TAP CHi NGHIEN CLTU Y HOC ~
MOT SO DAC OI^M DjCH TE HOC SA SUT TRI TUE 0 NGU'O'I CAO TU6l TAI HAI QUAN, HUYEN HA NQI
Le Van T u a n \ Hoang Van T a n ^ Le Du'c Hinh' 'Sp Giao due va Dao t^o.
^Vien Ve smh Dich tS Trung wang. ^Trw&ng Dai hoc Y Ha %"
Myc tieu nghien cwu cat ngang mo ta mdt s6 dac diem djch td hpc sa sut tri tud d ngw&i cao tuoi t^i hai xa ngoai thanh cua huypn Sdc Son va hai phwong ndi thanh cua guan Ddng Da, thanh phd Ha Ndi dwoc tien hanh tren quin the 1.767 ngw&i cao tuoi vao thing 9 nam 2010- Kdt qua:Ty Id mac sa siit tri tup H 4.24%, tmng dd tai hai xa ngoai thanh la 5,06%, tai hai phw&ng npi thanh li 3,56% Dp tuoi cing cao cd ty 1$ mic benh cang cao Ty le mic bdnh giam din khi hoc vin cang cao Mot s6 ydu td lien quan la ban than co Hen sw tai bidn mach nao (20,8%). tien sCr ban than giam tri nh& (8.5%) va gia dinh cd ngw&i giam tri nho (8,1%).
TO khoa: sa sut tri tue, ngu'O'i cao tuoi, dac d i l m djch t l
I. DAT
V A N O ^S u gia tgng dan sd gia hien nay cd d lat ea cac nudc phat t n l n , dac bidt tang manh d cac nudc dang phat t n l n va cdn nghdo Bung no dan sd ngudi eao tudi dat ra nhilu thgch thirc mdl cho mdl qudc gia trdn eac mat xa hdi, kmh t l va dieh vu y te [1]
O Vigt Nam, Irong 25 nam qua khdng nh&ng sd ngudi cao tuoi dang tang len nhanh chdng (4,6 tneu ngm 1989, 6,2 tngu nam 1999 vg 9,1 tneu nam 2004) ma ty le ngudi cao tuoi trong dan sd cung tang len tuang irng la 7,10%, 8,12% va 8,95% Theo d y bao, trong 25 nam tdi, ty Id ngudi eao luoi se lang gap ddi len tdl 16% [2] Ciing vdi s u "gia hoa dan s6", md hinh benh tat d Viet Nam eung dang thay doi rd ret, trong dd sa sut tn tue gay anh hudng nghigm trong d i n c h i t luang sdng eua ban than ngudi eao tudi cung nhu ngudi nha benh nhan Tuy nhign, lai Vigt Nam, d i n nay mdl cd mdt sd it cdng Irinh nghign eiru v l sa
Dia chi hen he Le Van Tuan, Vu Cong tac HSSV. Bd Giao due va Dao tao
Email Muan@moet edu vn Ngaynhan 29/12/2013 Ngay auoc chap thuan 28/4/2014
sut tri tue, chu ygu nghign ciru trgn lam sgng, chua ed eac sd lieu ve dich l l hoc
c a c nghign ciru dich tg hoc trgn t h l gidi dS chl rd. D l phdng tranh va d i l u In hieu qua sa silt tri tug, mdt trong eae xu hudng hign nay Ici phat hien s d m va kiem soat tdt eae y l u to nguy ca sa siit Iri tue vdi hy vong iam giam hoae eham khdi phat bgnh [3] Dk phat hien sam sa sut tri lue d n g u d i eao ludi tai mot khu v y c la thanh phd Hg Npi, c l n phai tiln hanh khao sat xac dmh ly le sa siit tri tug va xac dmh cae y l u td nguy co mdl each quy md trgn ngudi eao tuoi d Ha Ndi X u l t phat t u nhii'ng iy do trgn, chung tdi t i l n hanh nghign ciru dg tai "Mdt sd dac d i l m djch te hoc sa sill tri tue d n g u d i cao ludi tai mot so quan, huyen Hg Ndi" n h l m muc lieu: Md ta^
mdt s6 dac diem djch l l hpe sa sut tri tu0 a ngudi eao tudi lai m d l sd xa, phudng thuOc hai quan, huyen Ha Ndi
