住院共病老年人衰弱状态分布及其影响因素

Frail status and influencing factors in elderly inpatients with comorbidity

目的明确住院共病老年人衰弱状态分布特点,进一步探讨其影响因素。方法横断面调查选取2015年11月至2017年7月成都市第五人民医院老年科收治的≥60岁住院共病患者440例。根据衰弱状态将患者分为衰弱组150例及非衰弱组290例,比较2组患者一般人口学资料、共病、衰弱状态及老年综合征情况。采用SPSS 23.0进行统计分析。根据数据类型,组间比较采用独立样本t检验、Mann-Whitney U检验或χ~2检验。采用Mantel-Haenszel χ~2检验分析衰弱分布趋势。危险因素分析采用向后逐步法二元logistic回归。结果 440例患者总体存在5(4,7)种慢性疾病,Charlson合并症指数(CCI)为(5.59±1.82)分。入选患者衰弱患病率为34.1%(150/440),衰弱前期占60.0%(264/440)。趋势性检验结果显示,随年龄和CCI评分升高,衰弱患病率显著增加,差异有统计学意义(P<0.05);衰弱五要素中,体质量下降发生率随年龄和CCI评分增加而增加,握力下降和疲乏发生率随年龄增加而增加,差异亦有统计学意义(P<0.05)。与非衰弱患者比较,衰弱组患者年龄增大,学历较低,合并慢性心力衰竭、慢性阻塞性肺疾病、抑郁、认知功能障碍、尿失禁、高跌倒风险、功能依赖的比例显著升高,但多重用药比例显著降低,差异有统计学意义(P<0.05)。经校正混杂因素后,二元logistic回归分析表明,抑郁(OR=2.178,95%CI 1.252～3.790)和功能依赖(OR=1.942,95%CI 1.029～3.668)是衰弱的独立危险因素。结论住院共病老人中普遍存在衰弱,且衰弱的患病率与年龄和共病严重程度呈趋势性增加,抑郁和功能依赖与衰弱状态密切相关。

Objective To clarify the distribution characteristics of frail status in elderly inpatients with comorbidity,and to further explore its influencing factors.Methods A cross-sectional survey was conducted among 440 inpatients with comorbidities over 60 years old in our department from November 2015 to July 2017.According to their status of frailty,they were divided into frailty group(n=150)and non-frailty group(n=290).The general demographic data,comorbidities,frailty status and senile syndrome were compared between the 2 groups.SPSS statistics 23.0 was used for statistical analysis.Independent sample t test,Mann-Whitney U test or Chi-square test was used to compare the difference between 2 groups.Mantel-Haenszel Chi-square test was employed to analyze the trend of frailty distribution.Risk factors were analyzed by backward stepwise binary logistic regression.Results Among the 440 elderly patients,they suffered from 5(4,7)kinds of chronic diseases on average,and the mean score of Charlson comorbidity index(CCI)was(5.59±1.82).The prevalence of frailty was 34.1%(150/440),and that of pre-frailty status was 60.0%(264/440).Trend test results showed that with older age and increased CCI score,the prevalence of frailty was increased significantly(P<0.05).Among the 5 factors of frailty,the incidence of weight loss was increased with older age and increased CCI score,while the incidences of grip decrease and fatigue were increased with older age(P<0.05).Compared with non-frailty group,the frailty group were older,lower educational level,and higher fall risk,and were more prone to having chronic heart failure,chronic obstructive pulmonary disease(COPD),depression,cognitive impairment,urinary incontinence,and functional dependence,but they had significantly lower proportion of polypharmacy(all P<0.05).After adjustment for confounding factors,binary logistic regression analysis showed that depression(OR=2.178,95%CI 1.252-3.790)and functional dependence(OR=1.942,95%CI 1.029-3.668)were independent risk factors for frailty.Conclusion Frailty is common in the elderly inpatients with comorbidities,and the prevalence of frailty tends to increase with oler age and severer comorbidities.Depression and functional dependence are closely related to the status of frailty.