Special Issue: Geriatric Diseases
Prevalence and Spatial Analysis of Chronic Comorbidity among Chinese Middle-aged and Elderly People
Concurrent with global aging, China is seeing significantly increased base-case prevalence of chronic diseases and growing prevalence of multimorbidity, which seriously affect the safety and quality of life in middle-aged and elderly Chinese people. Understanding the spatial attributes of data is an effective way to learn the epidemic regularity of the disease. There is no research on the spatial distribution of chronic comorbidity.
To analyze the prevalence and spatial distribution of chronic comorbidity in Chinese middle-aged and elderly people (≥45 years) , providing support for the development of measures for regional containment of chronic diseases.
This study was carried out in March 2021. Data about sociodemographic characteristics and prevalence of 14 chronic diseases stemmed from the four wave of the China Health and Retirement Longitudinal Study, involving 19 498 people aged 45 and above. The geographic information system, ArcGIS 10.2 and Geoda 1.18 were used to conduct a spatial statistical analysis of prevalence of these chronic diseases.
In 2018, the prevalence of chronic comorbidity among middle-aged and elderly Chinese people was 55.77% (10 874/19 498) . And the prevalence of chronic comorbidity varied significantly by sex, age, educational background and marital status (P<0.05) . Arthritis or rheumatism was found to be the disease that most frequently coexisted with other diseases (58.23%, 6 332/10 874) . In terms of two comorbidities coexisted, gastric disease with arthritis or rheumatism had the highest prevalence (16.68%, 655/3 928) . As for three comorbidities coexisted, hypertension with gastric disease and arthritis or rheumatism had the highest prevalence (8.12%, 227/2 796) . The regional prevalence of comorbidity ranged from 39.86% (405/1 016 for Guangdong) to 75.25% (76/101 for Xinjiang) . Global spatial autocorrelation analysis showed that the spatial distribution of the chronic comorbidity prevalence showed a positive autocorrelation indicated by the Moran's I〔0.303 542 (P=0.006) 〕. Local spatial autocorrelation analysis showed that the Moran's I value of Qinghai, Gansu and Fujian were statistically significant (P<0.05) . The cluster type of Qinghai and Gansu was high-high, and that of Fujian was low-low.
The prevalence of chronic comorbidity among middle-aged and elderly Chinese people was high, with spatial differences. Priority should be given to the containment of highly prevalent chronic diseases, such as rheumatism, hypertension and gastric disease, and the key regions for containment were mainly in the northwest part of China.
The problem of population aging is serious in China, and chronic diseases comorbidity is becoming more and more common.
Based on the health ecology model, to systematically understand the main influencing factors of chronic disease comorbidity among the elderly in China, and to provide scientific reference for the prevention and control of chronic disease comorbidity among the elderly in China.
Based on the follow-up data of China Health and Retirement Longitudinal Study (CHARLS) 2018, a total of 10 779 samples aged ≥60 years were selected in March 2021. After excluding the samples with missing data and unqualified data, a total of 7 354 samples was included in this study. With the occurrence of chronic comorbidities (having ≥2 chronic conditions) as the dependent variable and the inclusion of independent variables according to the 5 dimensions of the health ecology model, a multivariate Logistic regression model was used to analyze the influencing factors of chronic disease comorbidity in the elderly.
Among the elderly≥60 years old in China, the comorbidity rate of chronic diseases was 65.16% (4 792/7 354) , with 32.16% (1 541/4 792) patients suffered from two kinds of chronic diseases, and the diseases with the largest combination of two comorbidities were hypertension with arthritis or rheumatism〔16.42% (253/1 541) 〕. The results of the multivariate Logistic analysis showed that for the risk of comorbidities of chronic diseases in the elderly, females were higher than that in males〔OR (95%CI) =1.371 (1.177, 1.596) 〕, those over 70 years old were higher than those aged 60-70 years old〔OR (95%CI) =1.189 (1.061, 1.333) 〕, those who slept for 6-8 hours or more than 8 hours at night were lower than those who slept for less than 6 hours at night〔OR (95%CI) =0.759 (0.678, 0.850) , OR (95%CI) =0.686 (0.572, 0.821) 〕, those who took nap time of 0.5-1.0 h and over 1.0 h were higher than those of less than 0.5 h 〔OR (95%CI) =1.238 (1.102, 1.391) , OR (95%CI) =1.219 (1.604, 1.396) 〕, those who felt general and less satisfied with their health were higher than those who were very satisfied〔OR (95%CI) =1.755 (1.537, 2.004) , OR (95%CI) =5.890 (4.930, 7.037) 〕, those who registered in urban areas were higher than those in the rural areas〔OR (95%CI) =1.167 (1.036, 1.315) 〕, those living in the central and western regions were higher than those in the eastern region〔OR (95%CI) =1.311 (1.158, 1.483) , OR (95%CI) =1.491 (1.315, 1.692) 〕, those who were working were lower than those who had worked〔OR (95%CI) =0.768 (0.680, 0.866) 〕, and those with annual income > 50 000 per capita were higher than that of less than 20 000 yuan〔OR (95%CI) =1.413 (1.009, 1.978) 〕.
The incidence of chronic diseases comorbidity is higher in the elderly in China. The influencing factors of comorbidity of chronic diseases are multi-level and multi-dimensional. There are complex relationships between different influencing factors, which suggest strengthening multi-dimensional intervention and management of chronic diseases from individual to environment, so as to improve the health level of the population.
Vitamin D levels decrease with age and are associated with the occurrence of osteoporosis, fractures, falls and muscle weakness that are common in older adults. In addition, its association with quality of life in the elderly has also been increasingly paid attention.
To investigate the vitamin D level and its correlation with health-related quality of life in the elderly population dwelling in community in Beijing, and to provide decision-making reference for improving the full life-cycle quality of life of this population.
The data of this study were obtained from the BEYOND research database carried out in Chaoyang District and Fengtai District of Beijing from November 2017 to July 2018. A total of 1 066 elderly people aged ≥ 60 were included for analysis. Clinical information including demographic and socioeconomic characteristics, biochemical markers of bone metabolism, bone mineral density, left and right hand grip strength, sitting test, and history of falls and fractures during 2-year follow-up was collected. According to the level of 25-hydroxyvitamin D〔25 (OH) D〕, the subjects were divided into vitamin D deficient group, vitamin D insufficient group and vitamin D sufficient group, and the EuroQol Five-dimensional Questionnaire (EQ-5D) was used to evaluate the quality of life of the subjects.
Among the 1 066 subjects, 729 (68.39%) were in the vitamin D deficient group, 291 (27.30%) were in the vitamin D insufficient group, and 46 (4.32%) were in the vitamin D sufficient group. Serum levels of procollagen type 1 N-terminal propeptide (P1NP) , alkaline phosphatase (ALP) , parathyroid hormone (PTH) , osteocalcin (OST) , and cross-linked type I collagen carboxyl-terminal peptide (β-CTX) , left hip overall T value, right hip overall T value, and left hand grip strength were statistically significant among three groups (P<0.05) . There were significant differences in pain discomfort dimension and EQ-5D utility value among the three groups (P<0.05) . The EQ-5D utility value of vitamin D sufficient group was higher than that in both vitamin D deficient group and vitamin D insufficient group (P<0.05) . The results of multiple linear regression analysis showed that 25 (OH) D level was an influence factor of EQ-5D utility value in the elderly (P<0.05) .
The prevalence of vitamin D deficiency and insufficiency in the elderly in the community in Beijing was 68.39% and 27.30%, respectively. The level of vitamin D is positively correlated with bone mineral density, grip strength and EQ-5D total utility value in the elderly. Early screening of vitamin D levels in the elderly population and timely supplementation with adequate intakes are of great significance to maintain and improve the health-related quality of life in the population.
Prevalence and Distribution Trends of Mild Cognitive Impairment among Chinese Older Adults：a Meta-analysis
Mild cognitive impairment (MCI) has become a major disorder affecting the quality of life of Chinese older adults, a rapidly increasing population. Understanding MCI prevalence in this population is important for promoting healthy ageing, but there is a lack of comprehensive reports on MCI prevalence in a large national sample of older adults in the past decade.
To examine the trends of MCI prevalence and geographical distribution in Chinese older adults in the past 10 years, providing data support for further research on public service policies for the elderly.
In January 2021, we searched for studies about MCI prevalence in Chinese older adults published from January 2010 to December 2020 from databases of SinoMed, CQVIP, Wanfang Data, CNKI, PubMed, Ovid, SpringerLink, and EmBase, and extracted data regarding MCI prevalence from the eligible ones, then chose effects models with indicators based on the within-study heterogeneity.
A total of 47 studies were included, involving 137 599 samples. The overall prevalence of MCI in Chinese older adults in the last decade was 19%〔95%CI (17%, 21%) 〕. Demographic analysis showed the following results: the MCI prevalence was 17%〔95%CI (15%, 19%) 〕 and 19%〔95%CI (17%, 21%) 〕 for men and women, respectively, 16%〔95%CI (11%, 22%) 〕 and 23%〔95%CI (16%, 30%) 〕 for urban and rural areas, respectively, 16%〔95%CI (14%, 19%) 〕 and 24%〔95%CI (20%, 28%) 〕for those living with a spouse and without, respectively, and 13%〔95%CI (9%, 17%) 〕, 12%〔95%CI (9%, 15%) 〕, 17%〔95%CI (13%, 20%) 〕, 26%〔95%CI (20%, 31%) 〕, 33%〔95%CI (24%, 42%) 〕and 42%〔95%CI (22%, 62%) 〕 for those at 60-64 years, 65-69 years, 70-74 years, 75-79 years, 80-84 years, 85 and above, respectively. Besides this, MCI prevalence showed a trend of decrease with the increase of education level: 30%〔95%CI (25%, 35%) 〕 in those with little education (<1 year of education) , while 10%〔95%CI (7%, 13%) 〕 in those with university education (>12 years of education) . Spatial distribution trend: prevalence varied significantly between provinces (autonomous regions/municipalities) (15%-37%) and between northern, northwestern, eastern, south-central, southwestern parts of China (17%-22%) . Temporal distribution trend: the prevalence showed an increasing trend in the last decade (11%-28%) .
