老年综合征对老年2型糖尿病患者的躯体功能和跌倒风险的影响

亓倩倩; 辛红菊; 周洲薇; 阮春燕; 赵静

doi:10.16766/j.cnki.issn.1674-4152.002368

老年综合征对老年2型糖尿病患者的躯体功能和跌倒风险的影响

doi: 10.16766/j.cnki.issn.1674-4152.002368

1.
浙江医院门诊部，浙江杭州 310030
2.
浙江医院护理部
3.
浙江医院综合病房

基金项目:

浙江省医药卫生科技计划项目 2019KY268

详细信息

通讯作者:
辛红菊, E-mail: daban335@sina.com

中图分类号: R587.1 R592
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- 文章访问数: 336
- HTML全文浏览量: 146
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-08
- 网络出版日期: 2022-08-13

Effect of geriatric syndrome on physical function and fall risk in elderly patients with type-2 diabetes

1.
Outpatient Department, Zhejiang Hospital, Hangzhou, Zhejiang 310030, China

摘要

摘要: 目的探讨老年综合征对老年2型糖尿病患者的躯体功能以及跌倒风险的影响。方法选取2019年2月—2020年2月在浙江医院门诊就诊和住院治疗的老年2型糖尿病患者165例为研究对象，根据患者老年综合征的种类和数量分为0~1种组(36例)、2~3种组(73例)、4~6种组(56例)。比较和分析老年综合征对老年2型糖尿病患者的躯体功能以及跌倒风险的影响。结果 4~6种组年龄、离异/丧偶比例、害怕跌倒比例、辅具使用率、近1年出现跌倒史发生率、跌倒高风险率以及日常生活能力缺陷和平衡步态功能下降的比例均明显高于0~1种组和2~3种组患者(均P＜0.05)；经单因素及多因素logistic回归分析显示衰弱是老年2型糖尿病患者日常生活能力缺陷、平衡与步态功能下降、近1年出现跌倒的独危险因素(均P＜0.01)；认知功能下降是跌倒风险增高、平衡与步态功能下降、近1年出现跌倒的独立危险因素(均P＜0.01)；营养不良是日常生活能力缺陷、跌倒风险增高、平衡与步态功能降低、近1年出现跌倒的独立危险因素(均P＜0.01)。结论衰弱、营养不良以及认知功能下降等老年综合征会引起老年2型糖尿病患者躯体功能下降和跌倒风险增高，临床应对老年2型糖尿病患者进行老年综合评估并采取干预措施以提高其生活质量。
- 老年综合征 /
- 2型糖尿病 /
- 躯体功能 /
- 跌倒风险
Abstract: Objective To investigate the effects of geriatric syndrome on the physical function and the risk of fall in elderly patients with type-2 diabetes. Methods A total of 165 elderly patients with type-2 diabetes who were treated or hospitalised in our hospital from February 2019 to February 2020 were selected as the research subjects. According to the type and quantity of geriatric syndrome, the patients were divided into 0-1 type group (n=36), 2-3 type group (n=73), and 4-6 type group (n=56). The effects of geriatric syndrome on physical function and fall risk in elderly patients with type-2 diabetes were compared and analysed. Results The proportion of age, proportion of divorce/widowed, proportion of fear of falling, use rate of assistive devices, incidence of falling history in the past 1 year, incidence of high risk of falling, impairment of daily living and decline of balance gait in 4-6 groups were significantly higher than those in 0-1 group and 2-3 group (all P < 0.05). Univariate and multivariate logistic regression analysis showed that fattening was the only risk factor for impairment of daily living ability, decline in balance and gait function, and fall in recent 1 year in elderly patients with type 2 diabetes (all P < 0.01). Cognitive decline was an independent risk factor for increased risk of fall, decreased balance and gait function, and the occurrence of fall in the past 1 year (all P < 0.01). Malnutrition was an independent risk factor for daily living impairment, increased risk of falls, reduced balance and gait function, and falls in the past 1 year (all P < 0.01). Conclusion Geriatric syndromes such as frailty, malnutrition, and cognitive decline, can lead to decreased physical function and increased fall risk in elderly patients with type-2 diabetes. Comprehensive geriatric assessment and intervention measures should be taken to improve the quality of life of elderly patients with this disease.
- Geriatric syndrome /
- Type-2 diabetes /
- Physical function /
- Fall risk

