基于前瞻性队列设计的老年人衰弱评估及对健康结局的影响研究

Frailty is the most problematic expression of population ageing. It is a state of vulnerability to adverse health outcomes, which has profound significance for health and social care. A number of frailty models have been developed, however, there is no consensus definition and measure of frailty. Most studies have just focused on a frailty model and its effect on health outcomes. Comparison of different frailty models and their associations with health outcomes is helpful to provide feasible screening instruments of frailty and identify the high risk population of frailty and adverse health outcomes as well as some modifying factors, which has implications for interventions on frailty and adverse outcomes. We will introduce four frailty models including phenotype, FRAIL, frailty index, and Tilburg frailty indicator, which have been relatively well developed and evaluated abroad. This is a prospective observational cohort study among older people. We will undergo annual assessments of frailty and health outcomes such as comorbidity, fall, ADL and IADL, cognition, depression, quality of life, hospitalization, emergency care use, institutionalization, mortality, as well as other sociodemographic characteristics during 2-year follow-up. We will evaluate the prevalence and trajectory of frailty and examine their determinants, as well as evaluate the psychometric performance. We will also examine the associations of frailty with health outcomes, including the effect of the level of and rate of change in frailty on the incidence/level of and rate of change in adverse health outcomes.

衰弱是影响老年人身心健康和生存质量、加重社会医疗负担的主要因素，及时识别、预防或减缓衰弱的发生与进展对实现健康老龄化有重要意义。国际上提出了不同的衰弱发展模型并研制了各种测量工具，但对于衰弱定义及测量仍无一致意见，且大多数研究仅关注一种衰弱模型与健康结局的关系。开展多种衰弱模型对健康结局预测能力的纵向比较研究，将有助于完善老年人衰弱评估体系。本研究采用理论分析和实证研究的方法，基于衰弱身体单维和生理-心理-社会多维发展模型，引进或修订国外测量性能较好的四种衰弱测量工具（即身体表型、衰弱指数、FRAIL和Tilburg衰弱量表），应用前瞻性队列研究设计，追踪2年，采取现场调研方法实证分析，评价老年人衰弱现状及对不良健康结局发生发展的影响，以识别衰弱高危人群及可改变因素，为预防或减缓衰弱及不良结局干预提供决策建议；并比较不同衰弱筛查工具的测量性能，为识别衰弱人群提供适宜技术。

衰弱是一种以生理储备功能降低为主的老年综合征，增加失能、跌倒和死亡等不良结局发生风险，给公共卫生和医疗保健带来巨大挑战。目前国内外研究局限于某一种衰弱工具对健康结局的影响，且对衰弱或各维度或各指标对健康结局发生发展的影响研究较少。识别应用广泛且信效度良好的衰弱模型、分析老年人衰弱现状及相关因素、探讨衰弱发生发展对不良结局发生发展的影响，将为优化衰弱筛查与管理提供理论基础和科学依据。本研究采用多阶段分层抽样方法，按照社会经济状况抽取了山东省济南市历下区、市中区、天桥区三个行政区，每个行政区中抽取若干个社区，对符合标准的1235名社区老年人进行调查研究与身体功能测量，并于1年后、2年后分别进行随访。结果发现，以老年综合评估为效标，衰弱工具（Fried、FRAIL、SOF、TFI、GFI、CFAI）的诊断准确性较好，且多维衰弱工具的诊断准确性显著优于单维衰弱工具；衰弱工具（Fried、FRAIL、SOF、TFI、GFI、CFAI、FI）对新发不良结局（失能、跌倒、住院及组合结局）的预测能力不同，FI较好但自报式FRAIL与FI的预测能力相当，可用于社区老年人中进行衰弱筛查。进一步探究衰弱的影响因素，发现年龄、认知障碍、抑郁、疼痛、多重用药、社会支持与衰弱显著相关，其中抑郁、疼痛、多重用药可以显著预测老年人2年后的新发衰弱；年龄、性别、抑郁、疼痛、多重用药、社会支持是衰弱发展轨迹的影响因素。在探讨衰弱对不良结局影响时发现，衰弱可以显著预测社区老年人新发失能、低身体功能、认知障碍、住院及低生活质量；基线衰弱显著预测抑郁、认知、ADL及IADL、生活质量的发展轨迹；衰弱发展轨迹能显著预测IADL、生活质量的发展轨迹。本项目实现了预期目标，已发表SCI/&SSCI论文13篇、国内核心期刊论文9篇。在国内及国际学术会议做特邀或主题口头报告9人次，会议摘要收录7篇，培养硕士研究生5名毕业，指导多名博士和硕士发表学术论文。通过本项目与多位衰弱领域、公共卫生、老年领域专家建立密切学术合作关系。