考克斯比例风险回归模型估计1，217例受试者丧失独立性的风险比（HR）。结果随访期间，494例失独，其中致残376例，死亡118例。在男性和女性中，根据虚弱的严重程度分类，独立性丧失的发生率呈显著的线性趋势。相比之下，MetS和独立性的丧失之间没有关系。与健康参与者相比，被归类为虚弱前期和虚弱的受试者丧失独立性的风险增加，性别和年龄调整的HR（95%CI）分别为1.5（1.2-1.9）和2.4（1.8-3.3）。校正性别、年龄、代谢综合征、低血清总胆固醇、慢性肾脏疾病、贫血、低血清白蛋白、认知功能障碍和既往卒中史后，独立性丧失的多变量HR（95%CI）分别为1.5（1.2-1.9）和2.1（1.5-2.9）。年龄65-74岁的受试者中，虚弱的独立性丧失发生率的风险程度大于年龄≥ 75岁的受试者。结论：在日本老年人中，虚弱与独立性丧失事件显著相关。代谢综合征的存在对随后发生的残疾和死亡率在老年日本没有影响。我们的研究结果表明，在衰老的早期阶段筛查和干预虚弱，有利于延长日本老年人的健康预期寿命。
Objectives To investigate the relationship between frailty, metabolic syndrome (MetS), and loss of independence leading to the onset of disability or death among community-dwelling older Japanese. Methods Between 2002 and 2011, we conducted a 7-year prospective study involving 1,453 residents aged 65 years and over, initially free of disability, who underwent a comprehensive geriatric assessment in Kusatsu town. Statistical analysis was conducted for those with complete values, resulting in a variable number of subjects for each data point. Frailty was defined for 1,335 subjects as three or more of the following criteria: weight loss (> 2-3 kg in the past six months), weakness (grip strength was< 26 kg for men and< 18 kg for women), exhaustion (answer of" no" to the question" Do you feel full of energy?" on the Geriatric Depression Scale), slowness (usual gait speed< 1.0 m/s), and low physical activity (answer of" less than once a week" to the question" How often do you usually go outdoors?"). MetS was defined for 1,450 subjects from the Japanese definition. The Cox proportional-hazard regression model was used to estimate hazard ratio (HR) of loss of independence for 1,217 subjects. Results During the follow-up, 494 cases of loss of independence, including 376 disabilities and 118 deaths were identified. In men and women, the incidence of the loss of independence showed a significant linear trend according to the severity classification of frailty. By contrast, there was no relationship between MetS and the loss of independence. Subjects classified as prefrail and frail had an increased risk of loss of independence compared with robust participants, with sex-and age-adjusted HRs (95% CIs) of 1.5 (1.2-1.9) and 2.4 (1.8-3.3), respectively. After adjusting for sex, age, the presence of MetS, low serum total cholesterol, chronic kidney disease, anemia, low serum albumin, cognitive impairment, and past history of stroke, the respective multivariable HRs (95% CIs) of loss of independence were 1.5 (1.2-1.9) and 2.1 (1.5-2.9). The magnitude of the risk of loss of independence incidence for frailty was greater among the subjects aged 65-74 years than those aged≥ 75 years. Conclusions Frailty was significantly associated with incident loss of independence among elderly Japanese. The presence of MetS had no effect on subsequent onset of disability and mortality in elderly Japanese. Our findings suggest screening and intervention for frailty in the early stage of aging are beneficial to prolong healthy life expectancy of elderly Japanese.