Associations between multimorbidity and frailty transitions among older Americans

IF 9.1 1区 医学
Yan Luo, Yuming Chen, Kaipeng Wang, Carson M. De Fries, Ziting Huang, Huiwen Xu, Zhou Yang, Yonghua Hu, Beibei Xu
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引用次数: 1

Abstract

Background

The associations of multimorbidity patterns with transitions between frailty states remain unclear in older individuals.

Methods

We used data from the National Health and Aging Trends Study 2011–2019. Frailty was measured annually using the Fried frailty phenotype. Multimorbidity patterns at baseline were identified using latent class analysis based on 14 chronic conditions. We used the semi-Markov multi-state model to investigate the influences of multimorbidity characterized by condition counts and patterns on subsequent frailty transitions over follow-ups.

Results

Among 9450 participants aged ≥65 years at baseline, 34.8% were non-frail, 48.1% were pre-frail and 17.0% were frail. Over a median follow-up of 4.0 years, 16 880 frailty transitions were observed, with 10 527 worsening and 6353 improving. For 7675 participants with multimorbidity, four multimorbidity patterns were identified: osteoarticular pattern (62.4%), neuropsychiatric–sensory pattern (17.2%), cardiometabolic pattern (10.3%) and complex multimorbidity pattern (10.1%). Compared with no disease, multimorbidity was significantly associated with an increased risk of worsening transitions, including from non-frail to pre-frail (hazard ratio [HR] = 1.35; 95% confidence interval [CI] = 1.21–1.52), from non-frail to frail (HR = 1.68; 95% CI = 1.04–2.73), from pre-frail to frail (HR = 2.19; 95% CI = 1.66–2.90) and from pre-frail to death (HR = 1.64; 95% CI = 1.11–2.41). Compared with the osteoarticular pattern, neuropsychiatric–sensory, cardiometabolic and complex multimorbidity patterns had a significantly higher risk of worsening frailty (all P < 0.05).

Conclusions

Multimorbidity was associated with dynamic transitions between frailty states and death among older American adults, and the associations varied across multimorbidity patterns. The findings could offer significant implications for public health policymakers in planning interventions and healthcare resources. They also might inform clinicians regarding providing targeted clinical treatment and health management based on multimorbidity patterns of older people.

美国老年人多重疾病和虚弱转变之间的关系
背景:在老年人中,多病模式与虚弱状态转换之间的关联尚不清楚。方法我们使用2011-2019年国家健康与老龄化趋势研究的数据。脆弱性每年使用弗里德脆弱性表型进行测量。基于14种慢性疾病的潜在类别分析确定了基线时的多发病模式。我们使用半马尔可夫多状态模型来研究以病情计数和模式为特征的多病态对随后随访的虚弱转变的影响。结果在9450名年龄≥65岁的参与者中,34.8%为非虚弱,48.1%为虚弱前期,17.0%为虚弱。在中位随访4年期间,观察到16880例虚弱转变,其中10527例恶化,6353例改善。在7675名患有多重疾病的参与者中,确定了四种多重疾病模式:骨关节模式(62.4%)、神经精神-感觉模式(17.2%)、心脏代谢模式(10.3%)和复杂多重疾病模式(10.1%)。与无疾病相比,多病与恶化转变的风险增加显著相关,包括从非虚弱到虚弱前(危险比[HR] = 1.35;95%可信区间[CI] = 1.21-1.52),从非体弱到体弱(HR = 1.68;95% CI = 1.04-2.73),从体弱前期到体弱(HR = 2.19;95% CI = 1.66-2.90)和从虚弱前期到死亡(HR = 1.64;95% ci = 1.11-2.41)。与骨关节型相比,神经精神-感觉型、心脏代谢型和复杂多病型的衰弱恶化风险明显更高(P <0.05)。结论:在美国老年人中,多发病与虚弱状态和死亡之间的动态转变有关,并且这种关联因多发病模式而异。研究结果可能为公共卫生政策制定者规划干预措施和卫生保健资源提供重要意义。它们还可能为临床医生提供基于老年人多病模式的有针对性的临床治疗和健康管理提供信息。
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来源期刊
Journal of Cachexia, Sarcopenia and Muscle
Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine
自引率
12.40%
发文量
0
期刊介绍: The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.
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