老年住院患者不同衰弱表型筛查及其影响因素分析

Different Frailty Screening Tools and the Influential Factors in Elderly Hospitalized Patients

目的通过筛查老年住院患者不同衰弱表型并比较其各自影响因素,分析其各自特点和不同的适用人群。方法采用连续入组方法,选取2019年2月~5月在解放军总医院心血管内科住院的老年患者100例,进行Freid衰弱表型(FFP)、衰弱筛查量表(FRAIL)、临床衰弱量表(CFS)评估。结果通过FFP、FRAIL和CFS量表评估100例患者,衰弱发生率分别为24%、8%、18%,衰弱前期分别为59%、66%和68%。3种评估方法Kappa一致性检验,Kappa值分别为0.159、0.135和0.361(0<Kappa≤0.475),FFP与FRAIL及CFS与FRAIL的Kappa值差异均有统计学意义(P<0.05)。单因素分析显示,3种评估方法既有各自不同的影响因素,又有相同的影响因素,FFP表型与多项冠心病的病因和临床改变均显著相关(P<0.05),FRAIL、CFS与多项老年衰弱综合征显著相关(P<0.05),共同的影响因素有老年人生活自理能力、躯体平衡协调、运动能力、活动受限、身体虚弱及机体凝血状态(P<0.05),FRAIL和CFS在老年认知、失能、虚弱、营养方面具有相同的影响因素(P<0.05)。logistic多因素分析显示,计时起立行走测试(TUGT)、心绞痛和D-二聚体是FFP衰弱的危险因素(P<0.05);老年焦虑是CFS衰弱的危险因素,生活完全自理、工具性生活自理能力是衰弱的保护因素(P<0.05);不能外出活动是FRAIL衰弱的危险因素,生活完全自理、体质量无下降是衰弱的保护因素(P<0.05)。结论FFP表型、FRAIL及CFS衰弱表型评估,均能实现对老年心血管病住院患者快速衰弱筛查目的,但衰弱评估结果及影响因素差异较大,应根据不同的研究对象选择不同的筛查工具,可更好地提高筛查的准确性和有效性。

Objective To evaluate the frailty of elderly inpatients by using different tools and compare their influential factors,and analyze their characteristics and applicable population.Methods 100 elderly inpatients in the Cardiovascular Department of the PLA General Hospital were selected from February 2019 to May 2019.Fried frailty phenotype(FFP),FRAIL scale,and clinical frailty scale(CFS)were used to assess the frailty of patients.Results The incidence of frailty in elderly hospitalized patients with cardiovascular disease was 24%in FFP,8%in FRAIL scale and 18%in CFS.The incidence of early frailty was 59%in FFP,66%in FRAIL and 68%in CFS.Kappa consistence analysis showed that Kappa values were 0.159 in FFP,0.135 in FRAIL and 0.361 in CFS(0>Kappa≤0.475).There was significant difference in Kappa values between FFP and FRAIL,and between CFS and FRAIL(P<0.05).Univariate analysis showed that there were the same and different influential factors among the three assessment tools.FFP was significantly correlated with the etiology and clinical changes of coronary heart disease(P<0.05).FRAIL and CFS were significantly correlated with geriatric frailty syndromes(P<0.05).Among the three methods,the common influential factors included the self-care ability,body balance,exercise ability,limited activity,physical weakness and coagulation status(P<0.05).There were the same influential factors including cognition,disability,weakness and nutrition between FRAIL and CFS(P<0.05).Logistic multivariate analysis showed that TUGT,angina pectoris and D-dimer were independent risk factors for FFP(P<0.05).Aging anxiety was an independent risk factor for CFS.The ability of self-care,instrumental self-care were protective factors for CFS(P<0.05).Not going out was an independent risk factor for FRAIL,while self-care ability and stable body weight were the protective factors for FRAIL(P<0.05).Conclusion FFP,FRAIL and CFS could be used to screen the frailty in elderly inpatients with cardiovascular disease.However,the frailty assessment results and influential factors are quite different.The different frailty screening tools should be selected according to different population,which can improve the accuracy and effectiveness of screening.