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表 1 3组老年2型糖尿病老年综合征患者一般资料比较

Table 1. Comparison of general data among three groups of elderly patients with geriatric syndrome of type 2 diabetes mellitus

组别	例数	年龄 (x±s，岁)	性别[例(%)]			文化程度[例(%)]		离异/丧偶 [例(%)]	BMI (x±s)
组别	例数	年龄 (x±s，岁)	男性	女性		初中及以下	高中及以上	离异/丧偶 [例(%)]	BMI (x±s)
0~1种组	36	69.68±2.17	21(58.33)	15(41.67)		12 (33.33)	24(66.67)	4(11.11)	24.42±1.53
2~3种组	73	71.25±2.32	38(52.05)	35(47.95)		24(32.88)	49(67.12)	18(24.66)	24.65±1.85
4~6种组	56	73.81±2.79	33(58.93)	23(41.07)		17(30.36)	39(69.64)	22(39.29)	24.82±1.78
统计量		33.874^a	0.731^b			0.123^b		9.165^b	0.566^a
P值		＜0.001	0.413			0.989		0.010	0.569

组别	例数	吸烟史[例(%)]	饮酒史[例(%)]		害怕跌倒[例(%)]	辅具使用率[例(%)]		空腹血糖(x±s，mmol/L)
0~1种组	36	8(22.22)	11(30.56)		11(30.56)	0		7.53±1.64
2~3种组	73	8(22.22)	21(28.77)		23(31.51)	18(24.66)		7.21±1.75
4~6种组	56	16(28.57)	17(23.29)		34(60.71)	23(41.07)		7.62±1.54
统计量		0.677^b	0.055^b		7.155^b	19.797^b		1.073^a
P值		0.713	0.973		0.028	＜0.001		0.344

组别	例数	糖化血红蛋白 (x±s，mg/L)		近1年跌倒史 [例(%)]		跌倒高风险 [例(%)]	生活能力缺陷 [例(%)]		平衡步态功能下降 [例(%)]
0~1种组	36	6.41±0.87		5(13.89)		1(2.78)	1(2.78)		1(2.78)
2~3种组	73	6.56±0.83		18(24.66)		11(15.07)	13(17.81)		29(39.73)
4~6种组	56	6.76±0.79		25(44.64)		22(39.29)	37(66.07)		34(60.71)
统计量		2.088^a		11.295^b		20.306^b	51.629^b		31.028^b
P值		0.127		0.004		＜0.001	＜0.001		＜0.001
注：^a为F值，^b为χ²值。

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表 2 影响躯体功能下降和跌倒风险的单因素分析[例(%)]

Table 2. Univariate analysis of physical function decline and fall risk [cases (%)]

组别	例数	衰弱	营养不良	抑郁	认知功能下降	多重用药	睡眠障碍
日常生活能力正常	114	27(23.68)	34(29.82)	22(19.30)	19(16.67)	21(18.42)	25(21.93)
日常生活能力缺陷	51	35(68.63)	31(60.78)	9(17.65)	17(33.33)	17(33.33)	12(23.53)
χ²值		30.343	14.146	0.603	5.738	4.420	0.052
P值		< 0.001	< 0.001	0.802	0.017	0.036	0.820
高跌倒风险	35	20(57.14)	22(62.86)	8(22.86)	25(71.43)	10(28.57)	8(22.86)
低跌倒风险	130	42(32.31)	43(33.08)	23(17.69)	11(8.46)	28(21.54)	29(22.31)
χ²值		7.251	10.243	0.482	64.096	0.769	0.005
P值		0.007	0.001	0.487	< 0.001	0.380	0.945
近1年有跌倒	42	23(54.76)	22(52.38)	9(21.43)	23(54.76)	11(26.19)	8(19.05)
近1年无跌倒	123	39(31.71)	40(32.52)	22(17.86)	13(10.57)	26(21.14)	29(23.58)
χ²值		7.095	5.265	0.257	35.847	0.459	0.369
P值		0.008	0.022	0.612	< 0.001	0.498	0.543
平衡与步态正常	64	41(64.06)	37(57.81)	13(20.31)	27(42.19)	7(10.94)	14(21.87)
平衡与步态降低	101	21(20.79)	28(27.72)	18(17.82)	9(8.91)	31(30.69)	13(22.77)
χ²值		31.271	14.856	0.159	25.431	8.625	2.321
P值		< 0.001	< 0.001	0.690	< 0.001	0.003	0.128

