Analysis On The Distribution And Influence Factors Of Frailty And Its Subtypes Of Mild Cognitive Impairment In Community Older Adults

Research Background:Along with the social aging process accelerating,Prevalence of Alzheimer’s disease（age-related diseases）and other types of dementia showed a trend of rising year by year.Nowadays,there are no specific drugs to treat dementia.Basic and clinical research on prevention and treatment strategies for dementia has shifted to the pre-clinical stage of dementia（mild cognitive impairment）.Frailty,an important predictor of dementia,increases the risk of fatigue 、 fracture 、 hospitalization or Admission to long-term care facilities and death in older adults.Older adults with MCI in community have a high prevalence of frailty and complex attribution,and potentially inappropriate medication（PIM）is also a significant risk factor for frailty.Therefore,the attribution system under different categories of frailty in MCI and whether PIM is involved in the occurrence of frailty in MCI remain to be further explored.Research Purpose:（1）To describe the frailty status of older adults with MCI in community,and to clarify the frailty category and population characteristics of this population;（2）To sort out the related factors of frailty in older adults with MCI in community,and to elaborate the attribution systems under different categories of frailty in this population;（3）Describe the exposure of PIM to frailty in older adults with MCI in community,and preliminarily explore the contribution of PIM to frailty in this population.Research Methods:In this study,a cross-sectional study and multi-stage sampling method were used to select older adults with MCI in community as the subjects in Baohe District of Hefei city.The general data questionnaire 、 Montreal Basic Cognitive Assessment Scale（Mo CA-B）、Mini-Mental State Examination（MMSE）、Comprehensive Frailty Assessment Tool（CFAI）、Barthel index（BI）、Depression Scale Short-form（GDS-15）、Pittsburgh Sleep Quality Index（PSQI）、 Short-form Mini-nutritional Assessment（MNA-SF）、Short Physical Performance Battery（SPPB）and criteria of potentially inappropriate medications for old adults in China were used as the evaluation tools.SPSS 25.0 was used for statistical analysis,Shapiro-Wilk test was used for normality test of data.The enumeration data were described by frequency and percentage,and the measurement data of normal distribution were described by mean and standard deviation,the measurement data of non-normal distribution were described by median and quartile.Single factor measurement data were analyzed by c 2 test 、 t test or Mann-Whitney U test.Multiple linear regression analysis was used to explore the classification attribution of frailty in MCI,and Logistic regression analysis was used to explore the effect of PIM on frailty and frailty subtypes.Research Results:1.The frailty status of older adults with MCI in community The prevalence of frailty and non-frailty in older adults with MCI in community was 66.8% and 33.2%,respectively.The average score of frailty was 33.85±13.85,the average score of each subtype item was physical frailty（6.38±2.56）、psychological frailty（15.19±7.78）、social frailty（7.22±5.03）,and psychological frailty is more prominent.2.PIM use in older adults with MCI in community The overall prevalence of PIM in older adults with MCI in community was 64%,82.3% in frailty group and27.1% in non-frailty group,and the difference between the two groups was significant（P<0.05）.Clopidogrel was the most frequently used PIM,and blood system drugs were the most frequently used PIM system.3.Single factor measurement on older adults with MCI in community（1）Demographic variables: gender,age,marriage,physical activity and economic status were associated with overall frailty in MCI;age,education,marriage,physical activity and economic status were associated with physical frailty;age,marriage,physical activity and economic status were associated with psychological frailty,and age,marriage,inhabiting information,physical exercise and economic status were correlated with social frailty;（2）Physical function variables: comorbidities index,eyesight status,hearing status,chewing function,nutrition,lower limb muscle function,BMI,grip strength,sleep and daily life ability are associated with overall frailty,physical frailty,and social frailty of MCI;in the psychological frailty subtypes,there was no difference between groups in BMI variables,and all other variables were associated with psychological frailty;（3）Cognitive and psychological variables:cognitive function,depression,and apathetic were associated with overall frailty,physical frailty,and psychological frailty;in the social frailty subtypes,only depression and apathetic scores showed differences between groups;（4）Social activity variables: social activity,social isolation and social support were associated with overall frailty,physical frailty,psychological and social frailty in MCI;（5）PIM variables: PIM was associated with overall frailty,physical frailty,psychological and social frailty in MCI.4.Multiple linear regression analysis of frailty in older adults with MCI in community（1）overall frailty: marriage,eyesight status,lower limb muscle function,comorbidity index,daily living ability,depression,apathetic and PIM explained 84%of total explanatory power;（2）physical frailty: lower limb muscle function,comorbidity index,daily living ability,apathetic explained 74% of total explanatory power;（3）psychological: age,marriage,economic sources,comorbidity index,daily living ability,cognitive function,depression,apathetic and PIM explained 75% of total explanatory power;（4）social frailty: age,marriage,depression,apathetic and PIM explained 61% of total explanatory power.5.Logistic regression analysis of frailty in older adults with MCI in community（1）overall frailty: after controlling for other confounding factors,the prevalence of frailty with PIM was 2.11 times higher than that without PIM（OR=2.11,95%CI=0.66-4.67,P<0.05）,the prevalence of frailty with Cardiovascular system PIM was 2.85 times higher than that without Cardiovascular system PIM（OR=2.85,95%CI=1.03-7.88,P<0.05）;（2）physical frailty: after controlling for other confounders,the number and system of PIM administration had no significant effect on frailty;（3）psychological: after controlling for other confounding factors,the prevalence of frailty with PIM was 5.26 times higher than that without PIM（OR=5.26,95%CI=1.80-15.38,P<0.05）,the prevalence of frailty with Cardiovascular system PIM was 5.71 times higher than that without Cardiovascular system PIM（OR=5.71,95%CI=1.64-19.86,P<0.05）;（4）social frailty: after controlling for other confounding factors,the prevalence of frailty with PIM was 4.03 times higher than that without PIM（OR=4.03,95%CI=1.81-9.00,P<0.05）,and the prevalence of frailty with Nervous system PIM was 5.15 times higher than that without Nervous system PIM（OR=5.15,95%CI=1.63-16.22,P<0.05）,the prevalence of frailty with Blood system PIM was 2.71 times higher than that without Cardiovascular system PIM（OR=2.71,95%CI=1.19-6.21,P<0.05）.Research Conclusion:（1）The prevalence of frailty was higher in older adults with MCI in community,and the degree of psychological frailty was the most prominent.（2）PIM was common in older adults with MCI in community patients,and the largest number of PIM users was Clopidogrel and Blood system.（3）In the attribution of older adults with MCI in community frailty and its subtypes,for the overall frailty,the contribution rate of apathetic is higher and PIM contributed to variations.For frailty subtypes of attribution,limb muscle function,comorbidity index,daily living ability and apathetic are influence factors of physical frailty;age,marriage,economic sources,comorbidity index,daily living ability,cognitive function,depression,apathetic and PIM are influence factors of psychological frailty;age,marriage,depression,apathetic,social support and PIM are influence factors of social frailty.（4）The number of PIM significantly increased the risk of MCI frailty,and cardiovascular system PIM contributed the most to the risk of overall frailty and psychological frailty,while Nervous system PIM and of Blood system PIM contributed the most to the risk of social frailty.