The prevalence of MCI in Chinese elderly population showed an increasing trend from January 2010 to December 2020, with differences across provinces (autonomous regions/ municipalities) and 5 geographical regions. In addition, the prevalence was higher in the female, less educated, older, rural, and spouseless groups.
As China enters a deep aging society, falls and fall-related injuries in older adults have gained increased attention, with increasing emergence of relevant studies, and continuous updates in relevant guidelines. In 2022, The World Falls Task Force assembled 96 experts from 39 countries to develop the World Guidelines for Falls Prevention and Management for Older Adults: a Global Initiative. The guidelines were developed using the person-centered methodology and the latest evidence on e-health for the prevention of falls, with full consideration of the needs of fall management of older adults, and their caregivers and other stakeholders' perspectives on preventing falls in older adults, as well as the guideline applicability in various care settings and locations with limited resources, which provide new clinical recommendations on the screening, assessment, and management of risk for falls among community-dwelling older adults. This paper offers an in-depth interpretation of the guidelines and an analysis of the effective practical guidance in the guidelines, providing practical guidance for Chinese physicians, nurses and community health workers to prevent and manage falls in older adults.
In recent decades, ischemic stroke is increasingly prevalent, which has become the second leading cause of death and disability in the world. Insulin resistance and obesity are closely related to the development of ischemic stroke. At present, a number of studies have confirmed that obesity is associated with a variety of metabolic diseases and the role of insulin resistance played in the pathogenesis. But it is still unclear whether TyG, an indicator of insulin resistance, and TyG combined with obesity indicators can be used to predict ischemic stroke.
To assess the influencing factors of TyG, and its combination with different obesity indicators for new-onset ischemic stroke in a cohort of middle-aged and elderly people during a 10-year follow-up .
A prospective cohort design was used. The cohort included 9 406 middle-aged and elderly individuals who attended the 2011 Epidemiological Survey on Cancer Risk in Type 2 Diabetics conducted in six communities in Luzhou (including Qiancao, Xiaoshi, Longmatan, Baolaiqiao, Dashanping and Yutang) . Baseline data were collected, including TyG and its combination with different obesity indicators〔TyG-waist circumference (WC) , TyG-waist-to-height-ratio (WHtR) , TyG-body mass index (BMI) , and TyG-waist-to-hip-ratio (WHR) 〕. A 5-year follow-up initiated since June to November 2016, and a 10-year follow-up initiated since April to June 2021 were conducted, with new-onset ischemic stroke incidence (obtained through Luzhou Health Commission and Luzhou Center for Disease Control & Prevention) as an endpoint. For assessing the predictive value of baseline TyG, TyG-WC, TyG-WHtR, TyG-BMI, and TyG-WHR for new-onset ischemic stroke, patients were divided into quartiles of TyG〔Q1 (n=2 351) , Q2 (n=2 351) , Q3 (n=2 352) , Q4 (n=2 352) 〕, quartiles of TyG-WC〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHtR〔Q1 (n=2 349) , Q2 (n=2 349) , Q3 (n=2 348) , Q4 (n=2 348) 〕, and quartiles of TyG-BMI〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHR〔Q1 (n=2 343) , Q2 (n=2 343) , Q3 (n=2 342) , Q4 (n=2 342) 〕, respectively. Multivariate Logistic regression analysis was used to explore the relationship between TyG, TYG-WC, TYG-WTHR, TYG-BMI, TYG-WHR and new ischemic stroke in the elderly.
During the follow-up period, 527 (5.6%) of the 9 406 middle-aged and elderly people had new-onset ischemic stroke. After adjusting for multiple confounding variables, multivariate Logistic regression analysis showed that the risk of new ischemic stroke in the fourth quartile group of TyG was 1.569 times higher than that in the first quartile group of TyG〔OR=1.569, 95%CI (1.007, 2.437) , P=0.046〕. The risk of new ischemic stroke increased by a factor of 1.467, 2.012, and 2.132 in the second, third and fourth quartile groups of TyG-WC〔 OR=1.467, 95%CI (1.010, 2.131) , P=0.044; OR=2.012, 95%CI (1.270, 3.187) , P=0.003; OR=2.132, 95%CI (1.119, 4.063) , P=0.021〕compared with that in the first quartile group of TyG-WC. The risk of new ischemic stroke increased by a factor of 1.481, 1.548, and 1.705 in the second, third and fourth quartile groups of TyG-BMI 〔OR=1.481, 95%CI (1.071, 2.048) , P=0.018; OR=1.548, 95%CI (1.066, 2.247) , P=0.022; OR=1.705, 95%CI (1.054, 2.759) , P=0.030〕compared with that in the first quartile group of TyG-BMI.
The risk of new-onset ischemic stroke in middle-aged and elderly type 2 diabetics in Luzhou increased with the elevation of TyG-WC and TyG-BMI, so TyG-WC and TyG-BMI may be predictors of new-onset ischemic stroke in this population.
Oral frailty has been recently suggested as a novel construct defined as a decrease in oral function with a coexisting decline in cognitive and physical functions, which is associated with many adverse events in older adults, such as frailty, sarcopenia, disability, and mortality. We reviewed the definition, symptoms, diagnosis criteria, assessment tools of oral frailty in older people, and summarized its recent research status as well as possible influencing factors, then suggested that future research on oral frailty in older Chinese adults could be carried out in aspects involving developing oral frailty assessment tools appropriate for older Chinese people, implementing survey studies on oral frailty, enriching study designs and contents and enhancing oral frailty intervention studies.
Prevalence of Osteoporosis in Chinese Elderly People: a Meta-analysis
The prevalence of osteoporosis is high and increases gradually with age. Osteoporosis and its related fractures have exerted a heavy economic burden on patients' families, and the society, so it is urgent to prevent and treat osteoporosis. Understanding osteoporosis prevalence is a prerequisite for containing osteoporosis in China.
To understand osteoporosis prevalence in Chinese elderly people through a meta-analysis.
PubMed, CNKI, Wanfang Data Knowledge Service Platform and VIP databases were searched to collect cross-sectional studies about osteoporosis prevalence in Chinese elderly people published from January 1, 2000 to March 20, 2021. Data from eligible studies were extracted, and methodological quality of these studies was assessed. Meta-analysis was performed by using Stata 12.0.
A total of 48 studies involving 68 932 cases were included. Meta-analysis showed that the overall prevalence of osteoporosis in Chinese adults aged ≥60 years was 37.7%〔95%CI (33.8%, 41.7%) 〕. Subgroup analyses indicated that osteoporosis prevalence in Chinese adults aged ≥60 years was 35.9%〔95%CI (31.1%, 40.8%) 〕 from 2010 to 2020, while that was 39.6%〔95%CI (33.4%, 45.9%) 〕 between 2000 and 2009. Osteoporosis prevalence in this age group in southern and northern China was 39.7%〔95%CI (34.0%, 45.5%) 〕, and 35.7%〔95%CI (30.1%, 41.2%) 〕, respectively. Osteoporosis prevalence in men, and women of this age group was 27.3%〔95%CI (23.9%, 30.7%) 〕 and 48.4%〔95%CI (42.7%, 54.1%) 〕, respectively. The prevalence of osteoporosis in those aged 60-69, 70-79, and over 80 was 32.2%〔95%CI (28.6%, 35.7%) 〕, 41.9%〔95%CI (36.9%, 46.9%) 〕 and 51.8%〔95%CI (43.9%, 59.7%) 〕, respectively.
Current evidence shows that the prevalence of osteoporosis in Chinese older adults is 37.7%, and it increased with age.
Developmental Trajectory of Frailty in Chinese Elderly People：an Analysis Based on the Latent Growth Model
Frailty is a prominent manifestation of aging. Frailty in Chinese older people has been studied mostly using cross-sectional designs, but its developmental trajectory has been rarely studied using longitudinal designs.
To examine the developmental trajectory and associated factors of frailty in Chinese older people using the data of four national waves of China Health and Retirement Longitudinal Study (CHARLS) .
The data of this study obtained from four national waves〔2011 (the baseline survey), and 2013, 2015 and 2018 (follow-up surveys) 〕 of CHARLS, which was initially conducted in 2011, and was followed by tracking once every 2 to 3 years with multi-stage PPS sampling for middle-aged and elderly groups in 28 provincial administrative regions of China, covering 150 counties and 450 villages. The surveyees were coded, and matched, then 2 267 cases (≥60 years old) involved in the four waves of surveys were selected as the sample. Frailty was assessed by the frailty index (FI). Mplus was used to construct three types of unconditional latent growth models, and the optimal fitting model was selected to determine the developmental trajectory of frailty of Chinese older people, and was used to develop the conditional latent growth model. The effects of time-invariant factors (gender, education level) and time-varying factors (physical activity, smoking, alcohol consumption, sleep) on frailty were examined.
