The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study
The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study
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DOI：
10.1111/j.1365-2796.2008.02017.x
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发表时间：
2009-02-01
影响因子：
11.1
通讯作者：
Fratiglioni, L.
中科院分区：
文献类型：
--
作者：
Marengoni, A.;von Strauss, E.;Fratiglioni, L.
我们旨在理清慢性多病共存和残疾对老年人3年功能下降和生存的影响。前瞻性队列研究，平均随访2.8年。来自瑞典国王岛项目（1987 - 2000年）的老年人。共1099名受试者，年龄77 - 100岁，生活在社区和养老机构。研究了基线时的医学诊断（基于临床检查、用药情况、病历和血液检测）以及功能评估（依据卡茨指数）与随访期间发生的功能下降和死亡的关系。基线时，12.1%的参与者有残疾，52.3%受多病共存影响。随访期间，363人死亡，85人功能恶化。慢性病的数量逐渐增加功能下降的风险[风险比（HR）从患一种疾病的受试者的1.5增加到患4种及以上疾病的人的6.2]。然而，对于死亡率并非如此，因为患一种疾病的人和患4种及以上疾病的人的死亡风险比相同（HR = 2.3）。基线残疾对生存的影响最大，与疾病数量无关[患一种疾病的受试者中HR = 8.1；95%置信区间（CI）= 4.8 - 13.7，患2种及以上疾病的人中HR = 7.7；95%CI = 4.7 - 12.6]。在老年受试者中，慢性残疾而非多病共存成为功能和生存最强的不良预后因素。
We aimed to disentangle the effect of chronic multimorbidity and disability on 3-year functional decline and survival in the elderly.Prospective cohort study with a mean of follow-up of 2.8 years.Swedish elderly persons from the Kungsholmen Project (1987-2000).A total of 1099 subjects, 77-100 years old, living in the community and institutions.Medical diagnoses (based on clinical examination, drug use, medical records and blood tests), and functional assessment (according to Katz Index) at baseline were investigated in relation to functional decline and death occurring during follow-up.At baseline, 12.1% of participants had disability, and 52.3% were affected by multimorbidity. During follow-up, 363 persons died and 85 worsened in functioning. The number of chronic conditions incrementally increased the risk of functional decline [hazard ratio (HR) increased from 1.5 in subjects with one disease to 6.2 in persons with 4+ diseases]. However, this was not the case for mortality, as the HR of death was the same for people with one disease as well as 4+ diseases (HR = 2.3). Baseline disability had the highest impact on survival, independently of number of diseases [HR = 8.1; 95% confidence interval (CI) = 4.8-13.7 in subjects with one disease and HR = 7.7; 95% CI = 4.7-12.6 in those with 2+ diseases].In the elderly subjects, chronic disability rather than multimorbidity emerged as the strongest negative prognostic factor for functionality and survival.