以质量求发展，以服务铸品牌

护理学报 ›› 2020, Vol. 27 ›› Issue (17): 24-29.doi: 10.16460/j.issn1008-9969.2020.17.024

• 调查研究 • 上一篇    下一篇

老年髋部脆性骨折患者衰弱现状及影响因素分析

张媛1, 史凌云2, 贾雪原1, 卢智1, 韦欢欢1, 王梅新2   

  1. 1.新疆医科大学 护理学院,新疆 乌鲁木齐 830000;
    2.新疆医科大学第一附属医院,新疆 乌鲁木齐 830000
  • 收稿日期:2020-04-19 出版日期:2020-09-10 发布日期:2020-10-15
  • 通讯作者: 王梅新（1958-）,女,甘肃秦安人,本科学历,教授,主任护师,硕士研究生导师,中华护理学会新疆分会理事长,护理部顾问。
  • 作者简介:张媛（1988-）,女,内蒙古鄂尔多斯人,本科学历,硕士研究生在读,主管护师。
  • 基金资助:
    新疆维吾尔自治区自然科学基金资助项目（2015211C064）

Current Situation of Frailty in Elderly Patients with Fragility Hip Fracture and Its Influence Factors

ZHANG Yuan1, SHI Ling-yun2, JIA Xue-yuan1, LU Zhi1, WEI Huan-huan1, WANG Mei-xin2   

  1. 1. School of Nursing, Xinjiang Medical University, Urumqi 830000,China;
    2. The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000,China
  • Received:2020-04-19 Online:2020-09-10 Published:2020-10-15

PDF (PC)

345

赞

摘要： 目的 了解老年髋部脆性骨折患者衰弱现状,分析其影响因素。方法 采用便利抽样法,选取2019年4—9月乌鲁木齐市4所三级甲等综合医院的老年髋部脆性骨折患者作为研究对象。采用基本资料、衰弱评估问卷、简易微型营养评估量表、简易认知状态量表、简明老年抑郁量表对其进行调查,采用二分类Logistic回归分析老年髋部脆性骨折患者衰弱发生的影响因素。结果 158例老年髋部脆性骨折患者衰弱评分（2.83±0.89）分,其中衰弱评分≥3分（即衰弱组）87例（55.1%）,衰弱评分<3分（即非衰弱组）71例（44.9%）。二分类Logistic回归分析结果显示：自我感觉健康状态、抑郁、共病状况是老年髋部脆性骨折患者衰弱的危险因素（P<0.05）,手握力是老年髋部脆性骨折患者衰弱的保护性因素（P<0.05）。结论 老年髋部脆性骨折患者的衰弱检出率较高,自我感觉健康状态较差、抑郁、共病状况、手握力低的老年患者衰弱发生率较高,医护人员尽早识别衰弱患者,加强衰弱管理,减少和延缓老年患者衰弱的发生。

关键词: 老年患者, 髋部脆性骨折, 衰弱, 影响因素

Abstract: Objective To investigate the status of frailty of elderly patients with fragility hip fracture and analyze its influencing factors.Methods With convenient sampling, from April to September 2019, elderly patients with fragility hip fracture from 4 tertiary grade A hopitals were surveyed by general information and clinical information questionnaire, Frail Scale, Simple Mini Nutritional Assessment Scale, Simple Cognitive State Scale, and Concise Geriatric Depression Scale. The influencing factors were analyzed by binary logistic regression.Results The frailty score of 158 elderly patients with fragility hip fracture was 2.83±0.89 and there were 87 patients (55.1%) in the frail group and 71 (44.9%) in the non-frail group. Binary logistic regression showed that self-rated health status, depression, and comorbid condition were risk factors for frailty in elderly patients with fragility hip fractures (P<0.05) and hand grip strength was a protective factor (P<0.05). Conclusion There is relatively high prevalence of frailty in elderly patients with fragility hip fracture and self-rated health status, depression, comorbid conditions, and low hand grip strength are risk factors. It is critical to conduct early identification of frailty and strengthen the management of frailty thus to reduce and delay the occurrence and development of frailty, and promote healthy aging.

