| ObjectiveTaking the elderly in the community as the object of study,this paper makes a deep understanding of the current situation of the frailty elderly in the community,probes into the related influencing factors,and analyzes the present situation and the relationship between the frailty and the loneliness,the ability of daily living,the cognitive ability and the quality of life.As well as through the prospective cohort research method,using the electronic health records of urban and rural residents in Taian City,Shandong Province,and combining with residents’ physical examination,the risk ratio model between frailty and fall is constructed,which is a sensitive index for screening the senile frailty.Reduce the risk of fall in the elderly,save medical and health resources,improve the quality of life of the elderly and to provide empirical evidence for community services.Methods1.By using literature and theoretical analysis,the Fried phenotype was used to evaluate the status of frailty.The elderly general information questionnaire,activity of daily living(Activity of Daily Living Scale,ADLs),loneliness scale(UCLA),the MOS item short from health survey(SF-36)were used as the questionnaires.Data of 488 elderly people aged 60 and above,including their daily activities,loneliness and quality of life,were collected in 5 communities of Taian City.SPSS 21.0 software was used to organize and analyze the data.By univariate analysis,multivariate Logistic regression model,Analysis of the influencing factors of frailty.Correlation analysis was used to explore the relationship between the frailty,activity of daily life,loneliness,and quality of life.AMOS software was used to construct the structural equation model which can affect the quality of life of the elderly through loneliness and activities of daily life.2.Based on the public health information system of Taian City,three representative communities were selected to follow up 504 elderly people over 60 years from March 1,2016 to October 31,2018,and the follow-up period was from March 1,2016 to October 31,2018.The main contents of residents’ health files include personal basic information,general health examination,lifestyle,health status and drug use,health management records of key groups and other medical and health service records.With the fall as the ending,the fall data collection was reported to the responsible doctor by myself or the caregiver and filled in the fall log,and the researchers were followed up by telephone every month.The Kaplan-Meier survival analysis was used to analyze the fall rate of different frailty groups.The Cox proportional hazard regression model was used to explore the relationship between different attenuation levels and falls,and the risk ratio(hazard ratio,was calculated respectively.HR)and 95% confidence interval.Results1.Cross-sectional study: A total of 488 elderly people in the community were investigated;The average age was 74.76±8.603 years old.209 cases(42.83%)were normal elderly,192 cases(39.34%)of pre-frailty,87(17.83%)cases of frailty stage;With the increase of age,the incidence of frailty was obviously increasing.181 cases of elderly people aged 70-79 years in Community;The incidence of pre-frailty and frailty was 50%and 6% respectively.121 cases of the 89-year-old elderly;The incidence of pre-frailty and frailty was 41% and 46% respectively.25 cases were over 90 years old,the incidence of frailty was as high as 100%.The scores of activity of daily living in different group were(14.02±0.169;14.99±2.360;21.57±6.830)and the scores of loneliness in different group were(33.10±6.218;36.51±8.682;57.77±13.857),and the score of cognitive status in different group were(26.44±3.669;25.30±3.915;23.93±4.697)and the score of quality of life in different group was(82.57±6.840;66.26±11.174;51.96±13.328),respectively.P<0.001,the difference was statistically significant.The results of univariate analysis showed that there were significant differences among the groups of different frailty variables(P<0.01);Age,sex,smoking history,drinking history,monthly income,medical expenses,sleep time,types of diagnosed diseases,types of medication and pain were significantly different in the elderly in community.Among them,the older,the female,the good economic conditions,the higher incomes,the shorter sleep times the serious pains,the more comorbidities,the frailty degree is heavy(the frailty score is high).Pearson correlation analysis was carried out between the ability of self-care of daily life,cognitive function,loneliness and quality of life of the elderly,and their dimensions with the level of frailty.The