II. OOl TU'gNG VA PHU'ONG PHAP
1. D6i tu'O'ng
Ngudi cao tuoi tir 60 tuoi t r d lgn dang smh song trgn dia ban cua thanh pho Ha Ndi, du'OC lua chon vao nghign c u u theo cgc tigu chuin
TCNCYH 87 (2) - 2014
• TAP CHI NGHIEN CUOJ Y HOC sau: ti> 60 tuoi t r d len, cd hd khau thudng trii
va dang sinh sdng lai khu vue nghidn eiru, khdng phan bigt gidi linh, t u nguygn tham gia vg hap tac nghign ciru, cd trinh dp hoe v l n lir bilt doc - b i l l viet trd len Khdng dua vgo nghign ciru ngudi gia y l u , bj d i l c , Ida, due thCiy tinh the, liet nua ngudi
2. Dja d i l m nghien c i i ' u : B i n xg, phudng thudc mgt quan vg mdt huyen cua Thanh phd Ha Ndi, xa Thanh Xuan va Minh Tri thude huygn Sdc San, phudng Phuang Mai va Kim Lign thupc qugn Ddng Da
3. Thd'i gian nghien CLPU: tir thgng 9 nam 2010 d i n mang 9 nam 2012
4. Phu'O'ng p h a p : nghien eiru md la vdi thilt k l cat ngang
- C d mau nghign cuu:
Sir dung cdng thdc tinh ed mau [4] sau P (1 - P) n = ? ( 1 • on.)
Trongdd n ed m l u nghign eiru, ZJI.QC) Hg s6 tin cgy, Vdi a = 0.05 va do tm eay la 95% ~
> Z(i_a;2i - 1.96, p. ty lg hign m l c sa siit tri tug d ngudi tren 60 luoi tai edng ddng ^ 4,63%
(lay theo k i t qua nghien eiru trude do [5], d dd ehinh xac tuygt ddi, chon d = 0,015 Tic cdng thirc tinh d u a c ca m l u c l n nghien ciru lai mdt khu vue (n = 800) Du k i l n cd khoang 5% (40 ddi tuang) khdng hap tac nghien ciru tai mdi khu vue (ndi va ngoai thanh) Do dd, mdl khu vyc c l n nghien eiru c d m l u n = 840 T6ng so ngudi cao tuoi c l n d i l u tra tai hai khu virc ngi va ngoat thanh cua thgnh phd Ha Ndi
= 840 X 2 = 1.680 (ngudi cao tuoi).
- Ky thuat chgn mau: Thdnh phd Ha Ndi flLFp'c ehia thanh hai khu vue ndi thanh va ngogi thanh, mpt qugn va mdt huygn eua hai khu vyc dup'c ehpn lam dia diem nghign ciru
Chpn chu dich qugn Ddng Da vg huygn Sdc San Chon ngau nhien phudng Phuang Mai va Kim Lign eua quan Ddng Da va hai xa Thanh Xugn va Minh Tri cua huygn Sde San Lap danh sgch loan bd sd ngudi cao tuoi tir 60 tuoi trd lgn cua bdn xa, phudng duae chon iam dia d l l m nghidn ciru neu trgn. T i l n hanh chon m l u theo phuang phap "edng liln eong"
- Quy trinh nghien ciru, ky thuat, cdng cu thu thap thdng tin: theo 2 budc
Budc 1 D i l u tra sang loc.- d i l u tra vign d i n tan nha tung hd gia dinh cd ngudi cao tuoi va t i l n hanh phdng van theo m l u philu in san va danh gig sgng loe b l n g t r i e nghiem danh gia trang thai tam tri thu nhd MMSE (Mini Mental State Examination) [6] Nhirng ddi tuong ed bleu hien nghi ngd sa sut tri tud (tdng d l l m t r i e nghiem MMSE £ 23 diem) se duae danh gia chuydn sau d bude 2 b l n g eac bieu mau t i l p theo dk cd e h i n dodn ehinh xac
