Investigation Of Multimorbidity And Geriatric Syndromes In The Elder People With Family Doctor In A Tianjin Community

Objective With the aging of population structure and the progress of science and technology in China,the number of the oldest people has been increasing.At present,most Chinese elders are cared home-based,and family doctors are faced with new challenges.As they age,the chronic diseases that haunt the elders are undergoing silent changes,and multimorbidity with two or more chronic diseases is gradually becoming common among the elderly.The occurrence of various chronic diseases and complications causes gradual changes to the functions and structures of various systems and organs of the elderly,which are manifested as syndrome that affect their life quality such as sleep disorders,chronic pains,and constipation,visual impairment,malnutrition,geriatric depression,all of which are known as geriatric syndrome.With the new diagnostic and treatment system of family doctor,physical diseases of the elderly in communities can be addressed in a well-targeted manner,attention to the health management of chronic diseases,especially multimorbidity,reduce the happening of the complications of chronic disease,reduce preventable risk factors of geriatric syndrome,effectively improve the quality of life of the elderly,and thus reduce the burden on society.Methods Among the residents who have signed a contract with a group of family doctors in Changye Street,Heping District,Tianjin,the elderly over 60 years old who participated in the physical examination from May 2016 to December 2016 were selected for comprehensive geriatric assessment(by investigators).The collection of information was completed in the form of a questionnaire.Subjects are voluntarily participating.A total of 1241 elderly people were enrolled in the research object after removing those with conscious disorders,severe visual impairment,hearing impairment,and those who are unable to communicate with normal language and do not cooperate.1241 participants in the study were analyzed for their chronic diseases,comorbidities,geriatric syndrome and the influence of gender(male group n=534,female group n=707),age(group of 60-69 years old n=392,group of 70-79 years old n=543,?80 years old group n=306)on the occurrence of geriatric syndrome,and the influence of medication on the disease control.According to the number of multimorbidities,the subjects were divided into 2-type(n = 215)groups,3-type(n = 259)groups,4-type(n = 245)groups,5 or more types(n = 398)of groups to analyze the relationship between the number of multimorbidities,and geriatric syndrome.The subjects were divided into hypertension group(n=874)and diabetes group(n=344)to understand their medication status and disease control.The high blood pressure group was divided into the standard group(n=429)and the non-standard group(n=445)to analyze the relationship between the blood pressure control and geriatric syndrome;The diabetes group was divided into the standard group(n=194)and the non-standard group(n=150)to analyze the relationship between the blood glucose control and geriatric syndrome.Results The average age of the recruited research subjects was(73.6±7.63)years old,and one or more geriatric syndrome problems,multimorbidity,chronic pain,chronic constipation,hearing disorders,sleep disorders,malnutrition,depression,visual impairment,polypharmacy,disability,urinary incontinence,choked cough occurred in 90%,90%,71.2%,33.2%,33.0%,31.3%,24.0%,18.6%,18.1%,12.7%,10.5%,6.5%,2.5%,respectively,of these patients.The sex analysis of overall population showed that the female had significant increased risks in having two or more geriatric syndromes(59% vs.76.4%),and higher incidences of visual impairment(15.5% vs.20.1%),chronic pain(59.6% vs.80.1%),chronic constipation(28.7% vs.36.6%),sleep disorders(22.5% vs.37.9%),urinary incontinence(4.5% vs.7.9%),malnutrition(20.8% vs.26.5%)than the male(P<0.05).The different aging groups analysis in these patients revealed that the risk of geriatric syndromes was increased with growing of age.The investigation analysis showed that the more multimorbidities were,the higher the incidences of visual impairment,hearing impairment,geriatric depression,multiple medications,sleep disorders,urinary incontinence,chronic pain,constipation,and disability would be(P <0.05).The number of Chronic diseases was positively correlated with the number of geriatric syndromes(r=0.343,P<0.05).The control condition of chronic disease represented by hypertension and diabetes showed that the risks of visual impairment(21.1% vs.13.3%),disability(17.5% vs.5.83%),geriatric depression(22.7% vs.15.4%),multiple medication(39.3% vs.16.8%)were higher in patients under standardization of normal blood pressure that those reaching its standard,and significant differences were seen in these patients.The incidences of visual impairment(18.7% vs.9.8%),disability(20% vs.10.3%),geriatric depression(26.7% vs.10.3%)in patients under standardization of blood glucose were higher than those reaching the standardization.Conclusion The prevalence of chronic disease,multimorbidity and geriatric syndrome is very high.The gender,age,number of chronic diseases,disease control of the elderly all affect the risk of various geriatric syndrome problems.While focusing on chronic diseases of the elderly,family doctors should also timely conduct comprehensive geriatric assessment and individualized management for the elderly who have signed family doctors,so as to reduce the occurrence of complications of chronic diseases,improve the prognosis of basic diseases and improve the quality of life of the elderly.