| Background:Frailty refers to a non-specific state in which the decline of the human body’s physiological reserve leads to an increase in the vulnerability of the body and a decrease in the ability to resist stress.Scientific assessment and early intervention can reduce the risk of disability,hospitalization and death.The high incidence of frailty is an important part of geriatric syndrome.The integrated intervention of traditional Chinese and western medicine is the future direction,and it is also the entry point for clinical research on geriatrics to take advantage of traditional Chinese medicine.There are many frailty assessment scales,and there are few scales and clinical data suitable for Chinese people with traditional Chinese medicine characteristics,and the dynamic assessment is insufficient,and the intervention research is still in the exploratory stage.Repeated clinical application and comparison with internationally recognized scales have shown good reliability and validity,and have been copyrighted by China Copyright Protection Center.Based on this scale,this paper intends to carry out a dynamic assessment of frailty in the elderly population in Beijing.By analyzing the correlation between frailty and disease,constitution,TCM syndromes,and biomarkers,it explores its dynamic change characteristics and understands different stages of frailty(different stages of frailty).Frailty,pre-frailty,frailty),and conduct real-world observational research on the current Chinese and Western medicine and multidisciplinary comprehensive intervention models and effects,in order to find problems and propose countermeasures.Objective:To explore the dynamic characteristics of frailty,the outcomes of frailty in different stages and their associated factors in the elderly population in Beijing area.To observe and analyze the effect of different traditional Chinese and Western medicine intervention methods on senile frailty in the real world.To explore the value of urinary 8-oxo-Gsn in frailty assessment and frailty intervention in the elderly.Method:1 Analysis of the distribution characteristics of TCM syndromes of weakness and its influencing factors:Subjects:The subjects we recruited were mainly from the Department of Traditional Chinese Medicine of Beijing Hospital,Beijing Geriatrics Hospital,Yuquan Hospital of Tsinghua University,Fuxing Hospital affiliated to Capital Medical University,Beijing Pinggu District Hospital,Beijing Luhe Hospital affiliated to Capital Medical University,and Emergency General Hospital,between December 2020 and December 2021.Inclusion criteria:① age≥ 60 years old;② voluntarily signed the informed consent;③able to complete the assessment independently or with the assistance of medical staff and family members.Exclusion criteria:①Frailty grade>9(CFS-09 scale);②Severe cardiovascular and cerebrovascular diseases,acute infectious diseases,acute liver and kidney damage in the past three months;failure of vital organs to maintain normal life Physical signs,those who need circulatory support,respiratory support,and intravenous nutrition support;③organ transplant recipients;④ cases deemed unsuitable for inclusion by the researchers.Collect general information of the research subjects,such as age,gender,ethnicity,occupation type,marital status,history of living alone,history of allergies,history of smoking,history of drinking,cognitive impairment,history of falls,history of long-term pain,physical activity,chronic diseases,Types of western medicines,intervention methods,etc.,use the "Integrated Chinese and Western Medicine Aged Frailty Assessment Scale "and" Clinical Frailty Scale"(CFS-09 Scale)to assess the frailty of the research subjects,calculate the TCM frailty index and conduct frailty rating,TCM syndrome differentiation Reference to TCM Syndrome Diagnosis:Refer to "Traditional Chinese Medicine Clinical Diagnosis and Syndrome Part"(GB/T16751.2-1997)and "Traditional Chinese Medicine Diagnosis"(People’s Health Publishing House,2002).Statistical methods:SPSS 20.0 statistical software was used,count data were described by frequency and percentage,normally distributed measurement data were represented by X±s,and non-normally distributed measurement data were represented by median and interquartile range;For comparison of group data,t test or nonparametric test was used;for nonparametric test,Mann-Whitney U test was used for comparison of two groups of samples,and Kruskal-Wallis H test was used for multiple groups;for categories of≥3 groups,the significance level was corrected by bonferroni method after the event.Pairwise comparison:Multiple linear regression model was used for analysis of influencing factors;P<0.05 was considered statistically significant.This study has been approved by the Ethics Review Committee of Beijing Hospital of the Ministry of Health(2021BJYYEC-023-01).2 Analysis of the dynamic changes of TCM syndromes of frailty and the influencing factors of frailty outcome:The first part of the research subjects