全科门诊慢性病老年患者衰弱与共病现状及其影响因素调查  

Investigation on the status of frailty and comorbidity in elderly patients with chronic diseases in general practice clinics and their influencing factors

作　　者：杨小芹 金秀华 郭思佳 何娟 YANG Xiao-qin;JIN Xiu-hua;GUO Si-jia;HE Juan(General Practice Clinic,Huinan Community Health Service Center,Shanghai University of Traditional Chinese Medicine,Shanghai 201300,CHINA;Department of Rheumatology and Immunology,Peking University Shenzhen Hospital,Shenzhen 518000,Guangdong,CHINA)

机构地区：[1]上海中医药大学附属惠南社区卫生服务中心全科,上海201300 [2]北京大学深圳医院风湿免疫科,广东深圳518000

出　　处：《海南医学》2025年第7期1032-1037,共6页Hainan Medical Journal

基　　金：国家自然科学基金(编号:81901641);上海市浦东新区卫生系统优秀青年医学人才培养计划项目(编号:PWRq2022-08)。

摘　　要：目的调查上海浦东新区某社区全科门诊慢性病老年(≥60岁)患者的衰弱及共病现状,并分析其影响因素。方法采用方便抽样方法对2023年6~11月就诊于上海市浦东新区惠南社区卫生服务中心全科门诊罹患≥1种慢性病的700例共病老年患者进行问卷调查,收集其基本资料、慢性病情况,对患者进行老年衰弱综合征快速综合评估(CGA)。采用多元Logistic回归分析慢性病患者衰弱的影响因素。结果共发放问卷700份,回收有效问卷680份,问卷有效率为97.1%。全科门诊慢性病老年人衰弱、衰弱前期和非衰弱的发生率分别为10.9%、31.9%和57.2%,其中93.2%的衰弱患者存在共病。全科门诊老年共病患者占64.7%,随着罹患慢性病数量增多衰弱患病率有增高趋势,罹患1种、2种、3种、4种、≥5种慢性病老年患者衰弱患病率分别为2.1%、5.34%、21.1%、27.7%、25.0%。不同共病模式的老年患者衰弱患病率不同,在罹患两种慢性病的患者中,以“高血压+心绞痛及急性心脏疾病发作(23.7%)”为最常见共病组合,其衰弱患病率为24.2%。多元Logistic回归分析结果显示,共病、存在营养风险、肌少症、轻度认知障碍均是全科门诊慢性病老年患者发生衰弱的危险因素。结论上海市浦东新区惠南社区卫生服务中心全科门诊慢性病老年人衰弱与共病发生率高,共病、营养风险、肌少症和轻度认知障碍均是老年慢性病患者罹患衰弱的危险因素,这提示社区卫生服务中心应重点关注共病老年群体,建立包含营养管理、肌力训练和认知筛查的综合干预体系。Objective To investigate the status of frailty and comorbidity among elderly patients(≥60 years old)with chronic diseases in a general practice clinic in Pudong New District,Shanghai,and to analyze the influencing factors.Methods A convenience sampling method was used to conduct a questionnaire survey on 700 elderly patients with≥1 chronic disease who visited the General Practice Clinic of Huinan Community Health Service Center in Pudong New District,Shanghai,from June to November 2023.Basic information and chronic disease status were collected,and a rapid comprehensive geriatric assessment(CGA)was performed to evaluate frailty.Multivariate logistic regression analysis was used to identify the influencing factors of frailty in patients with chronic diseases.Results A total of 700 questionnaires were distributed,and 680 valid questionnaires were collected,with an effective response rate of 97.1%.The prevalence rates of frailty,pre-frailty,and non-frailty among elderly patients with chronic diseases in the General Practice Clinic were 10.9%,31.9%,and 57.2%,respectively.Among the frail patients,93.2%had comorbidities.Elderly patients with comorbidities accounted for 64.7%of the total,and the prevalence of frailty increased with the number of chronic diseases.The prevalence rates of frailty in elderly patients with 1,2,3,4,and≥5 chronic diseases were 2.1%,5.34%,21.1%,27.7%,and 25.0%,respectively.The prevalence of frailty varied among different comorbidity patterns.Among patients with two chronic diseases,the most common comorbidity combination was"hypertension+angina and acute cardiac events(23.7%)",with a frailty prevalence of 24.2%.Multivariate logistic regression analysis showed that comorbidity,nutritional risk,sarcopenia,and mild cognitive impairment were all risk factors for frailty in elderly patients with chronic diseases in the General Practice Clinic.Conclusion The prevalence of frailty and comorbidity among elderly patients with chronic diseases in the General Practice Clinic of Huinan Community Heal

关 键 词：全科门诊 老年人 衰弱 慢性病 共病 影响因素 调查 

分 类 号：R195.4[医药卫生—卫生统计学]