The latent growth model with undefined curve fit the data better, and was selected as the optimal model to determine the frailty development trajectory. The results of χ2 (3) =36.16, CFI=0.992, TLI=0.984, RMSEA=0.070, SRMR=0.022, indicating that the frailty prevalence in older adults showed a trend of curvilinear increase. The values of intercept (initial level), slope (growth), and the variation of them of the model were significantly higher than 0 (P<0.01), indicating that there were significant individual differences in the initial level and growth rate of frailty. Gender and education level were negatively associated with the initial level of frailty (β=-0.113, -0.173, P<0.01). They were also negatively associated with the growth of frailty (β=-0.181, -0.151, P<0.01). Compared with men, women had higher initial level and faster growth rate of frailty (P<0.05). Compared to those with higher education level, those with lower education level had higher initial level and faster growth rate of frailty (P<0.05). Physical activity and sleep were negatively associated with frailty in all waves of surveys (P<0.05). Smoking was positively associated with frailty in 2011, 2015, 2018 waves of surveys (P<0.05). Alcohol consumption was positively associated with frailty in 2013 and 2015 waves of surveys (P<0.05) .
The frailty in Chinese older people showed a trajectory of curvilinear increase, and its initial level and growth rate had significant individual differences. Comparatively speaking, being female and having lower education level were associated with increased risk of having frailty. Moderate- and high-level physical activity and adequate sleep were associated with decreased risk of having frailty or alleviating frailty. Long-term smoking and drinking too much could exacerbate frailty.
Active implementation of patient-centered polypharmacy management for older adults with multimorbidity can help to identify and correct the medication errors that patients may have, avoid the occurrence of potential medication errors, reduce and control the development of drug-related diseases, improve the clinical treatment effect, and delay the disease progression, thereby facilitating the achievement of targets for disease control, and improvement of quality of life of patients. In the light of problems of polypharmacy in Chinese elderly patients with multimorbidity, we summarized relevant interventions including strengthening top-level design of management, building multidisciplinary teams, innovating medication management technologies, and meeting patients'needs of drug information, providing a reference for medication management of these patients. We found that problems of polypharmacy in Chinese elderly patients are serious, and actively exploring multiple approaches to polypharmacy management based on medication features of these patients may be a key breakthrough for addressing the problems.
With the aging and longer survival of the population, comorbid chronic diseases is increasingly common. The variety and complexity of diseases pose challenges to the health management of the elderly. There is a relative lack of multimorbidity pattern researches in China, which are necessary issues for research.
To investigate the patterns of coexistence of common multiple chronic conditions among the elderly in China, in order to help policymakers, researchers, and clinicians better understand the current status of multimorbidity among Chinese elderly.
Data on the demographic characteristics and health status of 14 chronic diseases were extracted from the respondents aged 60 years and above in the China Health and Retirement Longitudinal Study (CHARLS) 2018, association rules, cluster analysis, principal component analysis, latent class analysis were used to explore the multimorbidity patterns of Chinese elderly, and the results of different methods were compared.
The data from a total of 10 800 respondents were eventually included, there were differences among the patterns obtained by four methods. However, the consistent multimorbidity patterns were identified: hypertension, diabetes or elevated blood glucose, dyslipidemia; chronic lung disease and asthma; arthritis or rheumatism, stomach diseases or digestive diseases; stroke, memory-related diseases.
The consistent patterns obtained by different methods contain chronic diseases with significant relationships of etiologies. The reasons of differences in results are complex etiologic relationships and different method principles.
Chinese Consensus on Diagnosis and Assessment of Sleep Apnea Syndrome in Older Adults
It is a necessary trend to improve the quality of life of rapidly increasing number of older adults. Sleep disorders are significantly associated with the quality of life in older adults, among which sleep apnea syndrome (SAS) is second only to insomnia, which is an inducer of multiple diseases, and directly associated with many chronic diseases, such as cardiovascular and cerebrovascular diseases, Alzheimer's disease, metabolic abnormalities, respiratory diseases, even leads to sudden death. So SAS in older adults should be given great attention by the whole society. With this in mind, the Chinese Association of Geriatric Sleep Medicine, Chinese Geriatrics Society invited Chinese sleep medicine experts to develop a consensus on the classification, risk factors, clinical symptoms, diagnosis and assessment methods, diagnostic procedures as well as complications of SAS in older adults based on a review of relevant clinical studies, aiming to provide a reference for the standardization of SAS diagnosis and assessment in China.
Considering that our country has entered an aging society, the health problems of the older people has evolved into a concern due to the association with a variety of diseases. In recent years, Chinese households and society have suffered a serious economic burden due to the increasing prevalence of dysphagia among the elderly.
The purpose of this study is to evaluate the prevalence of dysphagia in the elderly in China systematically.
PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, Wanfang Data, and China Biomedical Literature Database were searched for epidemiological studies related to the prevalence of dysphagia in the elderly in China. Searches were conducted from database inception to May 2022. Two researchers were responsible for screening literature and extracting data according to the inclusion and exclusion criteria. The AHRQ scale was used to evaluate the quality of cross-sectional studies. Meta-analysis was performed with Stata 15.0 software.
A total of 22 articles were analyzed, containing 308 289 patients, including 47 940 patients with dysphagia. Meta-analysis revealed that the prevalence of dysphagia in the elderly in China was 66.0%〔95%CI (58.0%, 73.0%) 〕. According to subgroup analysis, among elderly Chinese males and females dysphagia was prevalent in 38.0%〔95%CI (31.0%, 45.0%) 〕 and 38.0%〔95%CI (29.0%, 46.0%) 〕 of cases, respectively. The prevalence of dysphagia was 21.0%〔95 %CI (13.0%, 29.0%) 〕 in 60-69 years old, 28.0%〔95%CI (18.0%, 37.0%) 〕 in those aged 70-79, and 41.0%〔95%CI (31.0%, 50.0%) 〕 in those aged more than 80. In primary, secondary, and technical secondary school, and college and up, dysphagia was observed in 28.0%〔95%CI (20.0%, 35.0%) 〕, 32.0%〔95%CI (17.0%, 53.0%) 〕, 30.0%〔95%CI (18.0%, 42.0%) 〕 of the elderly. The prevalence of elderly dysphagia was 68.0% in the hospital〔95%CI (52.0%, 85.0%) 〕, 56.0%〔95%CI (41.0%, 71.0%) 〕 in the nursing home and 76.0%〔95%CI (56.0%, 97.0%) 〕 in the community. According to the Kubota Drinking Test, 32.0%〔95%CI (21.0%, 43.0%) 〕 of the elderly suffer from dysphagia, 41.0%〔95%CI (16.0%, 66.0%) 〕 exprience it according to the EAT-10 scale, and 35.0%〔95%CI (14.0%, 56.0%) 〕 suffer from it according to the Water Swallowing Test scale.
The prevalence of dysphagia among the elderly in China is 66.0%〔95%CI (58.0%, 73.0%) 〕. The prevalence of dysphagia among those≥80 years old, those with secondary school and technical secondary school education, elderly care in community, and those with dysphagia diagnosed by the EAT-10 scale is high. In order to improve the quality of life and reduce the prevalence of dysphagia among the elderly, we must pay more attention to and understand elderly dysphagia early.
Dyslipidemia Prevalence in Chinese Older Adults：a Meta-analysis
China has stepped into an aging society, and its aging population is rapidly increasing. Recent years have seen a notable increased dyslipidemia prevalence in older adults, which has gained growing attentions as a major risk for cardiovascular and cerebrovascular diseases in this population. There is little consistency between studies on dyslipidemia prevalence in Chinese older adults due to differences of size and features of sample, design and setting.
To systematically evaluate the prevalence of dyslipidemia among Chinese older adults.
Cross-sectional studies relevant to the prevalence of dyslipidemia among Chinese elderly population were searched in databases including CNKI, CBM, CQVIP, WanFang, PubMed, Web of Science, Embase and the Cochrane Library from inception to May 2021. Two researchers performed literature screening and data extraction, separately. The Agency for Healthcare Research and Quality methodology checklist was used to assess the risk of bias. Stata 15.1 was adopted for meta-analysis.
A total of 19 cross-sectional studies were included, involving 101 931 cases, and 45 785 of them had dyslipidemia. Meta-analysis results showed that the overall prevalence of dyslipidemia among the participants was 48.0%〔95%CI (41.0%, 54.0%) 〕. Specifically, the prevalence of elevated total cholesterol (TC) , triglyceride (TG) , and low-density lipoprotein cholesterol (LDL-C) as well as lowered low high-density lipoprotein cholesterol (HDL-C) was 19.7%〔95%CI (13.8%, 25.5%) 〕, 20.8%〔95%CI (16.2%, 25.4%) 〕, 15.3%〔95%CI (10.7%, 19.8%) 〕, and 20.2%〔95%CI (7.9%, 32.4%) 〕, respectively. Sex-specific analysis found that men had higher prevalence of elevated LDL-C than women (17.2% vs 9.0%) . Women had higher overall prevalence of dyslipidemia than men (48.8% vs 39.5%) . Moreover, women also had higher prevalence of elevated TC (24.0% vs 12.9%) , and TG (23.4% vs 19.0%) , as well as lowered HDL-C (20.4% vs 14.7%) . Age-specific analysis revealed that dyslipidemia prevalence in age groups of 60-69, 70-79, and ≥80 years old was 39.9%, 31.8%, and 31.4%, respectively, showing a trend of decrease with age. The prevalence of elevated TC in 60-69 year-olds (12.9%) was higher than that of 70-79 year-olds (12.1%) or 80 year-olds and above (9.5%) . The prevalence of elevated LDL-C in 60-69 year-olds (10.0%) was higher than that of 70-79 year-olds (9.4%) or 80 year-olds and above (6.5%) . The prevalence of elevated TG in 70-79 year-olds (19.3%) was higher than that of 60-69 year-olds (16.4%) or 80 year-olds and above (15.5%) . The prevalence of lowered HDL-C in 70-79 year-olds (10.5%) was higher than that of 60-69 year-olds (9.7%) or 80 year-olds and above (9.5%) . Those aged ≥80 years had lower prevalence of various forms of dyslipidemia than 60-69 year-olds and 70-79 year-olds. Region-specific analysis indicated that compared to those from western China, participants from eastern China had higher overall prevalence of dyslipidemia (49.3% vs 36.8%) . Moreover, they also showed higher prevalence of elevated TC (23.0% vs 11.4%) , elevated LDL-C (21.3% vs 7.8%) and lowered HDL-C (13.5% vs 7.8%) . However, they had slightly lower prevalence of elevated TG (19.7% vs 20.0%) .
