目的 分析某部队医院老年共病患者衰弱发生情况、影响因素及其预后,为衰弱的个体化防治提供参考。方法 选取2021-01至2023-01武警北京总队医院老年科住院的150例患者作为研究对象,根据衰弱量表评分将患者分为非衰弱组(衰弱前期和无衰弱)(57例)和衰弱组(93例);收集两组年龄、所患共病类型、营养状态、体质量指数(BMI)、服药种类等基本资料,以及日常生活能力评分、认知功能、Charlson 共病指数(CCI)等,将有统计学意义的指标纳入logistic回归方程,分析老年共病患者衰弱发生的危险因素。所有患者均随访至2023-12,记录患者跌倒、失能、再入院、病死率。结果 衰弱组高龄(≥80岁)、有营养缺乏风险、共病种类≥9种、CCI分级重度、服药种类≥5种患者的构成比例分别为49.46%、65.59%、43.01%、84.95%、69.89%,均高于非衰弱组的8.77%、28.07%、0.00%、26.32%、33.33%;衰弱组合并糖尿病、慢性阻塞性肺疾病(COPD)、脑卒中患者的构成比例分别为84.95%、40.86%、38.71%,均高于非衰弱组的59.65%、21.05%、19.30%;差异均有统计学意义(P＜0.05)。logistic回归分析显示,年龄≥80岁、有营养风险、共病数量≥9种、CCI分级重度、合并脑卒中是老年共病患者衰弱发生的的危险因素(P<0.05)。随访至2023-12,非衰弱组平均随访(21.7±2.8)个月,衰弱组平均随访(20.9±2.6)个月,衰弱组跌倒、失能、死亡等不良预后发生率为23.66%,高于非衰弱组的5.26%;衰弱组再入院率为72.04%,高于非衰弱组的28.07%;差异有统计学意义(P＜0.05)。结论 某部队医院老年共病患者衰弱发生率较高;衰弱发生会导致患者预后不良;高龄、有营养风险、共病数量多、CCI分级重度、合并脑卒中是老年共病患者衰弱发生的的危险因素。

Objective To analyze the incidence, influencing factors and prognosis of frailty in elderly patients with comorbidity in a military hospital, and to provide reference for the individualized prevention and treatment of frailty. Methods A cross-sectional study was conducted to treat 150 hospitalized geriatric patients in Beijing Municipal Corps Hospital of Chinese People's Armed Police Force from January 2021 to January 2023 as study objects. The patients were divided into two groups according to the Frail scale score, 57 in non-frail (pre-frail and non-frail) group and 93 in frail group. Basic data such as age, comorbidity type, nutritional status, body mass index (BMI), medication type, ability of daily living score, cognitive function, and Charlson comorbidity index (CCI) of the two groups were collected, and statistically significant indicators were incorporated into logistic regression equation to analyze the risk factors of frailty in elderly comorbidity patients. All patients were followed up until December 2023, and the incidence of falls, disability, readmission, and death were recorded. Results The proportions of elderly patients (≥80 years old), nutritional risk, comorbidity ≥9, severe CCI grade, medication ≥5 in the frailty group were 49.46%, 65.59%, 43.01%, 84.95%, 69.89%, respectively, which were higher than 8.77%, 28.07%, 0.00%, 26.32%, 33.33% in the non-frailty group. The proportion of patients with diabetes, chronic obstructive pulmonary disease (COPD) and stroke in the frail group was 84.95%, 40.86% and 38.71%, respectively, which were higher than those in the non-frail group (59.65%, 21.05% and 19.30%); the differences were statistically significant (P<0.05). Logistic regression analysis showed that age ≥80 years old, nutritional risk, number of comorbidities ≥9, severe CCI grading, and combined stroke were risk factors for frailty in elderly patients with multiple diseases (P<0.05). Follow-up to December 2023, the average follow-up of the non-frail group was (21.7±2.8) months, and the average follow-up of the frail group was (20.9±2.6) months. The incidence of falls, disability, death and other adverse prognosis in the frail group was 23.66%, which was higher than that in the non-frail group (5.26%). The readmission rate of the frail group was 72.04%, which was higher than that of the non-frail group (28.07%); the difference was statistically significant (P<0.05). Conclusions The incidence of frailty in elderly patients with comorbidity in the military hospital is high, and frailty will lead to poor prognosis of patients. Advanced age, nutritional risk, number of comorbidities, severe CCI grading, and combined stroke are risk factors for frailty in elderly patients with comorbidity.