Research On Frailty Among Older Nursing Home Residents In Chengdu And Its Relationship With Adverse Outcomes

BackgroundWith the rapid development of population aging all over the world,it has become a major challenge that most countries need to face,and the accompanying problem of increasing pension burden has become increasingly heavy.With the change of pension concept,more and more elderly people will choose to live in nursing home.Therefore,the quality of life and risk prevention of the elderly in nursing home deserve our attention.Frailty refers to the age-related functional deterioration which leads to the decrease of physiological reserve,resulting in the non-specific state of increased vulnerability to external factors,decreased response to stress and resistance.Frail elderly self-balance is destroyed,and a series of clinical events can be caused by small external stimulus.Frailty not only increases the burden of care,but also is associated with adverse health outcomes,such as dysfunction,poor quality of life,falls,cognitive impairment,repeated hospitalization,and even death.The difference between frailty and aging is that aging is irreversible and progressive with aging.While frailty is different,if given appropriate intervention,it can be reversed.For this reason,frailty is considered to the pre-disability stage of the elderly,and has become a hot research topic in the international geriatric.There are different definitions of the frailty,and different measuring populations,so the prevalence of frailty being reported is difference.However,the general trend is that the prevalence increases with age,and women are higher than men.The prevalence of frailty in community was 4%-59.1%.Frailty has a higher prevalence in nursing home than community and hospital.A systematic review of the prevalence of frailty in nursing home showed that the prevalence of frailty in nursing home is 19.0%-75.6%.The current situation of frailty in nursing home is not optimistic.At present,there are more and more studies on frailty in our country,but most of them are about the elderly in community and hospital.There are few studies on the elderly in nursing home,the prevalence of frailty in nursing home is not clear.The study of the impact of frailty on adverse outcomes using prospective research is even less.ObjectiveTo investigate the older nursing home residents in Chengdu,understand the status of senile frailty and other geriatric syndrome,and analyze the influencing factors of frailty.Established an initial cohort of frail people,then followed-up,and collected adverse events,including death,falls and hospitalization,explored the impact of frailty on the short-term adverse outcomes of the elderly.MethodsPart ?: A cross-sectional survey was conducted to investigate the prevalence of frailty and its risk factors.Among 338 elderly people living in four nursing homes in Chengdu,Sichuan Province,from April to June 2018,were included in this research,by a face-to-face questionnaire.The questionnaire include demographic characteristics and disease types questionnaire(self-designed),Activities of Daily Living(ADL),Morse Fall Scale(MFS),Watian Drinking Water Test,9-question Patient Health Questionnaire(PHQ-9),Saint Louis University Mental Status(SLUMS),Confusion Assessment Method-Severity(CAM-S),Numeric Rating Scale(NRS),Mini Nutrition Assessment-Short Form(MNA-SF),Family Care Index Questionnaire and Frail Scale.Part ?: A nested case-control study was conducted to investigate the prognostic effect of frailty on recent adverse events(including death,falls and hospitalization)in the elderly by following up the initial cohort for six months.All the valid samples were followed up from October to November,2018.The incidence of adverse events of the elderly in nursing home was collected.The population with adverse outcomes was the case group,and the elderly without corresponding outcomes were the control group.According to the of different results,the matching ratio between the exposed group and the non-exposed group was different.The matching ratio of falls and hospitalization was1:3,and the matching ratio of death was 1:5.The prognostic effect of frailty on adverse events of the elderly in nursing home was discussed.The sex of the case group and the control group was the same and the age was less than 3 years old.Results1.A total of 338 elderly people were included in this study,320 valid questionnaires were collected,with an effective recovery rate of 94.6%.Including 122 males and 198 females,with an average age of 82.60±7.76 years,144 elderly peoplewith frailty,the prevalence of frailty was 45.00%.2.There are many health problems among the elderly in nursing home,and the incidence of all kinds of geriatric syndrome was higher.Among them,impaired ADL(72.50%),dysphagia(36.87%),cognitive impairment(90.63%),depression(41.25%),chronic pain(46.87%),nutritional impairment(52.81%)and family dysfunction(28.75%).3.The results of the univariate analysis showed that only age was the influencing factor of frail in demography data(P < 0.05);in health status and disease,alcohol consumption,hypertension,coronary heart disease,chronic obstructive pulmonary disease,digestive system diseases,osteoporosis,joint disease,multimorbidity and polypharmacy were the influencing factors of frail(P < 0.05);in geriatric syndrome,ADL,swallowing function,depression,cognitive impairment,malnutrition,chronic pain and delirium were the influencing factors of frail elderly(P < 0.05).4.During the follow-up,12 people died,42 fell and 65 hospitalized.Using conditional logistic regression analysis to analyze the follow-up outcome indicators.The results showed that frailty was an independent risk factor for the incidence of falls(OR=1.932,95%CI: 1.048-3.560,P=0.035)and hospitalization events(OR=1.699,95%CI: 1.040-2.776,P=0.013)of the elderly in nursing home.Conclusion1.The prevalence of frailty in nursing home in Chengdu was 45.00%.Medical staff and caregivers in nursing home should pay close attention to frailty in elderly.2.Age,alcohol consumption,hypertension,coronary heart disease,chronic obstructive pulmonary disease,digestive system diseases,osteoporosis,joint diseases,multimorbidity,polypharmacy,ADL,swallowing function,depression,cognitive dysfunction,malnutrition,chronic pain and delirium were the independent influencing factors of frail elderly.3.After six months of follow-up,we found that frailty was an independent risk factor of the incidence of falls and hospitalization events of the elderly in nursing home.