The overall prevalence of dyslipidemia was high in Chinese older adults. Sex-, age group- and region-specific differences were found in the overall prevalence of dyslipidemia, and prevalence of various forms of dyslipidemia. Due to limited number and non-ideal quality of the included studies, the above conclusions need to be verified by more high-quality studies.
The prevention and delay of disability is important for promoting healthy aging. Exercise intervention is an efficient strategy for disability prevention. Besides, exercise intervention presents significant therapeutic advantages and broad application prospects due to low cost, low implementation difficulty, high acceptance and wide application scenarios. Therefore, Nursing Group of Chinese Society of Geriatrics, Committee on Geriatric Nursing of Chinese Association of Geriatric Research, China Gerontological Nursing Alliance, National Center of Gerontology, Institute of Geriatric Medicine of Chinese Academy of Medical Sciences jointly developed and published Clinical Practice Guidelines for Exercise Interventions for the Prevention of Disability in Older Adults (2023). According to the methodologies specified in WHO Handbook for Guideline Development, the guidelines finally involve 32 recommendations and 18 clinical issues containing exercise principles, effectiveness and plans of different types of exercise, facilitators and barriers during exercise, aiming to provide a reference for the development and implementation of exercise programs for older adults at risk of disability and standardize clinical practice, thus promoting the gateway to improving physical function of the older adults, reducing the prevalence of disability, improving quality of life, contributing to healthy aging.
Along with the development of aging, much attention has been paid to geriatric health issues in China. Sleep disturbance is a common sleep problem endangering older people's health.
To systematically assess the prevalence of sleep disturbances in Chinese older people.
Studies about sleep disturbance in Chinese elderly were searched in database of CNKI, CQVIP, SinoMed, WanFang Data, PubMed, EmBase, The Cochrane Library, Web of Knowledge and PsycINFO from inception to 31st May, 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies using the 11 criteria recommended by the Agency for Healthcare Research and Quality. Stata 16.0 was used for meta-analysis.
A total of 91 studies, with a sample of 81 354 cases were included. Meta-analysis showed that the overall prevalence rate of sleep disturbances among Chinese older people was 46.0%〔95%CI (41.7%, 50.4%) 〕. Further analysis indicated that the prevalence of sleep disturbances among men and women was 40.0%〔95%CI (30.9%, 49.2%) 〕and 49.4%〔95%CI (42.8%, 55.9%) 〕, respectively. And it was 35.1%〔95%CI (28.8%, 41.4%) 〕 for the 60-70-year-olds, 46.1%〔95%CI (33.8%, 58.4%) 〕 for the 70-80-year-olds, and 44.4%〔95%CI (32.7%, 56.2%) 〕 for the 80-and-over-year-olds. The sleep disturbance prevalence rate among those living in urban and rural areas was 41.5%〔95%CI (32.8%, 50.2%) 〕and 44.0%〔95%CI (36.4%, 51.7%) 〕, respectively. And it was 46.3%〔95%CI (37.6%, 55.1%) 〕for those with junior high school or lower education level, and 37.9%〔95%CI (26.7%, 49.1%) 〕for those with senior high school or higher education level. Meta-regression analysis showed that marital status and chronic disease prevalence were associated with sleep disturbances (P<0.05) .
The prevalence of sleep disturbances in Chinese older people is high. To reduce the risk of sleep disturbances and improve the sleep quality in this group, the prevention and intervention of sleep disturbances should be valued and targeted interventions should be delivered.
Cognitive dysfunction refers to the functional impairment in one or more cognitive domains, mostly occurs in older adults. Cognitive dysfunction can commonly be divided into subjective cognitive decline (SCD), mild cognitive impairment (MCI) and dementia, depending on the degree of cognitive impairment. People with SCD or MCI have a higher risk of dementia, which seriously affects their quality of life, and imposes a huge burden on families and society. Numerous studies have demonstrated that physical activity is one effective non-pharmacological intervention for cognitive dysfunction, but there are no uniform standards for physical activity programs for cognitive dysfunction worldwide, and China still has no physical activity guidelines based on the values and preferences of older adults with cognitive dysfunction, partially impeding the dissemination and application of relevant evidence. In view of this, we developed a guideline containing eight recommendations that is applicable in China, namely the Clinical Practice Guideline on Non-pharmacological Interventions for Older Adults with Cognitive Dysfunction: Physical Activity, by the use of existing evidence, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework combined with values and preferences of Chinese older adults with cognitive dysfunction. This guideline will contribute to the reduction of the incidence of cognitive dysfunction, and preventing or slowing the progression of cognitive dysfunction to dementia.
The number of dementia patients is increasing along with the aging of the population. Dementia greatly impairs health and quality of life of patients, so early prevention and identification are particularly important.
To compare the results of the brief Community Screening Interview for Dementia (CSI-D) and the Mini-Mental State Examination (MMSE) in dementia screening, and to assess the examination consistency of the two scales.
In November 2021, we collected data of a sample of 2 668 middle-aged and elderly people with complete data (including assessment results of CSI-D and MMSE, sex, age, place of residence, education level and marital status) of the CHARLS 2018. The brief CSI-D and MMSE were used to screen the risk of dementia. Pearson correlation analysis was used to analyze the correlation of the scores of the brief CSI-D with those of MMSE. The consistencies of the two scales in the screening of dementia in all cases and subgroups divided by personal characteristics were calculated, the overall consistency was assessed using Kappa statistic.
The average CSI-D score and average MMSE score for all participants were (5.84±2.26) and (24.93±3.24) , respectively. Pearson correlation analysis showed that the brief CSI-D score was positively correlated with the MMSE score (r=0.394, P<0.001) . The overall prevalence of dementia was 27.36% (730/2 668) screened by the brief CSI-D, and was 22.11% (590/2 668) by the MMSE, showing statistically significant difference (χ2=40.167, P<0.001) . The consistency of the two scales in screening dementia in all cases was 20.22%, and ranged from 12.50% to 30.43% in screening dementia in subgroups divided by personal characteristics. Kappa statistic showed that the kappa value between the two scales was 0.121 (P<0.001) , suggesting a weak level of consistency.
In general, there are differences and weak consistency in the screening results of dementia between CSI-D and MMSE in general household population. Therefore, the use of the scales should be analyzed according to the actual situation. The in-depth comparison and discussion on the screening accuracy of the two scales could be further performed in combination with the gold standard for diagnosing dementia.
With the acceleration of population aging, multiple chronic diseases have become common in the elderly, and the research on multiple chronic diseases in the elderly is also increasing. However, few studies have been conducted to analyze its progress and hotspots.
To analyze the hotspots of multiple chronic diseases in the elderly at home and abroad, revealing the hotspots in frontiers research, so as to provide a reference for related researchers to track cutting-edge information.
The literatures related to multiple chronic diseases in the elderly were retrieved from Web of Science, Scopus, CNKI, Wanfang Data, VIP, PubMed, Chinese Medical Association Journal Full-text database, and APA-PsycINFO database of the American Psychological Association with the retrieval time of 2010-2021, based on text mining technology and bibliometrics method, etc. CiteSpace 6.1.3, PASW 18, BICOMB 2.04 and other software were used to analyze and visualize the trends in number of papers published, sources, authors, institutions, keywords and other aspects of literature publication. Strategic coordinate maps were drawn to analyze research hotspots in the field.
Finally, 9 392 literatures related to multiple chronic diseases in the elderly were involved, including 5 776 literatures in foreign language and 3 616 literatures in Chinese. The numbers of literatures related to multiple chronic diseases in the elderly both in foreign language and Chinese have increased exponentially in the past decade, with the annual growth rate of 13.27% in Chinese literature and 15.84% in foreign literature, suggesting the development stage of multiple chronic diseases in the elderly. Five mainstream research hotspots have been identified in both Chinese and foreign literatures. There are more literatures related to multiple chronic disease such as chronic obstructive pulmonary disease, diabetes mellitus, hypertension, and respiratory diseases. The foreign literatures have focused more on the psychiatric comorbidity, followed by somatic comorbidities such as diabetes mellitus, hypertension, and heart failure.
