背景:老龄化社会中功能性残疾的增加是一个国际医疗和公共卫生问题。咀嚼功能可能是功能性残疾的潜在危险因素,但是脆弱在协会中的作用尚未得到澄清。
方法:截至2018年4月,接受公共健康保险保险的四万五百六十二名65岁及以上社区居住的老年人,随访时间中位数为3.0年。咀嚼功能被归类为良好,中度,或者根据自我报告的问卷很差。功能性残疾的发展被定义为对长期护理需求的新证明。Cox比例风险模型用于计算风险比(HR)及其95%置信区间(CI)。
结果:在随访期间,1,397人经历了功能性残疾。在调整了年龄之后,性别,合并症,病史,和生活方式行为,与良好组相比,中度和贫困组的功能性残疾事件的HR显着较高(中度,HR1.21[95%CI,1.07-1.37];差,HR1.64[95%CI,1.03-2.62])。然而,在对脆弱相关因素进行额外调整后,即体重不足,定期锻炼,在中等组(HR1.06[95%CI,0.94-1.21])和较差组(HR1.51[95%CI,0.94-2.41])中,步态速度的相关性均减弱.
结论:在日本社区居住的老年人群中,咀嚼功能障碍与发生的功能性残疾显著相关。我们的发现表明,咀嚼功能障碍可能是虚弱的代用品,而不是功能障碍的直接原因。
BACKGROUND: Increase in functional disability in aging societies is an international medical and public health issue. Masticatory function may be a potential risk factor for functional disability, but the role of frailty in the association has not been clarified.
METHODS: Forty thousand five hundred sixty-two community-dwelling older adults aged 65 years and over who were insured by public health insurance as of April 2018 were followed up for a median of 3.0 years. Masticatory function was categorized as good, moderate, or poor based on a self-reported questionnaire. The development of functional disability was defined as a new certification of the need for long-term care. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs).
RESULTS: During the follow-up period, 1,397 individuals experienced functional disability. After adjusting for age, sex, comorbidities, medical history, and lifestyle behaviors, the HR for incident functional disability was significantly higher in the moderate and poor groups compared to the good group (moderate, HR 1.21 [95% CI, 1.07-1.37]; poor, HR 1.64 [95% CI, 1.03-2.62]). However, after additional adjustment for frailty-related factors-namely, underweight, regular exercise, and gait speed-the association was attenuated in both the moderate group (HR 1.06 [95% CI, 0.94-1.21]) and the poor group (HR 1.51 [95% CI, 0.94-2.41]).
CONCLUSIONS: Masticatory dysfunction was significantly associated with incident functional disability in a community-dwelling older Japanese population. Our findings suggest that masticatory dysfunction may be a surrogate of frailty rather than a direct cause of functional disability.