The Current Situation And Influential Factors Of Frailty On Elderly Patients With Diabetes

OBJECTIVETo investigate the prevalence of integral frailty and the degree of physical,psychological and social frailty about elderly patients with diabetes,then further explore its influencing factors and clarify the mechanism of action.So as to arouse the medical staff to pay close attention to frailty assessment in elderly patients with diabetes,and providing evidence-based basis for individual and holistic nursing interventions to prevent or delay frailty and improve the quality of life.METHODSThis survey was conducted by cross-sectional survey method during the period from January 2017 to August 2017.300 elderly patients with diabetes were selected from the Endocrinology Department and the geriatric ward of third-class A Hospital in Zhengzhou.The investigative tools included a self-designed general information questionnaire,TFI(Tilburg Frailty Indicator),SDSCA(the Scale of Diabetes Self-care Activities),Family APGAR index(APGAR),SSS(Social Support Scale)and Barthel Index(BI).Data was logged in Epidata3.1,analyzed by Spss19.0 for statistical description,one-factor analysis and regression analysis,and Amos17.0 to perform the structural equation model.RESULTS1.The mean score of total frailty was(5.26 ±2.87)points,and the average physical component score was(2.79 ±2.08)points,the average psychological component score was(1.40 ±0.94)points and the average social component score was(1.07±0.75)points.The incidence of frailty in elderly patients with diabetes was 46.3%.2.The average score of self-management behavior of elderly patients with diabetics was(41.80 ±12.32)points,the level of self-management behavior in each dimension from high to low was drug nursing,general diet,special diet,exercise management,blood glucose monitoring and foot nursing.75% patients were at moderate level of self-management behavior,and only 4.1% of them were at good level of self-management behavior.3.The mean score of somatic function of elderly patients with diabetes was(77.92 + 18.33)points,and 14.9% of them were completely independent and functional;68.6% of the patients were mild dysfunctional and basic self-care in daily life;9.1% of patients are moderately dysfunctional and the daily life needs help;7.4% of patients have severe functional disorder and their daily life is totally dependent.4.The average score of family function in elderly patients with diabetes was(5.64 ±2.21)points,among which the good family function was 42.2%,the moderate and severe family dysfunction was 37.5% and 20.3% separately.5.The average score of social support in elderly patients with diabetes was(30.30 ±6.32)points,and the mean score of objective support was(7.02 ±3.15)points,the mean score of subjective support was(18.65 ±3.56)points,and the mean score of utilization of social support was(5.57 ±1.06)points.6.The total score of frailty as the dependent variable,factors of statistical significance in the single factor such as age,the elderly educational level,marriage,type of medical insurance,smoking,diseases history,polypharmacy,complications of diabetes,comobidity,BMI,fasting blood glucose,glycosylated hemoglobin,self-management behavior level,somatic function,family function and social support as independent variables,classify the disordered set dummy variables and use stepwise multiple regression method to analyze the data.The multiple logistic regression showed that the level of self-management behavior,somatic function,family function,fasting blood glucose,comobidity and polypharmacy were the major influential factors(P<0.05),which can explain 34.8% of the total variance.7.According to the theory and literature review,using the maximum likelihood estimation to fit structural equation model which includes five variables: self-management behavior,somatic function,family function,social support and frailty.The fitting index: GFI=0.984,CFI=0.982,RMESA=0.063,which was a better fitting degree.The result of structural equation model showed that somatic function,family function,social support and self-management behavior level can negatively predict the occurrence and progress of frailty;the self-management behavior was the key factor influencing the frailty about the patients with diabetes,not only had a direct effect on the occurrence of frailty,but also was an intermediary variable.CONCLUTIONS1.The prevalence of frailty in elderly patients with diabetes was at a high level,containing different degrees of physical,psychological and social frailty.2.The major influencing factors of frailty in elderly patients with diabetes included self-management behavior,somatic function,family function,fasting blood glucose,comobility and polypharmacy,and other factors included social support,smoking,diabetes complications,etc.3.The level of self-management behavior was the key factor to affect the status of frailty,which had direct influence on the occurrence of frailty,and was also the intermediate variable of social support,family function and somatic function.