The analysis results shows that the field of multiple chronic diseases in the elderly is in a rapid development stage. Analysis of foreign literature shows that psychiatric comorbidity is a relatively hot topic but not mature enough, research results related to multiple chronic diseases in the elderly are abundant and diversified, but the research depth is in sufficient. Domestic literature analysis shows that chronic obstructive pulmonary disease combined with respiratory diseases in the elderly is at the core of the field, and there is a lack of studies related to psychiatric comorbidity such as depression and mutiple chronic diseases such as health situation, nursing and health care, which may become the main direction of research development in the future.
Multimorbidity has become a prominent public health problem in older people in China as the country reached an aging society. Summarizing the studies in multimorbidity in elderly population and analyzing and discussing the coping strategies are of great significance for comprehensive management of this group of people. Herein, we reviewed the latest studies about multimorbidity in older people involving management practice, diagnosis and treatment model, medication strategy, and the building of medical and nursing team and health management system. Besides that, we summarized the following coping strategies: establishing a patient-centered multimorbidity management research program, promoting the application of geriatric multimorbidity assessment tools, conduct research on the common etiology and pathogenesis of comorbidity, developing standardized guidelines/consensuses on multimorbidity management, formulating treatment schemes using the TCM ideas of "treating diseases according to syndrome" and "holistic treatment", Internet technologies and smart wearable devices, and conducting early risk assessment and management of multimorbidity. In addition, we provided a comprehensive outlook on future research directions. All this is aimed at providing a reference for further in-depth research in this field.
The prevalence of hip fractures is increasing due to increased number of aging people and availability of modern transportation. Elderly patients with hip fracture tend to have many basic diseases and poor prognosis, with 1-year postoperative mortality as high as 15%-25%. Timely screening of those at high risk of hip fractures with predictive tools and providing them with interventions can improve the prognosis. But there are rare studies and no appropriate objective indicators regarding predicted 1-year postoperative mortality in older hip fracture patients.
To assess the predictive association of Controlling Nutritional Status (CONUT) score and other possible associated factors for 1-year postoperative mortality in elderly patients with hip fracture.
A total of 399 patients with unilateral hip fracture (including femoral neck and intertrochanteric fractures) hospitalized in Xuanwu Hospital Capital Medical University from January 2013 to March 2016 were selected. General data, routine blood test results, biochemical and coagulation indices, and calculated CONUT score, geriatric nutritional risk index (GNRI) and neutrophil-to-lymphocyte ratio (NLR) were collected. All the patients received internal fixation or femoral head replacement procedure, and 1-year postoperative clinic- and telephone-based follow-up with death as an endpoint. Multivariate Logistic regression was used to identify influencing factors of 1-year postoperative mortality. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive value of CONUT score for 1-year postoperative mortality.
Among the 399 patients, 47 died and 352 survived at the end of follow-up. Multivariate Logistic regression analysis found that age〔OR=1.093, 95%CI (1.040, 1.148) 〕, old cerebral infarction〔OR=0.353, 95%CI (0.169, 0.737) 〕, serum creatinine〔OR=1.006, 95%CI (1.002, 1.010) 〕, CONUT score〔OR=1.261, 95%CI (1.005, 1.583) 〕 and NLR〔OR=1.049, 95%CI (1.003, 1.098) 〕 were associated with 1-year postoperative mortality (P<0.05). In predicting 1-year postoperative mortality, the area under the curve of CONUT score was 0.681〔95%CI (0.590, 0.771) 〕 with 4.5 as the optimal cutoff point, 48.9% sensitivity and 83.5% specificity. The area under the curve of NLR was 0.611〔95%CI (0.523, 0.699) 〕, with 7.055 μg/L as the optimal cutoff point, and 47.8% sensitivity and 75.9% specificity.
Age, old cerebral infarction, serum creatinine, CONUT score and NLR were associated with 1-year postoperative mortality in elderly patients with hip fracture. Preoperative CONUT score greater than 5 may be associated with worse postoperative nutritional status and higher risk of death. The CONUT score could be used for postoperative risk assessment in these patients.
Low attenuation area ratio (LAA%) and pectoral major parameters are in elderly patients with COPD related to pulmonary ventilation function, but there are few studies at home and abroad.
To analyze the correlation of LAA% and pectoral major parameters with impaired pulmonary ventilation function in elderly patients with COPD, and to explore the predictive value of LAA% and PMcsa in the severity of airflow restriction, in order to provide clinical basis for the early detection and diagnosis of COPD.
A total of 270 elderly patients with stable COPD who underwent chest CT and lung function examination in North Jiangsu People's Hospital affiliated to Yangzhou University from December 2019 to June 2021 were selected and divided into GOLDⅠgroup (FEVl%pred≥80%, n=47) , GOLD Ⅱgroup (50%≤FEVl%pred<80%, n=88) , GOLD Ⅲ group (30%≤FEVl%pred<50%, n=84) and GOLD Ⅳ group (FEVl%pred<30%, n=51) according to GOLD classification with their general information and CT quantitative indexes recorded. Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between LAA%, pectoralis major areas (PMcsa) and lung function. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of LAA% and PMcsa for FEV1%pred<50% and FEV1%pred<80%.
BMI and PMD in GOLDⅠgroup were higher than those in GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) , and the BMI in GOLD Ⅱgroup and GOLD Ⅲ group was higher than that in GOLD Ⅳ group (P<0.05) . PMcsa, PMI, FEV1%pred, FEV1 and FVC in GOLD Ⅰgroup were higher than those in GOLD Ⅱ group, GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . PMcsa, PMI, FEV1%pred, FEV1 and FVC in GOLD Ⅱ group were higher than those in GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . PMcsa, PMI , FEV1%pred, FEV1 and FVC in GOLD Ⅲ group were higher than those in GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅰ group were lower than those in GOLD Ⅱ group, GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅱ group were lower than those in GOLDⅢ group and GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅲ group were lower than those in GOLD Ⅳ group (P<0.05) . FEV1%pred, FEV1 and FVC were positively correlated with PMcsa, PMI and PMD (P<0.05) . Both FEV1%pred and FEV1 were negatively correlated with low attenuation area ratio (right LAA%, left LAA%, total LAA%) (P<0.05) . Multiple linear regression analysis show that gender, total LAA% and PMcsa were independent influencing factors of FEV1%pred. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV1%pred<50% in male patients were 0.832, 0.827, 0.834, 0.809, respectively. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV1%pred<50% in female patientswere 0.844, 0.801, 0.845, 0.839, respectively. The area under ROC curve of right lung LAA%, Left lung LAA%, total lung LAA% and PMcsa predicting FEV1%pred<80% in male patients were 0.830, 0.815, 0.831, 0.844, respectively. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV1%pred<80% in female patients were 0.805, 0.817, 0.807, 0.846, respectively.
The low attenuation area ratio and PMcsa can assess the severity of airflow restriction in elderly patients with COPD, and can be used as an important tool for early screening and severity assessment of COPD.
Due to susceptibility to multiple chronic diseases, polypharmacy is often needed in older adults, which may easily lead to increased risk of potentially inappropriate medications (PIM) if polypharmacy is accompanied by various alterations in pharmacokinetics and pharmacodynamics of medications. PIM are highly prevalent in older adults, which may be asociated with higher risks of frailty, falls, cognitive decline, and other adverse drug events. In China, the research on PIM is relatively weak, and PIM are insufficiently focused and often managed with non-standardized and non-intelligent approaches in primary care. We systematically reviewed recent studies in the prevalence, screening and assessment tools and management strategies of PIM in older adults, providing theoretical support and practical reference for reducing the harm of PIM and standardizing drug management.
The knowledge-based management model has been widely used in chronic disease management recently. The online-to-offline (OTO) model, a common internet-based chronic disease management model integrating online and offline resources, has been used in disease prevention besides disease treatment, and proven to be effective in supporting chronic disease management. However, there are few studies on the application of OTO model in the management of older adults with diabetes in China.
To explore the influence of OTO model on glycemic control and self-management behaviors in older adults with type 2 diabetes in the community.
By use of convenient sampling, older adults with type 2 diabetes (n=110) who were transferred from a tertiary hospital to five community hospitals in Shenyang were selected from August to October 2020. They were randomly assigned in a 1∶1 ratio, to receive a 12-month usual community-based health management (control group) , or a 12-month OTO model-based health management (intervention group) . The intervention results were evaluated by fasting blood glucose (FBG) , 2-hour postprandial glucose (2 h-PBG) and glycosylated hemoglobin (HbA1c) at baseline, and 6 months and 12 months after intervention, and total score and dimension scores of the Chinese version of Summary of Diabetes Self-care Activities (SDSCA-C) at baseline and 12 months after intervention.
A total of 105 cases (53 in the intervention group and 52 in the control group) who completed the study were finally included. Two groups had was no significant differences in mean levels of baseline FBG, 2 h-PBG and HbA1c (P>0.05) . Significant interaction effects produced by the intervention method and time, and significant main effects brought by both intervention method and time on FBG, 2 h-PBG and HbA1c were observed (P<0.05) . FBG, 2 h-PBG and HbA1c levels in the intervention group decreased significantly either at 6 or 12 months after intervention (P<0.05) . But in the control group, only FBG and 2 h-PBG levels decreased significantly at 6 and 12 months after intervention (P<0.05) . The 12-month intervention lowered FBG, 2 h-PBG and HbA1c levels more significantly than 6-month intervention in the intervention group (P<0.05) . But in the control group, only 2 h-PBG level was lowered more significantly by 12-month intervention than 6-month intervention (P<0.05) . The intervention group had lower mean FBG, 2 h-PBG and HbA1c levels than the control group either at 6 or 12 months after intervention (P<0.05) . At baseline there were no differences between the two groups in total score and dimension scores of SDSCA-C (P>0.05) . After 12 months of intervention, the total score and dimension scores of SDSCA-C increased insignificantly in the control group (P>0.05) , but increased notably in the intervention group (P<0.05) . The intervention group had much higher total score and dimension scores of SDSCA-C than the control group after the intervention (P<0.05) .
