Analiza indikatora i razvoj pouzdanog alata za procjenu fragilnosti kod osoba starije životne dobi u Bosni i Hercegovini/

Abstract

Uvod. Starenje je neizbježan proces koji postaje i javnozdravstveni problem. Fragilnost je vrlo učestala u populaciji starih osoba i sa sobom nosi rizik od loših zdravstvenih ishoda, uključujući povećanu smrtnost, institucionalizaciju, padove i hospitalizaciju. Primarni cilj studije bio je da se na osnovu korištenih upitnika, antropometrijskih i biohemijskih parametara formira jednostavan i pouzdan skrining upitnik za procjenu fragilnosti kod osoba starije životne dobi u Bosni i Hercegovini a primjenljiv u ambulanti porodične medicine. Sekundarni cilj bio je da se odrede referentne vrijednosti antropometrijskih mjerenja, funkcionalnih, nutritivnih, psiholoških, socijalnih i laboratorijskih indikatora fragilnosti. Metodologija. Studija presjeka je obuhvatila 510 osoba starijih od 65 godina starosti. Funkcionalni status ispitivan je pomoću Tinetti testa procjene hoda i ravnoteže. Fizička ograničenja su procijenjena i pomoću upitnika za dugotrajnu invalidnost Organizacije za ekonomsku saradnju i razvoj. Lawtonov-om skalom procijenjene su instrumentalne aktivnosti svakodnevnog života, a dnevne bazične pomoću Katz-ovog indeksa. Opšti upitnik za brzi skrining sarkopenije SARC-F korišten je kao potencijalni brzi skrining test na sarkopeniju, a procjena sarkopenije obuhvatila je i stisak šake, ustajanje sa stolice, Test ,,ustani i idi“, brzinu hoda, obim potkoljenice i obim nadlaktice. Antropometrijska mjerenja su obuhvatila indeks tjelesne mase, obim nadlaktice i obim srednje cirkumferencije potkoljenice. Nutritivni status procijenjen je pomoću Mini Nutritivna skala – MNA, a procjena socijalnog domena je izmjerena primjenom De Jongove skale usamljenosti i korištena je Kesler-ova skala psihološke uznemirenosti. Urađeni su sljedeći laboratorijski biomarkeri: laboratorijska analiza markera inflamacije CRP-visoko senzitivni, metabolički marker HbA1C i albumin kao serumski marker. Rezultati. Rezultati su pokazali da osobe sa sarkopenijom imaju veći broj hroničnih bolesti, broj posjeta ljekaru porodične medicine zbog ozbiljnih stanja i stanja koja nose rizik od umiranje, broj hospitalizacija i operativnih zahvata, kao i broj lijekova koje koriste. Uočeno je da ispitanici koji imaju sarkopeniju imaju i znatno veći procenat ozbiljanog poremećaja psihološkog distresa u odnosu na ispitanike koji su bili bez sarkopenije. Ispitanici muškog pola su imali veće vrijednosti tjelesne težine, visine, veći obim struka, obim nadlaktice, kao i obim srednje cirkumferencije potkoljenice u odnosu na ženski pol. Negativna korelacija pronađena je između tjelesne visine i SARC-F upitnika (p=0,044) a pozitivna između pomenutog upitnika i obima struka (p=0,003) kod žena, dok je kod muškaraca zabilježena negativna korelacija pomenutog upitnika i obima srednje cirkumferencije potkoljenice (p=0,025), što potkrepljuje činjenicu povezanosti sarkopenije i fragilnosti sa vrijednostima antropometrijskih parametara. Osobe koje su imale sarkopeniju imale su veće vrijednosti CRP-a u odnosu na osobe bez sarkopenije, što nije slučaj kada su u pitanju vrijednosti albumina i HbA1C-a. Zakjučak. Procjena fragilnosti treba uključiti detaljnu anamnezu, procjenu aktuelnog oboljenja, ispitivanje funkcionalnog, psihološkog i sociološkog statusa, određivanje antropometrijskih i laboratorijskih parametara. Granične vrijednosti obima struka se moraju prilagoditi starijoj populaciji, i vrijednosti CRP-a se mogu koristiti u sklopu analize drugih parametara za procjenu fragilnosti. Novi upitnik za procjenu fragilnosti je pouzdan i može se koristiti u ambalnti porodične medicine.

Introduction. Aging is an inevitable process that is also becoming a public health problem. Frailty is very common in the elderly population and carries with it the risk of poor health outcomes, including increased mortality, institutionalization, falls, and hospitalization. The primary aim of the study was to form a simple and reliable screening questionnaire for assessing frailty in elderly people in Bosnia and Herzegovina, based on the used questionnaires, anthropometric and biochemical parameters, which is applicable in family medicine. The secondary aim was to determine the reference values of anthropometric measurements, functional, nutritional, psychological, social and laboratory indicators of frailty. Methodology. This cross-sectional study included 510 persons older than 65 years of age. Functional status was examined using the Tinetti test for assessing gait and balance. Physical limitations were also assessed using the long-term disability questionnaire of the Organization for Economic Cooperation and Development. Instrumental activities of daily life were assessed using the Lawton scale, and daily basic activities using the Katz index. The general questionnaire for rapid screening of sarcopenia SARC-F was used as a potential rapid screening test for sarcopenia, and the assessment of sarcopenia including hand grip, standing up from a chair, "get up and go" test, walking speed, midupper arm circumference (MUAC) and calf circumference (CC). Anthropometric measurements included body mass index, upper arm circumference and lower leg circumference. Nutritional status was assessed using the Mini Nutritional Scale - MNA, and the assessment of the social domain was measured using the De Jong Loneliness Scale and the Kessler Psychological Distress Scale was used. This laboratory biomarkers were analyzed: laboratory analysis of inflammation markers CRP-highly sensitive, metabolic marker HbA1C and albumin as a serum marker. Results. The results showed that people with sarcopenia have a higher number of chronic diseases, higher number of visits to the family medicine doctor due to serious conditions and conditions that carry the risk of dying, higher number of hospitalizations and surgeries, as well as the number of medications they use. It was observed that subjects with sarcopenia have a significantly higher percentage of serious psychological distress disorder than subjects without sarcopenia. Male respondents had higher values of body weight, height, larger waist circumference, upper arm circumference, as well as lower leg circumference in comparison to females. A negative correlation was found between body height and the SARC-F questionnaire (p=0.044) and a positive correlation between the mentioned questionnaire and waist circumference (p=0.003) in women, while in men a negative correlation was recorded between the aforementioned height and the circumference of the middle leg circumference (p=0.025). Which supports the fact that sarcopenia and frailty are related to the values of anthropometric parameters. People who had sarcopenia had higher CRP values compared to people without sarcopenia, which is not the case when it comes to albumin and HbA1C values. Conclusion. Assessment of frailty should include detailed anamnesis, assessment of current illness, examination of functional, psychological and sociological status, determination of anthropometric and laboratory parameters. Limit values of waist circumference must be adapted to the elderly population, and CRP values can be used as part of the analysis of other parameters to assess frailty. The new questionnaire for assessing frailty is reliable and can be used in ambulatory of family medicine.