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护理学报 ›› 2023, Vol. 30 ›› Issue (23): 6-11.doi: 10.16460/j.issn1008-9969.2023.23.006

• 研究生园地 • 上一篇    下一篇

医养结合型养老机构老年人可逆性认知衰弱现状及影响因素分析

任影1,2, 于卫华2,1, 张利1   

  1. 1.安徽医科大学 护理学院,安徽 合肥 230601;
    2.安徽医科大学第三附属医院(合肥市第一人民医院) 护理部,安徽 合肥 230061
  • 收稿日期:2023-07-31 出版日期:2023-12-10 发布日期:2024-01-09
  • 通讯作者: 于卫华(1963-),女,安徽阜阳人,本科学历,主任护师,硕士研究生导师。E-mail:ywh-zr@tom.com
  • 作者简介:任影(1997-),女,安徽淮北人,本科学历,硕士研究生在读。
  • 基金资助:
    国家重点研发计划项目(2020YFC2008802); 2023年度安徽医科大学护理学院研究生青苗培育项目(hlqm12023042)

Current status of reversible cognitive frailty of elderly people in medical-nursing combined care institutions and its influencing factors

REN Ying1,2, YU Wei-hua2,1, ZHANG Li1   

  1. 1. School of Nursing, Anhui Medical University, Hefei 230601, China;
    2. Dept. of Nursing Administration, the Third Affiliated Hospital of Anhui Medical University (the First People's Hospital of Hefei), Hefei 230061, China
  • Received:2023-07-31 Online:2023-12-10 Published:2024-01-09

摘要: 目的 调查医养结合型养老机构老年人的可逆性认知衰弱现状,并分析其影响因素。方法 采用方便抽样法,于2023年2—5月抽取合肥市5所医养结合型养老机构的438名老年人为调查对象,采用一般资料调查表、Fried衰弱表型、蒙特利尔认知评估量表、临床痴呆评定量表、单条目主观认知下降评定、微型营养评估量表及简版老年抑郁量表对其进行调查,采用二元Logistic回归分析老年人可逆性认知衰弱的影响因素。结果 医养结合型养老机构老年人可逆性认知衰弱发生率为29.0%。二元Logistic回归结果显示,年龄(OR=3.243、9.832)、慢性病数量(OR=2.700、4.508)、抑郁情绪(OR=3.681)是医养结合型养老机构老年人可逆性认知衰弱的危险因素(均P<0.05);文化程度(OR=0.448、0.387、0.316)、自评睡眠质量(OR=0.475)、营养状况(OR=0.298、0.106)、运动锻炼情况(OR=0.496、0.483)是医养结合型养老机构老年人可逆性认知衰弱的保护性因素(均P<0.05)。结论 医养结合型养老机构老年人可逆性认知衰弱发生率为29.0%,医务人员应重点关注高龄、文化程度低、慢性病数量多、自评睡眠质量差、运动锻炼少、营养不良及抑郁的老年人,并制定针对性干预策略以减少或避免可逆性认知衰弱的发生发展。

关键词: 老年人, 医养结合型养老机构, 可逆性认知衰弱

Abstract: Objective To investigate the current status of reversible cognitive frailty among the elderly in medical-nursing combined care institutions and analyze its influencing factors. Methods From February to May 2023, convenience sampling was used to select 438 elderly people from 5 medical-nursing integrated care institutions in Hefei as the subjects. General information questionnaire, Fried Frailty Phenotype, Montreal Cognitive Assessment, Clinical Dementia Rating Scale, Single Item Subjective Cognitive Decline, Mini Nutritional Assessment (MNA) and the Geriatric Depression Scale (SDS) were used for the investigation. Binary Logistic regression was used to analyze the influencing factors of reversible cognitive frailty in the elderly. Results The incidence of reversible cognitive frailty was 29.0% in the elderly in medical-nursing integrated care institutions. Binary Logistic regression analysis showed that age(OR=3.243, 9.832), number of chronic diseases(OR=2.700, 4.508)and depression(OR=3.681)were the risk factors for reversible cognitive frailty in the elderly in medical-nursing integrated care institutions(all P<0.05). Education background(OR=0.448, 0.387, 0.316), self-rated sleep quality(OR=0.475), nutritional status(OR=0.298,0.106)and exercise(OR=0.496,0.483)were its protective factors(all P<0.05). Conclusion The incidence of reversible cognitive frailty was 29.0% in the elderly in medical-nursing integrated care institutions. It is crucial to pay closer attention to specific subgroups within this population, including those who are advanced in age, have lower levels of education, multiple chronic diseases, poor self-rated sleep quality, limited physical exercise, malnutrition, and depression. Targeted intervention strategies should be implemented to mitigate or prevent the occurrence and progression of reversible cognitive frailty.