Bude 2 D i l u tra, ddnh gig chuyen sau Ngudi cao tuoi nghi ngd sa siit tri tue duae mdl d i n Phdng kham t h i n kmh - tam ly duae bo tri ngay tai cdng ddng, duac danh gig eac chirc nang nhan thirc khac nhau Chan dodn sa sut tri tue theo eac lieu ehuan sach T h i n g ke C h i n doan benh Tam t h i n l l n thir t u DSM-
!V[1]
- Bien so va chi so nghien cu-u + Cae bien sd ve thdng tin chung va t i l n sir cua ngudi cao tudi Tuoi, gidi tinh, trinh do hoc v l n , mdt sd b i l n sd v l t i l n sir m l c benh tang huylt ap (theo tidu c h u i n eua Uy ban hen Qudc gia VII [7]), tai b i l n mach nao cu {ed thilu sdt t h i n kmh khu trii xay ra ddt ngdt tdn tai trgn 24 gid [8]), benh tim-maeh, giam tri nhd, dai thao dudng, tang lipid mau vg mdt so benh khge lien quan
+ Cae b i l n sd sgng loc, xae dmh ty le hien m l c sa silt tri tud va yeu to nguy ca cua sa
TCNCYH 87 (2)-2014
TAP CHi NGHIEN C U U Y HOC
sut tri tue theo cac nhdm nguy c a benh tim maeh, c h u y i n hoa, lam ly-xa hdi va n i p s6ng
- Phu-o-ng phap khdng chi sai s6: Sai s6 ky thuat- t h l y thudc chuyen khoa I h y c hien.
Sai sd nhd lai T h i l l k l phieu rd. Sai sd do v i n g mat: thdng bgo ro, hai l l n khdng gap thi loai- Sai sd d u . chpn ngudi d i n d u d n g . Sai so vgo sd lieu: giam sal ky, nhap vg x u ly s6 lieu do ehu nhigm d l tgi thuc hien
5. Xu- ly s 6 lifiu: 8 6 lieu dyp'c x u ly bang p h l n mem SPSS 17.0.
6. Oao di>c t r o n g n g h i e n CIPU Muc tieu nghien ciru n h l m hoan thien thdng tin v l sa siit tri tue, thdng tin ca nhan d u a c giiJ bi mat, ddi l u a n g l y nguyen. Benh nhan dup'c kham va phat m p l sd thuoc mi^n phi tiiy theo s i r r khoe ngudi benh
I I I . K ^ T Q U A
Bang 1. Ty le mSc sa s i i t t r i tue 6- ngu'd'i c a o t u 6 i
Khu vice
2 phircyng noi thanh 2 xa ngoai thanh C h u n j
Sa SI So liFO'ng
34 41 75
Jt t r i tue
%
3.66 6.06 4,24
K h o n g 8 6 lu'cmg 922 770 1692
sa s u t t r i t u e
%
96.44 94.94 95.76
Ty le m l c sa siit tri tug a ngudi eao tuoi la 4,24%; Trong dd, ty lg a hai xa ngoai thanh If 5,06% va hai phudng ndi thgnh lg 3,56% S u khac biet ehua cd y nghTa thong kg vdi p > 0,05.
Bang 2. Ty le m l c sa sut t r i tue theo n h o m t u d i
Nhom t u 6 i 60 - 64 (s6 lirgng = 478) 65 - 69 {s6 lirong = 399) 70 - 74 (s5 llfong = 348) 76 - 79 (sa lifOng = 281) 80 - 84 (s6 lirong = 78) 85 - 89 (so lirong = 59) 90 (sd lirong = 24)
Sa s u t t r i tue So lu'ong
3 7 12 16 20 11 6
%
0.6 1.8 3.5 5,7 11.2 8.6 25.0
K h o n g sa s u t t r i tue 3 6 lu'ong
475 392 336 265 158 48 18
%
99.4 98.2 96.5 94,3 88,8 81.4 75.0
P
< 0.001
Dd tuoi cgng cao, ty le m l c sa sut tri lue cang eao S u khac bigt cd y nghTa t h i n g kg (p < 0,001)-
TCNCYH 87 (2) - 201*
• TAP CHI NGHIEN COU Y H p C Bang 3. Ty 13 mdc sa sut tri tue theo givi tinh
Nam (so lirong = 780) NO' (s6 lyo'ng = 987)
Sa sut tri tue n 28 47
%
3,6 4.8
Khong n 752 940
sa sut tri tue
%
96.4 95.2
Ty le mae sa sut tri tue d nam gidi lg 3,6%, ntr gidi lg 4,8%. S u khac biet chua cd y nghTa thdng ke vdi p > 0,05.
