评估认知和虚弱的联合轨迹及其与患者报告结果的累积负担的关联。包括住院,养老院入院,和残疾。
对754名70岁以上的社区居民进行纵向研究。
690名参与者在1998年至2009年间对认知和虚弱进行了基线和至少一次随访评估。
使用迷你精神状态检查(MMSE)评估认知。虚弱由Fried表型的5个标准定义:肌肉无力,疲惫,低体力活动,萎缩,缓慢的行走速度。以群体为基础,混合建模方法用于拟合认知和脆弱的联合轨迹。住院的累积负担,养老院入院,使用一系列广义估计方程Poisson模型评估了与关节轨迹相关的141个月的残疾。
确定了四个关节轨迹,包括无认知弱点(27.8%),缓慢的认知衰退和进行性虚弱(45.5%),快速认知下降和进行性虚弱(20.2%),和认知脆弱(6.5%)。对于每个关节轨迹组,所有患者报告结局的间隔特定发生率密度率随着时间的推移而增加,除了住院外,仅在认知功能缓慢下降和进行性虚弱组出现明显的增加趋势。在所有患者报告的结果中,无认知虚弱组的累积负担最低[例如,养老院入院,7.5/1000人-月,95%置信区间(CI):4.8-11.7],而认知虚弱组的累积负担最高(例如,养老院入院,381.1/1000人-月,95%CI:294.5-493.1),除了住院。与无认知虚弱组相比,其他3个联合轨迹组的患者报告结局负担均显著更大.
社区生活的老年人表现出明显的认知和虚弱的联合轨迹,并随着年龄的增长经历越来越多的养老院入住和残疾负担,对那些处于认知脆弱轨道上的人来说负担最大。
To evaluate joint trajectories of cognition and frailty and their association with the cumulative burden of patient-reported outcomes, including hospitalization, nursing home admission, and disability.
Longitudinal study of 754 community-living persons aged 70 or older.
690 participants who had a baseline and at least one follow-up assessment of cognition and frailty between 1998 and 2009.
Cognition was assessed using the Mini-Mental State Examination (MMSE). Frailty was defined by the 5 criteria for the Fried phenotype: muscle weakness, exhaustion, low physical activity, shrinking, and slow walking speed. A group-based, mixture modeling approach was used to fit the joint trajectories of cognition and frailty. The cumulative burden of hospitalization, nursing home admission, and disability over 141 months associated with the joint trajectories was evaluated using a series of generalized estimating equation Poisson models.
Four joint trajectories were identified, including No cognitive frailty (27.8%), Slow cognitive decline and progressive frailty (45.5%), Rapid cognitive decline and progressive frailty (20.2%), and Cognitive frailty (6.5%). For each joint trajectory group, the interval-specific incidence density rates of all patient-reported outcomes tended to increase over time, with the exception of hospitalization for which the increasing trend was apparent only for the Slow cognitive decline and progressive frailty group. The No cognitive frailty group had the lowest cumulative burden of all patient-reported outcomes [eg, nursing home admissions, 7.5/1000 person-months, 95% confidence interval (CI): 4.8-11.7], whereas the Cognitive frailty group had the highest cumulative burden (eg, nursing home admissions, 381.1/1000 person-months, 95% CI: 294.5-493.1), with the exception of hospitalization. Compared with the No cognitive frailty group, the 3 other joint trajectory groups all had significantly greater burden of the patient-reported outcomes.
Community-living older persons exhibit distinct joint trajectories of cognition and frailty and experience an increasing burden of nursing home admission and disability as they age, with the greatest burden for those on a cognitive frailty trajectory.