台灣老人生理與認知衰弱症預測因子

Physical frailty and cognitive frailty are major health problems among older adults and the two aging syndromes can lead to adverse outcomes of hospitalization, nursing home admission, disability, and mortality, for older individuals and healthcare services for their families, and healthcare systems.
The two syndromes may have progression or improvement over time which would be mediated by predictors such as sociodemographics, comorbidities, physical and cognitive activities, and functional status. The relationships between cognitive functions and physical frailty have been established, although it is still unclear whether physical frailty causes cognitive decline or vice versa. Monitoring the progression of both physical frailty and cognitive frailty and investigating the relationship with possible predictors will help the prevention strategies for the progression of physical frailty to adverse health outcomes among older adults at high risk. Therefore, we conducted two longitudinal cohort studies with two study objectives: 1) to investigate the predictors of physical frailty trajectories, and 2) to investigate the predictors of cognitive frailty trajectories among older adults.
In these longitudinal cohort studies, community-dwelling older adults were recruited from outpatient clinics of a general hospital. For the first study objective, physical frailty status was defined using phenotype criteria, and global cognition was assessed using the Mini-Mental State Examination (MMSE) and 6 specific cognitive domains using the Mattis Dementia Rating Scale (MDRS) and Digit Symbol Substitution Test. For the second study objective, the baseline rates of cognitive frailty status (no cognitive frailty [no CF], reversible cognitive frailty [RCF], and potentially reversible cognitive frailty [PRCF]) and the transitions of the cognitive frailty status in the 2-year follow-up for men and women were observed. A group-based trajectory model was used to identify the latent trajectory groups of physical frailty and cognitive frailty, and multinomial logistic regression was used to examine the relationships between potential predictors and the selected latent trajectory groups for trajectories of both physical frailty and cognitive frailty.
For the first study objective, among 485 participants (168 men, 317 women, and mean age: 71.1±5.5 years) who completed 2 annual follow-up assessments, three physical frailty trajectory groups of improvement, no-change, and progression were identified. The results from multinomial logistic regression showed that after adjusting for baseline physical frailty status, age, sex, global cognition, regular exercise habits, and the number of comorbidities, higher scores on MDRS initiation/perseveration and attention were significantly associated with a lower risk of physical frailty progression. Conversely, no significant association was detected between MMSE scores and physical frailty improvement or progression.
For the second study objective, three distinct cognitive frailty trajectories were identified, namely, robust, improvement, and progression. Older age, at least 4 comorbidities, lower Tinetti’s balance and slower gait showed the significantly associated with a lower risk of cognitive frailty progression after adjustment for the baseline cognitive frailty status, older age, sex, Tinetti’s balance, gait velocity and the number of comorbidities. Without adjustment for baseline cognitive frailty status, older age, women, depression, and a higher number of comorbidities were significantly associated with cognitive frailty progression, while engaging in regular exercise, Tinetti’s balance, and gait velocity were significantly associated with cognitive frailty improvement.