Juan Luis Sánchez-Sánchez PhD , Wan-Hsuan Lu PhD , Daniel Gallardo-Gómez MSc , Borja del Pozo Cruz PhD , Philipe de Souto Barreto PhD , Alejandro Lucia MD , Pedro L Valenzuela PhD
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引用次数: 0
摘要
背景：内在能力（个人所有体能和智能的综合）与环境因素一起被认为是健康老龄化的标志。然而，内在能力是否能预测主要临床结果尚不清楚。我们旨在探索内在能力与老年人功能衰退和死亡率之间的关系：在这项系统性综述和荟萃分析中，我们在 MEDLINE（通过 PubMed）、Scopus 和 Web of Science 中进行了系统性检索，检索时间从数据库建立之初至 2024 年 2 月 14 日，检索对象为老年人（年龄≥60 岁），检索内容为评估内在能力与基本日常生活活动（BADL）或工具性日常生活活动（IADL）损伤或死亡风险之间关系的观察性纵向研究。估算值由两位评审员（JLS-S 和 W-HL）提取，并使用三级荟萃分析模型进行汇总。每项研究的质量由两位作者（JLS-S 和 PLV）使用纽卡斯尔-渥太华纵向研究量表进行独立评估。异质性采用两个级别的 I2 指标进行评估：研究内变异（第 2 级）和研究间变异（第 3 级）。对于内在能力与 IADL 和 BADL 之间的关系，我们使用 Pearson 和 Digby 公式将数据（标准化 β 系数和几率比 [ORs]）转换为皮尔逊积矩相关系数 (r)，以实现不同研究之间的可比性。对于内在能力与死亡风险之间的关系，则从生存分析中提取了带有 95% CI 的危险比 (HR)。本研究已在 PROSPERO 注册，编号为 CRD42023460482：我们在系统综述中纳入了 37 项研究（206 693 名参与者；平均年龄范围为 65-3-85-9 岁），其中 31 项纳入了内在能力与结果之间关系的荟萃分析；3 项研究（2935 名参与者）纳入了内在能力轨迹与 BADL 或 IADL 纵向变化之间关系的荟萃分析。内在能力与 BADL（Pearson's r -0-12 [95% CI -0-19 to -0-04]）和 IADL（-0-24 [-0-35 to -0-13]）的纵向损伤以及死亡风险（危险比 0-57 [95% CI 0-51 to 0-63]）成反比。研究还发现了内在能力轨迹与 IADL（而非 BADL）损伤之间的关系，随着时间的推移，内在能力的保持或提高与 IADL 损伤的降低有关（几率比 0-37 [95% CI 0-19 至 0-71]）。没有证据表明存在发表偏倚（Egger 检验 p>0-05），研究间异质性较低（I2=18-4%），但研究内异质性很大（I2=63-2%）：解释：内在能力与老年人的功能衰退和死亡风险成反比。这些研究结果可以支持将内在能力作为健康老龄化的标志，不过还需要进一步研究，以完善这一概念在不同环境和人群中的结构和可操作性：无：摘要的西班牙文和法文译文见 "补充材料 "部分。
Association of intrinsic capacity with functional decline and mortality in older adults: a systematic review and meta-analysis of longitudinal studies
Background
Together with environmental factors, intrinsic capacity (the composite of all the physical and mental capacities of an individual) has been proposed as a marker of healthy ageing. However, whether intrinsic capacity predicts major clinical outcomes is unclear. We aimed to explore the association of intrinsic capacity with functional decline and mortality in older adults.
Methods
In this systematic review and meta-analysis, we conducted a systematic search in MEDLINE (via PubMed), Scopus, and Web of Science from database inception to Feb 14, 2024, of observational longitudinal studies conducted in older adults (age ≥60 years) assessing the association of intrinsic capacity with impairment in basic activities of daily living (BADL) or instrumental activities of daily living (IADL) or risk of mortality. Estimates were extracted by two reviewers (JLS-S and W-HL) and were pooled using three-level meta-analytic models. The quality of each study was independently assessed by two authors (JLS-S and PLV) using the Newcastle–Ottawa Scale for longitudinal studies. Heterogeneity was evaluated using the I2 indicator at two levels: within-study (level 2) and between-study (level 3) variation. For associations between intrinsic capacity and IADL and BADL, we transformed data (standardised β coefficients and odds ratios [ORs]) into Pearson product moment correlation coefficients (r) using Pearson and Digby formulas to allow comparability across studies. For associations between intrinsic capacity and risk of mortality, hazard ratios (HRs) with 95% CIs were extracted from survival analyses. This study is registered with PROSPERO, CRD42023460482.
Findings
We included 37 studies (206 693 participants; average age range 65·3–85·9 years) in the systematic review, of which 31 were included in the meta-analysis on the association between intrinsic capacity and outcomes; three studies (2935 participants) were included in the meta-analysis on the association between intrinsic capacity trajectories and longitudinal changes in BADL or IADL. Intrinsic capacity was inversely associated with longitudinal impairments in BADL (Pearson's r –0·12 [95% CI –0·19 to –0·04]) and IADL (–0·24 [–0·35 to –0·13]), as well as with mortality risk (hazard ratio 0·57 [95% CI 0·51 to 0·63]). An association was also found between intrinsic capacity trajectories and impairment in IADL (but not in BADL), with maintained or improved intrinsic capacity over time associated with a lower impairment in IADL (odds ratio 0·37 [95% CI 0·19 to 0·71]). There was no evidence of publication bias (Egger's test p>0·05) and there was low between-study heterogeneity (I2=18·4%), though within-study (I2=63·2%) heterogeneity was substantial.
Interpretation
Intrinsic capacity is inversely associated with functional decline and mortality risk in older adults. These findings could support the use of intrinsic capacity as a marker of healthy ageing, although further research is needed to refine the structure and operationalisation of this construct across settings and populations.
Funding
None.
Translations
For the Spanish and French translations of the abstract see Supplementary Materials section.
期刊介绍：
The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.
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