老年综合评估在社区门诊老年患者衰弱状况研究中的应用

Application of a comprehensive geriatric assessment to analyze the frailty status of elderly out patients in community

目的利用老年综合评估(comprehensive geriatric assessment,CGA)技术评估社区门诊老年患者衰弱的发生率并分析其影响因素。方法选取2022年1月至12月在青岛市市南区某社区卫生服务中心签约就诊的279例老年患者作为研究对象。采用Fried表型筛查衰弱状况,采用CGA进行躯体功能状态、营养状态、精神状态、肌少症、共病、多重用药、睡眠状况评估,并收集血红蛋白、白蛋白、血脂、超敏C反应蛋白等实验室指标,分析衰弱与临床资料的关系。结果279例研究对象中衰弱组51例(18.28%),衰弱前期组89例(31.90%),无衰弱组139例(49.82%)。单因素分析显示3组年龄、性别、婚姻状况、是否吸烟、日常生活活动能力(ADL)、Tinetti评分、微型营养评定法(MNA-SF)评估、简易智力状态评估、老年抑郁、有无肌少症、共病种数、多重用药种数及血清总蛋白、白蛋白、血红蛋白、高密度脂蛋白、超敏C反应蛋白、血钙水平比较,差异有统计学意义(P<0.05)。有序多分类Logistic回归分析显示年龄、性别、吸烟、营养不良、共病种数、血清总蛋白、血红蛋白、超敏C反应蛋白为衰弱的影响因素(P<0.05)。结论社区近半数老年人为衰弱及衰弱前期患者,应用CGA可以早期筛查衰弱及衰弱前期患者,并可以从共病管理、营养支持等方面进行干预,从而提高老年人的生活质量。

Objective To evaluate the incidence of frailty in elderly outpatients in community by the comprehensive geriatric assessment(CGA)and to analyze its influencing factors.Methods From January 2022 to December 2022,totally 279 elderly out patients in community visited the health service center in Shinan District of Qingdao were selected as the study objects.The frailty was assessed by the Fried frailty phenotype(FFP).All the subjects were comprehensively evaluated by CGA for physical function status,nutritional status,mental status,sarcopenia,comorbidity,multiple drug use and sleep status.Laboratory indicators,such as hemoglobin(Hb),albumin(ALB),blood lipids and hypersensitive C-reactive protein(hs-CRP)were collected to analyze the relationship between frailty and clinical data.Results Among the 279 subjects,51 cases(18.28%)were in the frailty group,89 cases(31.90%)were in the pre-frailty group,and 139 cases(49.82%)were in the non-frailty group.Univariate analysis showed that age,sex,marital status,smoking status,activities of daily life(ADL),the Tinetti score,the mini nutritional assessment short-form(MNA-SF)score,the mini-mental state examination(MMSE)score,geriatric depression,sarcopenia,comorbidity,multiple drug use,total serum protein,ALB,Hb,high-density lipoprotein,hs-CRP,and blood calcium levels were significantly different among the three groups(P<0.05).Ordered logistic regression analysis showed that age,sex,smoking,malnutrition,number of comorbidities,total serum protein,Hb and hs-CRP were the influencing factors for frailty(P<0.05).Conclusion Nearly half of the elderly outpatients in community are frailty and pre-frailty.CGA in the elderly can be used to screen frailty and pre-frailty early,and can be intervene in comorbidities management and nutritional support,so as to improve the quality of life of the elderly.