老年慢性病住院患者认知障碍现状及基于口腔衰弱、生理弹性的风险预测模型构建

Prevalence of cognitive impairment and construction of a risk prediction model based on oral frailty and clinical physiological resilience in hospitalized elderly patients with chronic diseases

摘要

目的 探讨老年慢性病住院患者认知障碍现状及影响因素,构建并验证风险预测模型,为降低老年慢性病住院患者认知障碍提供借鉴。方法 采用简单随机抽样法,选自2025年3月-2025年8月于广西医科大学第一附属医院、皖南医科大学第一附属医院和芜湖市第二人民医院老年慢性病住院患者752例,采用一般资料调查问卷、认知障碍量表(AD8)、口腔衰弱量表(OFI-8)、临床生理弹性评估量表(CHEES)进行问卷调查。采用二元logistic回归分析老年慢性病住院患者认知障碍影响因素。结果 752例老年慢性病住院患者AD8量表得分2.00(1.00,5.00)分、OFI-8得分5.00(2.00,8.00)分、CHEES得分47.00(41.00,54.00)分,认知障碍发生率49.9%。年龄、慢性病病程、口腔衰弱是患者发生认知障碍的危险因素;婚姻状况(有伴侣)、文化程度高、临床生理弹性好是保护因素(均P<0.05)。基于以上回归分析结果构建的预测模型校准曲线拟合度良好;ROC曲线下面积为0.857(95%CI:0.826~0.887),灵敏度为90.6%,特异度为62.7%;显示该模型具有良好的临床适用性和实用性。结论 老年慢性病住院患者认知障碍发生率较高。医护工作者可针对其影响因素采取相应的干预措施,以期提高老年慢性病住院患者的认知功能。

Abstract

Objective To investigate the prevalence and influencing factors of cognitive impairment in hospitalized elderly patients with chronic diseases,and to establish and validate a risk prediction model,so as to provide a reference for reducing cognitive impairment in this population. Methods From March 2025 to August 2025,a total of 752 elderly inpatients with chronic diseases were enrolled from the First Affiliated Hospital of Guangxi Medical University,the First Affiliated Hospital of Wannan Medical University,and Wuhu Second People′s Hospital using a simple random sampling.All participants completed a set of questionnaires,including a general demographic questionnaire,the Ascertain Dementia 8(AD8)for cognitive impairment,the Oral Frailty Index-8(OFI-8),and the Clinical Health Evaluation and Scoring Scale(CHEES).Binary logistic regression were performed to explore the factors associated with cognitive impairment in elderly inpatients with chronic diseases. Results Among the 752 patients,the median(interquartile range)scores were 2.00(1.00,5.00)for AD8,5.00(2.00,8.00)for OFI-8,and 47.00(41.00,54.00)for CHEES.The prevalence of cognitive impairment was 49.9%.Logistic regression showed that age,duration of chronic diseases,and oral frailty were risk factors;while marital status,high education level,and good clinical physiological resilience were protective factors(all P<0.05).The prediction model showed good calibration.The area under the ROC curve was 0.857(95%CI:0.826~0.887),with a sensitivity of 90.6%and specificity of 62.7%,indicating favorable clinical applicability and practicability. Conclusion The prevalence of cognitive impairment is high in hospitalized elderly patients with chronic diseases.Medical staff can implement targeted interventions according to the associated factors to improve cognitive function in these patients.

关键词

住院老年患者 / 慢性病 / 认知障碍 / 口腔衰弱 / 临床生理弹性

Key words

Hospitalized elderly patients / Chronic diseases / Cognitive impairment / Oral frailty / Clinical physiological resilience

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基金资助

安徽省教育厅重大课题项目(2024AH040381)

安徽省高等学校省级质量工程项目(2020xsxxkc457)

皖南医学院校级科研项目(2020kcbz06)

中华医学会杂志社护理科研课题(CMAPH-NRD2025044)