住院共病老年人认知衰弱现状及其影响因素  

Current status of cognitive frailty and its influencing factors in hospitalized elderly with comorbidities

作　　者：王凌霄 杨永学[1,2] 管丽娟[1,2] 沈静[1,2] WANG Ling-Xiao;YANG Yong-Xue;GUAN Li-Juan;SHEN Jing(Department of Geriatrics,Chengdu Fifth People′s Hospital,Chengdu 611130,China;Institute of China-France Geriatrics,Chengdu Fifth People′s Hospital,Chengdu 611130,China)

机构地区：[1]成都市第五人民医院1老年病科,成都611130 [2]成都市第五人民医院中法老年疾病研究所,成都611130

出　　处：《中华老年多器官疾病杂志》2019年第10期738-742,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：四川省卫生与计划生育委员会科研课题(150021)~~

摘　　要：目的明确住院共病老年人认知衰弱分布特点,进一步探讨其影响因素。方法 回顾性分析2015年11月至2018年1月在成都市第五人民医院老年病科住院的老年共病患者(年龄≥60岁)692例。采用老年综合评估衰弱指数(CGA-FI)量表评估衰弱状态,简易精神状态检查量表(MMSE)评估老年人认知情况;同时存在衰弱和认知障碍(CI)者定义为认知衰弱。采用Charlson合并症指数(CCI)进行共病严重程度评估。根据是否存在衰弱或CI将患者分为认知衰弱组(176例)、单纯衰弱组(176例)、单纯CI组(74例)和非认知衰弱组(266例)。收集并比较4组患者临床资料,分析共病老年患者认知衰弱分布特点。采用SPSS23.0软件对数据进行统计分析。多因素logistic回归法分析发生认知衰弱的独立影响因素。结果 纳入患者总体存在2~12种慢性疾病,CCI指数为5.5±1.9。25.4%(176例)的共病患者存在认知衰弱。趋势性检验显示,认知衰弱患病率随年龄、CCI级别的增高和Barthel日常生活能力的下降呈趋势性增加(P<0.001)。与其他3组比较,认知衰弱组患者年龄、CCI,以及入院情况(病危/病重)、急性心力衰竭、慢性骨关节炎、老年综合征(营养不良、平衡功能障碍、抑郁情绪、睡眠障碍、跌倒史)比例均显著升高,体质量指数及Barthel日常生活能力(ADL)评分较低,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,营养不良(OR=5.022,95%CI2.484~10.157;P<0.001)、营养不良高风险(OR=2.272,95%CI1.179~4.377;P=0.014)、平衡功能障碍(OR=4.803,95%CI2.898~7.960;P<0.001)、抑郁(OR=4.227,95%CI2.271~7.866;P<0.001)、骨关节炎(OR=2.707,95%CI1.332~5.501;P=0.006)是住院共病老年人发生认知衰弱的独立影响因素。结论 住院共病老年人普遍存在认知衰弱,年龄越大、共病程度和ADL障碍越严重,认知衰弱越明显。临床上应注意营养缺失、平衡力差并存在骨关节炎和抑郁的共病老年人群。Objective To identify the distribution characteristics of cognitive frailty among the elderly inpatients with multiple comorbidities and explore its influencing factors. Methods Clinical data of 692 elderly patients (over 60 years old) with different comorbidities hospitalized in our department from November 2015 to January 2018 were collected and retrospectively analyzed. Com- prehensive geriatric assessment-frailty index (CGA-FI) was used to assess the state of senile frailty,and mini-mental state examination scale (MMSE) was employed to evaluate the cognitive status of these patients. Those with both frailty and cognitive impairment (CI) were defined as cognitive frailty. The severity of comorbidities was assessed by Charlson complication index (CCI). In this way,the patients were divided into cognitive frailty group ( n =176),simple frailty group ( n =176),simple CI group ( n =74) and non- cognitive frailty group ( n =266). The clinical data were compared among the 4 groups,and the distribution characteristics of cognitive frailty were analyzed. SPSS statistics 23.0 was used to analyze the data. Multivariate logistic regression analysis was employed to analyze the independent factors of cognitive frailty in these patients. Results There were totally 2-12 kinds of chronic diseases in the patients,and the CCI index was 5.5±1.9. The incidence rate of cognitive frailty was 25.4%(176 cases) in the cohort,and the rate was increased with older age,elevated CCI level and decreased Barthel index for activities of daily living (ADL) according to the results of trend test ( P <0.001). Compared with the other 3 groups,the patients of the cognitive frailty group were older and had significantly larger proportions of CCI,critical/severe conditions at admission,acute heart failure,chronic osteoarthritis,and geriatric syndrome (malnutrition,balance dysfunction,depression,sleep disorder and fall history),and obviously lower body mass index (BMI) and Barthel index ( P <0.05). Multivariate logistic regression analysis showed t

关 键 词：老年人 住院患者 共病 认知衰弱 

分 类 号：R592[医药卫生—老年医学]