The OTO model-based health management could contribute to improving glycemic control and self-management behaviors in older type 2 diabetics, which may benefit effective long-term management of diabetes.
The needs of outpatient services, a key accessible health resource, are increasing in an increasingly aging population in China. So rational allocation of outpatient service resources to meet older people's health needs is a key to improving their health level.
To explore the factors affecting the utilization of outpatient services in the elderly, to provide feasible suggestions for improving older people's health level and the allocation of medical resources.
This study was conducted in 2021 using the data of older people (≥60 years old) attending the CHARLS 2018. The number of using outpatient services in these people in the past month prior to the CHARLS 2018 and associated factors were studied using a system developed based on the framework of Anderson's Behavioral Model of Health Services Use, with sex, age, marital status, the type of hukou (rural or urban), education level, smoking and drinking were classified as predisposing factors, health insurance, monthly household income per capita and the average distance from home to medical institutions as enabling factors, and chronic disease prevalence and self-rated health as need factors. The zero-inflated negative binomial regression (ZINB) was used to identify factors associated with the use of outpatient services.
In all, 9 551 older people were included for analysis. Among them, non-users of outpatient services in the past month numbered 8 038 (84.16%), and one-time, two-time, and three or more-time users numbered 749 (7.84%), 367 (3.84%), and 397 (4.16%), respectively. The number of using outpatient services differed statistically by the type of hukou, education level, smoking, drinking, health insurance prevalence, monthly household income per capita, chronic disease prevalence, and self-rated health status (P<0.05). The results of Logit regression model (one part of the ZINB) in fitting the data indicated that older age, high school education or above, having health insurance, suffering from a chronic disease and poor self-rated health were associated with increased probability of utilizing outpatient services (P<0.05). And the results of negative binomial count model in fitting the data indicated showed that the age of 70-74 years was associated with decreased probability of utilizing outpatient services, while an average distance of greater than 1 km but less than 10 km between home and medical institutions, and three types of self-rated health (good, poor and very poor) were associated with increased probability of utilizing outpatient services (P<0.05) .
Our study indicates that the use of outpatient services was insufficient in these older people, which was associated with predisposing, enabling and need factors. To improve this, it is suggested to rationally strengthen the provision of outpatient services to vulnerable groups with underuse of such services and individuals with needs of high-quality services. In addition, attention should be given to chronic disease management and self-rated health of the elderly to improve their awareness and level of health management.
The Self-rated Fall Risk Questionnaire (FRQ) developed by the US CDC is one of the few questionnaires applied for fall risk self-assessment in community-dwelling older adults, which is thought to be simple and highly applicable. The Modified Falls Efficacy Scale (MFES) is also widely used in the fall risk assessment in older adults. Thus the comparison between the Self-rated FRQ and MFES in identifying fall risk in older adults would be meaningful.
To explore the applicability of the Chinese version of Self-rated FRQ (FRQ-C) in assessing the fall risks in community-dwelling older Chinese adults by comparing it with the Chinese version of MFES (MFES-C) .
A total of 203 seniors above 65 who received physical examination services, treatment services, or vaccination services from the community health center were selected by use of convenience sampling and invited to attend a survey for understanding their demographics, and fall risk rated by the MFES-C and the Self-rated FRQ-C. ROC analysis was conducted to assess the performance (sensitivity, specificity, positive and negative predictive values) of the Self-rated FRQ-C and MFES-C in the prediction of having at least one or two falls in the past year.
Fifty-eight (28.6%) of them fell once or more in the past year. The mean score of the Self-rated FRQ-C for the fall group was higher than that of the non-fall group with a statistically significant difference (P<0.001) . But no significant difference in the mean score of the MFES-C was found between the two groups (P>0.05) . Those with high fall risk assessed by the Self-rated FRQ-C (≥4 points) had higher prevalence of fall (P<0.05) . However, no higher prevalence of fall was found in those with high fall risk assessed by the MFES-C (≤112 points) (P>0.05) . The AUC values in identifying having one or more falls in the past year for the Self-rated FRQ-C and MFES-C were 0.74〔95%CI (0.68, 0.81) 〕 and 0.59〔95%CI (0.50, 0.68) 〕. When identifying having two or more falls in the past year, the AUC value of the Self-rated FRQ-C increased to 0.80〔95%CI (0.70, 0.90) 〕, and that of the MFES-C increased to 0.65〔95%CI (0.52, 0.78) 〕. The sensitivity and specificity of the Self-rated FRQ-C with a threshold of 4 points were 81.0% and 51.7%, respectively, and those of the MFES-C with a threshold of 112 points were 53.5% and 60.0%, respectively.
Compared with the MFES-C, the Self-rated FRQ-C may have higher sensitivity in identifying fall risk in older adults with higher operability and applicability in community settings.
Gait speed and grip strength are simple markers of physical capability, which are associated with adverse outcomes in the elderly. However, there are few studies on the prediction of adverse outcomes in this population by the combination of the two markers.
To investigate the associations of gait speed and grip strength with adverse outcomes in geriatric inpatients.
A cohort design was used in this study. From August 2015 to December 2018, eligible geriatric inpatients aged≥65 years were recruited from Department of Geriatrics, Fuxing Hospital, Capital Medical University. We measured the gait speed and grip strength with 6-meter walking test and dynamometer, respectively. By the gait speed, the patients were divided into tertiles (T1 group: ≤ 0.6 m/s, T2 group: >0.6-0.8 m/s, T3 group: >0.8 m/s). By the grip strength, they were divided into L1, L2 and L3 tertiles (L1 group: ≤ 21.6 kg for males, ≤ 14.6 kg for females; L2 group: > 21.6 kg but ≤ 28.2 kg for males, >14.6 kg but ≤ 19.4 kg for females; L3 group: >28.2 kg for males, >19.4 kg for females). Follow-up was conducted by telephone once every three months within one year after discharge and once half a year after this until December 31, 2019. All-cause mortality and falls were recorded. Survival curves were constructed by the Kaplan-Meier method. Cox regression analysis was used to investigate the association of gait speed, grip strength, or their combination with all-cause mortality and falls. ROC curves for comparing the ability of the two makers or their combination on predicting all-cause mortality and falls.
Among the 685 patients, 29 (4.2%) were lost to follow-up, and the other 656 cases who finished the follow-up with complete data were included for analysis. During the follow-up period, 130 patients (19.8%) died from all causes and 147 patients (22.4%) experienced falls. There were 222, 225 and 209 patients in the low, moderate and high tertiles of gait speed (T1, T2 and T3 groups), and 215, 229 and 212 patients in the low, moderate and high tertiles of grip strength (L1, L2 and L3 groups), respectively. Log-rank test showed that the cumulative survival curves of all-cause mortality and falls differed significantly among T1, T2 and T3 groups (P<0.01). The same results were obtained in L1, L2 and L3 groups (P≤0.01). Cox regression analysis with adjustment for potential confounders showed that compared to patients in high tertiles of both gait speed and grip strength, the risk of all-cause mortality significantly increased in those both in low gait speed and low or moderate tertiles grip strength〔HR=3.29, 95%CI (1.13, 9.55) ; HR=3.09, 95%CI (1.08, 8.85) ; P<0.05〕, and the risk of fall significantly increased in those in low tertiles of both gait speed and grip strength 〔HR=1.92, 95%CI (1.13, 4.27), P<0.05〕. The prediction probability of the joint diagnostic model of gait speed and grip strength was estimated by Logistic regression analysis, and the AUC of the combination of them for predicting all-cause mortality and falls was 0.756 〔95%CI (0.710, 0.801) 〕, and 0.700〔95%CI (0.659, 0.741) 〕, respectively.
In geriatric inpatients, the combination of gait speed and grip strength had higher predictive value for all-cause mortality and falls, which is helpful to optimize the health management.
As population aging progresses, the prevalence of multimorbidity and polypharmacy is increasing in older adults, which may increase the risk of potentially inappropriate medication, causing adverse health outcomes.
To systematically assess the prevalence and associated factors of potentially inappropriate medication in community-dwelling Chinese older adults, in order to provide a reference for developing relevant intervention strategies.
In June 2022, we searched databases of CNKI, CQVIP, Wanfang Data, SinoMed, PubMed, EmBase, and Web of Science from inception to June 2022 for studies on potentially inappropriate medication in community-dwelling older adults in China. Two reviewers independently selected studies, extracted data and assessed the quality of included studies according to the Agency for Healthcare Research and Quality methodology checklist. Meta-analysis was conducted using Stata 12.0.
A total of 24 studies were included, including two with high quality and 22 with moderate quality. Meta-analysis showed that the pooled prevalence of potentially inappropriate medication was 34.8%〔95%CI (31.3%, 38.3%) 〕in community-dwelling older adults in China. Pooled estimates showed 75 years or above〔OR (95%CI) =1.261 (1.074, 1.481) 〕, five or more comorbidities〔OR (95%CI) =3.287 (1.405, 7.691) 〕, and taking five or more medications〔OR (95%CI) =1.800 (1.305, 2.481) 〕or taking 10 or more medications〔OR (95%CI) =4.380 (2.612, 7.347) 〕were associated factors of potentially inappropriate medication.
