Introduction: In older US nursing home (NH) residents, there is limited research on the prevalence of physical frailty, its potential dynamic changes, and its association with cognitive impairment in older adults’ first 6 months of NH stay. Methods: Minimum Data Set (MDS) 3.0 is the national database on residents in US Medicare-/Medicaid-certified NHs. MDS 3.0 was used to identify older adults aged ≥65 years, newly admitted to NHs during January 1, 2014, and June 30, 2016, with life expectancy ≥6 months at admission and NH length of stay ≥6 months (N = 571,139). MDS 3.0 assessments at admission, 3 months, and 6 months were used. In each assessment, physical frailty was measured by FRAIL-NH (robust, prefrail, and frail) and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale (none/mild, moderate, and severe). Demographic characteristics and diagnosed conditions were measured at admission, while presence of pain and receipt of psychotropic medications were at each assessment. Distribution of physical frailty and its change over time by cognitive impairment were described. A nonproportional odds model was fitted with a generalized estimation equation to longitudinally examine the association between physical frailty and cognitive impairment, adjusting for demographic and clinical characteristics. Results: Around 60% of older residents were physically frail in the first 6 months. Improvement and worsening across physical frailty levels were observed. Particularly, in those who were prefrail at admission, 23% improved to robust by 3 months. At admission, 3 months, and 6 months, over 37% of older residents had severe cognitive impairment and about 70% of those with cognitive impairment were physically frail. At admission, older residents with moderate cognitive impairment were 35% more likely (adjusted odds ratio [aOR]: 1.35, 95% confidence interval [CI]: 1.33–1.37) and those with severe impairment were 74% more likely (aOR: 1.74, 95% CI: 1.72–1.77) to be frail than prefrail/robust, compared to those with none/mild impairment. The association between the 2 conditions remained positive and consistently increased over time. Discussion/Conclusion: Physical frailty was prevalent in NHs with potential to improve and was strongly associated with cognitive impairment. Physical frailty could be a modifiable target, and interventions may include efforts to address cognitive impairment.
Dement Geriatr Cogn Disord

中文翻译：

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美国疗养院老年人的身体虚弱和认知障碍


简介：在美国养老院 (NH) 老年居民中，关于老年人入住 NH 前 6 个月身体虚弱的患病率、其潜在的动态变化及其与认知障碍的关系的研究有限。方法：最小数据集 (MDS) 3.0 是美国医疗保险/医疗补助认证的 NH 居民的国家数据库。 MDS 3.0用于识别年龄≥65岁、2014年1月1日至2016年6月30日新入NHs、入院时预期寿命≥6个月且NH住院时间≥6个月的老年人（ N = 571,139） 。使用入院时、3个月和6个月时的MDS 3.0评估。在每次评估中，通过 FRAIL-NH（强健、脆弱和虚弱）来衡量身体虚弱程度，通过精神状态和认知表现量表（无/轻度、中度和重度）简短访谈来衡量认知障碍。在入院时测量人口统计学特征和诊断状况，同时在每次评估时测量是否存在疼痛和接受精神药物。描述了认知障碍导致的身体虚弱的分布及其随时间的变化。非比例优势模型与广义估计方程相匹配，以纵向检查身体虚弱和认知障碍之间的关联，并根据人口和临床特征进行调整。结果：大约 60% 的老年居民在前 6 个月内身体虚弱。观察到身体虚弱程度的改善和恶化。特别是，在入院时处于虚弱状态的患者中，23% 的人在 3 个月后病情改善为健康。 入院时、3个月和6个月时，超过37%的老年居民有严重的认知障碍，其中约70%的认知障碍患者身体虚弱。入院时，患有中度认知障碍的老年居民的可能性高出 35%（调整后优势比 [aOR]：1.35，95% 置信区间 [CI]：1.33–1.37），患有严重认知障碍的老年居民的可能性高出 74%（aOR：1.74） , 95% CI: 1.72–1.77) 与无损伤/轻度损伤的患者相比，体弱多于预衰弱/健壮。这两种情况之间的关联仍然是正相关，并且随着时间的推移不断增强。讨论/结论：身体虚弱在非健康人群中普遍存在，有改善的潜力，并且与认知障碍密切相关。身体虚弱可能是一个可修改的目标，干预措施可能包括解决认知障碍的努力。

老年痴呆症认知障碍