miertyo 2010-1-8 12:34
85歲以上人口迅速增加
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
December 23, 2009 — 根據線上發表於2009年12月22日英國醫學期刊(British Medical Journal)的「Newcastle 85+世代研究」結果，2010年時，英國85歲以上「超老」人口將增加33%。
資深研究者、泰恩河畔新堡新堡大學老化與生命力學院的Thomas B.L. Kirkwood在新聞稿中表示，這些85歲的人似乎是樂觀的，他們避開了與特定不佳因素有關的死亡率風險，因此對於本身的老化影響有特別多的資訊。
「Newcastle 85+世代研究」的目標是評估非特定85歲世代之臨床、生物與心理社會特徵，以評估後續的老化相關健康軌跡。
該報告描述這個世代之原始健康資料的一個橫斷面分析，包括出生於1921年的1,042人，登記參與泰恩河畔新堡綜合開業醫與英國北泰恩賽德基層照護組織。
主要研究終點是詳細的健康評估與回顧綜合開業紀錄，包括考量的疾病、藥物與使用綜合開業服務的資訊。研究對象被允許拒絕研究協定中的各種要素。
1,453名適合者之中，851人(58.6%)參與健康評估和紀錄回顧，188人(12.9%)只有紀錄回顧，3人(0.2%)只有健康評估；因為退出研究而使得有些參數有闕漏值，最多只有1,030人的紀錄回顧資料、853人的健康評估資料。
健康評估樣本包括530名婦女(62.1%)，89人(10.4%)屬於機構式照護。最主要的疾病是高血壓(57.5%，592/1030)與骨關節炎(51.8%，534/1030)，其他狀況包括聽力不佳有59.6% (505/848)、視力不佳有37.2% (309/831)、嚴重或完全尿失禁有21.3% (173/813)、中度或嚴重認知不佳有11.7% (96/824)。
健康評估發現可能有疾病但是原本的醫療紀錄中沒有記載的，包括高血壓有25.1%(206/821)、缺血性心臟病有12.6% (99/788)、憂鬱有6.9%(53/772)、失智有6.7% (56/840)、心房纖維顫動3.8% (30/788)，不過，未診斷的糖尿病與甲狀腺疾病很罕見(1%，分別是7/717與6/762)。
雖然參與者報告指出難以進行的日常活動項目中位數為3種(四分位距為1-8)，相較於其他同年齡者，77.6%(646/832)的參與者將自己的健康排序為良好、很好或極佳。過去一年中，93.8% (960/1024)的參與者曾經和一般開業醫師聯絡。
相較於男性，婦女有顯著較高的疾病數(中位數，5 vs 4；P = .033)與失能分數(中位數，4 vs 2；P = .0006)，不過，她們在過去3個月比較少有門診(29% [150/524] vs 37% [118/320]；勝算比0.7；95%信心區間0.5 - 0.9)。
研究作者寫道，這一大群85歲的世代，自我排序的健康與功能性能力都顯示為良好，即便有一些疾病和不佳狀況。高血壓、缺血性心臟病、心房纖維顫動、憂鬱和失智可能未被診斷。兩性之間值得注意的差異是：婦女數量大於男性且有較多疾病和失能。
研究限制包括可能有偏見、信賴自我報告，無法一般化到其他族群。
研究作者結論表示，我們的研究顯示的是，一個可以改善此年齡族群之後續健康的可行介入機會，如果資料外推到未來，已開發國家更多的85歲長者，對健康和社會照護之影響、以及需提供的資源都相當深遠。
波士頓大學醫學中心醫學副教授Thomas Perls醫師在編輯評論中表示，當確認年長者的適當治療時，需將功能性狀態納入考量。
Perls醫師寫道，失能是這些年長者之死亡率的較佳預測因子，而非疾病。功能性狀態是建立其治療目標的重要考量，而非只有年紀。應優先瞭解基因，以及某些人在處理疾病上優於其他人的可調整因素。
The Medical Research Council支持本研究。作者們皆宣告沒有相關財務關係。
BMJ. 線上發表於2009年12月22日。
Population of Individuals Aged 85 Years and Older Rapidly Increasing
By Laurie Barclay, MD
Medscape Medical News
December 23, 2009 — The prevalence of individuals 85 years of age or older — often described as the "oldest old" — may increase by 33% in the United Kingdom by 2010, according to the results from the Newcastle 85+ cohort study published online December 22 in the British Medical Journal.