Key words: the elderly patient, fragility fracture, frailty, influence factor

中图分类号: 

  • R473.6
[1] Junius-Walker U, Onder G,Soleymani D,et al.The Essence of Frailty:A Systematic Review and Qualitative Synthesis on Frailty Concepts and Definitions[J]. Eur J Intern Med,2018(56):3-10.DOI:10.1016/j.ejim.2018.04.023.
[2] Ko FC.Preoperative Frailty Evaluation: A Promising Risk-stratification Tool in Older Adults Undergoing General Surgery [J]. Clin Ther,2019,41(3):387-399.DOI:10.1016/j.clinthera.2019.01.014.
[3] Chen KW, Chang SF, Lin PL.Frailty as a Predictor of Future Fracture in Older Adults: A Systematic Review and Meta-analysis[J]. Worldviews Evid Based Nurs, 2017,14(4):282-293.DOI:10.1111/wvn.12222.
[4] 杨继平,石泽亚,周毅峰,等.老年衰弱患者术前评估管理证据汇总[J].护理学报, 2019,26(7):34-39.DOI:10.16460/j.issn1008-9969.2019.07.034.
[5] 中华医学会骨科学分会骨质疏松学组.骨质疏松性骨折诊疗指南[J].中华骨科杂志,2017,37(1):1-10. DOI:10.3760/cma.j.issn.0253-2352.2017.01.001.
[6] Hertz K, Santy-Tomlinson J.Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient[M]. Cham,Switzerland:Springer Open,2018.DOI:10.1007/978-3-319-76681-2.
[7] Pioli G, Bendini C, Pignedoli P, et al.Orthogeriatric Co-management-managing Frailty as Well as Fragility[J]. Injury,2018,49(8):1398-1402.DOI:10.1016/j.injury.2018.04.014.
[8] 代凤,苏迅,王蕾,等.握力大小对留置PICC肿瘤患者腋静脉血流动力学的影响[J].护理学报, 2019,26(1):8-11.DOI:10.16460/j.issn1008-9969.2019.01.008.
[9] 王燕秋,韩斌如,李非,等.胃肠道疾病老年住院患者衰弱现况及影响因素研究[J].护理学报,2016,23(6):7-11.DOI:10.16460/j.issn1008-9969.2016.06.007.
[10] 高会莹,程秀丽,江美娜,等.老年住院患者抑郁症状与衰弱状况关系的研究[J].中华老年医学杂志,2019,38(6):631-634.DOI:10.3760/cma.j.issn.0254-9026.2019.06.009.
[11] 李婉玲,兰红珍,孔婵,等.Bobath技术在脑卒中后偏瘫患者体位转移中的应用[J].护理学报,2018,25(1):53-55.DOI:10.16460/j.issn1008-9969.2018.01.057.
[12] 丁岚,马尔哈巴·吾买尔.网络健康管理平台对脑卒中患者自我效能及康复效果的影响[J]. 护理学报, 2015, 22(1):69-71.DOI:10.16460~.issnl008-9969.2015.01.069.
[13] Dent E, Lien C, Lim WS, et al.The Asia-pacific Clinical Practice Guidelines for the Management of Frailty[J].J Am Med Dir Assoc, 2017,18(7):564-575.DOI:10.1016/j.jamda.2017.04.018.
[14] 卫尹,曹艳佩,杨晓莉,等. 老年住院患者衰弱综合征现状及影响因素[J]. 复旦学报(医学版), 2018,45(4):496-502.DOI:10.3969/j.issn.1672-8467.2018.04.010.
[15] 杜红娣,张立,何志娟,等. 98例痴呆患者营养状况与家庭照护能力相关性研究[J].护理学报, 2018, 25(15):48-52.DOI:10.16460/j.issn1008-9969.2018.15.048.
[16] 蔡晓艳,邓小岚,张智,等.玩偶疗法对阿尔茨海默病患者认知功能和生活质量的影响[J].护理学报,2019,26(10):73-76.DOI:10.16460/j.issn1008-9969.2019.10.073.
[17] 奚兴,郭桂芳,孙静,等.社区老年人衰弱状况与抑郁症状关系的研究[J].护理学杂志,2014,29(15):87-89,92.DOI:10.3870/hlxzz.2014.15.087.
[18] 李阳,张立萍,罗洋,等.哈尔滨市社区老年人衰弱现状及其影响因素调查[J].护理研究,2018,32(2):224-228.DOI:10.3969/j.issn.1009-6493.2018.02.016.
[19] 贾文文,赵慧楠,戴付敏,等.老年糖尿病患者衰弱现状及影响因素研究[J].中华护理杂志,2019,54(2):188-193.DOI:10.3761/j.issn.0254-1769.2019.02.005.
[20] 王斗,郝玉芳,李怡,等.老年衰弱评估工具在国内的应用进展[J].中华现代护理杂志,2019,25(10):1205-1208. DOI:10.3760/cma.j.issn.1674-2907.2019.10.004.