Bang 4. Ty le mgc sa sOt tri tue theo trinh do hoc v l n
Trinh do hoc van
Sa sut tri tue Khong sa s i i t tri tue
Biet doc-biel viet (so lup'ng = 322) Tllu hoc (s6 lu'ong = 273) Trung hoc co so (so lugng = 345)
Pho thdng trung hoc (s6 luong = Dgi hpc - cao dang - trung nghigp (so luong = 587)
= 223) d p chuyen
15 9 5 11
5.5 2,6 2.2 1.9
258 336 218 576
94.5 97.4 97.8 93,1
Sau dai hpc (sd luang = 17) 0,0
Ty |g m l c sa sut tri lue cd xu hudng giam a ngudi cd trinh dd hoe v l n eao. S u khgc bigt ed y nghTa thong kg vdi p < 0,001
Bang 5. Ty le m l c sa sut tri tue theo t i l n su' tang huylt ap
Tl§n SU' tang huyet ap
Sa Slit tri tue
n
%
Khong sa n
sut tri tue
%
PBin than C6 (s6 lugng = 680) KhSng (so lugng = 1 087)
33 42
4.9 3.9
647 1 045
95.1 96.1
>0.05
Gia ainh
C6(s6 lugng = 431) Kh6ng (so lu'gng = 1 336)
8 67
1.9 5,0
423 1 269
98,1 95.0
TCNCYH 87 (2) - 2014
T « P CHi NGHIEN C U U Y HOC • Ty le mac sa sut tri tue g nguoi CO tien s u ban than benh tang huygt ap (4.9%) cao hgn so
vgi nguoi khong cb ti4n s t n a y (3,9%). S u khac biet khong cb y nghTa thbng ke (p > 0.05). Tyle mac sa sut tri tue g nguoi tiSn su' gia dinh cb ngugi tang huySt ap (1.9%) cac hgn so vbi ngiroi khong cb tiSn sir nay (5.0%) S u khac biet cb y nghTa thbng ke (p < 0.05),
Bang 6. Ty le m i c sa sut tri tue theo tidn su' tai bidn mach nao
Sa n
Slit tri tue
%
Khong n
sa sut tri tue
%
Ban than Cb (sb luong = 72) Khong (sb lugng = 1.695 )
15 60
20.8 3.5
57 1,635
79.2 96.5 Gia dinh
Cb (sb luong = 83) Khbng (sb luong = 1 684)
0 75
0.0 4,5
83 1 609
100.0 95.5
Ty le mac sa sut tri tue g ngugi cb tien sir ban than mac tai bien mach nao (20.8%) cac ticrn Sb vbi nguoi khbng cb tien s u nay (3.5%) va chua thay cb truong hgp sa sut tri tue g ngud'i CO tien s u gia dinh tai bibn mach nao S u khac biet cb y nghTa thbng ke (p < 0.05)
Bang 7. Ty le mac sa sut tri tue theo ti4n su' benh tim mach
Sa n
sut tri tue
%
Khong sa sut tri t u e
n
%
Ban than
Cb (s6 lugng = 254) Khbng (s6 luong = 1 5 1 3 )
9 66
3.6 4.4
245 1.447
96.5 95.6 Gia dinh
Cb (sb lugng = 175) Khbng (sb luong = 1 592)
6 69
3.4 4.3
169 1.523
96.6 95,7
- > 0.05
Ty le m l c sa silt tri tue g ngubi cb tien sir ban than mac benh tim mach (3.5%) th^p tiffn ngugi khbng cb tiSn s u nay (4.4%) Ty le mSc sa sut tri tue b ngugi tiSn s u gia dinh cb b|nh tim mach (3.4%) thap hgn khbng dang k i so vgi ngubi khbng cb tibn s i i nay (4.3%) S u khSc b*l khbng cb y nghTa thbng ke (p > 0.05)
TCNCYH 87 (2) - 201t
• TAP CHi NGHIEN C l / U Y HOC
IV. BAN LUAN