Potentially inappropriate medication is common in community-dwelling older adults in China, whose risk is associated with older age, multimorbidity and polypharmacy. Prevention and management of potentially inappropriate medication should be paid attention to individuals with the above characteristics.
Population aging is a major challenge in the global healthcare field. Due to pathological and physiological changes in ageing skin, skin injuries are highly prevalent in older population. And epidemiological studies on skin injuries in this population has become a research hotspot recently.
To examine the prevalence and epidemiological characteristics of three types of skin injuries 〔pressure injuries (PI) , incontinence-associated dermatitis (IAD) and skin tears (ST) 〕in elderly inpatients using a multicenter cross-sectional study, providing a basis for formulating strategies for the prevention of skin injuries in older people.
A multicenter study was carried out in 52 hospitals selected from 16 provinces, two autonomous regions and two municipalities of China, from which 1 067 nurses who had completed the online homogenization training conducted by our research group and passed the relevant examination were selectedas investigators. Every 2-3 nurses were divided into a investigation group. Eligible older inpatients were selected as participants. Full body skin examination for screening skin injuries was conducted in participants in each hospital by nurses using the same tools and methods. PI, IAD and ST were defined and classified by relevant international guideline or expert consensus, respectively. Then demographics, length of stay (LOS) , chronic disease history, use of medications in the past month, living independence and risk of PI assessed by the Braden Scale of the participants were collected. After that, two nurses of each group signed to confirm the results, and uploaded to https://www.wjx.cn. SPSS 22.0 was used for statistical analysis.
A total of 14 675 elderly inpatients were investigated, and all of them responded effectively (100.0%) . The respondents had an average age of (73.5±9.0) years and a median LOS of 7 (4, 13) days, among whom 56.3% (8 262/14 675) were men, and 43.7% (6 413/14 675) were women; 95.5% (14 020/14 675) were Han people, and 4.5% (655/14 675) were 19 ethnic minorities. The overall prevalence of the three types of skin injuries was 6.0% (881/14 675) , of which the prevalence of PI, IAD, ST and at least two types of skin injuries was 3.3% (484/14 675) , 1.4% (199/14 675) , 0.8% (110/14 675) and 0.6% (88/14 675) , respectively. Epidemiologic characteristics: Han people had higher prevalence of skin injuries compared with ethnic minorities (6.2% vs 2.9%, P=0.001) . Eighty-year-olds had higher prevalence of skin injuries than 71-80-year-old (10.2% vs 6.1%, P<0.001) and 60-70-year-old (10.2% vs 3.8%, P<0.001) . Those suffering from at least two chronic diseases had higher prevalence of skin injuries compared with those without chronic diseases (5.7%-12.0% vs 2.9%, P<0.005) or those with only one chronic disease (5.7%-12.0% vs 4.4%, P<0.005) . Users of two or more medications had higher prevalence of skin injuries compared with non-medication users (6.1%-10.2% vs 2.7%, P<0.005) or users of one medication (6.1%-10.2% vs 4.6%, P<0.005) . Those with LOS of over 30 days had higher prevalence of skin injuries compared with those with LOS of 8-30 days (10.7% vs 4.4%, P<0.016 7 ) or ≤7 days (10.7% vs 7.1%, P<0.016 7) . The prevalence of skin injuries in those with PI risk was higher than that in those without risk (20.5% vs 1.6%, P<0.05) . The prevalence of skin injuries in dependent-living individuals was higher than that of independent-living individuals (7.0% vs 0.9%, P<0.05) . The frequently-occurring sites were caudal sacral (57.9%) and heel (14.3%) for PI, peri-anal region (68.3%) and hip fissure (24.6%) for IAD, and lower limbs (38.2%) and upper limbs (28.2%) for ST. PI combined with IAD mostly occurred in sacrococcygeal region (71.0%) . PI combined with ST were common in sacrococcygeal region (50.0%) and heel (35.7%) . ST combined with IAD mostly occurred in caudal sacral (33.3%) , perianal region (33.3%) and gluteal fissure (33.3%) . PI, IAD and ST coexisted mostly in caudal sacral (50.0%) and gluteal fissure (50.0%) .
The prevalence of skin injuries in Chinese older people is high, and may increase with age, prevalence of chronic diseases and use of systemic medications, and dependent-living. In particular, PI risk may be associated with significantly higher possibility of developing skin injuries. Coexistence of multiple types and anatomical sites of skin injuries are important characteristics. The above-mentioned epidemiologic characteristics should be considered when formulating prevention strategies of skin injuries in the elderly.
There are few studies on the relationship between sleep time and falls at present, and the research results are inconsistent.
To explore the relationship between sleeping time and falls in middle-aged and elderly residents in China, and to provide reference for preventing falls in this population.
The study based on the data from China Health and Retirement Longitudinal Survey (CHARLS) data in 2015. 18 181 subjects aged ≥45 years with complete key data were included. Collect the indicators of the middle-aged and old people in the past two years, such as falls and medical treatment, sleep time, demographic characteristics, behavior and lifestyle, health status, self-life satisfaction and self-rated health. The subjects were divided into 5 groups according to the sleep time per night: <5 h (2 945 cases) , 5-<6 h (2 755 cases) , 6-<7 h (reference group, 3 824 cases) , 7 to <8 hours (3 257 cases) and ≥8 hours (5 400 cases) . Logistic regression model was used to adjust different variables to gradually evaluate the relationship between sleep time and the occurrence of falls and medical treatment for falls in the past two years.
The average sleeping time of middle-aged and elderly people was (6.4±1.9) hours, the incidence of falls in the past two years was 17.01% (3 092/18 181) , and the rate of medical treatment for falls was 6.95% (1 264/18 181) . The incidence of falls in subjects with sleep time <5 h, 5-<6 h, 6-<7 h, 7-<8 h and≥8 h were 25.26% (744/2 945) , 19.82% (546/2 755) , 15.51% (593/3 824) , 14.03% (457/3 257) , 13.93% (752/5 400) , the incidence of falling to hospital was 10.97% (323/2 945) , 8.09% (223/2 755) , 6.04% (231/3 824) , 5.43% (177/3 257) and 5.74% (310/5 400) , which were significant differences demonstrated by the trend chi-square test, and the difference was statistically significant (P<0.05) . Compared with 6-<7 hours after adjusting factors such as age, gender, those with sleeping time ≥8 hours had a significantly lower risk of falling〔OR (95%CI) =0.88 (0.78, 0.99) 〕, and those with sleeping time <5 h and 5-<6 h had a significantly higher risk of falling〔OR (95%CI) <5 h=1.31 (1.16, 1.49) , OR (95%CI) 5-<6 h=1.14 (1.00, 1.30) 〕. The middle-aged and old people who slept less than 5 hours per night had a higher risk of falling and seeking medical treatment〔OR (95%CI) =1.30 (1.08, 1.56) 〕.
The incidence of falls in middle-aged and elderly people in China is relatively high, sleep time <6 hours per night will increase the risk of falls, and sleeping≥8 hours may reduce the risk of falls. Adjusting sleeping time of middle-aged and elderly people and strengthening lifestyle intervention can effectively reduce the incidence of falls in the middle-aged and elderly people.
The older adults are high risk population for malnutrition. Malnutrition is closely associated with numerous adverse clinical outcomes, which may seriously affect the physical health and life quality of the older adults, causing heavy burdens on families and society. Therefore, it is of great importance to take effective measures to improve malnutritionin the older adults, and non-pharmacological interventions have been proved to be important measures to improve nutritional status. However, there is no domestic clinical practice guideline for non-pharmacological interventions specifically for malnourished older adults. Therefore, nutrition experts from China Gerontological Nursing Alliance, National Center for Gerontology and National Clinical Research Center for Geriatric Disorders developed the guideline based on the Grading of Recommendation Assessment, Development and Evaluation (GRADE) including 9 recommendations of non-pharmacological intervention formal nourished older adults through a comprehensive search and analysis of the latest domestic and international literature on malnutrition in the elderly, in order to improve malnutrition and quality of life in the older adults. This guideline focuses on malnourished older adults who can be fed orally and enteral nutrition, parenteral nutrition is not covered by the scope of this guideline.
The Beers criteria is a tool for evaluating potentially inappropriate medication (PIM) in elderly patients widely used in various fields, such as clinical practice, teaching research, supervision and administration. The 2023 American Geriatrics Society Beers criteria (AGS Beers criteria) for PIM use in older adults are the seventh overall update, using the development methodology following previous versions, which includes the rigor of the evidence review and synthesis process. This paper provides a detailed interpretation of the new version of AGS Beers criteria. The AGS Beers criteria aims to reduce the incidence of PIM in older adults by optimizing drug selection. The 2023 AGS Beers criteria can also be used in the education of clinicians and patients, assessment of care quality, health care costs and drug use patterns in older adults. In addition to the five tables associated with PIM as main contents, several drugs and criteria have been added based on updated evidence, mainly on the revisions and streamlining of existing drugs and criteria. The added and revised content mainly involves anticoagulants, antiplatelet agents and hypoglycemic agents. The synthesis of anticoagulation recommendations has been added in the new version of AGS Beers criteria. Thirty-three drugs were removed due to low usage or not on the U.S. market. The 2023 AGS Beers criteria summarizes seven principles on the application of Beers criteria to ensure proper clinical use. Overall, the 2023 AGS Beers criteria have improved its accuracy and utility, which can better identify and reduce PIM prescriptions for the elderly patients and further guide the clinical development of rational drug use regimens.
