基于老年综合评估的全程“微信”个案健康管理在体检老年人中应用的成效 [中文引用][英文引用]

目的  探讨基于老年综合评估（comprehensive geriatric assessment，CGA）的全程“微信”个案健康管理模式在体检老年人中的应用成效，旨在提升老年人健康行为能力。方法  采用随机对照试验方法，选取 2022 年 7 月至 2023 年 6 月于本院特需医疗中心门诊体检的老年人 100 例，采用随机数字表法将其分为对照组和试验组各 50 例。两组均进行 CGA，对照组采用常规健康管理，试验组实施基于 CGA 的全程“微信”个案健康管理。分别在干预前、干预 3 个月、6 个月和 12 个月时比较两组老年人的健康行为能力自评量表（self-rated abilities for health practices scale，SRAHP）评分；分别在干预前、干预 12 个月时比较两组老年人衰弱状况量表（fatigue，resistance，ambulation，illnesses，& loss of weight scale，FRAIL）、微型营养评定简表（mini nutritional assessment-short form，MNA-SF）评分；比较干预后两组老年人跌倒发生率。结果  所有患者均完成研究。重复测量方差分析结果显示，两组 SRAHP 总分在时间主效应、组间主效应与交互效应均有统计学显著性（F 时间 =193.451，P<0.001；F 组间 =23.661，P<0.001；F 交互 =29.970，P<0.001），进一步分析发现，干预 6 个月和 12 个月时试验组 SRAHP 总分高于对照组（均P<0.001）；干预 12 个月时试验组患者衰弱程度与营养状况优于对照组（均 P<0.05）；跌倒发生率试验组低于对照组（P<0.05）。结论  基于 CGA 的全程“微信”个案健康管理模式能有效提高体检老年人健康行为能力，改善衰弱和营养状况，降低跌倒发生率，可为老年健康管理提供参考。

Objective To study the effect of incorporating comprehensive geriatric assessment（CGA）into the whole-process WeChat-based case health management in elderly population who took annual physical examinations，thereby to improve their ability in health self-management. Methods A randomised controlled trial was conducted to select 100 elderly people who took annual physical examinations in our hospital from July 2022 to June 2023. The elderly were randomly divided into a control group and an trial group， with 50 people per group. CGA was applied to both groups，but the control group was under conventional health management，while the trial group received the incorporation of CGA into a whole-process WeChat-based case health management. The self-rated abilities for health practices scale（SRAHP）was used to compare the scores between the two groups before intervention，at 3，6 and 12 months after intervention. The scores of fatigue，resistance，ambulation，illnesses & loss of weight scale（FRAIL）and the mini nutritional assessmentshort form（MNA-SF）were compared between the two groups before intervention and at 12 months after intervention. Incidence of falls was also evaluated after intervention. Results All the participants completed the study. Repeated measures analysis of variance showed that total SRAHP scores had statistical significances in main effect on time，group and interaction（Ftime=193.451，P<0.001； Fgroup=23.661，P<0.001；Finteraction=29.970，P<0.001）. Further analysis revealed that the elderly in trial group had higher total scores in SRAHP than those in the control group at 6 and 12 months after intervention（both P<0.001）. At 12 months after intervention，the trial group showed better scores in FRAIL and MNA-SF than the control group（both P<0.05）as well as with a lower incidence of falls（P<0.05）. Conclusion Incorporation of CGA into a comprehensive WeChat-based case health management，over a long-term，can effectively enhance the ability in health self-management among elderly individuals who take annual health examinations，improve frailty and nutritional status and reduce the incidence of falls. The health self-management discovered from this study provides a valuable reference for health management among the elderly people who take annual physical examinations.