慢性阻塞性肺疾病患者的老年综合征调查

Prevalence of geriatric syndrome: a survey in elderly patients with chronic obstructive pulmonary disease

目的探讨稳定期老年慢性阻塞性肺疾病(COPD)患者老年综合征的罹患情况。方法对选取我院老年医学科门诊2015年10月至2016年12月就诊的100例年龄≥65岁稳定期老年COPD患者进行老年综合评估,评估患者共患慢病、营养风险、情绪、认知、睡眠障碍、跌倒风险、日常生活能力、6分钟步行距离(6MWD)等。结果入组患者平均年龄(76±5)岁,共患慢病0～10种,平均患老年综合征数3.8±1.5,55%存在多重用药,47%存在日常生活能力下降,68%存在工具性日常生活能力下降,营养不良及风险、情绪障碍、认知损害、睡眠障碍的发生率分别为55%,52%,40%和51%。共患慢病组,营养不良发生率(61%与35%)、情绪障碍发生率(58%与30%)、认知损害发生率(44%与26%)、睡眠障碍发生率(55%与39%)和跌倒高风险发生率(35%与17%)均高于无共患慢病组,且差异均有统计学意义(P<0.05);共患慢病组6MWD较无共患慢病组[(329±59)m与(420±62)m]更短,差异有统计学意义(P<0.05)。结论老年COPD患者营养不良、情绪障碍、睡眠障碍、认知损害等老年综合征发生率高,日常生活及活动能力下降,需要进行老年综合评估及个体化管理。

Objective To investigate the prevalence of geriatric syndrome in elderly patients with stable chronic obstructive pulmonary disease(COPD). Methods A total of 100 elderly patients with stable COPD(aged 65 years old or above) who visited our geriatics clinic between October 2015 and December 2016 were enrolled in this study.The patients were assessed for chronic comobidities, nutritional risk, mood, cognitive impairment, sleep disturbance,risk of falls, ability of daily activities, and 6-minute walking distance(6 MWD). Results The patients enrolled was(76±5) years old by mean age, with 0 to 10 individual chronic comorbidities, and affected by amean 3.8 ±1.5 signs of geriatric syndrome. Of all patients, 55% were receiving multiple medications, 47% had lowered ability of daily living,and 68% had difficulty with instrumental daily life. The incidence rates of malnutrition, mood disorders, cognitive im-pairment, and sleep disorders were 55%, 52%, 40%, and 51%, respectively. Patients with chronic comorbidities showed higher prevalence of malnutrition(61% vs 35%), mood disorders(58% vs 30%), cognitive impairment(44% vs26%), sleep disorders(55% vs 39%) and higher riskof falls(35% vs 17%) compared with those without chronic comorbidities(P<0.05). Moreover, the 6 MWD was shorter(329±59)m vs(420±62)m in this patient subset, with statistically significant difference(P<0.05). Conclusion Elderly COPD patientsare more likely to suffer geriatric syndrome including malnutrition, mood disorder, sleep disturbance and cognitive impairment, and also lowered ability of daily liv-ing and activities. Comprehensive evaluation and individualized management of this patient subset is needed.