背景

衰弱多见于老年人，对多种健康结局具有不利影响。疼痛，失眠和抑郁症状在老年人中很常见，可以治愈，并且与衰弱相关。然而，尚不清楚这些症状是否与衰弱相关，以及它们如何相互影响，比个体症状对衰弱的影响是否更大。护士了解这些关联对于为衰弱老年人提供高质量的以患者为中心的护理非常重要。

目标

确定疼痛，失眠和抑郁症状与衰弱的独立关联，并检查其对老年人衰弱的协同作用。

设计

队列研究的横断面分析。

场所

美国社区。

参加者

来自国家健康和老龄化趋势研究（N = 7,609）的社区居民老年人，该研究是美国医疗保险受益人的全国代表性调查。

方法

衰弱状态通过身体衰弱表型5个特征确定，包括 :(1) 动作减慢 ;(2 )体重减轻 ;(3) 力量 ( 抓力 )减弱 ;(4) 疲劳 ;(5) 身体 活动减少 / 低能量消耗。疼痛根据上个月自我报告的疼痛来确定。失眠包括自我报告睡眠困难和难以维持睡眠。抑郁症状由患者健康问卷2评估。使用Logistic回归模型对社会人口统计学，健康相关和行为协变量进行调整。

结果

样本主要是80岁以下（72％），女性（57％）和非西班牙裔白人（81％）。大约53％的人经历了一定程度的疼痛，11％的人难以入睡，6％的人难以维持睡眠，15％的人有抑郁症状；46％衰弱前期，14％衰弱状态。在疼痛（OR：1.81，95％CI：1.60，2.04），难以入睡（OR：1.23，95％CI：1.04，1.46）和抑郁症症状中（OR：2.29，95％CI：1.85，2.84）发现与衰弱前期和衰弱的独立关联。疼痛与抑郁症状之间的相互作用项（OR：1.87，95％CI：1.14、3.07）以及难以入睡和抑郁症状之间的相互作用项（OR：2.66，95％CI：1.15、6.13）对衰弱前期和衰弱的影响具有显著统计学意义。

结论

疼痛，难以入睡和抑郁症状是身体衰弱的独立危险因素，可能对身体虚弱产生协同作用。应该采取干预措施来解决这些症状，以减少衰弱的不利影响。

Background

Frailty is prevalent in older adults and has adverse effects on multiple health outcomes. Pain, insomnia, and depressive symptoms are commonly seen and treatable symptoms in older adults and are associated with frailty. However, it is unknown whether these symptoms are independently associated with frailty and how they interact with each other creating a greater impact on frailty than individual symptoms. It is important to understand these associations for nurses to provide high-quality patient-centered care for older adults with frailty.

Objectives

To determine independent associations of pain, insomnia, and depressive symptoms with frailty and examine their synergistic impact on frailty among older adults.

Design

A cross-sectional analysis of a cohort study.

Setting

Communities in the United States.

Participants

Community-dwelling older adults from the National Health and Aging Trend Study (N=7,609), a nationally representative survey of Medicare Beneficiaries in the United States.

Methods

Frailty status was determined by five criteria of the Physical Frailty Phenotype: exhaustion, low physical activity, weakness, slowness, and shrinking. Pain was determined by self-reports of bothersome pain in the last month. Insomnia included self-reports of difficulty initiating sleep and difficulty maintaining sleep. Depressive symptom was assessed by the Patient Health Questionnaire-2. Logistic regression models were used adjusting for sociodemographic, health-related and behavioral covariates.

Results

The sample was mainly under 80 years old (72%), female (57%), and non-Hispanic White (81%). Approximately 53% experienced bothersome pain, 11% had difficulty initiating sleep, 6% had difficulty maintaining sleep, and 15% had depressive symptom; 46% were pre-frail and 14% were frail. Independent associations with pre-frailty and frailty were found in pain (odds ratio [OR]: 1.81, 95% CI: 1.60, 2.04), difficulty initiating sleep (OR: 1.23, 95% CI: 1.04, 1.46) and depressive symptom (OR: 2.29, 95% CI: 1.85, 2.84). Interaction terms between pain and depressive symptom (OR: 1.87, 95% CI: 1.14, 3.07), and between difficulty initiating sleep and depressive symptom (OR: 2.66, 95% CI: 1.15, 6.13) were significant, suggesting a synergistic impact on pre-frailty and frailty.

Conclusions

Pain, difficulty initiating sleep, and depressive symptoms are independent risk factors of frailty and may have a synergistic impact on frailty. Interventions should be developed to address these symptoms to reduce the adverse effects of frailty.

原文链接：

https://www.sciencedirect.com/science/article/abs/pii/S0020748921000055