Qua didu tra nghign c u u md la Iren mdt quan the 1,767 ngudi cao tuoi va nghien ciru bgnh - Chung tren 225 ngudi cao tuoi vgo thang 9 nam 2010, ehung tdi dua ra mdl sd ban lugn ve mdt sd dae diem djch lg hpe sa sill tri lue d ngudi cao luoi tai 2 quan, huyen Ha NQi, cu the nhu sau: Ty le ngudi eao tudi mlc sa siit tri lug d ca hai khu vue nghien ciru la 4,24%. Kgt qua ngy vg khu v y c ngoai thgnh cua chiing tdi t h l p han kdt qua eua Nguyin Ngoc Hda (4,6%), nhung v l n trong khoang tin cay 95% theo k i t qua nghign eiru cua Nguyin Ngoc Hda (4,03-5,12) [5]
Ty le m l c sa s u t t r i t u e theo n h d m t u d i Ngudi cao tuoi d dp tuoi eang cao thi ty le mlc sa sut tri tue cgng eao; cir sau dp 5 - 10 nam tuoi, ty Id tang lgn 1,5 ddn 2 l l n K i t qua cua chiing tdi eung phu hgp vdi sd hgu eua Nguyin Ngoc Hog va cua Ikeda [5; 9] la cw sau mdl khoang 5 nam, ty le m l c sa siit tri tug lgi tang lgn gan g i p ddi
Ty le mac sa s u t t r i tue a* ngu'd'i cao t u d i theo g i o i tinh, nir gidi cao han nam gidi, tuy nhign, su chenh lech giCra hai gidi khdng dang ke (p > 0,05) Nhan dinh ty le nay cua chiing toi tuang duang so vdi k i t qua eua Nguydn Ngoc Hoa, Nguygn Kim Viet va cdng s u [5; 10]
Ty le m l c sa sut t r i t u e theo t r i n h do hoc van Ty lg m l c eao n h l t d trinh dd hoc v l n thlp nhlt lg b i l l doc - b i l l v i l t (10,9%) sau dd giam d i n theo cac trinh do hoc v l n cao han Nhan djnh nay cua chiing ldi cting phii hap vdi Nguygn Ngoc Hoa, Nguygn Kim Viet 15,10]
Ty If mSc sa s u t t r i tue theo tidn su"
b f n h t | t ; Nghign ciru cua ehiing tdi eho t h l y nhdm c6 t i l n sir ban thgn m l c tai b i l n maeh nSo cd ty lg m l c sa sut tri tug cao n h l t (20,8%); Sau dd la nhdm cao luoi cd t i l n sir bin thgn cd giam tri nhd (8,5%) Hign nay v l n
d l nghien ciru v l l i l n s u giam tri nhd chua d u a c d l cap n h i l u qua cac nghien ciru trong nude- Tuy nhign, thay vi lim h i l u v l t i l n s u ban thgn giam tri nhd, mdt sd tac gia ddnh gia vg t i l n s u gia dinh ed ngudi sa sut tri tue. K i t qua cua Nguygn Ngoc Hog eho t h l y ty le hien mac theo nhdm l i l n sir nay lg 28,0% cao han so vdl nhdm l i l n sir binh thudng (3,8%) tdi 9,8 l l n [5] Ngoai ra trong nghign cuu nay, chiing tdi khdng gap trudng hap sa sdt tri tue nao d nhO'ng ngudi t i l n sir gia dinh m l c lai b i l n maeh nao
V. K^T LUAN
K i t qua nghien eiru e l l ngang Irgn quan t h l 1 767 ngudi cao tuoi tai hai xa cua huygn Sdc San vg hai phudng ciia quan Ddng Da vgo thgng 10 nam 2010 cho I h l y
Ty le mac sa siit tri tug a ngudi eao tuoi lg 4,24%, ty le m l c tai hai xa ngoai thgnh la 5,06%, tai hai phudng ndi thanh la 3,56% Dp tudi cang cao cd ty Id m l c benh eang cao Ty le m l c bgnh giam d i n khi trinh dp hoc v l n cang cao.
Mdt sd yeu td tien su ed ty lg m l c sa siit tri tug eao la ban thgn ed lien sir tai b i l n mach ngo (20,8%), tign s d ban than giam tri nhd (8,5%) va gia dinh cd ngudi giam trf nhd (8,1%) vg tang h u y l t ap (4,9%)
KI^N NGH!