Key words: elderly people, medical-nursing combined care institutions, reversible cognitive frailty

中图分类号: 

  • R473.59
[1] Kelaiditi E, Cesari M, Canevelli M, et al.Cognitive frailty:rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group[J]. J Nutr Health Aging, 2013, 17(9):726-734.DOI:10.1007/s12603-013-0367-2.
[2] Ruan Q, Yu Z, Chen M, et al.Cognitive frailty, a novel target for the prevention of elderly dependency[J]. Ageing Res Rev, 2015, 20:1-10.DOI:10.1016/j.arr.2014.12.004.
[3] Goldberg TE, Chen C, Wang Y, et al.Association of delirium with long-term cognitive decline:a Meta-analysis[J]. JAMA Neurol,2020,77(11):1373-1381.DOI:10.1001/jamaneurol.2020.2273.
[4] Wang W, Si H, Yu R, et al.Effects of reversible cognitive frailty on disability, quality of life, depression, and hospitalization: a prospective cohort study[J]. Aging Ment Health, 2022,26(10):2031-2038.DOI:10.1080/13607863.2021.2011835.
[5] Solfrizzi V, Scafato E, Seripa D, et al. Reversible cognitive frailty, dementia,all-cause mortality, the Italian longitudinal study on aging[J]. J Am Med Dir Assoc,2017,18(1):89.e1-89.e8.DOI:10.1016/j.jamda.2016.10.012.
[6] Ruan Q, Xiao F, Gong K, et al.Prevalence of cognitive frailty phenotypes and associated factors in a community-dwelling elderly population[J]. J Nutr Health Aging,2020,24(2):172-180. DOI:10.1007/s12603-019-1286-7.
[7] Fried LP, Tangen CM, Walston J, et al.Frailty in older adults:evidence for a phenotype[J].J Gerontol A Biol Sci Med Sci,2001,56(3):146-156.DOI:10.1093/gerona/56.3.m146.
[8] 郝秋奎, 李峻, 董碧蓉, 等. 老年患者衰弱评估与干预中国专家共识[J].中华老年医学杂志, 2017, 36(3):251-256.DOI:10.3760/cma.j.issn.0254-9026.2018.04.001.
[9] Nasreddine ZS, Phillips NA, Bédirian V, et al.The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc,2005,53(4):695-699.DOI:10.1111/j.1532-5415.2005.53221.x.
[10] 王炜, 王鲁宁. 蒙特利尔认知评估量表在轻度认知损伤患者筛查中的应用[J].中华内科杂志,2007, 46(5):414-416.
[11] Cameron J, Worrall-Carter L, Page K, et al.Screening for mild cognitive impairment in patients with heart failure:montreal cognitive assessment versus mini mental state exam[J]. Eur J Cardiovasc Nurs,2013,12(3):252-260.DOI:10.1177/1474515111435606.
[12] Hughes CP, Berg L, Danziger WL, et al.A new clinical scale for the staging of dementia[J]. Br J Psychiatry,1982,140:566-572.DOI:10.1192/bjp.140.6.566.
[13] 中国老年医学学会认知障碍分会. 临床痴呆评定量表简体中文版[J].中华老年医学杂志,2018,37(4):367-371.
[14] Jessen F, Amariglio ER, Boxtel VM, et al.A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's disease[J]. Alzheimer's Dementia,2014,10(6):844-852.DOI:10.1016/j.jalz.2014.01.001.
[15] 陈颖勇, 张正敏, 左倩倩,等.广州市某社区老年人可逆性认知衰弱现状及影响因素[J].解放军护理杂志,2022, 39(6):13-16.DOI:10.3969/j.issn.1008-9993.2022.06.004.
[16] Guigoz Y, Vella BJ.Malnutrition in the elderly:the Mini Nutritional Assessment(MNA)[J].Ther Umsch, 1997,54(6):345-350.
[17] Tsai AC, Chang TL, Yang TW, et al.A modified Mini Nutritional Assessment without BMI predicts nutritional status of community-living elderly in Taiwan[J]. J Nutr Health Aging, 2010, 14(3):183-189. DOI:10.1007/s12603-010-0046-5.
[18] Vellas B, Guigoz Y, Garry PJ, et al.The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients[J]. Nutrition,1999,15(2):116-122.DOI:10.1016/s0899-9007(98)00171-3.