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表 3 影响躯体功能下降、跌倒风险增加的多因素分析变量赋值

Table 3. Multivariate analysis of variables affecting the decline of physical function and increase of fall risk

变量	赋值方法
老年衰弱	无=0，有=1
营养不良	无=0，有=1
认知功能下降	无=0，有=1
多重用药	无=0，有=1
日常生活能力缺陷	无=0，有=1
跌倒风险增高	无=0，有=1
平衡与步态功能下降	无=0，有=1
近1年出现跌倒	无=0，有=1

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表 4 影响患者日常生活能力缺陷的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis on the influence of patients ' ability of daily living defects

项目	B	SE	Wald χ²	P值	OR值	95% CI
老年衰弱	1.371	0.615	4.970	< 0.001	3.939	1.180~13.146
营养不良	1.135	0.576	3.883	< 0.001	3.111	1.006~9.619
认知功能下降	0.185	0.142	1.697	0.101	1.203	0.911~1.589
多重用药	0.158	0.195	0.657	0.084	1.171	0.972~1.411

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表 5 影响患者跌倒风险增高的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis on the risk of fall in patients

项目	B	SE	Wald χ²	P值	OR值	95% CI
老年衰弱	0.316	0.203	2.423	0.060	1.372	0.921~2.042
营养不良	1.108	0.531	4.354	< 0.001	3.028	1.107~8.572
认知功能下降	0.982	0.487	4.066	0.003	2.670	1.028~6.933
多重用药	0.196	0.156	1.579	0.087	1.217	0.896~1.652

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表 6 影响患者平衡与步态功能降低的多因素logistic回归分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
老年衰弱	1.216	0.597	4.149	< 0.001	3.373	1.047~10.869
营养不良	1.143	0.589	3.766	< 0.001	3.136	1.116~8.808
认知功能下降	0.898	0.331	7.360	0.004	2.454	1.283~4.695
多重用药	0.165	0.098	2.835	0.092	1.179	0.973~1.429

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表 7 影响患者近1年出现跌倒的多因素logistic回归分析

Table 7. Multivariate logistic regression analysis of the incidence of fall in the past year

项目	B	SE	Wald χ²	P值	OR值	95% CI
老年衰弱	0.945	0.478	3.908	0.004	2.573	1.008~6.565
营养不良	0.979	0.481	4.143	0.004	2.662	1.037~6.832
认知功能下降	0.965	0.431	5.013	0.005	2.625	1.128~6.108
多重用药	0.159	0.096	2.743	0.116	1.172	0.971~1.415

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参考文献(22)

