Frailty Risk Patterns and Mortality Prediction in Community-Dwelling Older Adults: A 3-Year Longitudinal Study.

IF 4.2 2区 医学 Q2 GERIATRICS & GERONTOLOGY Journal of the American Medical Directors Association Pub Date : 2024-11-15 DOI:10.1016/j.jamda.2024.105359
Mengjiao Yang, Yang Liu, Kumi Watanabe Miura, Munenori Matsumoto, Dandan Jiao, Zhu Zhu, Xiang Li, Mingyu Cui, Jinrui Zhang, Meiling Qian, Lujiao Huang, Tokie Anme
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Abstract

Objectives: Frailty is a heterogeneous syndrome with distinct patterns. This study aimed to identify frailty risk patterns and their predictive value for mortality in older adults.

Design: Prospective longitudinal study.

Setting and participants: Data were obtained from a 2017 survey of 609 independently mobile adults aged 65 years and older in suburban Japan, focusing on those at risk for at least 1 frailty dimension.

Methods: Frailty assessments were extracted from the Kihon checklist, and subgroups were identified using latent class analysis. Associations between frailty patterns and 3-year mortality were assessed using Kaplan-Meier survival analysis and Cox proportional hazards modeling.

Results: Three frailty patterns were identified: "high risk of cognitive impairment" (76.0%), "moderate risk of cognitive, physical, and oral dysfunction" (14.3%), and "high risk of cognitive, physical, and functional decline" (9.7%). We recorded 52 deaths during a mean follow-up time of 25.7 months (standard deviation: 12.6) and a median follow-up time of 26.5 months. Kaplan-Meier analysis showed significant survival differences among the groups (log-rank: P < .001). Compared with the high risk of cognitive impairment group, the moderate risk of cognitive, physical, and oral dysfunction group had a 145% higher mortality risk (adjusted hazard ratio, 2.45; 95% confidence interval, 1.22-4.90), while the high risk of cognitive, physical, and functional decline group exhibited a 220% higher risk of mortality (adjusted hazard ratio, 3.20; 95% confidence interval, 1.53-6.70).

Conclusions and implications: The findings reveal the heterogeneity of frailty among community-dwelling Japanese older adults, with a high prevalence of cognitive impairment risk. The subgroup with risk of cognitive, physical, and functional decline had the highest mortality risk, highlighting the need for multidimensional assessment and intervention.

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社区老年人的虚弱风险模式和死亡率预测:三年纵向研究
目的:虚弱是一种具有不同模式的异质性综合征。本研究旨在确定虚弱风险模式及其对老年人死亡率的预测价值:前瞻性纵向研究:数据来自 2017 年对日本郊区 609 名 65 岁及以上独立行动的成年人进行的调查,重点关注至少有一个虚弱维度风险的人群:从 Kihon 检查表中提取虚弱评估结果,利用潜类分析确定亚组。采用卡普兰-米尔生存分析法和考克斯比例危险模型评估虚弱模式与 3 年死亡率之间的关系:结果:确定了三种虚弱模式:"认知障碍高风险"(76.0%)、"认知、身体和口腔功能障碍中度风险"(14.3%)和 "认知、身体和功能衰退高风险"(9.7%)。我们记录了 52 例死亡病例,平均随访时间为 25.7 个月(标准差:12.6),中位随访时间为 26.5 个月。Kaplan-Meier 分析显示,各组间的存活率存在显著差异(log-rank:P < .001)。与认知障碍高风险组相比,认知、躯体和口腔功能障碍中度风险组的死亡风险高出145%(调整后危险比为2.45;95%置信区间为1.22-4.90),而认知、躯体和功能衰退高风险组的死亡风险高出220%(调整后危险比为3.20;95%置信区间为1.53-6.70):研究结果揭示了日本社区老年人体弱的异质性,其中认知障碍风险较高。具有认知、身体和功能衰退风险的亚组的死亡风险最高,这凸显了多维评估和干预的必要性。
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来源期刊
CiteScore
11.10
自引率
6.60%
发文量
472
审稿时长
44 days
期刊介绍: JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality
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