1 c l n Id chuc quan ly vg eham sde sue khoe ban dau ddi vdi ngudi cao tudi
2 Tang cudng cge hoat ddng thg lue, cgc hoal ddng xa hdi vd q u i n ehiing, eac hoat ddng lien quan den nhan thirc ap dung phii hap vdl dae diem eua tirng khu vuc nguai cao tudi sinh sdng
Lai cam en
Chung tdi xm cam an Ban Giam dde, cgc
TCNCYH 87 (2)-2014
TAP CHi NGHIEN CU'U Y HOC • phdng vg khoa Tam Than kinh - Bgnh vien Lao khoa Trung u a n g da giiip d a va lao d i l u kien thuan lai eho tdi trong qua trinh t h y c hien nghien cuu Chung tdi cam k i t khdng xung dot lai ieh l u ket qua nghign eiru
TAI LIEU THAM KHAO
1. Pham Khue (2002). Bgnh Alzheimer, Nha xuit ban Yhoc, 2 9 - 3 7
2. Tdng cue Thdng ke (2009). Tong d i l u tra dan sd va nhg d nam 2009, P h l n 111 Cgc bieu tdng hap suy rdng m l u Nha xuit ban Thdng ke, 1 7 4 - 1 7 6
3. Petersen RC, Ganguh Stevens JC (2001). Practice parameters early detection of dementia, UC\ (an evidence - based revievi/)", Report of the quaiity standards sub committee of the Amencan Academy of Neurology Neurology. 56, 1 1 3 3 - 1 1 4 2
4. Dupont W.D (1999). Slahstieal Modeling for Biomedical Researchers , A Simple Introduction to the Analysis of Complex Data Cambridge University Press, 108 - 201
5. Nguydn Ngoc Hoa (2006). Nghien eiru ty le hien m l c va mdt so y l u Id lign den sa siit
tri lue d- ngud'i eao tudi lai huyen Ba Vi, Hg Tgy (2005 - 2006) Luan van Thac s7 Y hgc.
Trwang Dai hoc Y Ha Not, 10 - 35 6. Folstein M.F, McHugh P.R Folstein S.E (1975). Mini - Mental Slate, a practical method for grading the cognitive slate of patients for the clinician, J psychiat Res, 12, 18 -19
7. National Institutes of Health (1997).
The sixth report of Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. NIH publication, 9 8 , 1 1 - 1 3
8. Bonita R (1992). Epidemiology of Stroke The Lancet, 339, 342 - 345
9. Ikeda M, Shigenobu K (2003). The prevalence of MCI among community dwelling elderly Seishin Shinkeigaku Zasshi, 105(4), 381 - 3 8 6
10. Nguydn Kim Viet, T r i n Vigt Nghj, Hoang DiJc Kiet (2001). Budc d l u danh gia sa sut tam t h i n d ngudi gia tai mdt quin th4 dgn eu thanh phd Thai Nguyen Tuyln tap edng trinh nghign ciru khoa hpc ciia Nghi6n ciru smh Trudng Dai hoc Y Ha Ndi, 176 -181.
Summary
SOME EPIDEMIOLOGICALCHARACTERISTICSOF DEMENTIAINTHE ELDERLYINTWORURAL DISTRICTSOF HANOI
The objective of this eross-seetional study vi^as to describe the characteristics of the epidemiol- ogy of dementiain the elderlyin two suburban communes in the Socson distnctand two urban wards of the Dongda district in Hanoi A total of 1 767elderly people from 60 years old to older without obvious physical defects such as loss of hearing, loss of vision, or paralysis were recruited for the study The average prevalence for dementia was 4 24% among the elderly participants.
The prevalence for dementia was different between the elderly living in the Socson and Dongda distncts A higher rate for demenha was observed in the elderly population living in the Socson distnct (5 06%) compared to only 3 56% for the elderly living in the Dongda district. In addition the higher the age of the participants, the higher the rate of dementia Prevalence rate for dementia was reduced among the elderly with a higher education A history of cerebral vascular accident (20 8%), personal history of memory impairment (8 5%),anda family history of memory impair- ment (8.1%) were observed to be important factors in causing dementia in these Wvo populations.
Keywords: dementia, the elderly, the epidemiology
750 TCNCYH 87 (2) - 2014
