老年糖尿病患者衰弱现状及影响因素研究
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摘要
目的调查老年糖尿病患者衰弱的发生状况并分析其影响因素,为临床护理干预提供理论依据。方法采用便利抽样法,选取郑州市某三级甲等医院300例老年糖尿病患者为研究对象,采用一般资料调查表、Tilburg衰弱量表、糖尿病自我管理行为量表进行调查。结果共回收296份有效问卷。研究对象中共有137例发生衰弱,衰弱发生率为46.3%,衰弱总分为(5.26±2.87)分,其中躯体衰弱(2.79±2.08)分,心理衰弱(1.40±0.94)分,社会衰弱(1.07±0.75)分。多元线性回归分析结果显示,合并多病、自我管理行为、糖化血红蛋白水平、文化程度、多重用药、吸烟是老年糖尿病患者衰弱程度的影响因素(P<0.05)。结论老年糖尿病患者衰弱发生率较高,且包含一定程度的躯体、心理和社会衰弱;医护人员应高度重视对该人群衰弱的评估,及时采取针对性的整体干预措施,预防或减缓老年糖尿病患者衰弱的发生发展。
Objective To investigate the current situation of frailty and its influencing factors in elderly patients with diabetes so as to provide theoretical basis for clinical nursing intervention. Methods Totally 300 elderly patients with diabetes were selected from a tertiary hospital in Zhengzhou via convenience sampling method,and were investigated by self-designed general information questionnaire,TFI(Tilburg Frailty Indicator) and SDSCA(Scale of Diabetes Self-care Activities). Results Totally 296 valid questionnaires were collected. A total of 137 elderly pa tients with diabetes suffered from frailty and the prevalence was 46.3%. The mean score of total frailty was(5.26 ±2.87),and the scores for each dimension were as follows:physical frailty(2.79±2.08),psychological frailty(1.40±0.94)and social frailty(1.07 ±0.75). Multiple linear regression showed that comorbidity,self-management behavior,glycosylated hemoglobin,educational degree,polypharmacy and smoking were the major influential factors(P<0.05). Conclusion The prevalence of frailty in elderly patients with diabetes was at a high level,containing different degrees of physical,psychological and social frailty. Medical staff should attach great importance to the assessment of frailty among elderly patients with diabetes,take targeted and holistic interventions timely to prevent or delay the development of frailty.
Objective To investigate the current situation of frailty and its influencing factors in elderly patients with diabetes so as to provide theoretical basis for clinical nursing intervention. Methods Totally 300 elderly patients with diabetes were selected from a tertiary hospital in Zhengzhou via convenience sampling method,and were investigated by self-designed general information questionnaire,TFI(Tilburg Frailty Indicator) and SDSCA(Scale of Diabetes Self-care Activities). Results Totally 296 valid questionnaires were collected. A total of 137 elderly pa tients with diabetes suffered from frailty and the prevalence was 46.3%. The mean score of total frailty was(5.26 ±2.87),and the scores for each dimension were as follows:physical frailty(2.79±2.08),psychological frailty(1.40±0.94)and social frailty(1.07 ±0.75). Multiple linear regression showed that comorbidity,self-management behavior,glycosylated hemoglobin,educational degree,polypharmacy and smoking were the major influential factors(P<0.05). Conclusion The prevalence of frailty in elderly patients with diabetes was at a high level,containing different degrees of physical,psychological and social frailty. Medical staff should attach great importance to the assessment of frailty among elderly patients with diabetes,take targeted and holistic interventions timely to prevent or delay the development of frailty.
引文
[1]Sinclair AJ,Abdelhafiz AH,Rodriguez-Manas L.Frailty and sarcopenia-newly emerging and high impact complications of diabetes[J].J Diabetes Complications,2017,31(9):1465-1473.
[2]Sinclair AJ,Rodriguez-Manas L.Diabetes and frailty:two converging conditions?[J].Can J Diabetes,2016,40(1):77-83.
[3]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):M146-M156.
[4]Perkisas S,Vandewoude M.Where frailty meets diabetes[J].Diabetes Metab Res Rev,2016,32(Suppl 1):261-267.
[5]Saum KU,Dieffenbach AK,Muller H,et al.Frailty prevalence and 10-year survival in community-dwelling older adults:results from the ESTHER cohort study[J].Eur J Epidemiol,2014,29(3):171-179.
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[7]Castro-Rodriguez M,Carnicero JA,Garcia-Garcia FJ,et al.Frailty as a major factor in the increased risk of death and disability in older people with diabetes[J].J Am Med Dir Assoc,2016,17(10):949-955.
[8]Cramm JM,Twisk J,Nieboer AP.Self-management abilities and frailty are important for healthy aging among communitydwelling older people;a cross-sectional study[J].BMC Geriatr,2014,14(1):28.
[9]Uchmanowicz I,Wleklik M,Gobbens RJ.Frailty syndrome and self-care ability in elderly patients with heart failure[J].Clin Interv Aging,2015,10:871-877.