were followed up every 3 months for 2 times in total(ie,3 evaluations).To analyze the transition of the frail state of the three groups of data without frailty,prefrailty,and frailty,the characteristics of TCM syndrome changes in each group in different stages of frailty and frailty outcomes,the effects of TCM intervention methods on frailty index and symptom score,and frailty and frailty outcomes influencing factors.3 Correlation analysis between frailty and urinary 8-oxo-Gsn:Select the subjects of a cross-sectional study in Beijing Hospital of a single center,take 5ml of morning urine on an empty stomach，and promptly send it to the Beijing Hospital Geriatrics Institute to detect the content of urinary 8-oxoGuo,analyze The correlation between this index and frailty index,CFS-09 scale frailty grade,TCM syndrome and TCM intervention method.Outcome:1 Analysis of the distribution characteristics of TCM syndromes of weakness and its influencing factors:① General information of the study population:1122 people were finally included in this study.The M(IQR)for age was 69(11).666 persons(59.36%)were weak,278(24.78%)were in the early stage of weakness,and 178(15.86%)were without weakness.There were 125 males(70.22%)and 53 females(29.78%)in the non-frailty group,and the M(IQR)for age was 66(7).Pre-frail group:160 males(57.55%),118 females(42.45%),and the M(IQR)for age was 68(8).In the frail group,there were 297(44.59%)males and 369(55.41%)females,and the M(IQR)for age was 72(12).②Clinical manifestations:The clinical manifestations of the elderly population were mainly a series of symptoms such as forgetfulness,fatigue,frequent urination at night,shortness of breath,insomnia,palpitations,thirst,crooked teeth,blurred vision,and backache.The main manifestations of the non-frail group were:shortness of breath,fatigue,frequent nocturia,chest tightness,forgetfulness,palpitations,dizziness,shaky teeth,thirst,and backache.The main manifestations in the early stage of weakness were:forgetfulness,fatigue,frequent urination at night,shortness of breath,insomnia,palpitations,thirst,teeth shaking,backache,blurred vision.The main manifestations of the debilitating stage were:forgetfulness,fatigue,insomnia,frequent urination at night,shortness of breath,blurred vision,dry eyes,crooked teeth,thirst,and backache.The proportion of TCM symptoms in the debilitating period gradually increased,and 12 symptoms accounted for more than 60%.Compared with the non-debilitating period,the proportions of forgetfulness,insomnia,blurred vision,dry eyes,and weak knees increased in the pre-debilitated and debilitated periods.more significant(P<0.05).③The distribution of TCM syndromes in different stages of weakness:the syndrome elements of this group were mainly Qi deficiency syndrome,blood stasis syndrome,phlegm turbidity syndrome,and damp syndrome),phlegm turbidity syndrome(80 persons,44.94%),yin deficiency syndrome(60 persons,33.52%);the pre-frailty group were:Qi deficiency syndrome(168 persons,60.43%),blood stasis syndrome(124 persons,44.60%),Yin deficiency syndrome(111 people,39.93%);the weak group were:Qi deficiency syndrome(474 people,71.17%),blood stasis syndrome(397 people,59.61%),Yin deficiency syndrome(293 people,43.99%).In this study,there were 985(87.79%)people with mixed syndromes,62(5.53%)people with pure false evidence,and 57(5.08%)people with pure truth without false evidence.There were a total of 213 TCM syndromes,and the top three were Qi deficiency and blood stasis syndrome(87 patients,7.75%),Qi deficiency and phlegm turbidity syndrome(77 patients,6.86%),and Yin deficiency and heat syndrome(31 patients,2.76%);none There were 52(24.41%)types in the frail group,with Qi deficiency and phlegm turbidity syndrome(37 patients,20.79%)ranking first;93(43.66%)types in the pre-frailty group,Qi deficiency and blood stasis syndrome(30 patients,10.79%),Qi deficiency and phlegm turbidity syndrome(30 patients,10.79%)(25 people,9.36%)ranked the top two,and there were 188(88.26%)types in the debilitated group,with many and complex syndromes,and no syndrome accounted for more than 10%.④Correlation analysis between TCM syndromes and frailty index:in addition to phlegm turbidity syndrome,qi deficiency syndrome,blood deficiency syndrome,yin deficiency syndrome,yang deficiency syndrome,blood stasis syndrome,qi stagnation syndrome,fire(heat)syndrome,and dampness syndrome The comparison of frailty index between groups has statistical significance;the frailty index is highest in yang deficiency syndrome,followed by blood deficiency syndrome,qi stagnation syndrome,blood stasis syndrome and dampness syndrome,and the debilitating index increases with the increase of the number of concurrent syndromes.rise.