results showed that there was a positive correlation between frailty and daily life ability,loneliness(r=0.648;r=0.708;P<0.01),and a negative correlation between frailty and cognitive function,quality of life and its dimensions(r=-0.238;r=-0.764;P<0.05).By logistic multivariate regression analysis,it is concluded that elderly,female,more drugs taken,high grade of pain,poor activity,high level of loneliness,and many kinds of diagnosed diseases are risk factors for frailty.On the basis of literature analysis and theoretical research,a structural equation model based on activity of daily life and loneliness as intermediary variable,weakness as independent variable and quality of life as dependent variable is constructed.The results show that frailty can directly negatively affect on the quality of life,and direct positively effect on ADL,Frailty through ADL and loneliness indirect effect on quality of life.By using Bootstrap method,5000 samples were randomly collected from the original data(N=488)to test the mediating effect.The total effect of frailty on quality of life was-0.821(95%CI:-0.861～-0.770),P<0.001,and the direct effect was-0.689(95%CI:-0.774～-0.217),P<0.001.The indirect effect is-0.132(95%CI:-0.207 ～-0.060),P<0.001,The intermediate effect accounts for 16.1% of the total effect.2.prospective cohort study: A total of 504 people were enrolled(male 303,female201).The whole cohort was followed up for a total of 1175.58 person-years,the average follow-up time was 27.99 months,the longest was 31 months,and the shortest was 1month.The average follow-up period was 2.33 person-years,with a total of 72 people falling down,with a fall rate of about 14.3%,among them 30 elderly were males,whiles42 elderly were females.The incidence of fall was 6% in the non-frailty group,18% in the pre-frailty group and 40% in the frailty group.The chi-square value was 59.573(P<0.001).It can be concluded that there is a statistical difference between the frailty and the incidence of falls.Kaplan-Meier survival curve shows that the risk of falling is the highest in the frailty group and the lowest in the non-frailty group(P<0.001).This study uses Cox regression model to study the relationship between fall and related covariables.The results of Cox regression analysis showed that age,sex and culture were adjusted for age,sex and cultural factors,and the risk of falling was increased in pre-frailty and frailty groups,taking non-frailty as the reference level.The HR values are 1.993(95%CI: 1.005-3.953)and 4.31(95%CI: 1.973-9.415),respectively.The older the age,the higher the risk of fall,with a HR value of 1.57(95%CI: 1.122-2.198).The risk of fall was higher in women than in men,with a HR value of 1.789(95%CI: 1.07-2.992).The higher the education level,the higher the risk of fall,the HR value was 1.4(95%CI:1.159-1.69).Conclusions1.The prevalence of pre-frailty was 39.34,and the prevalence of frailty was 17.83%.The incidence of pre-frailty stage was the highest among those aged 70-79 years,and the incidence rate of frailty elderly over 90 years old was the highest.Health care workers should focus on the elderly in these two groups and take corresponding intervention measures to improve the frailty situation and prevent adverse outcomes.2.The frailty status of the elderly in the community is affected by many variables: the elderly,women,many kinds of medication,high pain grade,poor activity,high loneliness and many kinds of diagnosed diseases should be pay special attention to them.By making individualized intervention measures and improving the living conditions of the elderly,the occurrence and development of frailty can be delayed.3.Frailty was negatively correlated with quality of life,and positively correlated with activity of daily life,loneliness and cognitive ability.frailty not only directly affects the quality of life,but also indirectly affects the quality of life through loneliness and the ability of daily life activities.Therefore,we can improve the quality of life and happiness of the elderly by reducing their loneliness and improving their ability of daily activities in life.4.The fall incidence was 6% in the non-frailty group,18% in the pre-frailty group,and 40% in the frailty group.5.Compared with the normal old people,the risk of falling increased in the pre-frailty and frailty elderly,Fall risk in the prefrailty elderly is 1.993 times that of the normal elderly,whiles the fall risk in the frailty elderly is 4.31 times that of the normal elderly.With the increase of age,the incidence of falls in the elderly also increased. |
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