社区老年衰弱发展轨迹预测及联合运动干预为核心的健康管理实证研究

Frailty is age-related syndrome characterized by decreased reserve and resistance to stressors, increasing vulnerability to adverse outcomes, such as falls, disability, long-term care and mortality. Frailty is a dynamic process placed between robust health and disability state in the disablement process, and is regarded as a pre-diability stage，including physical frailty, psychological frailty, social frailty, and environmental frailty. Worldwide prevalence of frailty varies from 5.2% to 19.1% in the population aged≧65. Frailty coexists together with disability and co-morbidity, representing increasing important public health concerns and has an incremental effect on health expenditures. Frailty has been considered to be a public health problem that urgently needs to be addressed. Prefrailty is transitional state between established frailty and robustness, where a person has some frailty characteristics but is able to respond to injury, disease or stress with a chance of complete recovery. The prevalence of prefrailty was 41.5%~49.3%, with the transition rate of 8.9%~37.1% to frailty state and 13.6%~28.1% to robust health status, so targeting the prefrail group is an effective way to delay the onset and progression of frailty. Thus, the study is to identify different patterns of frailty changes and reveal potential predictors affecting these trajectories in a longitudinal data. Based on the predictors analyzed in the data and frailty states, we are seeking to establish an economic and effective intervention program for the frailty elderly dwelling in community. In addition, the study will assess the effect of the intervention in the form of multicomponent exercise program together with education, nutritional supplement, cognitive training and psychological intervention on reverting prefrailty, preventing frailty progression in prefrailty, and the remediation of frailty. If the intervention program is shown to be effective, the study will provide valuable reference for the practice of health management in aged care services.

老年衰弱（frailty）是机体储备能力和抵御能力下降，对不良健康结局易感性增加，包括躯体衰弱、心理衰弱、社会衰弱和环境衰弱，其过程动态可逆。65岁老年人衰弱发生率为5.2%~19.1%。老年衰弱与失能、多病共存，给社会和家庭带来沉重的医疗和经济负担，已成为全球性公共健康问题。衰弱前期是健康与衰弱之间过渡阶段，发生率为41.5%~49.3%，衰弱转化率为8.9%~37.1%，健康逆转率为13.6%~28.1%，此期老年人尚存在自理能力，对损伤、疾病或外界压力能做出适当反应，更有机会得到恢复。因此衰弱前期是衰弱防治干预窗口期。本研究以社区老年人为研究对象，采用潜变量增长混合模型分析技术，预测老年衰弱发展轨迹及其影响因素；以此构建以联合运动为核心，辅以健康教育、营养支持、认知训练和心理干预的社区老年衰弱健康管理模式，并进行干预研究，促进衰弱前期和衰弱的逆转，为开展社区老年衰弱健康管理提供参考。

衰弱是机体储备能力和抵御能力下降，对不良健康结局易感性增加，包括躯体衰弱、心理衰弱、社会衰弱和环境衰弱，其过程动态可逆。衰弱是影响老年人身心健康和生活质量、加重家庭社会负担的主要因素，及时识别、预防、减缓衰弱的发生与进展对实现老龄化有重要意义。根据衰弱指征，分为衰弱前期和衰弱期，衰弱前期是健康与衰弱之间过渡阶段，是衰弱防治干预窗口期。构建老年衰弱及老年衰弱前期预测模型、纵向探索老年衰弱变化轨迹，对构建老年衰弱干预模型提供参考依据。本研究分两阶段进行，第一阶段纵向收集浙江省丽水市若干个社区老年人进行调查研究，于1年后进行随访，首先基于基线数据，构建老年衰弱和老年衰弱前期风险预测模型模型，结果发现，社区老年衰弱前期危险因素分别为年龄、住院史、跌倒史、运动量少、多病共存、抑郁倾向、认知功能下降、文化程度低、日常生活能力下降及多重用药；衰弱前期转化为衰弱的危险因素为衰弱前期转化为衰弱危险因素包括独居、合并多病、多重用药、跌倒史、住院史及日常生活功能障碍。通过一年后随访，进一步探索老年衰弱发展变化及其影响因素，发现衰弱状态缓解为22.1%、状态维持为45.3%、衰弱状态加重为32.6%，衰弱变化的主要影响因素为年龄和慢病多病。基于衰弱危险因素研究结果，构建老年衰弱干预模式并进行实证验证，研究结果发现，联合运动为核心，辅以健康教育、营养支持、认知训练和心理干预的社区老年衰弱健康管理模式，有效缓解老年衰弱变化，改善老年人身心健康状态。