[10]Alberti KG,Zimmet PZ.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med,1998,15(7):539-553.
[11]Gobbens RJ,Luijkx KG,Wijnen-Sponselee MT,et al.Towards an integral conceptual model of frailty[J].J Nutr Health Aging,2010,14(3):175-181.
[12]奚兴,郭桂芳,孙静.中文版Tilburg衰弱评估量表的信效度研究[J].护理学报,2013,20(8B):1-5.
[13]Toobert DJ,Hampson SE,Glasgow RE.The summary of diabetes self-care activities measure:results from 7 studies and a revised scale[J].Diabetes Care,2000,23(7):943-950.
[14]万巧琴,尚少梅,来小彬,等.2型糖尿病患者自我管理行为量表的信、效度研究[J].中国实用护理杂志,2008,24(7):26-27.
[15]Dong L,Liu N,Tian X,et al.Reliability and validity of the Tilburg Frailty Indicator(TFI)among Chinese communitydwelling older people[J].Arch Gerontol Geriatr,2017,73:21-28.
[16]Yanase T,Yanagita I,Muta K,et al.Frailty in elderly diabetes patients[J].Endocr J,2018,65(1):1-11.
[17]Li Y,Zou Y,Wang S,et al.A pilot study of the FRAIL Scale on predicting outcomes in Chinese elderly people with type2 diabetes[J].J Am Med Dir Assoc,2015,16(8):714-717.
[18]Gobbens RJ,van Assen MA,Luijkx KG,et al.The Tilburg Frailty Indicator:psychometric properties[J].J Am Med Dir Assoc,2010,11(5):344-355.
[19]李秋萍,韩斌如.外科住院老年病人衰弱现状及影响因素的调查分析[J].护理研究,2017,31(33):4307-4311.
[20]Castrejon-Perez RC,Gutierrez-Robledo LM,Cesari M,et al.Diabetes mellitus,hypertension and frailty:a population-based,cross-sectional study of Mexican older adults[J].Geriatr Gerontol Int,2017,17(6):925-930.
[21]嵇加佳,刘林,楼青青,等.2型糖尿病患者自我管理行为及血糖控制现状的研究[J].中华护理杂志,2014,49(5):617-620.
[22]Dunning T,Sinclair A,Colagiuri S.New IDF Guideline for man aging type 2 diabetes in older people[J].Diabetes Res Clin Pract,2014,103(3):538-540.
[23]Katakura M,Naka M,Kondo T,et al.Development,worsening,and improvement of diabetic microangiopathy in older people:six-year prospective study of patients under intensive diabetes control[J].J Am Geriatr Soc,2007,55(4):541-547.
[24]Hamada S,Gulliford MC.Mortality in individuals aged 80 and older with type 2 diabetes mellitus in relation to glycosylated hemoglobin,blood pressure,and total cholesterol[J].J Am Geriatr Soc,2016,64(7):1425-1431.
[25]Yanagita I,Fujihara Y,Eda T,et al.Low glycated hemoglobin level is associated with severity of frailty in Japanese elderly diabetes patients[J].J Diabetes Investig,2018,9(2):419-425.
[26]李灵艳,王青,张少景,等.老年住院患者共病及多重用药与衰弱关系的分析[J].北京医学,2018,40(1):8-11.
[27]成媛媛,王越,刘学,等.老年抑郁障碍患者的自杀意念及相关因素研究[J].中华行为医学与脑科学杂志,2015,24(11):1005-1007.
[28]Pegorari MS,Tavares DS.Factors associated with the frailty syndrome in elderly individuals living in the urban area[J].Rev Lat Am Enfermagem,2014,22(5):874-882.
[29]乔静,王青,赵清华.老年住院患者用药情况与衰弱的关系分析[J].中华现代护理杂志,2016,22(18):2539-2541.
[30]Kojima G,Iliffe S,Walters K.Smoking as a predictor of frailty:a systematic review[J].BMC Geriatr,2015,15(1):131.
[31]Etman A,Kamphuis CB,van der Cammen TJ,et al.Do lifestyle,health and social participation mediate educational inequalities in frailty worsening?[J].Eur J Public Health,2015,25(2):345-350.
[31]贾文文戴付敏Elliot J,等.老年糖尿病患者合并衰弱的相关研究进展[J].中华护理杂志,2017,52(6):697-701.
[2]Sinclair AJ,Rodriguez-Manas L.Diabetes and frailty:two converging conditions?[J].Can J Diabetes,2016,40(1):77-83.
[3]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):M146-M156.
[4]Perkisas S,Vandewoude M.Where frailty meets diabetes[J].Diabetes Metab Res Rev,2016,32(Suppl 1):261-267.
[5]Saum KU,Dieffenbach AK,Muller H,et al.Frailty prevalence and 10-year survival in community-dwelling older adults:results from the ESTHER cohort study[J].Eur J Epidemiol,2014,29(3):171-179.
[6]Liccini A,Malmstrom TK.Frailty and sarcopenia as predictors of adverse health outcomes in persons with diabetes mellitus[J].J Am Med Dir Assoc,2016,17(9):846-851.
