The Relationship Between Frailty And Cognitive Function Among Elderly Diabetes Patients

ObjectivesTo describe the current situation of cognitive function among elderly diabetes patients,and the effect of frailty on cognitive function,and to explore the mediating role of social support and depression between frailty and cognitive function,so as to provide a theoretical basis for promoting cognitive health of elderly diabetes patients.MethodsA convenience sampling method with elderly type 2 diabetes patients were selected from Grade ?-A hospitals.The research tools included general information questionnaire,the Frailty Phenotype(FP),Global Deterioration Scale(GDS),Montreal Cognitive Assessment Scale(MoCA)(Peking Version),Short Form Geriatric Depression Scale-15(GDS-15),and Social Support Rating Scale(SSRS).Excel and SPSS21.0 software was used to input and analyze the data.Results1.Totally 251 elderly type 2 diabetes patients were investigated in this study.Their age ranged from 60?88 years,with an average age of(67.82 ± 6.21).Among them,130(51.8%)were male patients,220(87.6%)were married,73(29.1%)were primary school graduates or below,88(35.1%)were Multiple users,175(70.1%)had complications,194(77.3%)had other chronic diseases,5(2%)HbAlc were normal.The mean scores of frailty,social support,depression,and cognitive function were 2.02±1.43,35.61±5.86,6.87±1.99 and 22.94±4.33 respectively.About 100(39.8%)patients had frailty,32.3%patients had depression,45.8%patients had cognitive impairment.2.The results of univariate analysis showed that patients with different ages(t=2.605,P=0.010),genders(t=-5.408,P<0.001)and educational levels(F=36.696,P<0.001)had significant differences in cognitive function scores.3.Correlation analysis showed that frailty was negatively correlated with social support and cognitive function(r=-0.215,P<0.001;r?-0.455,P<0.001),and positively correlated with depression(r=0.371,P<0.001);social support was positively correlated with cognitive function(r=0.264,P<0.001)and negatively correlated with depression(r=-0.309,P<0.001);depression was negatively correlated with cognitive function(r=-0.339,P<0.001).4.Taking frailty as the independent variable,social support and depression as the mediator variable,and cognitive function as the dependent variable,and controlling demographic characteristics and disease-related characteristics,using process plug-in to analyze the intermediary effect.The results of the mediating effect model of social support between frailty and cognitive function showed that the coefficients of indirect path frailty to social support(path a)and social support to cognitive function(path b)were-0.823(95%CI:-1.364,-0.281;P<0.005),0.104(95%CI:0.309,0.177;P<0.05),indirect effect(path a x path b)was-0.086,95%confidence interval was(-0.189,-0.015),excluding zero,which indicates that the mediating effect of social support was established.The results of the mediating effect model of depression between frailty and cognitive function showed that the coefficients of indirect path frailty to depression(path a)and depression to cognitive function(path b)were 0.494(95%CI:0.319,0.669;P<0.001),-0.340(95%CI:-0.566,-0.114;P<0.005),indirect effect(path a × path b)was-0.168,95%confidence interval was(-0.312,-0.042),respectively,excluding zero,indicating that the mediating effect of depression was significant.5.Taking frailty as the independent variable,social support and depression as the mediator variable,and cognitive function as the dependent variable to construct a multiple mediating model,and controlling demographic characteristics and disease-related characteristics,using process plug-in to analyze the intermediary effect.The results of the chain mediating model between social support and depression in frailty and cognitive function showed that the coefficients of indirect path frailty to social support(path a),social support to depression(path b),frailty to depression(path f),depression to cognitive function(path c)and social support to cognitive function(path e)were-0.823(95%CI:-1.364,-0.281;P<0.005),-0.086(95%CI:-0.125,-0.047;P<0.001),0.423(95%CI:0.251,0.595;P<0.001),-0.274(95%CI:-0.506,-0.041;P<0.05),0.081(95%CI:0.005,0.156;P<0.05).The indirect effect(path a x path b x path c)was-0.019,and Bootstrap test showed that the 95%confidence interval was(-0.052,-0.006),excluding zero,which indicates that the mediating model of social support and depression between frailty and cognitive function was established.The indirect effect(path a × path e)was-0.066,and Bootstrap test showed that the 95%confidence interval was(-0.161,0.003),including zero,which indicates that the mediating effect was no longer tenable.The indirect effect(path f × path c)was-0.116,and Bootstrap test showed that the 95%confidence interval was(-0.246,-0.009),excluding zero,indicating the existence of mediation effect.Conclusions1.The elderly patients with diabetes have poor cognitive function.Among them,the female,the older,and the lower education level patients are more worthy of attention to their cognitive function.2.The relationship between frailty and cognitive function is significant,and the cognitive function of frailty patients is significantly decreased.3.Social support plays an mediating role between frailty and cognitive function,and depression plays an mediating role between frailty and cognitive function among the elderly diabetes patients.4.The social support and depression play a chain mediating effect between frailty and cognitive function among the elderly diabetes patients.