体弱及其与 75 岁及以上居住在社区的老年人长期死亡率的关系。

IF 3.5 4区 医学 Q1 HEALTH POLICY & SERVICES Israel Journal of Health Policy Research Pub Date : 2024-07-16 DOI:10.1186/s13584-024-00614-y
Maor Lewis, Anthony Heymann, Galia Zacay, Dan Justo
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引用次数: 0

摘要

背景:虚弱是导致不良后果和死亡率的一个重要风险因素,是一个新出现的挑战,对公共卫生和临床实践有着深远的影响。对虚弱程度的测量有可能改善老年人的医疗保健服务。以色列以前从未大规模研究过全国范围内未经选择的社区老年人,尤其是 75 岁及以上老年人的体弱患病率及其与长期死亡率的关系:方法:在以色列第三大医疗保健服务提供商 Meuhedet 健康维护组织开展了一项回顾性队列研究,该组织为 127.6 万人(占以色列人的 13.8%)提供服务。研究人员对 75 岁及以上的老年人进行了为期 2 至 8 年的跟踪调查,研究了虚弱的普遍性及其与全因死亡率的关系。虚弱的定义采用累积缺陷法,利用了前 10 年的临床数据,包括 28 种慢性疾病和与年龄相关的健康缺陷:组群包括 43737 名老年人,中位年龄为 77 岁(IQR 75-82 岁);其中 19300 名(44.1%)为男性。总体而言,19,396 名(44.3%)老年人体弱:12,260 名(28.0%)轻度体弱,5,533 名(12.7%)中度体弱,1,603 名(3.7%)重度体弱。在随访期间,15,064 名(34.4%)老年人死亡:4,782 名(39.0%)轻度体弱,3,016 名(54.5%)中度体弱,1,080 名(67.4%)重度体弱。Cox 回归分析表明,死亡率与严重虚弱(HR 2.63,95%CI 2.45-2.80)、中度虚弱(HR 2.05,95%CI 1.96-2.14)和轻度虚弱(HR 1.45,95%CI 1.39-1.51)有关,与年龄、性别和人口部门无关。在90岁及以上的患者中,中度和重度虚弱患者的累积存活率没有明显差异(P = 0.408):在 75 岁及以上居住在社区的以色列老年人中,体弱现象十分普遍,而且与长期死亡率有关。考虑到在 90 岁之前,不同程度的虚弱都与长期死亡率有关,因此建议对这一人群进行早期识别和干预。政策制定者应考虑在人群健康和临床层面使用累积亏损法评估虚弱程度。
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Frailty and its association with long-term mortality among community-dwelling older adults aged 75 years and over.

Background: Frailty, a significant risk factor for adverse outcomes and mortality, poses an emerging challenge with profound implications for public health and clinical practice. The measurement of frailty offers potential enhancements in healthcare services for older adults. The prevalence of frailty and its association with long-term mortality in a nationwide, unselected population of community-dwelling older adults, particularly those aged 75 and over, has not been previously studied on a large scale in Israel.

Methods: A retrospective cohort study was conducted at Meuhedet Health Maintenance Organization, Israel's third largest healthcare service provider, serving 1,276,000 people (13.8% of Israelis). The prevalence of frailty and its association with all-cause mortality were studied among older adults aged 75 years and over who were followed for 2-8 years. Frailty, defined by the cumulative deficit method, utilized clinical data from the preceding 10-year period, comprising 28 chronic diseases and age-related health deficits.

Results: The cohort included 43,737 older adults, with a median age of 77 years (IQR 75-82 years); among them, 19,300 (44.1%) were males. Overall, 19,396 (44.3%) older adults were frail: 12,260 (28.0%) mildly frail, 5,533 (12.7%) moderately frail and 1,603 (3.7%) severely frail. During the follow-up period 15,064 (34.4%) older adults died: 4,782 (39.0%) mildly frail, 3,016 (54.5%) moderately frail and 1,080 (67.4%) severely frail. Cox regression analysis demonstrated that mortality was associated with severe frailty (HR 2.63, 95%CI 2.45-2.80), moderate frailty (HR 2.05, 95%CI 1.96-2.14), and mild frailty (HR 1.45, 95%CI 1.39-1.51), independent of age, gender, and population sector. Among patients aged 90 years and over, no significant differences in cumulative survival were found between those with moderate and severe frailty (p = 0.408).

Conclusions: Frailty is prevalent among community-dwelling Israeli older adults aged 75 years and over, and it is associated with long-term mortality. Considering its association with long-term mortality across frailty levels until the age of 90, early identification and intervention for frailty are recommended within this population. Policymakers should consider the use of the cumulative deficit method for evaluating frailty at both the population health and clinical levels.

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38
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28 weeks
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