⑤ Analysis of the influencing factors of frailty:Univariate analysis showed that the frailty index of elderly women was higher than that of elderly men(P<0.05);the frailty index increased with age(P<0.05);the frailty index of illiterate elderly was the highest(P<0.05);in terms of occupation type,non-manual labor frailty index>light manual labor>moderate manual labor>heavy manual labor(P<0.05);widowed,living alone,multiple medication history,long-term pain history,urinary incontinence,cognitive The frailty index was significantly higher in the elderly with cognitive impairment and history of falls(P<0.05);in the elderly with hypertension,dyslipidemia,coronary heart disease,diabetes,and chronic gastritis,the frailty index was higher than that in the elderly without the disease(P<0.05).The frailty index of the elderly absolute dependence>a small part of the dependence>most of the dependent>the elderly who were completely independent(P<0.05),the elderly who chose TCM intervention>the elderly who did not have TCM intervention(P<0.05).Multiple linear regression model suggested:gender,age,occupation type,allergy history,physical exercise,coronary heart disease,diabetes,dyslipidemia,long-term pain,urinary incontinence,cognitive impairment,history of falls,self-care level,TCM intervention and IM-FI Changes were correlated.However,educational level,marital status,history of living alone,smoking history,drinking history,and polypharmacy did not affect IM-FI.2 Analysis of the dynamic changes of TCM syndromes of frailty and the influencing factors of frailty outcomes:①General information:157 people were lost to follow-up in this study,and 965 people were finally included.Among them,501 were male,accounting for 51.92%;464 were female,accounting for 48.08%.The first assessment of frailty was 565,accounting for 58.55%;the pre-frailty was 250,accounting for 25.91%;the non-frailty was 150,accounting for 15.54%.In the second assessment,there were 516 persons with frailty,accounting for 53.47%,258 persons in the early stage of frailty,accounting for 26.74%,and 191 persons without frailty,accounting for 19.80%.In the third assessment,470 people were weak,accounting for 48.70%,254 people,accounting for 26.32%,and 241 people without weakness,accounting for 24.97%.Compared with the three evaluations,there was no significant change in the proportion of people in the early stage of frailty(P>0.05);while the number of people in the non-frailty stage gradually increased,and the number of people in the frailty stage gradually decreased(P<0.05).Based on the first assessment,they were divided into non-frailty group,pre-frailty group and frailty group.With the third assessment as the end point,according to the outcome of the frail state,it was divided into:maintenance group,progression group and reversal group.There were 629 patients in the maintenance group,accounting for 65.18%;79 patients in the progression group,accounting for 8.19%;and 257 patients in the reversal group,accounting for 26.63%.In the non-frail group,30(20%)progressed and 120(80%)maintained,and there was a statistical difference within the group;There were 111(44.4%)people who were reversals,and there was a statistical difference within the group;419(74.16%)people in the frail group were maintainers,and 146(25.84%)people were reversers,and there was a statistical difference within the group.This shows that the non-frailty group and the frailty group are mainly in the maintenance state,and the frailty reversal is the main factor in the early stage of frailty.In terms of maintenance of frailty,the proportion of pre-frailty group was significantly lower than that of non-frailty group and frailty group,and there was a statistical difference.In terms of frailty progression,there was no statistical difference between the prefrailty group and the nonfrailty group.In terms of frailty reversal,the prefrailty group was significantly higher than the frailty group(P<0.05).To sum up,the states of the non-frailty group and the frailty group were relatively stable,while the state of the pre-frailty group is unstable.There was no significant difference in the ratio of male to female and the age distribution among the maintenance group,the progression group and the reversal group.②Characteristics of changes in TCM syndromes:Weakness stage distribution of TCM syndromes at the first and last follow-up in each group:No weakness group:Compared with the first assessment,the third time of Qi deficiency syndrome and phlegm turbidity syndrome decreased,and no deficiency syndrome accounted for ratio increased(P<0.05).Pre-frail group:Compared with the first evaluation,the proportion of blood deficiency syndrome,Yang deficiency syndrome,and blood stasis syndrome decreased in the third time,and the proportion without evidence increased(P<0.05).Weak group:Compared with the first evaluation,the proportion of Qi deficiency syndrome and Yin deficiency syndrome increased in the third time(P<0.05).Based on the relative stability of the non-frail group and the frail group and the instability of the pre-frail group,the changes in Qi deficiency,Yin deficiency,and phlegm turbidity may have a general relationship with the outcome of frailty.Blood deficiency,Yang deficiency,blood stasis There may be a certain connection