Longitudinal Study Of Frailty And Short-term Adverse Outcome Events In Elderly Patients With Maintenance Hemodialysis

【Objective】1.To understand the current situation of frailty in elderly patients with maintenance hemodialysis(MHD),and to explore the influencing factors of frailty in elderly patients with MHD,so as to provide a preliminary research basis for carrying out nursing intervention measures for frailty in elderly patients with MHD and reducing the incidence of frailty in elderly patients with MHD.2.To track the development progress of frailty in elderly patients with MHD and the occurrence of short-term clinical adverse events,so as to provide practical reference for nurses to master the rules of frailty development and early notice the short-term adverse events in elderly patients with MHD.【Methods】Cross sectional study and longitudinal follow-up were used.From August to September,2020,using convenience sampling method,the self-made general data and clinical data questionnaire,Frailty phenotype(FP),Barthel index(BI),5-Item Geriatric Depression Scale(GDS-5),Perceived Social Support Scale(PSSS)and Short Form of 12 Health Survey Questionnaire(SF-12)were applied to investigate 266 elderly patients(≥60 years old)receiving MHD treatment in the blood purification centers of two Grade-A hospitals in Jinan,Shandong Province.264 valid questionnaires were collected,and the effective recovery rate was 99.25%.From November to December in 2020 and February to March in 2021,264 elderly patients with MHD were followed up by outpatient,inpatient or telephone to track the incidence of frailty and to record the incidence of clinical adverse outcome events(death,fall,hospitalization)with FP and selfmade record sheet of clinical adverse outcome events.Descriptive analysis,rank sum test,linear trend test,Spearman correlation analysis,ordered multiple Logistic regression analysis,Log-rank test and Cox survival analysis were conducted with SPSS 21.0 software.【Results】1.Among 264 elderly patients with MHD,the incidence of frailty,pre frailty,and non frailty were respectively 35.98%(95/264),47.35%(125/264)and 16.67%(44/264).There were 162 cases(61.36%)with decreased grip strength,130 cases(49.24%)with self-reported fatigue,117 cases(44.32%)with slower pace,92 cases(34.85%)with low physical activity and 19 cases(7.20%)with decreased body weight in sequence.2.The result of univariate analysis showed that gender,age,marital status,family per capita monthly income,the way of housing,smoking history,drinking history,exercise,self-rated health status,dialysis vascular access,dialysis hypotension,hypertension,heart disease,diabetes,number of disease types,number of oral drug types,albumin,serum potassium,hemoglobin,thyroid hormone,activities of daily living,depression,social support and quality of life had significant differences in the incidence of frailty in elderly patients with MHD(P<0.05).But there were no significant differences in the incidence of frailty among elderly patients with MHD between different occupations,education levels,medical payment methods,dialysis frequency,etc(P>0.05).The results of multivariate analysis showed that age,exercise,number of oral drugs types,albumin,hemoglobin,activities of daily living,depression and quality of life were the main influencing factors of frailty in elderly patients with MHD(P<0.05).3.The short-term development track of frailty in elderly patients with MHD showed an upward trend.The Cox survival analysis of short-term followup revealed that frailty was an independent risk factor for death events(OR=5.620,95%CI[1.134,27.845],P=0.034)and hospitalization events(OR=2.582,95%CI[1.039,6.419],P=0.041)in elderly patients with MHD within 3 months,and frailty was an independent risk factor for death events(OR=6.740,95%CI[1.855,24.493],P=0.004),fall events(OR=3.346,95%CI[1.216,9.209],P=0.019)and hospitalization events(OR=2.026,95%CI[1.013,4.051],P=0.046)in elderly patients with MHD within 6 months.【Conclusion】1.The incidence of frailty in elderly patients with MHD was 35.98%,and the decline of grip strength was the main manifestation of frailty.Clinical medical staff should pay more attention to the frailty and the decline of grip strength of elderly patients with MHD.2.Age,physical exercise,number of oral drug types,albumin,hemoglobin,activities of daily living,depression and quality of life were the main influencing factors of the frailty of elderly patients with MHD.3.The short-term development track of frailty in elderly patients with MHD showed an upward trend.4.Frailty was an independent risk factor on death events and hospitalization events within 3 months and 6 months in elderly patients with MHD,as well as,frailty was also an independent risk factor on fall events within 6 months in elderly patients with MHD.