[1]	顾敏华, 宋佳, 王雯晶, 等. 老年综合征的评估现状及展望[J]. 上海护理, 2016, 16(5): 64-67. https://www.cnki.com.cn/Article/CJFDTOTAL-SHHL201605024.htm GU M H, SONG J, WANG W J, et al. Current status and prospect of geriatric syndrome assessment[J]. Shanghai Nursing, 2016, 16(5): 64-67. https://www.cnki.com.cn/Article/CJFDTOTAL-SHHL201605024.htm
[2]	CHANDRA A, CRANE S J, TUNG E E, et al. Patient-reported geriatric symptoms as risk factors for hospitalization and emergency department visits[J]. Aging Dis, 2015, 6(3): 188-195. doi: 10.14336/AD.2014.0706
[3]	李清. 老年糖尿病患者老年综合评估量表观察与干预探讨[D]. 南宁: 广西医科大学, 2017. LI Q. Observation and intervention of comprehensive Geriatric Assessment Scale in elderly patients with diabetes mellitus[D]. Nanning: Guangxi Medical University, 2017.
[4]	韩小花, 薛临萍, 王芳, 等. 老年综合评估及干预在改善老年糖尿病合并老年综合征患者生活质量中的作用[J]. 中国药物与临床, 2016, 16(11): 1631-1632. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201611037.htm HAN X H, XUE L P, WANG F, et al. Effect of comprehensive geriatric assessment and intervention on improving quality of life in elderly patients with diabetes mellitus complicated with geriatric syndrome[J]. Chinese Remedies & Clinics, 2016, 16(11): 1631-1632. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201611037.htm
[5]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中国实用内科杂志, 2018, 38(4): 292-344. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm Diabetes Society of Chinese Medical Association. Guidelines for prevention and treatment of type 2 diabetes in China (2017 edition)[J]. Chinese Journal of Diabetes Mellitus, 2018, 38(4): 292-344. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201804009.htm
[6]	MOWLA A, ZANDI T. Mini-mental status examination: A screening instrument for cognitive and mood disorders of elderly[J]. Alzheimer Dis Assoc Disord, 2006, 20(2): 124. doi: 10.1097/01.wad.0000213812.35424.9b
[7]	MENOZZI A, DE LUCA L, OLIVARI Z, et al. Patients with non-ST-elevation acute coronary syndrome managed without coronary revascularization: An undertreated population[J]. G Ital Cardiol (Rome), 2016, 17(10): 816-826.
[8]	RUBENSTEIN L Z, ARKER J O, SALAV A, et al. Screening for undernutrition in geriatric practice: Developing the short-form mini-nutritional assessment (MNA-SF)[J]. J Gerontol A Biol Sci Med Sci, 2001, 56(6): 366-372. doi: 10.1093/gerona/56.6.M366
[9]	唐丹. 简版老年抑郁量表(GDS-15)在中国老年人中的使用[J]. 中国临床心理学杂志, 2013, 21(3): 402-405. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY201303015.htm TANG D. Application of short form geriatric depression scale (GDS-15) in Chinese elderly[J]. Chinese Journal of Clinical Psychology, 2013, 21(3): 402-405. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY201303015.htm
[10]	王悦, 余程东, 杨兴堂, 等. 匹兹堡睡眠质量指数在患近视青少年中的信效度评价[J]. 现代预防医学, 2019, 46(6): 1062-1065: 1069. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201906026.htm WANG Y, YU C D, YANG X T, et al. Reliability and validity of Pittsburgh sleep quality index in adolescents with myopia[J]. Modern Preventive Medicine, 2019, 46(6): 1062-1065: 1069. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201906026.htm
[11]	杨琛, 王秀华, 刘莉. Tinetti平衡与步态量表在移动及平衡能力评估中的应用进展[J]. 中国康复医学杂志, 2019, 34(5): 601-606. doi: 10.3969/j.issn.1001-1242.2019.05.023 YANG C, WANG X H, LIU L. Application progress of Tinetti Balance and Gait scale in the assessment of mobility and balance ability[J]. Chinese Journal of Rehabilitation Medicine, 2019, 34(5): 601-606. doi: 10.3969/j.issn.1001-1242.2019.05.023
[12]	YANG D C, LEE J D, HUANG C C, et al. Association between multiple geriatric syndromes and life satisfaction in community-dwelling older adults: A nationwide study in Taiwan, China[J]. Arch Gerontol Geriatr, 2015, 60(3): 437-442. doi: 10.1016/j.archger.2015.02.001
