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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
传真:010-66936756
E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
王凌霄,杨永学,管丽娟,沈静.住院共病老年人认知衰弱现状及其影响因素[J].中华老年多器官疾病杂志,2019,18(10):738~742
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
投稿时间:2019-05-22  
DOI:10.11915/j.issn.1671-5403.2019.10.160
中文关键词:  老年人;住院患者;共病;认知衰弱
英文关键词:aged; inpatients; comorbidity; cognitive frailty This work was supported by the Project of Scientific Research of Sichuan Health and Family Planning Commission
基金项目:四川省卫生与计划生育委员会科研课题(150021)
作者单位E-mail
王凌霄 成都市第五人民医院老年病科,成都 611130;成都市第五人民医院中法老年疾病研究所,成都 611130  
杨永学 成都市第五人民医院老年病科,成都 611130;成都市第五人民医院中法老年疾病研究所,成都 611130  
管丽娟 成都市第五人民医院老年病科,成都 611130;成都市第五人民医院中法老年疾病研究所,成都 611130  
沈静 成都市第五人民医院老年病科,成都 611130;成都市第五人民医院中法老年疾病研究所,成都 611130 drshenjing@163.com 
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中文摘要:
      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SPSS 23.0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%CI 2.484~10.157;P<0.001)、营养不良高风险(OR=2.272,95%CI 1.179~4.377;P=0.014)、平衡功能障碍(OR=4.803,95%CI 2.898~7.960;P<0.001)、抑郁(OR=4.227,95%CI 2.271~7.866;P<0.001)、骨关节炎(OR=2.707,95%CI 1.332~5.501;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。
英文摘要:
      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 hadsignificantly 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 that malnutrition (OR=5.022,5%CI 2.484-10.157; P<0.001), at high risk of malnutrition (OR=2.272,5%CI 1.179-4.377; P=0.014), balance dysfunction (OR=4.803, 95%CI 2.898-7.960; P<0.001), depression (OR=4.227,5%CI 2.271-7.866; P<0.001), and osteoarthritis (OR=2.707,5%CI 1.332-5.501; P=0.006) were the independent factors of cognitive frailty in hospitalized elderly patients with different comorbidities. Conclusion Cognitive frailty is quite common in elderly inpatients with comorbidities. The older, the severer of comorbidities and the more disable of ADL are, the more obvious the cognitive impairment is. In clinical practice, attention should be paid to the elderly patients with comorbidities, such as nutrition deficiency, poor balance, osteoarthritis and depression.
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