between the syndrome and the debilitating outcome.The distribution of TCM syndromes in each group at the first and last follow-up:the TCM syndromes in the maintenance group were mainly qi deficiency syndrome,blood stasis syndrome,yin deficiency syndrome and phlegm turbidity syndrome.Compared with the first evaluation,the proportion of yin deficiency syndrome increased(P<0.05).The distribution of TCM syndromes in the progress group was mainly blood stasis syndrome,qi deficiency syndrome,yin deficiency syndrome and phlegm turbidity syndrome.Compared with the first evaluation,the proportion of Qi deficiency syndrome,Yin deficiency syndrome,Qi stagnation syndrome,and damp syndrome increased,and the proportion of no evidence decreased(P<0.05).The distribution of TCM syndromes in the initial evaluation of the reversal group were mainly qi deficiency syndrome and blood stasis syndrome,and the proportion of yin deficiency syndrome and phlegm turbidity syndrome was equal,ranking third:The proportion of yang deficiency syndrome,blood stasis syndrome and qi stagnation syndrome decreased,while the proportion of no deficiency syndrome and no evidence increased(P<0.05).The debilitating outcomes in each group were mainly characterized by qi-yin deficiency,phlegm turbidity and blood stasis syndrome,among which the proportion of blood stasis syndrome in the progress group was the first,and the qi deficiency syndrome,yin deficiency syndrome,qi stagnation syndrome and damp syndrome gradually increased,and the maintenance There was basically no significant change in TCM syndromes in the group except for the gradual increase of yin deficiency syndrome.To sum up:Qi deficiency syndrome,blood stasis syndrome,and Qi stagnation syndrome increase or decrease with the progress and reversal of the debilitating state.Combined with the changing characteristics of TCM syndromes in different stages of frailty,blood stasis syndrome may be more closely related to the outcome of frailty.Multiple comparisons of the total amount of TCM syndrome elements in each group at each time point of frailty outcome:the total amount of TCM syndrome elements in the maintenance group did not change significantly with time,but gradually increased in the progress group,and decreased gradually in the reversal group(P<0.05).③ Distribution of TCM interventions:825 people(85.49%)used western medicine treatment at the initial assessment of the study population,and only 644 people(60.73%)chose TCM treatment.298 patients were treated with western medicine alone,accounting for 30.88%;59 patients were treated with traditional Chinese medicine alone,accounting for 6.11%;a total of 527 patients were treated with integrated traditional Chinese and western medicine,accounting for 54.61%;81 patients(8.39%)did not take any intervention measures.Only 145(15.03%)people applied non-drug intervention,and the intervention mode of traditional Chinese medicine combined with non-traditional Chinese medicine only accounted for 8.29%,a total of 80 people.The distribution of the first TCM intervention mode in each group of frailty stages:Horizontal comparison between the two groups:the proportion of TCM intervention in the pre-frailty group and the frailty group was higher than that in the non-frailty group(P<0.05).The proportion of traditional Chinese medicine intervention in the pre-frailty group was higher than that in the non-frailty group(P<0.05).There were no statistical differences between the two groups in other interventions.TCM intervention was related to the degree of frailty.The higher the degree of frailty,the higher the proportion of TCM intervention(P<0.05).The distribution of initial TCM intervention modes in each group of frailty outcomes:in terms of TCM intervention methods:TCM interventions based on TCM accounted for a higher proportion;TCM interventions,TCM interventions,and TCM+non-TCM interventions in the maintenance group and reversal group were significantly higher than those in the TCM intervention groups.Progression group(P<0.05).In terms of comprehensive intervention methods:the proportion of pure western medicine intervention and integrated traditional Chinese and western medicine intervention was higher;the proportion of pure western medicine intervention in the maintenance group and the reversal group was lower than that in the advanced group,and the proportion of pure traditional Chinese medicine intervention and integrated traditional Chinese and western medicine intervention was higher than that in the advanced group(P<0.05).To sum up:TCM intervention may be associated with frailty outcomes.