"These 85-year-olds seemed optimistic," senior author Thomas B.L. Kirkwood, from Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, said in a news release. "[They] evaded the risks of mortality associated with specific adverse factors and are therefore particularly likely to be informative about the effects of intrinsic ageing."
Goals of the Newcastle 85+ Study are to evaluate the clinical, biological, and psychosocial characteristics of an unselected cohort of 85-year-olds and to assess subsequent health trajectories with aging.
The report describes a cross-sectional analysis of baseline health data from this cohort, consisting of 1042 people born in 1921 and registered with the participating general practices in Newcastle upon Tyne and North Tyneside primary care trusts, United Kingdom.
Primary study endpoints were detailed health evaluation and review of general practice records, including information concerning disease, medication, and use of general practice services. Study participants were permitted to decline various elements of the protocol.
Of 1453 eligible persons, 851 (58.6%) participated in health evaluation plus record review, 188 (12.9%) in record review only, and 3 (0.2%) in health evaluation only. Because of study withdrawal and missing values for some parameters, data from record review are reported on a maximum of 1030 participants and from health evaluation on a maximum of 853 participants.
The health evaluation sample included 530 women (62.1%) and 89 participants who were in institutional care (10.4%). The most prevalent diseases were hypertension (57.5%, 592/1030) and osteoarthritis (51.8%, 534/1030). Other conditions included hearing impairment in 59.6% (505/848), visual impairment in 37.2% (309/831), severe or profound urinary incontinence in 21.3% (173/813), and moderate or severe cognitive impairment in 11.7% (96/824).
Health evaluation identified participants with possible disease not previously documented in their medical record, including hypertension in 25.1%, (206/821), ischemic heart disease in 12.6% (99/788), depression in 6.9% (53/772), dementia in 6.7% (56/840), and atrial fibrillation in 3.8% (30/788). However, undiagnosed diabetes mellitus and thyroid disease were rare (1%, 7/717 and 6/762, respectively).
Although participants reported difficulty performing a median of 3 (interquartile range, 1 - 8) activities of daily living, 77.6% (646/832) of participants rated their own health as good, very good, or excellent compared with others of the same age. In the previous year, 93.8% (960/1024) of participants had contact with general practitioners.
Compared with men, women had significantly higher disease counts (median, 5 vs 4; P = .033) and disability scores (median, 4 vs 2; P = .0006). However, they were less likely to have visited outpatient clinics in the previous 3 months (29% [150/524] vs 37% [118/320]; odds ratio, 0.7; 95% confidence interval, 0.5 - 0.9).
"This large cohort of 85 year olds showed good levels of both self rated health and functional ability despite significant levels of disease and impairment," the study authors write. "Hypertension, ischemic heart disease, atrial fibrillation, depression, and dementia may be underdiagnosed. Notable differences were found between the sexes: women outnumbered men and had more disease and disability."
Limitations of this study include possible referral bias, reliance on self-report, and lack of generalizability to other populations.
"Our study shows the opportunities available to intervene to improve health further in this age group," the study authors conclude. "If the data are extrapolated to the future, much larger, populations of 85 year olds in developed countries, implications for health and social care and the resources needed to provide these are profound."
In an accompanying editorial, Thomas Perls, MD, MPH, an associate professor of medicine from Boston University Medical Center in Massachusetts, suggests that functional status must be considered when determining appropriate medical treatment in the very old.
"Disability, rather than disease, is the better predictor of mortality at these older ages," Dr. Perls writes. "Functional status, rather than age alone, must be an important consideration in establishing goals of medical treatment in the very old. Understanding the genetic and modifiable underpinnings of how some people deal with disease better than others should be a priority."
The Medical Research Council supported this study. The study authors have disclosed no relevant financial relationships.
BMJ. Published online December 22, 2009.