社区老年人衰弱情况及其影响因素研究

Prevalence and Influencing Factors of Frailty among Elderly People in the Community

背景衰弱是健康与失能之间一种动态可逆的状态,与老年人不良结局密切相关,随着全球人口的快速老龄化,早期识别衰弱并根据其影响因素制定干预措施显得尤其重要。目的探究社区老年人衰弱情况及其影响因素,为进一步制定社区老年人衰弱干预措施提供参考依据。方法2018年6月—2019年6月在太原市卫生健康委员会协助下从太原市经济水平居中的社区中抽取6个社区并随机选取600名符合纳入标准的老年人为研究对象。由培训合格的专业医师在各居委会协助下直接入户调查。调查问卷包括基本资料、老年综合征相关评估量表〔微型营养评估量表(MNA-SF)、简易智力状态检查量表(MMSE)、Zung氏焦虑自评量表(SAS)、Zung氏抑郁自评量表(SDS)、阿森斯失眠量表、日常生活能力量表(ADL)〕、老年人衰弱情况调查表(FRAIL)。采用有序多因素Logistic回归分析探究社区老年人衰弱情况的影响因素。结果共发放问卷600份,回收有效问卷513份,有效回收率为85.5%。513例社区老年人中无衰弱431例(84.0%)、衰弱前期63例(12.3%)、衰弱19例(3.7%)。不同年龄、文化程度、居住环境、吞咽功能、合并慢性病数目、营养状态、认知功能、焦虑状态、抑郁状态、睡眠情况、日常生活能力老年人衰弱情况比较,差异有统计学意义(P<0.05)。有序多因素Logistic回归分析结果显示:合并慢性病数目〔OR=1.455,95%CI(1.071,1.974)〕、认知功能〔OR=0.915,95%CI(0.855,0.979)〕、抑郁状态〔OR=2.563,95%CI(1.185,5.540)〕、日常生活能力〔功能下降:OR=2.487,95%CI(1.310,4.721);功能明显障碍:OR=11.485,95%CI(4.424,29.815)〕是社区老年人衰弱情况的影响因素(P<0.05)。结论合并慢性病数目、认知功能、抑郁状态、日常生活能力是社区老年人衰弱情况的影响因素,可在上述影响因素的基础上有针对性地制定干预措施,减少社区老年人衰弱的发生。

Background Frailty is a term that describes a decrease in physiological function that results in dependency,which can be dynamic and reversible.Frailty is closely correlated with adverse health outcomes in older people,so it is particularly important to early identify frailty,and deliver interventions targeting its influencing factors in this group in a rapidly ageing world.Objective To investigate the frailty prevalence and influencing factors in the elderly in the community,providing evidence for the development of interventions for frailty in this population.Methods This household survey was carried out from June 2018 to June 2019 by eligible physicians with relevant trainings with the help of the neighborhood committee.Participants(n=600)were randomly selected from a random sample of 6 moderate-income communities with the assistance of Taiyuan Health Commission.The questionnaire used for collecting data includes three parts:general information,geriatric syndrome-related assessment〔Mini Nutritional Assessment-short Form(MNA-SF),Mini-mental State Examination(MMSE),Zung Self-rating Anxiety Scale(SAS),Zung Self-rating Depression Scale(SDS),Athens Insomnia Scale,Activities of Daily Living(ADL)Scale〕,and the FRAIL Scale.Multivariate ordinal Logistic regression analysis was adopted to analyze the influencing factors of frailty.Results Altogether,513(85.5%)cases who responded to the survey effectively were included in the final analysis.Of the respondents,431(84.0%)were robust,63(12.3%)were pre-frail,and 19(3.7%)were frail.The prevalence of frailty among the respondents differed significantly by age,education level,living environment,swallowing function,number of chronic diseases,nutritional status,cognitive function,anxiety status,depression status,sleep status,and level of independence in ADLs(P<0.05).Multivariate ordinal Logistic regression analysis found that number of chronic diseases〔OR=1.455,95%CI(1.071,1.974)〕,cognitive function〔OR=0.915,95%CI(0.855,0.979)〕,depression〔OR=2.563,95%CI(1.185,5.540)〕,level of independence in ADLs〔some dependency:OR=2.487,95%CI(1.310,4.721);very dependant:OR=11.485,95%CI(4.424,29.815)〕were the influencing factors of frailty(P<0.05).Conclusion The frailty of elderly in the community are affected by the number of combined chronic diseases,cognitive function,depression,and ability to perform ADL.Interventions for reducing the risk of frailty may be delivered based on the above-mentioned frailty-related factors.