The Relationship And Mediating Role Between Comorbidity And Frailty In Elderly Patients With Cardiovascular Disease And Abnormal Glucose Metabolism

ObjectiveTo investigate the frailty status of elderly patients with cardiovascular diseases and abnormal glucose metabolism,analyze the relationship between comorbidity,basic daily living ability(BADL),nutritional status and frailty,and explore the mediating role of basic daily living ability and nutritional status between comorbidity and frailty,so as to provide a theoretical basis for preventing the occurrence and development of frailty.To provide reference for formulating specific intervention measures in the next step.MethodFrom January 2022 to August 2022,a total of 291 elderly patients with cardiovascular diseases and abnormal glucose metabolism admitted to the cardiovascular medical ward of a third-class A hospital in Jinan,Shandong Province were selected as research objects by convenience sampling method.Data were collected by the Frail Scale,Charlson Comorbidity Index,Barthel Index,Mini Nutritional Assessment-short Form,and self-designed general data questionnaire.EpiData3.1 and SPSS 25.0 statistical software were used for data entry,collation and analysis,including descriptive statistical analysis,t test,variance analysis,Pearson correlation analysis and Spearson correlation analysis.Model 4 of process plug-in of SPSS 25.0 software was used to analyze the mediating role of basic daily living ability and malnutrition respectively between comorbidity and frailty.Model 6 of process plug-in was used to analyze the chain mediating role of basic daily living ability and nutritional status between comorbidity and frailty.The mediation is verified by the Bootstrap in the Process plugin.Results1.Comorbidity,BADL,nutritional status and frailty status of elderly patients with cardiovascular disease and abnormal glucose metabolismIn this study,291 cases were finally included,and the average score of frailty was(2.23±1.43).There were 152 patients with frailty,and the incidence of frailty was 52.2%.The average score of Charlson Comorbidity Index was(5.78±1.50),and 50.2%of the patients had severe comorbidity.207 patients with mild to moderate disabilities in BADL,accounting for 71.1%;A total of 196(67.4%),were at risk of malnutrition or malnutrition.Comparison of demographic and disease characteristics of frailty in elderly patients with cardiovascular disease and abnormal glucose metabolism.2.Demographic and disease characteristics of senile patients with cardiovascular diseases and abnormal glucose metabolismThere were statistically significant differences in frailty scores in age,sex,BMI,marital status,smoking status,drinking status,daily exercise,multiple drug use,and duration of underlying diseases(P<0.05).3.Correlation analysis of frailty,comorbidity,BADL and nutritional status in elderly patients with cardiovascular diseases and abnormal glucose metabolismCorrelation analysis showed that comorbidity were positively correlated with frailty(r=0.414,P<0.001),while comorbidity were negatively correlated with BADL and nutritional status(r=-0.399,P<0.001;r=-0.373,P<0.001),BADL was positively correlated with nutritional status(r=0.575,P<0.001),negatively correlated with frailty(r=-0.825,P<0.001),and negatively correlated with frailty(r=-0.695,P<0.001).The mediating role of basic daily living ability between comorbidity and frailty in elderly patients with cardiovascular diseases and abnormal glucose metabolism.4.Mediating role of BADL between comorbidity and frailty in elderly patients with cardiovascular diseases and abnormal glucose metabolismThe results showed that comorbidity had a significant positive predictive effect on frailty(β=0.289,P<0.001),and comorbidity had a significant negative predictive effect on BADL(β=-0.231,P<0.001).The absolute value of regression coefficient of comorbidity on frailty decreased after the addition of BADL(β=0.128,P<0.01).There was a significant correlation between comorbidity and frailty,BADL has a significant negative correlation with frailty(β=-0.699,P<0.001).BADL played a partial mediating role between comorbidity and frailty,with indirect effect of 0.161(-0.231*-0.699)and intermediate effect size of 55.7%(0.161/0.289).The results of Bootstrap mediation effect test showed that the 95%confidence interval of BADL’s Bootstrap was[0.084,0.239],excluding 0,and the mediation effect of BADL was significant.5.Mediating role of nutritional status between comorbidity and frailty in elderly patients with cardiovascular diseases and abnormal glucose metabolismThe results showed that comorbidity had a significant positive predictive effect on frailty(β=0.304,P<0.001),and comorbidity had a significant negative predictive effect on nutritional status(β=-0.229,P<0.01).The absolute value of regression coefficient of comorbidity on frailty decreased after adding nutritional status(β=0.174,P<0.01).There was a significant correlation between comorbidity and frailty,Nutritional status was negatively correlated with frailty(β=-0.567,P<0.001).Nutritional status of patients played a partial mediating role between comorbidity and frailty,with indirect effect of 0.130(-0.229*-0.567)and intermediate effect size of 42.7%(0.130/0.304).The results of the Bootstrap mediation effect test showed that the 95%confidence interval of the Bootstrap for nutritional status was[0.046,0.214],excluding zero,and the mediation of nutritional status was significant.6.Chain mediating effects of BADL and nutritional status on comorbidity and frailty in elderly patients with cardiovascular diseases and abnormal glucose metabolismThe chain mediating effect model of BADL and nutritional status between comorbidity and frailty showed that the total effect of comorbidity on frailty was 0.304.Indirect path comorbidity for BADL,BADL for nutritional status,comorbidity for nutritional status,nutritional status for frailty and BADL for frailty coefficients were-0.231,0.453,-0.124,-0.341,-0.539,indirect effect 3 was 0.036,and the 95%confidence interval of Bootstrap test was[0.017,0.058],excluding zero.BADL and nutritional status were established as chain mediators.The indirect effect 1 was 0.125,and the 95%confidence interval of Bootstrap test was[0.065,0.190],excluding zero.BADL’s mediating effect was still valid.The indirect effect 2 was 0.042,and the 95%confidence interval of Bootstrap test was[-0.003,0.091],including zero.The mediating effect of nutrition status was no longer established.After adding the mediating variables BADL and nutrition status,the direct effect was 0.102,with 95%confidence interval[0.021,0.183],excluding zero,P<0.05,which was still statistically significant,and the mediating effect was partially mediating.Conclusion1.The incidence of frailty in elderly patients with cardiovascular diseases and abnormal glucose metabolism is high.Medical staff should pay attention to and formulate corresponding intervention measures to reduce the occurrence and development of frailty.2.Age,sex,BMI,marital status,smoking and drinking status,daily exercise,multiple medication,and duration of underlying disease were correlated with frailty in elderly patients with cardiovascular disease and abnormal glucose metabolism.3.The basic daily living ability of elderly patients with cardiovascular diseases and abnormal glucose metabolism plays a mediating role between comorbidity and frailty,and the nutritional status plays a mediating role between comorbidity and frailty.4.The basic daily living ability and nutritional status of elderly patients with cardiovascular diseases and abnormal glucose metabolism play a chain mediating role between comorbidity and frailty.