高齢者における、身体活動、frailtyと長期的全死亡・心血管死亡率の関連性

高齢者における、身体活動、frailtyと長期的全死亡・心血管死亡率の関連性

住民ベース前向きコホート（60歳以上　n=3,896) 2000-01年


Physical Activity and Association Between Frailty and All‐Cause and Cardiovascular Mortality in Older Adults: Population‐Based Prospective Cohort Study
Sara Higueras‐Fresnillo , et. al.
Journal of the American Geriatrics Society
First published: 16 October 2018 https://doi.org/10.1111/jgs.15542

フォローアップ中央期間14年間、死亡総数 1,801、心血管疾患死 672
全死亡率への多変量ハザード比(95% 信頼区間）は、健常(robust)比較で、prefrailで 1.29 (1.14-1.45)、 frailで 2.16 (1.82-2.58)  (p‐trend ＜ .001)

身体不活発比較で、身体活発状態では、統計学的に有意に死亡率減少と関連(健常(robust)間　 18% (1–32%)、　prefrail者間　 28% (16–39%)、 frail者間　39% (17–55%) ）(all p ＜　.001)

健常(robust)かつ身体活発と比較し、frail及び身体不活発では全死亡率最も高い 2.45 (95%CI: 1.95–3.06)
身体活発なfrail者では、全死亡率ハザード比は、pre-frail及び身体活発と同等 (各々、1.70 (1.32–2.19) と 1.56 (1.34–1.82)）

prefrailだが身体活発対象者の死亡率は、健常(robust）だが身体不活発な被検者と同等
心血管疾患死亡率も同様の結果

---

---

示唆に富む報告


frail、pre-frailだろうが、robustだろうが、身体活発性が問題

 Fatigue, Resistance, Ambulation, Illness, and weight Loss (FRAIL) scaleからFrailを計測

---

厚労省やら一部東大系の連中が入り込むと急にうさんくさくなる日本の医療系疾患概念

フレイルは、厚生労働省研究班の報告書では「加齢とともに心身の活力（運動機能や認知機能等）が低下し、複数の慢性疾患の併存などの影響もあり、生活機能が障害され、心身の脆弱性が出現した状態であるが、一方で適切な介入・支援により、生活機能の維持向上が可能な状態像」

https://www.tyojyu.or.jp/net/byouki/frailty/about.html

(下線部分は恣意的追加でしょ)


J Am Med Dir Assoc. Author manuscript; available in PMC 2014 Jul 7.
Published in final edited form as:
J Am Med Dir Assoc. 2013 Jun; 14(6): 392–397.
doi:  [10.1016/j.jamda.2013.03.022]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084863/

The group defined frailty as

“A medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death.”

In addition to the definition, the group made 4 key points:

• Although recognizing that frail individuals could be disabled and that not all disabled persons are frail, the group agreed that the emphasis on case finding should target the pre-disabled not the dependent (defined here as persons with 1 or more deficits in basic activities of daily living). Targeting those who are frail and pre-disabled in this manner, case finding becomes of major importance, as it allows interventions that could prevent dependency.
• Although sarcopenia may be a component of frailty, it was agreed that frailty is more multifaceted than sarcopenia alone.
• The group agreed that a number of well-validated models of frailty existed and that the definitive diagnosis of frailty should be done by a geriatrician using the basic criteria of these well-defined models. It is accepted that these models predict increased vulnerability to adverse health outcomes and mortality.
• As conceived in this document, physical frailty differs from multimorbidity. Both are common, but multimorbidity is more pervasive, being present in 3 of 4 persons older than 65 years and 1 of 4 in those younger than 65.40 Physical frailty focuses on specific areas for which a general treatment approach can be developed, whereas multimorbidity moves the focus to the management of each condition separately, although both require multidimensional assessment and management. A larger construct of frailty, as proposed by Rockwood et al, as a state of increased vulnerability due to impairments in many systems that may give rise to diminished ability to respond to even mild stresses, incorporates multimorbidity and central nervous system impairments that can be recognized in relation to cognitive and affective disorders.