老年综合评估筛查高龄住院患者的衰弱状况及其危险因素研究

Comprehensive Geriatric Assessment for Screening Risk Factors and Frailty in Elderly Inpatients

目的采用老年综合评估技术筛查高龄住院患者的衰弱情况并分析其危险因素。方法连续选取2016年12月—2017年4月青岛市五家三级甲等医院老年科≥80岁新入院的高龄住院患者173例作为研究对象。采用Fried衰弱表型评估患者衰弱情况,将患者分为衰弱组72例、衰弱前期组52例、无衰弱组49例,同时采用老年综合评估技术对所有研究对象进行全面评估,分析3组年龄、性别、文化程度、体质指数(BMI)、平衡与步态评估量表(Tinetti)评分、日常生活活动能力(ADL)、营养风险发生率、认知功能障碍发生率、抑郁发生率、共病种数、多重用药种数、睡眠障碍发生率及钙、磷、清蛋白、血红蛋白水平差异,对衰弱影响因素的多因素分析采用有序多分类Logistic回归分析。结果衰弱组文化程度、BMI、Tinetti评分、ADL低于衰弱前期组及无衰弱组(P<0.05);衰弱组营养风险、认知功能障碍、抑郁发生率及共病种数高于衰弱前期组及无衰弱组(P<0.05)。衰弱组钙、清蛋白、血红蛋白水平低于无衰弱组(P<0.05)。有序多分类Logistic回归分析结果显示,BMI、共病种数、多重用药种数和认知功能障碍为衰弱的影响因素(P<0.05)。结论高龄住院患者衰弱发生率高,老年综合评估可从多维度筛查高龄衰弱患者的危险因素,在老年科临床工作中要全面评估高龄患者状态,并及时进行营养、康复锻炼、调整心态等干预,最大限度地改善高龄住院患者生活质量。

Objective To screen the frailty status and risk factors of the elderly inpatients aged over 80 years by Comprehensive Geriatric Assessment(CGA).Methods A total of 173 elderly inpatients aged over 80 years newly admitted to geriatric department in five 3A hospitals in Qingdao were enrolled as the research subjects from December 2016 to April 2017.The patients'frailty was assessed by Fried's frailty phenotype.The subjects were divided into frailty group(72 cases),pre-frailty group(52 cases)and non-frailty group(49 cases).At the same time,all the subjects were comprehensively evaluated by CGA to analyze the age,sex,educational level,body mass index(BMI),Tinetti score,daily living ability,nutritional risk,cognitive function,depression,comorbidity,multiple drug use,sleep disorder and differences in calcium,phosphorus,albumin and hemoglobin levels.The affecting factors of frailty was studied with ordinal multi-factorial Logistic regression analysis.Results The education level,daily activity ability,BMI,Tinetti score of the frailty group were lower than those of the pre-frailty group and the non-frailty group(P<0.05).The nutritional risk,cognitive function,depression incidence and comorbidity in the frailty group were higher than those in the pre-frailty group and the non-frailty group(P<0.05).The levels of calcium,albumin and hemoglobin in the frailty group were lower than those in the non-frailty group(P<0.05).Ordinal multi-factorial Logistic regression analysis showed that BMI,comorbidity,multiple drug use and cognitive function were the influencing factors of frailty(P<0.05).Conclusion The incidence rate of frailty in elderly inpatients is high.Risk factors of frailty can be screened by CGA from multiple dimensions.In the clinical work of geriatric department,the state of elderly patients should be comprehensively evaluated,and interventions such as nutrition,rehabilitation exercise and adjustment of mentality should be carried out in time to improve the quality of life of elderly inpatients to the greatest extent.