背景:在全球范围内,虚弱的老年人数量正在增加,所有国家都将面临日益增长的医疗保健和社会支持需求。这项综述的目的是总结与老年人虚弱相关因素的证据,使用社会生态方法。
方法:PubMed(MEDLINE),Scopus,WebofScience,ScienceDirect,Hinari(研究4life),截至2023年4月,对Trip数据库进行了系统搜索。考虑对60岁及以上老年人体弱者相关因素的观察性研究进行系统评价。没有语言,地理或设置限制被应用。然而,我们排除了在特定疾病背景下调查虚弱因素的系统综述.JoannaBriggs研究所系统评价和研究综合关键评估清单和ROBIS工具用于评估纳入研究的质量和偏倚风险。
结果:纳入了44项系统评价,涵盖1,150项主要研究,总共约2,687,911名参与者。几个危险因素,发现保护因素和生物标志物与虚弱有关,尤其是在社区居住的老年人中,包括来自荟萃分析的67个显著关联。对于与老年人相关的七个因素,证据的确定性被评为中等或达到中等水平。这些因素包括抑郁(OR4.66,95%CI4.07至5.34),孤独感(OR3.51,95%CI2.70至4.56),日常生活活动的局限性(OR2.59,95%CI1.71至3.48),营养不良的风险(OR3.52,95%CI2.96至4.17),饮食炎症指数评分(OR1.24,95%CI1.16至1.33),最大步行速度(标准化平均差(SMD)-0.97,95%CI-1.25至-0.68),和自我报告的咀嚼功能障碍(OR1.83,95%CI1.55至2.18)。此外,只有更多的坚持地中海饮食才显示出高水平的证据(OR0.44,95%CI0.31~0.64).
结论:本综述将通过促进健康的生活方式和解决与虚弱相关的所有可改变的危险因素,为预防策略和临床实践提供指导。未来的系统评价应该考虑异质性和出版偏见,因为这些是我们审查中降低证据水平的主要原因。
背景:PROSPERO2022,CRD42022328902。
BACKGROUND: The number of frail older people is increasing worldwide, and all countries will be confronted with their growing needs for healthcare and social support. The aim of this umbrella review was to summarize the evidence on the factors associated with frailty in older people, using a socioecological approach.
METHODS: PubMed (MEDLINE), Scopus, Web of Science, ScienceDirect, Hinari (research4life), and the Trip database were systematically searched up to April 2023. Systematic reviews of observational studies that explored factors associated with frailty in older adults aged 60 years and over were considered for inclusion. No language, geographical or setting restrictions were applied. However, we excluded systematic reviews that investigated frailty factors in the context of specific diseases. The Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and the ROBIS tool were used to assess the quality and risk of bias in the included studies.
RESULTS: Forty-four systematic reviews were included, covering 1,150 primary studies with approximately 2,687,911 participants overall. Several risk factors, protective factors and biomarkers were found to be associated with frailty, especially in community-dwelling older people, including 67 significant associations from meta-analyses. The certainty of the evidence was rated as moderate or reached moderate levels for seven factors relevant to older people. These factors include depression (OR 4.66, 95% CI 4.07 to 5.34), loneliness (OR 3.51, 95% CI 2.70 to 4.56), limitations in activities of daily living (OR 2.59, 95% CI 1.71 to 3.48), risk of malnutrition (OR 3.52, 95% CI 2.96 to 4.17), Dietary Inflammatory Index score (OR 1.24, 95% CI 1.16 to 1.33), maximal walking speed (Standardized Mean Difference (SMD) -0.97, 95% CI -1.25 to -0.68), and self-reported masticatory dysfunction (OR 1.83, 95% CI 1.55 to 2.18). Additionally, only greater adherence to a Mediterranean diet showed a high level of evidence (OR 0.44, 95% CI 0.31 to 0.64).
CONCLUSIONS: This umbrella review will provide guidance for prevention strategies and clinical practice by promoting healthy lifestyles and addressing all modifiable risk factors associated with frailty. Future systematic reviews should consider heterogeneity and publication bias, as these were the main reasons for downgrading the level of evidence in our review.
BACKGROUND: PROSPERO 2022, CRD42022328902.