老年住院患者共病及多重用药与衰弱关系的分析

Analysis of the relationship of comorbidity and polypharmacy with frailty in elderly inpatients

目的探讨老年住院患者共病及多重用药与衰弱的关系。方法采用横断面研究的方法,收集280例老年住院患者一般资料、共病数量和服药种类,采用衰弱指数(frailty index,FI)进行衰弱评估。根据FI值,将患者分为衰弱组(0.45≤FI<1,88例)、衰弱前期组(0.20<FI<0.45,79例)及非衰弱组(0<FI≤0.20,113例),比较各组患共病及多重用药情况,并进行统计学分析。结果 280例患者中,检出衰弱、衰弱前期及非衰弱的比例分别为31.4%、28.2%及40.4%;衰弱前期组和衰弱组患者共病数量多于非衰弱组,衰弱组患者≥2种疾病的比例明显高于非衰弱组和衰弱前期组(P<0.01);从非衰弱组到衰弱组,多重用药的比例呈增加趋势,分别为29.2%、34.2%及52.3%(P<0.01)。应用spearman相关分析显示,FI水平与共病数量、多重用药和年龄呈正相关(P<0.01),与文化程度呈负相关(P<0.05)。结论老年住院患者衰弱发生率高,同时合并多种疾病且服药数量较多,提示临床护士应主动了解患者的衰弱情况,全面评估患者,提供有针对性、个体化的护理措施。

Objective To analyze the relationship of comorbidity and polypharmacy with frailty in elderly inpatients. Methods General information, comorbidity and medication types of 280 elderly inpatients were collected with cross-sectional study method. Frailty（0.45≤FI1）, prefrailty（0.20FI0.45） and nonfrailty（0FI≤0.20） were assessed according to frail index（FI）. The comorbidity and polypharmacy were compared between the two groups. Results Among the 280 patients, the rates of frailty, prefrailty and nonfrailty were 31.4%, 28.2% and 40.4% respectively. The number of comorbidity in frailty and prefrailty patients were statistically higher than that in nonfrailty patients, and the proportion of more than 2 diseases in frail patients was statistically higher than those in nonfrailty patients and prefrailty patients（P〈0.01）. The percentage of polypharmacy in the nonfrailty group to the frailty group was 29.2%, 34.2% and 52.3% respectively（P〈0.01）. Spearman correlation analysis showed that there was a positive correlation between FI level with comorbidity, polypharmacy and age（P〈0.01）, and a negative correlation between FI level with educational level（P〈0.05）.Conclusion The incidence of frailty was high in elderly inpatients and with more comorbidity, polypharmacy. It suggests that clinical nurse should understand the patient＇s frailty initiatively and evaluate patients comprehensively to provide targeted and individualized care measures.