老年功能受损风险简易预测模型构建

doi:10.16138/j.1673-6087.2023.03.008

摘要/Abstract

摘要：

目的: 构建老年功能受损风险预测模型。方法: 选取2019年12月至2020年12月间入住上海交通大学医学院附属瑞金医院等4所三级甲等医院的住院老年患者共481例，收集基本资料、共病情况、老年综合征、检验结果等，根据国际功能、残疾和健康分类（International Classification of Functioning，Disability and Health，ICF）及功能受损评估量表（function impairment screening tool，FIST）评估，共231例患者存在功能受损。采用最小绝对收缩和选择算子（least absolute shrinkage and selection operator，LASSO）及Logistic回归筛选预测因素，构建Nomogram图。采用校准曲线、决策分析曲线、一致性指数（concordance index，C指数）等进行评价。结果: 筛选并纳入年龄段、性别、社交活动、脑卒中、糖尿病、焦虑、认知障碍、衰弱、白蛋白共9项预测因素构建老年功能受损Nomogram图，校准曲线和决策分析曲线验证模型具有良好的预测能力和临床效益。C指数=0.938[95%置信区间（confidence interval，CI）=0.917~0.959]提示区分度良好。结论: 本研究建立的老年功能受损Nomogram图具有良好的预测能力、临床效益和区分性，可简易快速评估老年功能受损风险，为临床预测老年功能受损提供了直观有效的指导工具。

关键词: 功能受损, 老年人, 预测模型, Nomogram图

Abstract:

Objective The main objective was to construct a risk prediction model of functional impairment in the elderly. Methods A total of 481 elderly patients who were admitted to four tertiary hospitals, including Shanghai Ruijin Hospital, from December in 2019 to December in 2020 were enrolled. The basic information, comorbidities, geriatric syndrome, and test results were collected. The functional impairment in 231 patients were assessed. LASSO and Logistic regression were adopted to screen predictors and construct a Nomogram. The calibration curve, decision analysis curve and concordance index(C index) were used for evaluation. Results Nine predictors including age group, gender, social activity, stroke, diabetes, anxiety, cognitive impairment, frailty and albumin were screened to construct a nomogram of impaired function in the elderly, and the calibration curve and decision analysis curve were used to validate the model, which indicated good predictive performance and clinical benefit. C index=0.938 [95% confidence interval (CI)=0.917-0.959] showed good discrimination. Conclusions The Nomogram established in the study has shown good predictive ability, clinical benefit and differentiation, which can be used easily and quickly to assess the risk of functional impairment in the elderly and provide an intuitive and effective guidance tool for clinical prediction of functional impairment in the elderly.

Key words: Functional impairment, Elderly, Risk prediction model, Nomogram

中图分类号:

R337

白婷婷, 李菲卡, 徐刚, 蒋倩雯, 吴方. 老年功能受损风险简易预测模型构建[J]. 内科理论与实践, 2023, 18(03): 177-182.

BAI Tingting, LI Feika, XU Gang, JIANG Qianwen, WU Fang. A simple prediction model for risk of functional impairment in elderly[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(03): 177-182.