[21] 焦静,应巧燕,刘华平,等.老年人衰弱状态筛查与评估工具研究进展[J].中华现代护理杂志,2019,25(18):2361-2364.DOI:10.3760/cma.j.issn.1674-2907.2019.18.029.
[22] 谢云,罗典清,颜雪,等.脆性髋部骨折患者的衰弱发生情况及其对关节功能和术后并发症的影响[J].实用骨科杂志,2019,25(2):189-192.
[23] van de Ree CLP, Landers MJF, Kruithof N,et al. Effect of Frailty on Quality of Life in Elderly Patients after Hip Fracture: A Longitudinal Study[J]. BMJ Open, 2019,9(7): e025941.DOI:10.1136/bmjopen-2018-025941.
[24] 尹佳慧,曾雁冰,周鼒,等.中国老年人衰弱状况及其影响因素分析[J].中华流行病学杂志,2018, 39(9):1244-1248.DOI:10.3760/cma.j.issn.0254-6450.2018.09.019.
[25] Valentini A, Federici M, Cianfarani MA, et al.Frailty and Nutritional Status in Older People:The Mini Nutritional Assessment as a Screening Tool for the Identification of Frail Subjects[J].Clin Interv Aging,2018(13):1237-1244.DOI:10.2147/CIA.S164174.
[26] Wilson JM, Boissonneault AR, Schwartz AM, et al.Frailty and Malnutrition Are Associated with Inpatient Postoperative Complications and Mortality in Hip Fracture Patients[J]. J Orthop Trauma, 2019, 33(3):143-148. DOI:10.1097/BOT.0000000000001386.
[27] Kojima G,Liljas AEM,Lliffe S.Frailty Syndrome: Implications and Challenges for Health Care Policy[J]. Risk Manag Healthc Policy, 2019(12):23-30.DOI:10.2147/RMHP.S168750.
[28] Curcio CL, Henao GM, Gomez F.Frailty among Rural Elderly Adults[J]. BMC Geriatr, 2014(14):2. DOI:10.1186/1471-2318-14-2.
[29] Song X, Wu J, Yu C, et al.Association between Multiple Comorbidities and Self-rated Health Status in Middle-aged and Elderly Chinese: The China Kadoorie Biobank Study[J]. BMC Public Health, 2018, 18(1):744.DOI:10.1186/s12889-018-5632-1.
[30] Li G, Hou G, Xie G, et al.Trajectories of Self-rated Health of Chinese Elders: A Piecewise Growth Model Analysis[J]. Front Psychol,2019(10):583.DOI:10.3389/fpsyg.2019.00583.
[31] Yang W, Li JX.Analysis of the Factors Affecting the Self-rated Health of the Elderly in China-taking the Data of China Health and Pension Tracking Survey (CHARLS) as an example[J]. Research on Ageing, 2017,5(11):23-36.DOI:10.3969/j.issn.2095-5898.2017.11.003.
[32] 马颖丽,王莹,孙超.握力测试在肝硬化患者衰弱评估中的应用[J].中华现代护理杂志,2019,25(15):1874-1878. DOI:10.3760/cma.j.issn.1674-2907.2019.15.007.
[33] Singh H, Kim D, Bemben MG, et al.Relationship between Muscle Performance and DXA-derived Bone Parameters in Community-dwelling Older Adults[J]. J Musculoskelet Neuronal Interact, 2017,17(2):50-58.
[34] Sui SX, Holloway-Kew KL, Hyde NK, et al.Handgrip Strength and Muscle Quality in Australian Women: Cross‐sectional Data from the Geelong Osteoporosis Study[J]. J Cachexia Sarcopenia Muscle, 2020, 11(3):690-697. DOI:10.1002/jcsm.12544.Epub ahead of prirot.
[35] 奚兴,郭桂芳,孙静,等.138例住院老年慢性病病人握力及其影响因素的调查分析[J].护理研究,2014, 28(2C):671-674. DOI:10.3969/j.issn.1009-6493.2014.06.011.
[36] Vaughan L, Corbin AL,Goveas JS.Depression and Frailty in Later 1ife:A Systematic Review[J].Clin Interv Aging,2015,15(10):1947-1958.DOI:10.2147/CIA.S69632.
