老年共病患者衰弱患病率的Meta分析

Prevalence of Frailty in Elderly Patients with Comorbidity:a Meta-analysis

背景随着人口老龄化问题日益严峻,老年人共病发生率呈现逐年上升的趋势。共病是老年人衰弱的关键危险因素,而衰弱使共病患者出现一系列不良健康结局的风险升高的同时,也会使其家庭医疗费用支出明显增加。尽早明确老年共病患者的衰弱患病情况,对于共病管理具有一定的指导价值。目的系统评价老年共病患者衰弱的患病率。方法于2021年12月,计算机检索中国知网、维普中文科技期刊全文数据库、中国生物医学文献数据库、万方数据知识服务平台、PubMed、EmBase、Web of Science及Cochrane Library,获取关于老年共病患者衰弱现状的调查研究,检索时限均为建库至2021-12-04。由两名研究者独立筛选文献、提取资料并采用美国卫生保健质量和研究机构(AHRQ)推荐的横断面研究质量评价量表和纽卡斯尔-渥太华量表(NOS)评价纳入研究的偏倚风险后,采用Stata 14.0软件进行Meta分析。结果共纳入25项研究,老年共病患者总计16062例。Meta分析结果显示,老年共病患者衰弱及衰弱前期患病率分别为26.7%[95%CI(21.9%,31.5%)]、47.7%[95%CI(43.9%,51.4%)]。亚组分析结果显示,患≥2、≥3、≥4、≥5种慢性病的老年人衰弱患病率分别为25.1%[95%CI(19.3%,30.8%)]、27.4%[95%CI(13.7%,41.0%)]、60.7%[95%CI(29.0%,92.4%)]、23.5%[95%CI(8.6%,38.5%)];大洋洲(52.1%)、亚洲(31.3%)老年共病患者衰弱患病率明显高于欧洲(16.9%)、南美洲(13.2%)老年共病患者;医院内的老年共病患者衰弱患病率(26.2%)高于社区老年共病患者(23.2%);通过临床衰弱量表(CFS)、Fried衰弱表型量表、FRAIL量表测出的老年共病患者衰弱患病率分别为42.8%[95%CI(38.4%,47.1%)]、22.2%[95%CI(17.8%,26.7%)]、8.5%[95%CI(6.3%,10.6%)];于2001—2010、2011—2015、2016—2020年接受调查的老年共病患者的衰弱患病率分别为21.0%[95%CI(13.2%,28.8%)]、19.0%[95%CI(13.1%,24.8%)]、37.7%[95%CI(22.6%,52.9%)]。结论老年共病患者衰弱患病率逐渐上升,不同共病数量、洲际、评估工具(下)、研究场所(中)的老年共病患者衰弱患病率存在差异。因此,相关人员应重视老年共病患者衰弱的早期筛查,并及时采取措施预防老年共病患者衰弱的发生。

Background The prevalence of comorbidity in the elderly is showing a rising trend year by year with the acceleration of population aging.Comorbidity is a key risk factor for frailty in the elderly.Then frailty only increases the risk of adverse health outcomes for patients with comorbidity,but also significantly increases their family medical expenses.It has a certain guiding value for the management of comorbidity to identify the frailty conditions of elderly patients with comorbidity as early as possible.Objective To systematically review the prevalence of frailty in elderly patients with comorbidity.Methods CNKI,VIP,CBM,WanFang,PubMed,EmBase,Web of Science and Cochrane Library were searched in December 2021 for the investigation studies on the current status of frailty in elderly patients with comorbidity published from inception to December 4,2021.Two researchers performed literature screening and data extraction independently.The cross-sectional study quality rating scale and Newcastle-Ottawa Scale(NOS)recommended by Agency for Healthcare Research and Quality(AHRQ)were used to assess the risk of bias of the included studies and Stata 14.0 was adopted for meta-analysis.Results A total of 25 studies involving 16 062 elderly patients with comorbidity were included.Meta-analysis results showed that the prevalence of frailty and pre-frailty in elderly patients with comorbidity was 26.7%[95%CI(21.9%,31.5%)]and 47.7% [95%CI(43.9%,51.4%)].Subgroup analysis showed that the prevalence of frailty in older adults with ≥ 2,≥ 3,≥ 4,and ≥ 5 chronic diseases was 25.1%[95%CI(19.3%,30.8%)],27.4%[95%CI(13.7%,41.0%)],60.7%[95%CI(29.0%,92.4%)],and 23.5%[95%CI(8.6%,38.5%)],respectively.The prevalence of frailty in elderly patients with comorbidity in Oceania(52.1%)and Asia(31.3%)were significantly higher than Europe(16.9%)and South America(13.2%).The prevalence of frailty in elderly patients with comorbidity in hospital(26.2%)was significantly higher than community(23.2%).The prevalence of frailty in elderly patients with comorbidity screened by Clinical Frailty Scale(CFS),Fried frailty phenotype scale and FRAIL Scale was 42.8%[95%CI(38.4%,47.1%)],22.2%[95%CI(17.8%,26.7%)]and 8.5%[95%CI(6.3%,10.6%)],respectively.The prevalence of frailty in elderly patients surveyed in 2001—2010,2011—2015,and 2016—2020 was 21.0%[95%CI(13.2%,28.8%)],19.0%[95%CI(13.1%,24.8%)]and 37.7%[95%CI(22.6%,52.9%)],respectively.Conclusion The prevalence of frailty in elderly patients with comorbidity is gradually increasing,with differences by number of co-morbidities,continents,assessment tools and study sites.Therefore,relevant personnel should pay attention to early screening of frailty in elderly patients with comorbidity and take timely measures to prevent the development of frailty in elderly patients with comorbidity.