图/表 6

图1

表1

图2

图3

图4

图5

参考文献 23

[1]	童玉芬. 中国人口的最新动态与趋势——结合第七次全国人口普查数据的分析[J]. 中国劳动关系学院学报, 2021, 35(4): 15-25.
[2]	张良文, 方亚. 2020-2050年我国城乡老年人失能规模及其照护成本的预测研究[J]. 中国卫生统计, 2021, 38(1): 39-42.
[3]	Beard JR, Officer A, de Carvalho IA, et al. The world report on ageing and health: a policy framework for healthy ageing[J]. Lancet, 2016, 387(10033): 2145-2154. doi: S0140-6736(15)00516-4 pmid: 26520231
[4]	石婧, 高超, 于普林. 老年人失能预防核心信息解读[J]. 中华老年医学杂志, 2019, 38(10): 1077-1078.
[5]	World Health Organization. International Classification of Functioning, Disability and Health(ICF)[G]. Geneva: World Health Organization, 2001.
[6]	张亚欣, 汤哲, 杨茗, 等. 老年人功能受损评估正式量表的建立[J]. 中华老年多器官疾病杂志, 2021, 20(4): 265-269.
[7]	陈习琼. 中国老年人口失能现状及地区差异[J]. 中国老年学杂志, 2022, 42(5): 1197-1201.
[8]	白金文, 马潇斌, 陈长香. 社区老年人失能状况及慢性病对其影响研究[J]. 中国全科医学, 2019, 22(1): 43-47. doi: 10.12114/j.issn.1007-9572.2019.01.009
[9]	廖少宏, 王广州. 中国老年人口失能状况与变动趋势[J]. 中国人口科学, 2021, 1: 38-49.
[10]	冯青青, 边萌, 杜毓锋. 社区老年人衰弱情况及其影响因素研究[J]. 中国全科医学, 2021, 24(24): 3032-3038. doi: 10.12114/j.issn.1007-9572.2021.00.530
[11]	黄改荣, 刘祥. 老年人衰弱与失能[J]. 中华老年医学杂志, 2019, 38(10): 1085-1087.
[12]	Fong JH. Disability incidence and functional decline among older adults with major chronic diseases[J]. BMC Geriatr, 2019, 19(1): 323. doi: 10.1186/s12877-019-1348-z pmid: 31752701
[13]	欧阳美娟, 郑丽燕, 谢永娴, 等. 居家老年人常见慢性病与失能关系的分析[J]. 中国医药科学, 2020, 10(10): 149-151.
[14]	王述寒, 田庆丰, 张涵, 等. 老年人综合能力现状及其与慢性病的相关性研究[J]. 中国全科医学, 2021, 24(36): 4569-4573. doi: 10.12114/j.issn.1007-9572.2021.02.063
[15]	Dong L, Freedman VA, Mendes de Leon CF. The association of comorbid depression and anxiety symptoms with disability onset in older adults[J]. Psychosom Med, 2020, 82(2): 158-164. doi: 10.1097/PSY.0000000000000763 pmid: 31688675
[16]	白金文, 郝习君, 李朝征, 等. 中高龄罹患慢病老年人社交回避与苦恼现状及其影响因素[J]. 中国老年学杂志, 2021, 41(17): 3810-3813.
[17]	江文静, 单培彦. 老年人失智与失能[J]. 中华老年医学杂志, 2019, 38(10): 1094-1096.
[18]	Torres JL, Castro-Costa E, Mambrini JVM, et al. Depressive symptoms, emotional support and activities of daily living disability onset[J]. Cad Saude Publica, 2018, 34(7): e00141917.
[19]	曾斌, 梁桂英, 张鸣生. 老年人失能与康复[J]. 中华老年医学杂志, 2019, 38(10): 1101-1103.
[20]	Calderón-Larrañaga A, Vetrano DL, Ferrucci L, et al. Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways[J]. J Intern Med, 2019, 285(3): 255-271. doi: 10.1111/joim.12843 pmid: 30357990
[21]	邝丽琼. 心理疏导疗法在社区失能老人心理干预中的效果观察[J]. 保健文汇, 2021, 22(10): 156-157.
[22]	常文红, 宋琼, 陈长香, 等. 家庭、社区、社会三层面综合干预对改善空巢失能老年人身心健康的效果[J]. 中国实用护理杂志, 2019, 35(1): 11-6.
[23]	孟亚莉, 郑松柏. 老年人低蛋白血症研究进展[J]. 中华老年医学杂志, 2020, 39(2): 228-232.

相关因素	β	SE	Walds	OR（95% CI）	P
性别	-1.014	0.335	9.176	0.363（0.186~0.692）	0.002
年龄（岁）
60~64			41.070		0.000
65~69	1.674	0.761	4.840	5.335（1.273~25.287）	0.028
70~74	1.455	0.803	3.281	4.285（0.923~21.731）	0.070
75~79	2.205	0.764	8.321	9.072（2.152~43.352）	0.004
80~84	2.534	0.743	11.625	12.602（3.122~57.762）	0.001
≥85	3.805	0.746	25.991	44.940（11.273~210.941）	0.000
社交活动频率（次）
>每周3			11.947		0.003
每周1~3	0.539	0.360	2.242	1.715（0.847~3.494）	0.134
每周<1	1.308	0.378	11.940	3.698（1.774~7.866）	0.001
脑卒中	0.841	0.353	5.678	2.320（1.166~4.677）	0.017
糖尿病	0.976	0.319	9.354	2.654（1.432~5.026）	0.002
焦虑	2.058	0.607	11.511	7.830（2.480~27.343）	0.001
认知障碍	0.858	0.425	4.064	2.358（1.036~5.542）	0.044
衰弱	2.799	0.336	69.319	16.434（8.708~32.717）	0.000
白蛋白（g/L）	-0.116	0.038	9.313	0.891（0.825~0.958）	0.002