[19] Shiekh JI, Yesavage JA. Geriatric Depression Scale(GDS):recent evidence and development of a shorter version[J].Clinical Gerontologist, 1986, 5(1):165-173. DOI:10.1300/J018v05n01.09.
[20] 唐丹. 简版老年抑郁量表(GDS-15)在中国老年人中的使用[J].中国临床心理学杂志,2013,21(3):402-405.DOI:10.16128/j.cnki.1005-3611.2013.03.036.
[21] Durmaz B, Soysal P, Ellidokuz H, et al.Validity and reliability of Geriatric Depression Scale-15(short form) in Turkish older adults[J]. North Clin Istanb,2018,5(3):216-220.DOI:10.14744/nci.2017.85047.
[22] Okura M, Ogita M, Arai H.Self-reported cognitive frailty predicts adverse health outcomes for community-dwelling older adults based on an analysis of sex and age[J]. J Nutr Health Aging,2019,23(7):654-664. DOI:10.1007/s12603-019-1217-7.
[23] Yoon DH, Lee JY, Shin SA, et al.Physical frailty and amyloid-β deposits in the brains of older adults with cognitive frailty[J]. J Clin Med,2018, 7(7):169. DOI:10.3390/jcm7070169.
[24] 陈楚媛, 沈勤.医养结合机构非卧床老年人衰弱现状及影响因素分析[J].护理学杂志,2022, 7(20):90-93.DOI:10.3870/j.issn.1001-4152.2022.20.090.
[25] Tang S, Liu M, Yang T, et al.Association between falls in elderly and the number of chronic diseases and health-related behaviors based on CHARLS 2018:health status as a mediating variable[J]. BMC Geriatr, 2022,22(1):374.DOI:10.1186/s12877-022-03055-x.
[26] Taylor CA, Bouldin ED, Greenlund KJ, et al.Comorbid chronic conditions among older adults with subjective cognitive decline,United states, 2015-2017[J]. Innov Aging,2020,4(1):1-10.DOI:10.1093/geroni/igz045.
[27] 张焱, 刘方, 徐瑞, 等. 养老机构老年人社会隔离、抑郁与衰弱的关系[J].护理研究,2022,36(9):1543-1546. DOI:10.12102/j.issn.1009-6493.2022.09.007.
[28] Pourmotabbed A, Boozari B, Babaei A, et al.Sleep and frailty risk :a systematic review and Meta-analysis[J]. Sleep and Breathing, 2020,24(3):1187-1197.DOI:10.1007/s11325-020-02061-w.
[29] Taveira A, Sousa B, Costa P, et al.Health management of malnourished elderly in primary health care:a scoping review[J]. BMC Prim Care, 2022, 23(1):272.DOI:10.1186/s12875-022-01883-9.
[30] Kwan RYC, Leung AYM, Yee A, et al.Cognitive frailty and its association with nutrition and depression in community-dwelling older people[J]. J Nutr Health Aging, 2019, 23(10):943-948. DOI:10.1007/s12603-019-1258-y.
[31] Wang S, Yin H, Wang X, et al.Efficacy of different types of exercises on global cognition in adults with mild cognitive impairment:a network Meta-analysis[J]. Aging Clin Exp Res,2019,31(10):1391-1400.DOI:10.1007/s40520-019-01142-5.
[32] 胡雅,刘丽华,付藏媚,等.孤独感对养老机构老年人生活质量的影响:抑郁与衰弱的链式中介作用[J].现代预防医学,2020,47(15):2801-2805.
[33] Srivastava S, Debnath P, Shri N, et al.The association of widowhood and living alone with depression among older adults in India[J]. Sci Rep, 2021, 11(1):21641.DOI:10.1038/s41598-021-01238-x.
[34] Ruan Q, D'onofrio G, Wu T, et al.Sexual dimorphism of frailty and cognitive impairment:potential underlying mechanisms (review)[J]. Mol Med Rep,2017,16(3):3023-3033.DOI:10.3892/mmr.2017.6988.
[35] 郭雪琪,谷奕樊,杨娇,等.养老机构睡眠障碍老人跌倒风险的危险因素研究[J].护理学报,2022,29(22):11-14. DOI:10.16460/j.issn1008-9969.
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