④Effects of different intervention modes on frailty:The frailty index and TCM symptom score of the first evaluation,the second evaluation and the third evaluation in the non-TCM intervention group increased in turn(P<0.05).The frailty index and TCM symptom score of the traditional Chinese medicine intervention group and the traditional Chinese medicine+non-traditional Chinese medicine intervention group decreased sequentially with the increase of follow-up times(P<0.05).The frailty index and TCM symptom score of the TCM intervention group decreased sequentially with the increase of follow-up times,while the frailty index and TCM symptom score of the non-TCM intervention group increased sequentially with the increase of the follow-up time(P<0.05).With the increase of follow-up times,the frailty index and TCM symptom score in the pure western medicine group and the non-intervention group increased in turn(P<0.05);the frailty index and TCM symptom score in the pure traditional Chinese medicine group and the integrated traditional Chinese and Western medicine group decreased in turn(P<0.05).⑤With the progression of frailty as the outcome variable,a binary logistic regression model was established.The results indicated that TCM intervention(OR=0.123,95CI=0.042-0.360,P=0.000<0.01)was a negative factor for frailty progression.3 Correlation analysis of urinary 8-oxo-Gsn with senile frailty and TCM intervention:A total of 152 people were included in this study,including 67 males,accounting for 44.08%,and 85 females,accounting for 55.92%.The youngest was 60 years old and the oldest was 102 years old.There were 114 persons with frailty,accounting for 75.00%;31 persons with early frailty,accounting for 20.39%;and 7 persons without frailty,accounting for 4.61%.The TCM syndromes were dominated by syndromes of deficiency and excess,accounting for 83.55%;7 patients with pure deficiency syndromes,accounting for 4.61%;and 18 patients with pure positive syndromes,accounting for 11.84%.There were statistical differences among gender,age and urinary 8-oxo-Gsn content.The urinary 8-oxo-Gsn content of females was higher than that of males;the group over the age of 80 was higher than the group of 60-79 years old(P<0.05).There were statistical differences among gender,age,TCM intervention and IM-FI index(P<0.05).The IM-FI index of women was higher than that of men;the 80-year-old group was higher than the 60-79-year-old group.Spearman correlation analysis showed that the correlation coefficient between IM-FI index and CFS-09 scale frailty grade was 1,showing a significant positive correlation(P<0.05);CFS-09 scale frailty grade and urinary 8-oxo-Gsn content The correlation coefficient was 0.249,showing a significant positive correlation(P<0.05);but there was no statistical difference between the IM-FI index and the urinary 8-oxo-Gsn content(P>0.05).There was no significant difference in the correlation between the total amount of TCM syndrome elements,the number of deficiency syndromes,and the number of evidences and the content of urinary 8-oxo-Gsn(P>0.05).There was no significant difference in urinary 8-oxo-Gsn content among the three groups of pure positive syndrome,pure deficiency syndrome and mixed syndrome of deficiency and excess(P>0.05).There was no significant difference in urinary 8-oxo-Gsn content among the groups in Qi deficiency syndrome,blood deficiency syndrome,Yin deficiency syndrome,Yang deficiency syndrome,phlegm turbidity syndrome,blood stasis syndrome,Qi stagnation syndrome,heat(fire)syndrome,and dampness syndrome.(P>0.05).According to whether the Chinese medicine intervention was applied or not,it was found that the difference in the urinary 8-oxo-Gsn content between the traditional Chinese medicine intervention group and the no traditional Chinese medicine intervention group was statistically significant.There was no significant difference in urinary 8-oxo-Gsn content among the groups without TCM intervention,TCM group,non-TCM group,and TCM combined with non-TCM group(P>0.05).There were statistically significant differences in urinary 8-oxo-Gsn content among the non-intervention group,traditional Chinese medicine intervention group,western medicine intervention group,and integrated traditional Chinese and western medicine intervention group(P<0.05),but after the bonferroni method was used to correct the significance level for post-hoc comparison.,there was no statistical difference between the groups(P>0.05).Conclusion:1 Frailty is common in old age.Female,advanced age,non-physical labor,history of allergies,no regular exercise,coronary heart disease,diabetes,dyslipidemia,long-term pain,urinary incontinence,cognitive impairment,history of falls,and low self-care level are signs of frailty in old age.negative factors.2 "Deficiency mixed with deficiency,mainly deficiency" is the basic mechanism of senile frailty.Qi deficiency,blood stasis,and yin deficiency are the main elements of senile frailty.3 Dynamic changes are more likely to occur in the early stage of frailty,and blood stasis syndrome may be related to the outcome of frailty.4 Traditional Chinese medicine intervention has a protective effect on the relief of senile frailty.5 Urinary 8-oxoGuo is positively correlated with the degree of frailty,and is closely related to the intervention of traditional Chinese medicine. |
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