| Background and Objectives: There are more and more older people in the world,and aging will inevitably lead to the gradual decline of the elderly’s physical function.In the elderly,there is a status between disease and health called frailty.Frailty is different from aging.It is characterized by decreased function of multiple physiological systems and increased vulnerability to stressors,which leads to various adverse outcomes,such as functional deterioration,hospitalization,and death.At the same time,frailty is also potentially reversible.Therefore,it is important to screen frail individuals in the elderly in order to prevent the poor prognosis of frailty.There is no unified definition of frailty so far.The mechanism of frailty and its influencing factors have been studied extensively at domestic and foreign research.With the further study on the influencing factors of frailty,some assessment tools for frailty have been constructed and developed,such as phenotype of Frailty(FP)and frailty index of accumulative deficits(FI).FP and FI are widely accepted and used for screening the prevalence of frailty in China is high and is on the rise.The elderly often has a variety of chronic diseases,such as hypertension.They will be more easily to suffer from cardiovascular and cerebrovascular diseases caused by hypertension and have high mortality.The awareness rate,treatment rate,and control rate of hypertension in China are relatively low.Therefore,the health status and blood pressure control in the elderly are important research areas of concern for geriatrics and general medicine,and there are few related researches on interventions of frailty.The aim of this study was to investigate and assess the prevalence of frailty and the influencing factors associated with frailty in the community-dwelling elderly adults with hypertension,and to study the effect of self-management of hypertension on patients with frailty.Patients and Methods: 1.A total of 240 community-dwelling adults with hypertension(aged over 60 years old)from the clinic of Tangqiao Community Health Service Center in Pudong New Area,Shanghai were collected from January 17 to March 29,2019.Among them,62 cases were more than 60 but less than 70 years old,101 cases were more than 70 but less than 80 years old,and 73 cases were more than 80 years old.Frailty was assessed by the Frailty Phenotype(FP)and 39-item Frailty Index(FI).These cases were divided into three groups(non-frailty,pre-frailty and frailty using by FP tool.The current incidence and the association between factors(ADL,depression,comorbidities,blood pressure,BMI,education,marriage,income)and frailty were analyzed in different rank of target patients.The FI scores were also calculated.2.A total of 84community-dwelling adults with hypertension who are the members of self-management teams in Tangqiao,Pudong New Area,Shanghai were collected.Among them,40 cases were more than 60 but less than 70 years old,36 cases were more than 70 but less than 80 years old,and 7 cases were more than 80 years old.We aim to make a comparison of the prevalence of frailty in the two groups,so that we value the role of self-management of hypertension on patients with frailty.Results A total of 236 patients with non-management and 83 patients with management were finally included.By using FP measurement,37 patients were determined as frailty(prevalence rate: 15.7%),116 as pre-frailty(prevalence rate: 49.2%),and 83(prevalence rate: 35.2%)as non-frailty.The most common changes were found decreased in the fields of grip strength(48.7%),pace(23.7%),physical activity(15.3%)and weight(1.3%).Other changes were followed by fatigue(28.8%).FI value was distributed in skew state,which showed the average value of 0.194(standard deviation 0.104),and ranged from 0.026-0.526.Mann-Whitney U test showed that the median FI value of males(0.186,0.253-0.103)and females(0.179,0.244-0.115)were not significantly different(P = 0.717).The FP was highly correlated(r=0.735,P<0.05)with the FI.FP and FI were significantly correlated with outcome variables(BADL,IADL,falls in the past year,hospitalization in the past year,cardiovascular complications,cerebrovascular complications,polypharmacy),and FI was related to them more greatly than FP.After adjustment for variables which showed significant differences in the univariate analysis,Multivariate ordinal logistic regression showed that comorbidities,age,depression and education were significantly associated with frailty(P<0.05).The likelihood of being in a lower frailty trajectory was greater among those reporting less than five comorbidities(OR(95% CI)3.432(1.950 to 6.032)),those in the 60–69 year-old(OR(95% CI)8.917(4.023 to 19.767)),and those in the 70–79 year-old(OR(95% CI)5.709(2.889 to 11.280)).Compared to those less than a primary school education,patients with college education(OR(95% CI)3.380(1.486 to 7.698))and with secondary school education(OR(95% CI)2.300(1.075 to 4.918))were more likely to be in a lower frailty trajectory.Compared to those who were depressed,patients who were likely depressed(OR(95% CI)1.740(0.608 to 4.983))and patients who were not depressed(OR(95% CI)3.557(1.380 to 9.180))were more likely to be in a lower frailty trajectory.There were significant differences between the non-management group and management group in terms of the prevalence of frailty,blood pressure and comorbidities after the Propensity Score Matching.Compared with non-management group,the control of blood pressure was better in management group(P <0.05),the proportion of comorbidities over than five and polypharmacy was lower(P <0.05),the FI value was lower(P <0.05),and the prevalence of frailty was lower in the management group(P <0.05).Conclusion: A variety of social,psychological,physical,and demographic factors such as age and education are independently factors associated with frailty.As a reversible geriatric syndrome,frailty should be prevented by way of controlling the associated factors.As a comprehensive management of the chronic disease,self-management of hypertension plays a positive role in the process of frailty by improving the health condition of the elderly,which can provide us a good way to prevent and treat frailty. |
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