The Study On Frailty Influential Factors And Its Relationship With Serum 25-hydroxy Vitamin D

BackgroundFrailty is defined as an important geriatric syndrome that embodies a cumulative decline in reserves of multiple human physiologic systems or the function,when a threshold of expression of risk is reached,minor irritation can cause adverse health events,such as admission,fall,death,etc.It is characterized by decline in reserves of multiple human physiologic systems.The frailty status can be judged by the widespread use of frailty phenotype in the world.According to the frailty phenotypic(weight loss,weakness,slowness,low physical activity level,exhaustion),people with 3 or more components were classified as frail,those with one or two components considered to be pre-frailty,and those with none of the above components considered to be robust.The pathogenesis of frailty is complex,and frailty is affected by many factors such as sex,age,chronic disease,nutrition,immunity,cognitive function and so on.Comprehensive geriatric assessment(CGA)is a process of multi angle comprehensive assessment,identification,diagnosis for the elderly.This assessment includes ten dimensions like cognition,emotion and motivation,a total of dozens of projects.CGA can help doctor fully understand the health status of the elderly,and has been widely used in clinical as a essential assessment tool in the field of geriatric medicine.Vitamin D is one of the essential vitamins of the human body.It plays a wide and important role in body by combining with vitamin D receptor which distributes in various tissues of the human body.In addition to regulating calcium phosphorus metabolism,vitamin D has the function in immune system,cell proliferation and differentiation,induction of tumor cell apoptosis and so on.In addition,in recent years,vitamin D has been found to play an important role in the development of frailty.At present,there are few studies on frailty.And,the research on frailty in China is still in its infancy,especially for the study about the frailty influential factors and the relationship between frailty and serum vitamin D.The purpose of this study is to analyse the influencing factors of frailty based on the CGA,and explore the relationship between frailty and serum 25-hydroxy vitamin D(25(OH)D)in elderly patients by evaluating the frailty status and serum 25(OH)D level in order to provide a theoretical basis for the intervention and research of frailty.Part 1 The status and the influential factors of frailty for elderly individuals ObjectivesCGA and frailty phenotype were conducted on elderly patients to analyze the influencing factors of frailty.Methods1.Elderly patients were selected form a tertiary general hospital of Yangzhou from 2016.08 to 2017.02.2.General data were collected by self-designed general data questionnaire which includes gender,age,and educational level.Frailty phenotype was used to evaluate the frailty status of the elderly,the International Physical Activity Questionnaire(IPAQ)was used to determine the level of physical activity.And based on the CGA,the sleep,cognition,daily living ability and psychological status of the elderly were evaluated respectively by Athens Insomnia Scale(AIS),Mini Mental Status Examination(MMSE),Activity of Daily Living Scale(ADL),Geriatric Depression Scale(GDS),Self-rating Anxiety Scale(SAS).ResultsA total of 241 elderly patients were included in the study.The prevalence of frailty,pre-frailty and robustness were 24.07%,43.15%and 32.78%,respectively.Univariate analysis showed that the frailty of the elderly was statistically different in the age,per capita monthly income,education level,career,smoking history,self-assessment health,number of diseases,sleep status,ADL,IADLs,MMSE,depression and anxiety(P<0.05).Logistic regression indicated that increasing age,smoking,depression and high score of activity of daily living(ADL)were significant risk factors associated with frailty and high score of MMSE was a protective factor.ConclusionThe incidence of frailty among hospitalized elderly patients is not optimistic,and is affected by many factors.Age,smoking history,depression,ADL,and MMSE are the independent factors of the frailty.In the clinical work,we should pay attention to the frailty status of the elderly patients and take comprehensive measures to intervene frailty.Part 2 Relationship between frailty and serum 25-hydroxy vitamin DObjectivesAnalyze the relationship between frailty and serum 25(OH)D,so as to provide scientific basis for clinical intervention research.Methods1.Elderly patients were selected form a tertiary general hospital of Yangzhou from 2016.08 to 2017.02.2.Frailty phenotype was used to evaluate the frailty status of the elderly.3.Serum 25(OH)D content was measured by enzyme linked immune sorbent assay(ELISA).ResultsThe average serum 25(OH)D concentration of all subjects was(16.288±7.466)ng/ml.The percentage of vitamin D sufficiency,insufficiency,deficiency and serious deficiency was 6.64%,23.24%,49.79%,and 20.33%,respectively.The average serum 25(OH)D concentration of no-frailty,pre-frailty and frailty were(21.379±6.972)ng/ml),(16.062±6.125)ng/ml,(9.880±4.627)ng/ml,respectively.And,compared with pre-frailty and no-frailty elderly,the 25(OH)D concentration of frailty patients were lower(P<0.05).Logistic regression showed that vitamin D was the independent contributing factor for frailty and the 5 frailty phenotypes:weight loss,weakness,slowness,low physical activity level,exhaustion(P<0.05).ConclusionElderly patients in hospital have severe vitamin D deficiency or insufficiency,and low level vitamin D is a risk factor associated with frailty and frailty phenotypes.The lower the vitamin D level,the higher the risk of elderly patients with frailty.