社区老年衰弱综合征的影响因素研究

Influencing Factors of Frailty Syndrome in Elderly People in the Community

背景随着我国人口老龄化程度加深,老年衰弱综合征引起的社会和经济问题日益凸显。老年衰弱综合征会导致跌倒、残疾、住院等不良事件的发生。但目前我国关于老年衰弱综合征的流行病数据较少。目的探究社区老年衰弱综合征的现状及其影响因素。方法采用随机抽样法选取2018年4-9月在上海市嘉定区安亭镇黄渡社区卫生服务中心进行健康体检的老年人408例作为研究对象。研究者自制一般资料调查问卷和基础慢性病调查问卷,并由经统一培训的调查员在询问研究对象后填写,其中部分资料从上海市嘉定区安亭镇黄渡社区卫生服务中心老年人体检数据库导出;Fried衰弱表型检查由调查员辅助研究对象完成,以确定研究对象的衰弱程度;采用有序多因素Logistic回归模型分析影响社区老年衰弱综合征的基础慢性病因素。结果 408例老年人中,非衰弱期184例、衰弱前期201例、衰弱期23例。不同衰弱程度老年人的性别、年龄、身高、2017年体质量、2018年体质量、婚姻状况、文化程度、居住状况、饮食习惯、吸烟史比较,差异均有统计学意义(P<0.05)。衰弱期老年人基础慢性病的患病率由高到低排列前6项依次是:高血压、脑梗死、骨质疏松症、冠心病、慢性阻塞性肺疾病、糖尿病;不同衰弱程度老年人慢性阻塞性肺疾病、脑梗死、慢性肝病、慢性肾病、高脂血症、骨质疏松症患病率比较,差异均有统计学意义(P<0.05)。有序多因素Logistic回归分析结果显示,慢性阻塞性肺疾病[OR=4.339,95%CI(1.580,11.911)]、脑梗死[OR=2.787,95%C(I0.510,1.540)]、骨质疏松症[OR=2.048,95%C(I0.083,1.350)]是发生社区老年衰弱综合征的影响因素(P<0.05)。结论慢性阻塞性肺疾病、脑梗死、骨质疏松症是发生老年衰弱综合征的影响因素,全科医生可通过定期筛查识别高危衰弱人群,尤其对慢性阻塞性肺疾病、患脑梗死和骨质疏松症的患者要多加重视,及时预测其不良事件的发生并指导老年衰弱综合征患者及其家属正确认识该疾病,重视老年人健康情况,提高老年人生活质量。

Background In China,the prevalence of frailty syndrome in increased aging population has caused increasingly prominent social and economic problems.Frailty syndrome can lead to adverse events such as falls,disability,and hospitalization.But there are few epidemiological data on frailty syndrome in China.Objective To investigate the prevalence and influencing factors of frailty syndrome in community-dwelling elderly people.Methods From April to September 2018,a survey was conducted in a random sample of 408 elderly people recruited from Jiading District Anting Town Huangdu Community Health Service Center,Shanghai.Two self-developed questionaires(named General Information Questionaire and Underlying Chronic Disease Questionaire) were used in the survey and were filled by unifiedly trained investigators after interviewing the participants and extracting data from the physical exmination database of elderly people of the service center.The Fried Frailty Phenotype was also used in the survey for asessing the prevelence of frailty and was completed by the participants with the guidance of investigators.Multivariate ordered Logistic regression was used to analyze underlying chronic diseases and frailty syndrome.Results The participants were found to consist of nonfrail group(n=184),prefrail group(n=201) and frail group(n=23).The three groups showed significant differences in gender, age, height, 2017 BMI, 2018 BMI, marital status,educational level, living status, eating habits, smoking history(P<0.05).The top 6 highly prevalent underlying chronic diseases were hypertension,cerebral infarction,osteoporosis,coronary heart disease,chronic obstructive pulmonary disease and diabetes.The prevalence rates of chronic obstructive pulmonary disease,cerebral infarction,chronic liver disease,chronic kidney disease,hyperlipidemia and osteoporosis differed significantly across the groups(P<0.05).Multivariate ordered Logistic regression found that chronic obstructive pulmonary disease[OR=4.339,95%CI(1.580,11.911)],cerebral infarction[OR=-4.176,95%CI(-0.372,-0.134)] and osteoporosis[OR=-2.044,95%CI(-0.311,-0.006)] were associated with frailty syndrome(P<0.05).Conclusion Chronic obstructive plumonary disease,cerebral infarction and osteoporosis are the influencing factors of frailty syndrome.To timely predict adverse events associated with frailty syndrome,frailty syndrome should be screened regularly by primary care physicians to identify those at high risk of frailty syndrome,especially those with chronic obstructive plumonary disease,cerebral infarction and osteoporosis.Moreover,to improve the quality of life of the elderly,guidance should be given to frailty syndrome patients and their family members to increase their attention to patient health.