Page 41 - 2022-31-中国全科医学

·3878· http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn

investigate the prevalence and influencing factors of cognitive frailty，and its relationship with two-year post-discharge mortality
in hospitalized elderly patients with comorbidities. Methods The data were collected from part of the project "Research and
Demonstration of Clinical Management and Community-based Continuing Care Models for Older People with Comorbidities"，
involving a cluster sample of older inpatients with comorbidity aged ≥ 60 years recruited from Department of Gerontology，Chengdu
Fifth People's Hospital from November 2015 to January 2018. Demographics，chronic disease prevalence，and comprehensive
geriatric assessment results were collected. Cognitive frailty was assessed by the FRAIL scale and Mini-Mental State Examination.
Binary Logistic regression was used to analyze the influencing factors of cognitive frailty. The survival status was investigated at the
end of a two-year follow-up after discharge. Cox regression was used to analyze the relationship of cognitive frailty with two-year post-
discharge mortality. Results A total of 554 cases were included，and 15.9%（88/554）of them had cognitive frailty. Compared
with non-cognitive frailty group，cognitive frailty group had older average age，lower prevalence of high school education or above，
lower average family care score，higher prevalence of malnutrition，depression，dependence in activities of daily living and balance
dysfunction（P<0.05）. Binary Logistic regression analysis showed that malnutrition，balance dysfunction，and family care disorder
were independent factors of cognitive frailty. During the follow-up period，456 patients（82.3%）survived，81（14.6%）died，
and 17（3.1%）were lost to follow-up. After controlling for confounding factors，Cox regression analysis indicated that，the risk of
two-year post-discharge mortality in cognitive frailty group was 2.039〔95%CI（1.060，3.922）〕times higher than that of those
with normal cognitive function and non-frailty，and was 5.266〔95%CI（3.159，8.778）〕times higher than that of those with
simple cognitive frailty（P<0.05）. Conclusion Cognitive frailty is common among elderly inpatients with comorbid conditions，
and it can increase the relative risk of two-year post-discharge mortality. Clinical medical workers should pay more attention to this
group to identify high-risk individuals of cognitive frailty as soon as possible and give them preventive interventionsin time.
【Key words】 Aged；Multiple chronic conditions；Inpatients；Cognitive frailty；Root cause analysis；Prognosis

老年患者普遍存在共病的情况；共病不仅影响患者 性研究项目。选取 2015 年 11 月至 2018 年 1 月入住于
的功能状态和生活质量，还会增加其不良预后的发生风 成都市第五人民医院老年科的年龄≥ 60 岁的共病患者
险和疾病管理的复杂性。认知衰弱是介于正常脑老化和 （同时存在≥ 2 种慢性病或老年综合征）为研究对象。
痴呆之间的一种认知损伤状态，是指排除痴呆后，同时 纳入标准：（1）生命体征稳定且能配合完成相关评估；
存在躯体衰弱和认知功能障碍。与单纯衰弱或认知障碍 （2）有良好的语言表达能力，与调查者沟通无障碍；（3）
老年人相比，认知衰弱老年人发生不良临床结局（如住 自愿参与研究，已签署知情同意书。排除标准：（1）既
院、入住养老院、跌倒、痴呆、失能和死亡）的累积概 往已明确诊断患有痴呆，或痴呆筛查结果呈阳性者〔经
率明显增高 ［1-2］ 。认知衰弱被认为是痴呆的前驱阶段和 简易精神状况检查量表（MMSE）评定〕；（2）存在严
痴呆预防的新靶点 ［3］ ，具有一定的可逆性。因此，早 重躯体功能障碍或自理能力等级为完全依赖〔Barthel 指
期识别认知衰弱高危人群并对其进行及时干预将有助于 数量表（BI）得分≤ 40 分〕者；（3）合并急危重症（如
降低共病老年人不良预后的发生风险、提高其晚年生活 急性心肌梗死、急性重症胰腺炎、多器官功能衰竭）或
质量、减轻家庭和社会的医疗与经济负担。然而，目前 处于疾病终末期（预计生存时间≤ 6 个月）者。本研究
大多数研究者仅关注到单纯衰弱或单纯认知功能障碍对 已通过成都市第五人民医院伦理委员会审批（审批号：
共病老年人产生的不利影响，对于认知衰弱的危害尚未 AF-54-2019.21）。本研究拟采用二元 Logistic 回归分析
引起足够的重视。同时，我国认知衰弱领域研究多采用 影响住院共病老年人认知衰弱发生的因素。基于文献回
文献综述法，国内尚缺乏大规模的流行病学调查及队列 顾和专家咨询，初步拟定 21 个自变量。假设样本量至
研究。本研究通过探讨老年共病患者认知衰弱的发生现 少应为自变量数目的 20 倍，同时考虑拒访率和无效问
状及其影响因素，以及认知衰弱与住院共病老年人出院 卷不超过 20%，确定最终所需的样本量为 504。
后 2 年死亡风险之间的关系，旨在引发医护人员对老年 1.2 资料收集 采用自行设计、统一编制的问卷收集患
共病患者认知衰弱状况的关注，进而助力实现认知衰弱 者的一般资料、慢性病患病信息。由经过统一培训的调
的早期识别与及时干预，提高老年共病患者的生存质量， 查员（老年科医师）通过“面对面”询问、查阅患者住
减少其负性临床事件的发生，最终促进其健康老化。 院病历的方式进行信息采集，内容包括年龄、性别、受
1 对象与方法 教育程度、婚姻状况、有无家庭照顾者、吸烟史、饮酒史、
1.1 研究对象 本研究为“老年共病患者临床管理模式 身高、体质量，以及冠心病、高血压、慢性阻塞性肺疾病、
及社区延续性医疗模式研究与示范”项目中的一部分， 骨质疏松、充血性心力衰竭、糖尿病等疾病的患病情况。
此项目是一项针对中国≥ 60 岁老年人健康状况的前瞻 1.3 老年综合评估 由老年科医师对患者进行老年综