Effects of community-based frailty-preventing intervention on all-cause and cause-specific functional disability in older adults living in rural Japan: A propensity score analysis
Effects of community-based frailty-preventing intervention on all-cause and cause-specific functional disability in older adults living in rural Japan: A propensity score analysis
复制标题
基于社区的衰弱预防干预措施对日本农村老年人全因和特定原因功能障碍的影响：倾向评分分析
DOI：
10.1016/j.ypmed.2023.107449
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发表时间：
2023
影响因子：
5.1
通讯作者：
Fujiwara Yoshinori
中科院分区：
文献类型：
--
作者：
Nofuji Yu;Seino Satoshi;Abe Takumi;Yokoyama Yuri;Narita Miki;Murayama Hiroshi;Shinkai Shoji;Kitamura Akihiko;Fujiwara Yoshinori
在老龄化社会中，预防衰弱至关重要。我们研究了基于社区的衰弱预防计划对于延迟社区老年人功能障碍发生的有效性。 2014 年至 2019 年，日本 Yabu 市开设了 48 个以社区为基础的衰弱预防课程（FPC，每次 60 分钟，每周一次），包括抗阻运动和营养或心理社会项目。我们于 2012 年进行了一项基线调查，并对参与者进行了长达 6.8 年的跟踪（从建立第一个 FPC 起 4.8 年）。我们分析了 3350 名老年人的数据。主要和次要结局分别是功能性残疾和特定原因功能性残疾（包括痴呆、心血管和骨科疾病）的发生。除了粗略的 Cox 比例风险回归之外，还使用治疗加权逆概率 (IPTW) 和倾向评分匹配（PSM；918 名非参与者和 459 名参与者）来调整混杂因素。与非参与者相比，参与者更有可能是女性并且拥有健康的生活方式。在随访期间，690 人出现功能障碍。在 IPTW（风险比 0.53，95% 保密区间 0.38–0.75）和 PSM（0.52，0.37–0.71）分析中，参与者发生事件功能障碍的风险比显着低于非参与者。在年龄分层分析中，仅在 75 岁以上的亚组中观察到显着相关性。在针对特定原因的分析中，参与显着且持续地减少了痴呆引起的功能障碍事件（IPTW 0.47, 0.25–0.86；PSM 0.45, 0.25–0.83）。基于社区的 FPC 可有效预防该人群的功能性残疾，尤其是由痴呆症引起的功能性残疾。
Preventing frailty is crucial in aging societies. We examined the effectiveness of a community-based frailty-prevention program for delaying the onset of functional disability among community-dwelling older adults. From 2014 to 2019, 48 community-based frailty prevention classes (FPC, 60 min/session, once a week), comprising resistance exercise and nutritional or psychosocial programs, were established in Yabu City, Japan. We conducted a baseline survey in 2012 and followed up with participants for up to 6.8 years (4.8 years from establishing the first FPC). We analyzed data from 3350 older people. The primary and secondary outcomes were the onset of functional disability and cause-specific functional disability (including dementia and cardiovascular and orthopedic diseases), respectively. In addition to crude Cox proportional hazard regression, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM; 918 nonparticipants and 459 participants) were used to adjust for confounders. Participants were more likely to be female and have a healthy lifestyle than nonparticipants. During the follow-up, 690 individuals developed a functional disability. The hazard ratio of incident functional disability in the participants was significantly lower than that in nonparticipants in the IPTW (hazard ratio 0.53, 95% confidential interval 0.38–0.75) and PSM (0.52, 0.37–0.71) analyses. In age-stratified analysis, significant associations were observed only in the ≥75-year-old subgroup. In a cause-specific analysis, participation significantly and consistently reduced incident functional disability caused by dementia (IPTW 0.47, 0.25–0.86; PSM 0.45, 0.25–0.83). Community-based FPC may be effective for preventing functional disability, especially caused by dementia, in this population.