Influencing Factors Of Frailty In Elderly Patients With Coronary Heart Disease And The Correlation Between Frailty And TCM Constitution

Objective:1.Understand the current situation of frailty and its influencing factors in elderly patients with coronary heart disease;2.To understand the distribution characteristics of TCM constitution in elderly patients with coronary heart disease complicated with frailty,and to explore the correlation between frailty and TCM constitution3.Explore the relationship between malnutrition,sleep disturbance,self-management,grip strength and depression through structural equation modeling,and the path and degree of action on the frailty of elderly patients with coronary heart disease,so as to propose targeted prevention and delay of frailty in elderly patients with coronary heart disease.provide the scientific basis for interventions to promote healthy ageing.Methods: This study belongs to a cross-sectional survey.According to the inclusion and exclusion criteria,the elderly patients with coronary heart disease who were hospitalized in the first,second and geriatric departments of the Department of Cardiovascular Medicine,Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from March 2021 to November 2021 were conveniently selected.325 patients.General information questionnaire,FRAIL scale,Geriatric Depression Scale(GDS-5),Coronary Heart Disease Self-Management Behavior Scale,Simple Nutrition Assessment Method(MNA-SF),Pittsburgh Sleep Quality Index(PSQI)scale,elderly The version of the TCM constitution type judgment table is used as a research tool to conduct an investigation.A total of 325 questionnaires were distributed,325 were recovered,11 invalid questionnaires were excluded,and314 were valid questionnaires.Excel was used to input and organize data,and SPSS25.0 and Amos26.0 were used for statistical data analysis.Statistical methods mainly include descriptive analysis such as composition ratio,mean and standard deviation to analyze general data;use chi-square test,variance analysis,rank sum test to conduct univariate analysis of frailty in elderly patients with coronary heart disease;use multivariate ordered Logistic regression was used for multivariate analysis of patient frailty;Spearman correlation was used to analyze the correlation between patient frailty and nutrition,depression,sleep,self-management and grip strength;The correlation between frailty and different TCM constitutions was analyzed by column correlation number;Structural equation model was used to analyze the relationship and action path between patient frailty and influencing factors.Results: 1.The incidence of frailty in elderly patients with coronary heart disease was 25.5%,the incidence of pre-frailty was 41.1%,and the incidence of no frailty was 33.4%;65.3% of patients felt fatigued,and 40.8%of patients had 5 or more diseases.Increased resistance/decreased endurance accounted for 23.2% of patients,decreased free mobility in 21% and decreased body weight in 6.4%.2.The incidence of depression in elderly patients with coronary heart disease was 36%;the incidence of malnutrition or risk of malnutrition was35%;patients with sleep disorders accounted for 75.8% of the total;Most of the patients’ self-management abilities were at a low level;the overall condition of grip strength was(22.82±7.21).3.The TCM constitution of elderly patients with coronary heart disease in descending order of proportion is phlegm-dampness,blood stasis,yang deficiency,qi deficiency,yin deficiency,peace,qi stagnation,dampness and heat,and special endowment.The frequency of TCM constitution in elderly patients with coronary heart disease complicated with frailty is highest in yang deficiency constitution(25%),followed by qi deficiency constitution(20%),phlegm damp constitution(17.5%),yin deficiency constitution(16.3%),blood stasis constitution(11.3%)),Qi stagnation(6.3%),and special qualities(1.3%).4.Univariate analysis showed that age,gender,marital status,living status,smoking status,drinking status,presence or absence of comorbidities,number of comorbidities,long-term medication use,medication quantity,cardiac function classification,grip strength,self-management ability,There were statistically significant differences in nutritional status,depression and sleep status among different frailty levels(P<0.05).Multivariate analysis showed that age,gender,self-management ability,grip strength,number of comorbidities,depression,sleep status were the influencing factors of frailty in elderly patients with coronary heart disease(P< 0.05).5.Correlation analysis found that depression,sleep status and frailty were significantly positively correlated(P<0.01),and nutrition,self-management,grip strength were significantly negatively correlated with frailty(P<0.01);depression was significantly correlated with nutrition,self-management,and grip strength.There was a significant negative correlation(P<0.01),and a significant positive correlation with sleep status(P<0.01);nutrition was significantly positively correlated with self-management and grip strength(P<0.01),and significantly negatively correlated with sleep(P<0.01);Self-management was significantly negatively correlated with sleep status(P < 0.01),and significantly positively correlated with grip strength(P < 0.01);grip strength was significantly negatively correlated with sleep status(P < 0.01).There is a significant correlation between the debilitating status of elderly coronary heart disease and the quality of peace,yang deficiency,yin deficiency and qi deficiency(P<0.05),and the correlation coefficients are 0.312,0.193,0.147,and 0.198,respectively.6.Path analysis showed that sleep status,nutrition,grip strength,and self-management had direct effects on frailty,of which nutrition had the greatest direct effect,with a path coefficient of-0.429,followed by self-management path coefficient of-402,grip strength path coefficient of-0.370,sleep The condition path coefficient is 0.238.Sleep status also had indirect effects on frailty through depression,nutrition and self-management,with a path coefficient of 0.132 and a total effect of 0.370;nutrition had an indirect effect on frailty through grip strength,with a path coefficient of-0.132 and a total effect of-0.561;depression through nutrition had an indirect effect on frailty,grip strength and self-management had indirect effects on frailty,and the path coefficient was 0.652.Conclusion(s):1.The incidence of frailty in elderly patients with coronary heart disease is high;The nutritional status,depression status,sleep status,self-management ability and grip strength of elderly patients with coronary heart disease are not optimistic and need to be improved.2.Age,male sex,and number of comorbidities ≥ 5 were risk factors for frailty in elderly patients with coronary heart disease.3.Self-management ability,nutrition,depression,sleep and grip strength were closely related to frailty in elderly patients with coronary heart disease.The lower the self-management ability,the worse the nutritional status,the more serious the depressive symptoms,the worse the sleep quality,the lower the grip strength level,and the higher the degree of frailty.4.The factors that affect the frailty of elderly patients with coronary heart disease are complex,and the order of effect is: depression,nutritional status,self-management,grip strength,and sleep status.It is suggested that clinical attention should be paid to the nutrition,sleep,depression and other conditions of elderly patients with coronary heart disease,and attention should be paid to screening for frailty in patients with malnutrition,poor sleep quality,low self-management ability,and low grip strength.To intervene in patients at risk of frailty or already frail,try to move forward the threshold of prevention and intervention for frailty,so as to improve the prognosis and quality of life of elderly patients with coronary heart disease.5.The TCM constitution types of elderly patients with coronary heart disease complicated with frailty are mainly biased constitutions,and the constitution of yang deficiency,yin deficiency,and qi deficiency are closely related to the frailty of elderly patients with coronary heart disease.It is suggested that from the perspective of body differentiation and nursing,attention should be paid to the identification of traditional Chinese medicine constitutions in elderly patients with coronary heart disease,and it is especially necessary to screen the risk of debilitating constitution types that are closely related to debilitation.