[13]	满孝云. 老年2型糖尿病患者老年综合征现状及与生活质量的关系[D]. 青岛: 青岛大学, 2017. MAN X Y. Relationship between geriatric syndrome and quality of life in elderly patients with type 2 diabetes mellitus[D]. Qingdao: Qingdao University, 2017.
[14]	何媛媛, 严光. 重视老年综合征的评估和干预[J]. 中国临床保健杂志, 2020, 23(5): 577-581. doi: 10.3969/J.issn.1672-6790.2020.05.001 HE Y Y, YAN G. Attach importance to assessment and intervention of geriatric syndrome[J]. Chinese Journal of Clinical Healthcare, 2020, 23(5): 577-581. doi: 10.3969/J.issn.1672-6790.2020.05.001
[15]	梁芳, 范亚坤, 张世阳, 等. 住院老年患者老年综合征的调查研究[J]. 河北医科大学学报, 2017, 38(6): 710-712. doi: 10.3969/j.issn.1007-3205.2017.06.021 LIANG F, FAN Y K, ZHANG S Y, et al. Investigation of geriatric syndrome in hospitalized elderly patients[J]. Journal of Hebei Medical University, 2017, 38(6): 710-712. doi: 10.3969/j.issn.1007-3205.2017.06.021
[16]	郭金花, 阳丹, 张军. 个体化多元运动干预对住院老年患者衰弱状态和躯体功能的影响[J]. 中华老年多器官疾病杂志, 2019, 18(9): 661-664. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG201909007.htm GUO J H, YANG D, ZHANG J. Effect of multi-component individualized exercise intervention on frailty and physical function in elderly inpatients[J]. Chinese Journal of Multiple Organ Diseases in the Elderly, 2019, 18(9): 661-664. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG201909007.htm
[17]	蓝艳, 刘文伟, 陆丽莹, 等. 老年糖尿病周围神经病变患者平衡功能、日常生活活动能力与跌倒相关性研究[J]. 中西医结合心血管病电子杂志, 2020, 8(4): 65-66. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202004057.htm LAN Y, LIU W W, LU L Y, et al. Relationship between balance function, activities of daily living and falls in elderly patients with diabetic peripheral neuropathy[J]. Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine (Electronic), 2020, 8(4): 65-66. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH202004057.htm
[18]	黄立群, 高洁, 牟焕玉, 等. 养老机构老年人营养状态对其日常生活活动能力的影响: 躯体功能的中介作用[J]. 中国实用护理杂志, 2019, 35(2): 132-136. doi: 10.3760/cma.j.issn.1672-7088.2019.02.010 HUANG L Q, GAO J, MOU H Y, et al. Effects of nutrition status on activities of daily living among nursing home residents: the mediating role of physical function[J]. Chinese Journal of Practical Nursing, 2019, 35(2): 132-136. doi: 10.3760/cma.j.issn.1672-7088.2019.02.010
[19]	彭娟. 对老年2型糖尿病合并认知功能障碍患者进行个体化护理的效果研究[J]. 当代医药论丛, 2020, 18(9): 251-252. doi: 10.3969/j.issn.2095-7629.2020.09.183 PENG J. Effect of individualized nursing for elderly patients with type 2 diabetes mellitus complicated with cognitive dysfunction[J]. Contemporary Medical Symposium, 2020, 18(9): 251-252. doi: 10.3969/j.issn.2095-7629.2020.09.183
[20]	孙晓娅, 贺志强, 王立群, 等. 社区55岁及以上人群轻度认知功能障碍与跌倒风险的关联研究[J]. 中华疾病控制杂志, 2020, 24(2): 200-203, 216. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202002016.htm SUN X Y, HE Z Q, WANG L Q, et al. Association of mild cognitive impairment with incidence of falls in communities aged 55 and over[J]. Chinese Journal of Disease Control & Prevention, 2020, 24(2): 200-203, 216. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202002016.htm
[21]	于卫华, 王莉, 徐忠梅. 社区老年人常速行走步态特征与跌倒的相关性研究[J]. 中华护理杂志, 2017, 52(1): 44-48. doi: 10.3761/j.issn.0254-1769.2017.01.009 YU W H, WANG L, XU Z M. The relationship between gait features at usual speed and falls among community-dwelling elderly people[J]. Chinese Journal of Nursing, 2017, 52(1): 44-48. doi: 10.3761/j.issn.0254-1769.2017.01.009
[22]	丁文萃, 王丽晖, 杨洁, 等. 血糖波动与老年2型糖尿病患者并发认知功能障碍的关系研究[J]. 解放军医药杂志, 2019, 31(9): 48-50, 59. doi: 10.3969/j.issn.2095-140X.2019.09.011 DING W C, WANG L H, YANG J, et al. Relationship between blood sugar fluctuation with cognitive dysfunction in elderly patients with type 2 diabetes mellitus[J]. Medical & Pharmaceutical Journal of Chinese People's Liberation Army, 2019, 31(9): 48-50, 59. doi: 10.3969/j.issn.2095-140X.2019.09.011