[37] 何婷,沈珊珊,褚娇娇,等.老年人抑郁症状与功能状态和衰弱的相关性研究[J].中华老年医学杂志,2017,36(6):613-617. DOI:10.3760/cma.j.issn.0254-9026.2017.06.003.
[38] Brown PJ, Roose SP, Fieo R, et al.Frailty and Depression in Older Adults: A High-risk Clinical Population[J]. Am J Geriatr Psychiatry,2014, 22(11):1083-1095.DOI:10.1016/j.jagp.2013.04.010.
[39] Soysal P, Veronese N, Thompson T,et al.Relationship between Depression and Frailty in Older Adults: A Systematic Review and Meta-analysis[J]. Ageing Res Rev, 2017(36):78-87. DOI:10.1016/j.arr.2017.03.005.
[40] Chu W, Chang SF, Ho HY, et al.The Relationship Between Depression and Frailty in Community-dwelling Older People: A Systematic Review and Meta-analysis of 84,351 Older Adults[J].J Nurs Scholarsh,2019,51(5):547-559.DOI:10.1111/jnu.12501.
[41] Morri M, Ambrosi E, Chiari P,et al.One-year Mortality after Hip Fracture Surgery and Prognostic Factors: A Prospective Cohort Study[J]. Sci Rep, 2019,9(1):18718.DOI:10.1038/s41598-019-55196-6.
[42] Castrejon-Perez RC, Gutierrez-Robledo LM, Cesari M, et al.Diabetes Mellitus,Hypertension and Frailty:A Population-based, Cross-sectional Study of Mexican Older Adults[J].Geriatr Gerontol Int,2017, 17(6):925-930.DOI:10.1111/ggi.12805.
[43] Morri M, Forni C, Marchioni M,et al.Which Factors Are Independent Predictors of Early Recovery of Mobility in the Older Adults’population after Hip Fracture?A Cohort Prognostic Study[J]. Arch Orthop Trauma Surg, 2018, 138(1):35-41.DOI:10.1007/s00402-017-2803-y.
[1] 汪冰清, 宋永霞, 何红叶, 李京京, 刘杉杉, 洪静芳. 慢性心力衰竭患者自我护理影响因素的研究进展[J]. 护理学报, 2020, 27(2): 33-37.
[2] 赵慧慧, 周春兰, 谢衍庆, 傅晓幼, 区洁霞, 王润. 广州市3 135名小学生健康素养现状及影响因素分析[J]. 护理学报, 2020, 27(17): 30-34.
[3] 吴丽, 赵方方, 彭梦云, 关红. 304名临床护士隐性缺勤现状及影响因素分析[J]. 护理学报, 2020, 27(17): 45-49.
[4] 黄结英, 王晶, 陈瑜. 1 008名大专护生自主学习能力现状及影响因素分析[J]. 护理学报, 2020, 27(15): 1-6.
[5] 陈菲菲, 庞永慧, 茅乃权, 罗洁宁, 蔡道玲. 老年肺癌患者衰弱现状及影响因素分析[J]. 护理学报, 2020, 27(15): 7-11.
[6] 邓辉, 黎敏, 王春霞, 左凤林. 社区-医院-家庭互动管理模式在社区老年人衰弱干预实践[J]. 护理学报, 2020, 27(15): 21-24.
[7] 陈晓宇, 黄洁微, 李艳萍, 周佩如. 危重症患者指尖血糖监测结果的影响因素及对策研究进展[J]. 护理学报, 2020, 27(15): 25-28.
[8] 王金艳, 吴丽萍, 邢丽莉, 龚晶晶. 297名助产士共情能力调查分析[J]. 护理学报, 2020, 27(14): 5-8.
[9] 李姮, 石美霞, 郭倩楠. 山西省1546名养老护理员培训认同感现状及影响因素分析[J]. 护理学报, 2020, 27(14): 9-12.
[10] 唐芳, 罗顺清, 程婷, 杨红, 曾莉, 丁维浪, 高樱, 陈德芬. 川崎病并发冠状动脉瘤患儿父/母焦虑抑郁状况及影响因素分析[J]. 护理学报, 2020, 27(14): 35-39.
[11] 郑雯雯, 鲁春红, 吕桂兰, 王芳. 222例维持性血液透析患者的病耻感现状及影响因素分析[J]. 护理学报, 2020, 27(14): 44-48.
[12] 张晓茹, 童宇平. 急诊护士突发公共卫生事件应急能力影响因素分析[J]. 护理学报, 2020, 27(13): 1-5.
[13] 刘巧艳, 步红兵, 尹卫, 朱丽群, 黄贤凤, 沈支佳, 朱冬梅, 许步慧, 齐银银, 孙赞赞, 杨玲. 住院老年2型糖尿病患者低血糖管理的最佳证据总结[J]. 护理学报, 2020, 27(13): 27-32.
[14] 李秋萍, 韩斌如, 陈曦. 外科大手术老年患者发生术后低蛋白血症影响因素的队列研究[J]. 护理学报, 2020, 27(11): 66-70.
[15] 任晶晶, 王艳红, 薛文俊, 张言, 王惠琳. 459例社区老年人衰弱与认知功能的相关性分析[J]. 护理学报, 2020, 27(10): 54-56.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!