Evaluation Of The Effect Of CGA-Based Interventions In Patients With Chronic Obstructive Pulmonary Disease Complicated With Geriatric Syndrome

Objectives The comprehensive geriatric assessment?CGA?was applied to the patients with chronic obstructive pulmonary disease?COPD?in stable stage complicated with geriatric syndrome?GS?.The comprehensive assessment and reasonable intervention were carried out in the aspects of disease,physical functional status,mental health and social environment conditions,and to explore its role in improving nutritional status,depressive state and sleep quality of patients,promoting pulmonary function recovery and improving the quality of life of patients,so as to provide some clinical reference for the treatment of COPD patients with geriatric syndrome.Methods From October 2017 to April 2018,102 stable COPD patients in the geriatric department of the Affiliated Hospital of North China University of Technology were collected.Diagnostic Criteria:The diagnostic criteria for COPD are based on the diagnostic criteria for COPD as defined in the 2017 Global Initiative for Chronic Obstructive Lung Disease?GOLD?.Inclusion criteria:1)age between 60-90 years;2)clear consciousness;3)hospitalization time over 72h;4)at least one of the following geriatric syndrome?including falls,malnutrition,depression,sleep disorders,oral problems?;5)Sign the informed consent form;6)seek approval from the ethics committee.The patients were randomly divided into two groups according to the parity of the ending number of the medical record number at admission.The intervention group was composed of 49 patients whose ending number was odd.Even number was the control group,a total of 53cases.Before the intervention,the names,genders,ages,education levels,marital status,smoking and alcohol history and geriatric syndrome of the two groups of patients were collected.Before the study,the names,gender,age,education level,marital status,tobacco and alcohol history,combined GS status,body mass index?BMI?and other data of the two groups were collected,and the blood and biochemical indicators of the patients were collected,including Albumin?Albumin,ALB?,hemoglobin?Hb?,prealbumin?PA?,and complete lung function tests.The short-form mini nutrition assessment?MNA-SF?was used to assess the nutritional status of all selected patients within 3 days after admission.The Geriatric Depression Scale?GDS?was used to assess the patient's depression status.The Pittsburgh sleep quality index?PSQI?was used to assess the patient's sleep quality,and the patient's dyspnea was performed using a modified British Medical Research Cuncil?mMRC?.The CGA was completed at the same time,and the quality of life of the patients was assessed using the COPD Assessment Test?CAT?.During the study,patients in both groups were given routine In the study,both groups were given regular treatment by the GOLD guide,and the intervention group was targeted at the CGA process.The intervention lasted for 2 months.At the end of this study,the nutritional status,mental state,sleep status,degree of dyspnea,the quality of life of the patients were evaluated for the second time,and the related indicators of pulmonary function and nutritional status were reexamined.All the research data were analyzed by SPSS17.0.The counting data of the two groups were expressed by examples and percentages,and the comparison between the two groups was performed byc2test.The data of normal distribution of measurement data were expressed by x±s.Two independent samples t-test was used for comparison between groups,and paired data t-test was used for comparison between before and after groups.P<0.05 showed significant difference.Results 1 There were no significant differences in gender,age,education level,marital status,history of tobacco and alcohol,BMI and the types and numbers of geriatric syndrome and CGA data between the two groups?P>0.05?.2 Before the intervention,there were no significant differences in ALB,Hb,PA and other blood biochemical nutrition indicators,and MNA-SF scores between the two groups?P>0.05?.After the intervention,ALB,Hb,PA and MNA-SF score were improved in both groups,and the improvement was more significant in the intervention group than the control group?P<0.01?,suggesting that CGA and intervention could improve the nutritional status of patients.3 Depression status was assessed before the intervention,and there was no significant difference in the GDS scores between the two groups?P>0.05?.After the intervention,the GDS scores of the two groups were lower than before,and the reduction of the intervention group was better than that of the control group?P<0.01?,suggesting that CGA and intervention can improve the depression status of the patients.4 There was no significant difference in PSQI score between the two groups before the intervention?P>0.05?.After the intervention,PSQI score of patients in the intervention group was higher than before,while no significant improvement was observed in the control group?P<0.01?,suggesting that the sleep quality improvement effect of the intervention group was better than that of the control group.5 Before the intervention,the lung function indexes of the two groups were tested.The FEV₁,FEV₁/FVC and FEV₁%of the two groups were compared,there was no significant difference?P>0.05?.After the intervention,FEV₁,FEV₁/FVC,and FEV₁%of the patients in the two groups were improved,and the improvement degree in the intervention group was more significant?P<0.05?.6 Before the intervention,the dyspnea degree of the two groups was evaluated.There was no significant difference between the two groups?P>0.05?.After the intervention,the mMRC scores of the two groups were lower than before,and the improvement of the intervention group was more significant than that of the control group?P<0.01?,suggesting that CGA and intervention can improve the symptoms of dyspnea.7 There was no significant difference in CAT scores between the two groups before the intervention?P>0.05?.After the intervention,the CAT scores of the two groups were improved,and the improvement of the intervention group was more significant?P<0.01?,indicating the quality of life of the intervention group was significantly improved.Conclusions Applying CGA to COPD patients with geriatric syndrome,and discovering potential problems affecting patients'health,and giving reasonable intervention,can have the following effects:1)improve the patient's nutritional status,depression,sleep hygiene,improve sleep quality;2)improve the patient's lung function and clinical symptoms,improve the patient's quality of life.Figure 0;Table 10;Reference 43.