Relationship Between Depression,malnutrition And Cognitive Frailty In Elderly Patients With Multimorbidity

ObjectiveTo investigate the relationship between depression,malnutrition and cognitive frailty in elderly patients with multimorbidity.To explore the mediating effect of malnutrition on depressive symptoms and cognitive frailty in elderly multimorbidity;To analyze the effect of additive interaction between depressive symptoms and malnutrition on cognitive frailty in elderly multimorbidity.MethodsFrom July 2020 to November 2020,a total of 381 multimorbidity over 60 years old were selected from the geriatrics department of two third-level,first-level hospitals in Shandong Province by the method of convenient sampling.The tools included the general data questionnaire,the Montreal cognitive assessment scale,the frailty phenotype,the 5-item geriatric depression scale,the clinical dementia rating scale,and the simple nutrition assessment scale.Excel 2013,SPSS 24.0 and Mplus 8.0 were used for data analysis.Statistical methods include descriptive analysis,independent sample t-test or chi-square test,Logistic regression analysis,etc.The mediating effect of malnutrition on depressive symptoms and cognitive frailty was verified by Z test.The additive interaction between depressive symptoms and malnutrition in elderly multimorbidity was evaluated using relative excess risk(RERI),attribution ratio(AP),and interaction index(S).Results1.In this study,107 elderly multimorbidity with depressive symptoms,accounting for 28.1%of the total number;187 were malnourished,accounting for 49.1%;90 patients with cognitive frailty,accounting for 23.6%.2.Univariate analysis results showed that the proportion of elderly multimorbidity with cognitive frailty was higher in patients with depressive symptoms and malnutrition.The elderly multimorbidity with cognitive frailty were older,less educated,divorced or widowed,mostly living alone,no intellectual activity,lack of regular exercise,poor sleep quality,and multiple drug use(P<0.05).There were no statistical differences in gender and medical payment methods among the elderly multimorbidity with different cognitive frailty states(P>0.05)3.Logistic regression analysis showed that depressive symptoms(OR=3.39,P<0.001)and malnutrition(OR=2.26,P<0.05)both increased the risk of cognitive frailty in elderly multimorbidity,and depressive symptoms were significantly correlated with malnutrition(OR=1.71,P<0.05).Education level,marital status,regular exercise,intellectual activity and sleep quality were also the main influencing factors of cognitive frailty in elderly multimorbidity.4.The results of mediating effect analysis showed that there was a significant relationship between depressive symptom scores and cognitive frailty(c=0.63,P<0.001).In depressive symptoms score and cognitive frailty relation model after scoring in malnutrition,depressive symptoms score on standardized regression coefficients of cognitive frailty is reduced,the relationship between the two remained significant(c’=0.33,P<0.001),and depressive symptoms score and score was significant malnutrition(a=0.54,P<0.001),malnutrition scores and the relationship between the cognitive frailty significantly(b=0.53,P<0.001).The results of Z test showed that malnutrition had a significant mediating effect on depressive symptoms and cognitive frailty in elderly patients with multimorbidity(Z=7.65,P<0.001).5.The results of additive interaction analysis showed that among the elderly patients with cognitive frailty multimorbidity,OR with depressive symptoms only was 5.04(P<0.001),OR with malnutrition only was 2.16(P<0.05),OR with depressive symptoms and malnutrition at the same time was 16.27(P<0.001).After calculation,the additive interaction evaluation indexes RERI=10.07(0.06,20.08),AP=0.62(0.33,0.91),S=2.94(1.23,7.00),indicating that depression symptoms and malnutrition have additive interaction on cognitive frailty.Conclusions1.The status of cognitive frailty in elderly multimorbidity should not be ignored.Educational level,marital status,regular exercise,intellectual activity and sleep quality are the influencing factors of cognitive decline in elderly multimorbidity.2.There is a significant correlation between depressive symptoms and cognitive frailty in elderly multimorbidity,and depressive symptoms increase the risk of cognitive frailty in elderly multimorbidity3.Malnutrition has a significant mediating effect between depressive symptoms and cognitive frailty in elderly patients with multimorbidity.4.In elderly multimorbidity,depressive symptoms and malnutrition have an additive interaction with cognitive frailty.