高龄共病患者衰弱发生的相关因素分析

Analysis of related factors of frailty in very elderly patients with multimorbidity

目的探讨分析高龄共病患者衰弱发生的相关因素。方法横断面研究,选取2022年8月至2023年3月在复旦大学附属华东医院老年医学科病房住院治疗的高龄共病患者119例,收集患者的一般情况、罹患疾病数量与种类、筛查衰弱状态,了解患者共病基本状态。并通过老年综合评估的方式,将研究对象分成衰弱与非衰弱两组,对性别、年龄、平衡步态评分(Tinetti)、肌少症风险、痴呆、抑郁、深静脉栓塞风险、吞咽功能障碍、共病指数、用药数量、基本日常生活活动能力(BADL)评分、工具性日常生活能力(IADL)评分、营养风险筛查量表(NRS-2002)评分、压力性损伤风险评估量表(Norton)评分及社会支持评定量表(SSRS)评分等作单因素分析以及多因素Logistic回归分析,了解各因素与衰弱发生的相关性。结果共纳入119例高龄共病住院患者,年龄为(90.8±5.9)岁,衰弱发生率为68.9%(82例)。单因素分析结果显示,衰弱组的年龄(t=-3.131,P=0.002)、Tinetti平衡步态评分(Z=-5.544,P<0.001)、肌少症风险(χ^(2)=39.205,P<0.001)、吞咽功能障碍(χ^(2)=5.937,P=0.015)、Charlson共病指数(Z=-2.565,P=0.010)、用药数量(Z=-3.325,P<0.001)、BADL(Z=-5.871,P<0.001)、IADL(Z=-5.062,P<0.001)、Norton评分(Z=-5.922,P<0.001)及SSRS社会支持度(Z=-2.637,P=0.008)与非衰弱组比较,均差异有统计学意义。经多因素Logistic回归分析,Tinetti平衡步态评分(OR=0.843,95%CI:0.737~0.966,P=0.014)、肌力下降(OR=11.226,95%CI:2.157~58.432,P=0.004)、肌少症(OR=18.084,95%CI:2.041~106.211,P=0.009)、Norton评分(OR=0.462,95%CI:0.254~0.838,P=0.011)、用药数量(OR=1.153,95%CI:1.000~1.329,P=0.049)是衰弱的独立相关因素。结论在高龄共病患者中,衰弱的发生率极高,跌倒风险、肌力下降/肌少症风险、压疮风险、多重用药与衰弱独立相关。

Objective To investigate the factors contributing to frailty in very elderly patients with multimorbidity.Methods This cross-sectional study enrolled 119 very elderly patients with multimorbidity who were hospitalized in the Department of Geriatrics of Huadong Hospital Affiliated to Fudan University from August 2022 to March 2023.The study aimed to understand the basic status of multimorbidity by collecting general information,the number and types of diseases,and frailty status.The subjects were divided into frail and non-frail groups through comprehensive geriatric assessment.Various factors including gender,age,Tinetti balance gait score,risk of sarcopenia,dementia,depression,risk of deep vein thrombosis,dysphagia,comorbidity index,medication count,Basic Activities of Daily Living(BADL)score,Instrumental Activities of Daily Living(IADL)score,Nutritional Risk Screening 2002(NRS-2002)score,Norton pressure injury risk assessment score,and Social Support Rating Scale(SSRS)score were compared.The correlation between each factor and the occurrence of frailty was analyzed using univariate analysis and multivariate Logistic regression analysis.Results A total of 119 elderly inpatients with multimorbidity,with an average age of 90.8±5.9 years old,were included in the study.The incidence of frailty was 68.9%(82 cases).Univariate analysis revealed significant statistical differences between the frail group and the non-frail group in various factors including age(t=-3.131,P=0.002),Tinetti score(Z=-5.544,P<0.001),risk of sarcopenia(χ^(2)=39.205,P<0.001),dysphagia(χ^(2)=5.937,P=0.015),Charlson comorbidity index(Z=-2.565,P=0.010),medication count(Z=-3.325,P<0.001),BADL(Z=-5.871,P<0.001),IADL(Z=-5.062,P<0.001),Norton score(Z=-5.922,P<0.001),and SSRS social support(Z=-2.637,P=0.008).Multivariate logistic regression analysis showed that the Tinetti score(OR=0.843,95%CI:0.737-0.966,P=0.014),decreased muscle strength(OR=11.226,95%CI:2.157-58.432,P=0.004),sarcopenia(OR=18.084,95%CI:2.041-106.211,P=0.009),Norton score(OR=0.462,95%CI:0.254-0.838,P=0.011),and medication count(OR=1.153,95%CI:1.000-1.329,P=0.049)were independently associated with frailty.Conclusions In very elderly patients with multimorbidities,the occurrence of frailty is notably increased.Frailty is linked to multiple risks including falls,muscle weakness/sarcopenia,pressure ulcer risk,and polypharmacy,and these risks are independent of other factors.