住院高龄老年患者贫血与日常生活能力衰弱共病特点分析

Characteristic analysis of anemia,activities of daily living,frailty and multimorbidity in hospitalized patients of advanced age

目的分析住院高龄老年患者贫血、共病、生活能力、衰弱分布情况及相互关系。方法选取我院老年医学科住院的255例≥80岁的患者,回顾性收集患者的一般情况,记录慢性疾病,并完善日常生活能力(ADL)及(临床衰弱量表)(CSF-09)评估,实验室指标(血红蛋白、平均红细胞体积、平均红细胞血红蛋白浓度、叶酸、维生素B12、血清铁、铁蛋白、肌酐等)。分析贫血、日常生活能力受损、衰弱、共病的患病率,贫血类型特点。结果 255例住院高龄老年患者中贫血174例,占总人数68.2%,其中轻度贫血90例(51.7%)、中度贫血77例(44.3%)、重度贫血7例(4.0%),正细胞性贫血143例(82.2%)。贫血原因中营养性贫血(即缺铁性贫血或巨幼细胞性贫血)65例(37.4%),慢性病贫血89例(51.1%),合并慢性肾脏病3-5期的贫血90例(51.7%),多因素贫血84例(48.3%)。男性、女性贫血差异无统计学意义。高龄组(80~89岁)与超高龄组(≥90岁)在血红蛋白水平、疾病数、疾病负担、共病指数方面差异无统计学意义(P>0.05),高龄组与超高龄组在ADL方面平均秩和分别为118.19、156.68,衰弱方面平均秩和分别为118.12、156.88,差异均有统计学意义(U=8039.5、8052.0,均P=0.000)。住院高龄老年患者不同贫血程度在ADL(H=20.5,P=0.000)、CSF-09(H=29.7,P=0.000)、疾病数(H=16.2,P=0.001)、疾病负担(H=20.7,P=0.000)、共病指数(H=12.6,P=0.006)方面的差异具有统计学意义。结论贫血、衰弱、共病在住院高龄老年人中患病率高,贫血预示了更严重的生活能力受损、疾病负担、衰弱程度,应重视高龄老年人的贫血、衰弱及慢性疾病的管理。

Objective To investigate the frequency of anemia,multimorbidity,impaired activities of daily living and frailty in advanced age inpatients,and to analyze the interrelations between them.Methods A total of 255 inpatients over 80 years old at the department of geriatrics in our hospital were included.General conditions and chronic diseases of patients were collected.Activities of daily livingC ADLland frailty were evaluated by using the Barthel Index Scale and Clinical Frailty Scale-09(CFS-09)respectively,and laboratory tests for hemoglobin,mean red blood cell(RBC)volume,mean RBC hemoglobin concentration,folic acid,vitamin B12,serum iron,ferritin,and creatinine were conducted.The prevalence rates of anemia,impaired activities of daily living,frailty and multimorbidities and the characteristics of anemia were analyzed.Results Of the 255 elderly inpatients,174 had anemia,accounting for 68.2%.For patients with anemia,143 had normocytic anemia(82.2%),and in terms of severity,90 had mild anemia(51.7%),77 had moderate anemia(44.3%),and 7 had severe anemia(4.0%).The causes of anemia included nutritional anemia(iron deficiency anemia or megaloblastic anemia)(65 cases,37.4%),anemia of chronic disease(89 cases,51.1%),anemia due to stage 3-5 chronic kidney disease(90 cases,51.7%)and anemia due to multiple factors(84 cases,48.3%).There was no significant difference in anemia between men and women.There was no significant difference in hemoglobin level,number of diseases,disease burden or comorbidity index between the advanced age group(80-89 years old)and the very advanced age group(90 years old or over)(P>0.05).There were significant differences in mean rank sums of ADL and CFS-09 between the advanced age group and the very advanced age group(118.19 vs.156.68,118.12 vs.156.88,U=8039.5 and 8052.0,P=0.000).There were also significant differences in ADL(H=20.5,P=0.000),CSF-09(H=29.7,P=0.000),number of diseases(H=16.2,P=0.001),disease burden(H=20.7,P=0.000)and comorbidity index(H=12.6,P=0.006)between hospitalized elderly patients with different degrees of anemia.Conclusions The prevalence rates of anemia,frailty and multimorbidity are high in advanced age inpatients.Anemia predicts increased impairment of living capacity,burden of disease and degree of frailty.Heightened emphasis is required on the management of anemia,frailty and multimorbidity in advanced age patients.