Chinese aging population degree will transform mild to moderate. During addressing aging issues by proactive national strategies and healthy aging strategies, the sleep health of older peoplecannot be ignored.
To explore the effect of working after retirement on sleep quality in Chinese older people, providing relevant reference data for improving sleep quality in this group of people.
In August 2021, data of working after retirement prevalence and sleep health in subjects aged ≥60 years (n=7 862) were obtained from the 2018 China Family Panel Studies (CFPS) conducted by Peking University with permission. They were divided into working after retirement and non-working after retirement groups by working after retirement prevalence. Normal sleep duration (within 4 to 10 hoursper night) , abnormal sleep duration (≤4 or ≥10 hours per night) , sleeping late (going to bed after 23 o'clock) in accordance with relevant diagnostic criteria used in international studies on sleep health in middle-aged and older people. Self-reported perceptions of sleep quality were classified into optimistic and pessimistic according to subjective evaluation of sleep efficiency and effect. Binary Logistic regression model was used to explore the effect of working after retirement on sleep duration, perception of sleep quality and the time to go to sleep.
Among the subjects, 5 705 (72.56%) had optimistic sleep quality, 6 508 (82.78%) had normal sleep duration, and 7 464 (94.94%) went to sleep earlier than 23: 00, and 4 005 (50.94%) still worked after retirement. After controlling for age, gender, maritalstatus, education level, personality traits and other factors, working after retirement was associated with increased probability of higher optimism with sleep quality〔OR (95%CI) =1.205 (1.069, 1.358) 〕, more normal sleep duration〔OR (95%CI) =1.306 (1.137, 1.499) 〕, and earlier time to go to sleep〔OR (95%CI) =1.596 (1.253, 2.033) 〕.Working after retirement was associated with increased probability of good sleep quality (P<0.05) .
As working after retirement may be contributive to good sleep quality in older people, it should be supported and guaranteed by governmental policies.
Factors Associated with Older Adults' Intention to Use Community-based Elderly Care：a Study Using the Decision Tree and Logistic Regression Models
Community-based elderly care may effectively contribute to the handling of serious elderly care challenges brought by an increasingly aging population in China.
To explore the factors associated with older adults' intention to choose community-based elderly care using the decision tree and Logistic regression models.
This questionnaire survey was conducted in three communities selected from Daqing by convenient sampling from August to December 2020. 500 eligible community-dwelling older adults (≥60 years old) were selected as the research objects. The decision tree and Logistic regression models were used to explore factors associated with these older adults' intention to choose community-based elderly care via analyzing their demographics, self-rated physical and mental health, and family and social support collected by the survey.
Altogether, 489 cases (97.8%) who effectively responded to the survey were included for analysis. The prevalence of intending to choose community-based elderly care in the respondents was 32.5% (159/489) . Logistic regression analysis revealed that the older adults' understanding level of community-based elderly care, views of elderly care, sense of loneliness, and intergenerational relationship had varying degrees of influence on their intention to choose community-based elderly care (P<0.05) . The decision tree analysis found that the older adults' understanding level of community-based elderly care, views of elderly care, sense of loneliness, social network, self-rated health, education level, and living status (alone or not) were key factors influencing their intention to choose community-based elderly care (P<0.05) . By both Logistic regression and decision tree analyses, understanding level of community-based elderly care, views of elderly care, and sense of loneliness were found to be three factors influencing older adults' intention to use community-based elderly care most. In exploring the factors associated with older adults' intention to choose community-based elderly care, Logistic regression analysis had an AUC of 0.985 (0.974, 0.996) with 94.34% sensitivity and 95.75% specificity, and decision tree analysis had an AUC of 0.980 (0.968, 0.992) with 88.05% sensitivity and 97.87% specificity, the performance of the two was similar (Z=-0.625, P=0.268) .
The combination of decision tree and Logistic regression model has high application value in the study of influencing factors of community pension willingness of the elderly. The prevalence of intending to use community-based elderly care was relatively low in Daqing older adults. To improve this, it is suggested to take actions to change older adults' traditional views of elderly care, to better their physical and mental health and family relationships.
Chronic heart failure is a syndrome occurring at the end-stage of multiple cardiovascular diseases. In the condition, nutritional and metabolic problems such as loss of appetite, diarrhea, abdominal distension, and constipation are highly prevalent, which in turn affect the prognosis of heart failure. The relationship of nutritional assessment results with prognosis in chronic heart failure has been studied extensively, while nutritional assessment for older adults with chronic heart failure has been rarely studied, and there is no clinically recognized assessment method.
To perform a comparative analysis of four nutritional assessment methods in terms of clinical prognosis prediction in elderly patients with chronic heart failure.
Eligible older inpatients with chronic heart failure (n=199) were recruited from Department of Cardiology, ICU, and Department of Geriatrics, Linyi People's Hospital from June 2018 to June 2020. Data were collected via reviewing the medical records and telephone-based follow-ups, including sex, age, height, weight, serum albumin (ALB) level, BMI, Geriatric Nutritional Risk Index (GNRI) , and result of Nutrition Risk Screening 2002 (NRS2002) , as well as prognosis〔containing three classifications: in-hospital deaths (n=43) and in-hospital survivors (n=156) ; one-year deaths (n=51) and one-year survivors (n=148) ; readmission within half a year (n=69) and readmission after half a year (n=130) 〕. Multivariate Logistic regression analysis was used to explore the prognostic factors of chronic heart failure. The analysis of ROC curve with AUC value was carried out to comparatively estimate prognosis predictive values of the nutritional assessment methods.
There were significant differences in mean age, serum ALB, GNRI and NRS2002 score between in-hospital deaths and survivors (P<0.05) . The mean age, height, serum ALB, GNRI and NRS2002 score were also significantly different between one-year deaths and survivors (P<0.05) . Those with readmission within half a year had significantly different mean BMI, serum ALB, GNRI and NRS2002 score compared with those with readmission after half a year (P<0.05) . For predicting in-hospital death, the AUC of serum ALB was 0.76〔95%CI (0.68, 0.84) , P<0.001〕, and that of NRS2002 score was 0.80〔95%CI (0.73, 0.86) , P<0.001〕. In predicting one-year death, the AUC of serum ALB was 0.75〔95%CI (0.67, 0.82) , P<0.001〕, and that of NRS2002 score was 0.82〔95%CI (0.76, 0.88) , P<0.001〕. The AUC of NRS2002 score in predicting readmission within half a year was 0.73〔95%CI (0.65, 0.80) , P<0.001〕.
On the whole, NRS2002 score could be the first choice for prognostic assessment in elderly patients with chronic heart failure, for it was more effective in predicting the risks of in-hospital death, one-year death and readmission within half a year than serum ALB level, GNRI and BMI.
Chronic diseases have become an important public health problem that affects the economic and social development of country and population health. Quantifying the disease and economic burden of the elderly can provide a better understanding of the impact of chronic diseases on individuals and society.
To understand the prevalence of common chronic diseases among the elderly in Shanxi Province and explore the quality-adjusted life year (QALY) loss and economic loss which caused by chronic diseases.
From June to August in 2019, a multi-stage random sampling method was used to select 3 250 elderly people aged≥ 60 years from 11 cities in Shanxi Province as the research subjects for a questionnaire survey. The questionnaire included general demographic information, disease status survey, and health-related quality of life status. The European Five-Dimensional Health Scale (EQ-5D-5L) was used to assess the health-related life quality of the elderly. The QALY loss caused by chronic diseases was calculated based on the Chinese EQ-5D-5L utility value score system, and the QALY loss and economic loss caused by common chronic diseases in Shanxi Province in 2019 were estimated by using population and GDP per capita from statistical bulletin.
The results of univariate analysis showed that there were significant differences in the utility value of EQ-5D-5L among the elderly with different ages, living regions, educational levels, marital status, and family per capita monthly income (P<0.05) . The results of multiple linear regression analysis showed that higher per capita monthly income of families, being married and younger age were the protective factors for the health utility value of EQ-5D-5L (P<0.05) . The prevalence of chronic diseases among the elderly in Shanxi Province was 58.49% (1 901/3 250) . The top 5 chronic diseases by prevalence were: hypertension 29.45% (957/3 250) , diabetes 10.83% (352/3 250) , rheumatism or rheumatoid arthritis 10.28% (334/3 250) , hearing impairment 8.09% (263/3 250) , gastritis or peptic ulcer 6.49% (211/3 250) . Based on the estimation of the total population of Shanxi Province, the loss of QALY caused by five common chronic diseases in Shanxi Province in 2019 was 2 078 685 years, and the economic loss was 95 045 792 940yuan. The chronic disease causing the most QALY loss and economic loss in Shanxi Province was rheumatism or rheumatoid arthritis in Datong, Taiyuan and Luliang; in Jincheng, Yangquan city was hearing impairment; In Jinzhong, Linfen, Yuncheng, Shuozhou, Xinzhou, Changzhi City was hypertension.
The prevalence of chronic diseases among the elderly in Shanxi Province was relatively high, and chronic diseases will not only cause the loss of QALY of the elderly, but also cause a huge economic burden. Common chronic diseases vary by region in Shanxi Province, each region should determine the priority of disease prevention and treatment according to the actual situation, identify the key objectives and population of health management, so as to achieve a multiplier effect.
Special Issue: Geriatric Diseases