[7]Castro-Rodriguez M,Carnicero JA,Garcia-Garcia FJ,et al.Frailty as a major factor in the increased risk of death and disability in older people with diabetes[J].J Am Med Dir Assoc,2016,17(10):949-955.
[8]Cramm JM,Twisk J,Nieboer AP.Self-management abilities and frailty are important for healthy aging among communitydwelling older people;a cross-sectional study[J].BMC Geriatr,2014,14(1):28.
[9]Uchmanowicz I,Wleklik M,Gobbens RJ.Frailty syndrome and self-care ability in elderly patients with heart failure[J].Clin Interv Aging,2015,10:871-877.
[10]Alberti KG,Zimmet PZ.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med,1998,15(7):539-553.
[11]Gobbens RJ,Luijkx KG,Wijnen-Sponselee MT,et al.Towards an integral conceptual model of frailty[J].J Nutr Health Aging,2010,14(3):175-181.
[12]奚兴,郭桂芳,孙静.中文版Tilburg衰弱评估量表的信效度研究[J].护理学报,2013,20(8B):1-5.
[13]Toobert DJ,Hampson SE,Glasgow RE.The summary of diabetes self-care activities measure:results from 7 studies and a revised scale[J].Diabetes Care,2000,23(7):943-950.
[14]万巧琴,尚少梅,来小彬,等.2型糖尿病患者自我管理行为量表的信、效度研究[J].中国实用护理杂志,2008,24(7):26-27.
[15]Dong L,Liu N,Tian X,et al.Reliability and validity of the Tilburg Frailty Indicator(TFI)among Chinese communitydwelling older people[J].Arch Gerontol Geriatr,2017,73:21-28.
[16]Yanase T,Yanagita I,Muta K,et al.Frailty in elderly diabetes patients[J].Endocr J,2018,65(1):1-11.
[17]Li Y,Zou Y,Wang S,et al.A pilot study of the FRAIL Scale on predicting outcomes in Chinese elderly people with type2 diabetes[J].J Am Med Dir Assoc,2015,16(8):714-717.
[18]Gobbens RJ,van Assen MA,Luijkx KG,et al.The Tilburg Frailty Indicator:psychometric properties[J].J Am Med Dir Assoc,2010,11(5):344-355.
[19]李秋萍,韩斌如.外科住院老年病人衰弱现状及影响因素的调查分析[J].护理研究,2017,31(33):4307-4311.
[20]Castrejon-Perez RC,Gutierrez-Robledo LM,Cesari M,et al.Diabetes mellitus,hypertension and frailty:a population-based,cross-sectional study of Mexican older adults[J].Geriatr Gerontol Int,2017,17(6):925-930.
[21]嵇加佳,刘林,楼青青,等.2型糖尿病患者自我管理行为及血糖控制现状的研究[J].中华护理杂志,2014,49(5):617-620.
[22]Dunning T,Sinclair A,Colagiuri S.New IDF Guideline for man aging type 2 diabetes in older people[J].Diabetes Res Clin Pract,2014,103(3):538-540.
[23]Katakura M,Naka M,Kondo T,et al.Development,worsening,and improvement of diabetic microangiopathy in older people:six-year prospective study of patients under intensive diabetes control[J].J Am Geriatr Soc,2007,55(4):541-547.
[24]Hamada S,Gulliford MC.Mortality in individuals aged 80 and older with type 2 diabetes mellitus in relation to glycosylated hemoglobin,blood pressure,and total cholesterol[J].J Am Geriatr Soc,2016,64(7):1425-1431.
[25]Yanagita I,Fujihara Y,Eda T,et al.Low glycated hemoglobin level is associated with severity of frailty in Japanese elderly diabetes patients[J].J Diabetes Investig,2018,9(2):419-425.
[26]李灵艳,王青,张少景,等.老年住院患者共病及多重用药与衰弱关系的分析[J].北京医学,2018,40(1):8-11.
[27]成媛媛,王越,刘学,等.老年抑郁障碍患者的自杀意念及相关因素研究[J].中华行为医学与脑科学杂志,2015,24(11):1005-1007.
[28]Pegorari MS,Tavares DS.Factors associated with the frailty syndrome in elderly individuals living in the urban area[J].Rev Lat Am Enfermagem,2014,22(5):874-882.
[29]乔静,王青,赵清华.老年住院患者用药情况与衰弱的关系分析[J].中华现代护理杂志,2016,22(18):2539-2541.
[30]Kojima G,Iliffe S,Walters K.Smoking as a predictor of frailty:a systematic review[J].BMC Geriatr,2015,15(1):131.
[31]Etman A,Kamphuis CB,van der Cammen TJ,et al.Do lifestyle,health and social participation mediate educational inequalities in frailty worsening?[J].Eur J Public Health,2015,25(2):345-350.
[31]贾文文戴付敏Elliot J,等.老年糖尿病患者合并衰弱的相关研究进展[J].中华护理杂志,2017,52(6):697-701.