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20 April 2023, Volume 37 Issue 4 Previous Issue    Next Issue

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Short-term effect of Qi-Kui granules combined with dulaglutide in the treatment of clinical stage of diabetic kidney disease in the elderly WANG Li-juan, FENG Fei, ZHOU Jing-bo, RUAN Yuan, ZHA Min, PU Qiang, YU Jiang-yi 2023, 37 (4):  348-351.  doi: 10.3969/j.issn.1003-9198.2023.04.007 Abstract ( 152 )   PDF (994KB) ( 633 )   Save Objective To observe the short-term effect of Qi-Kui granules combined with dulaglutide in the treatment of clinical stage of diabetic kidney disease (DKD)in the elderly. Methods A total of 80 elderly patients with clinical stage of DKD hospitalized in the Department of Endocrinology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from November 2019 to June 2021 were enrolled and divided into experiment group and control group by random number table, with 40 cases in each group. The control group was subcutaneously injected with dulaglutide injection 1.5 mg once a week; The experiment group took Qi-Kui granules 10 g on the basis of the control group, 3 times daily. Both groups were treated for 12 weeks. The levels of fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), systolic blood pressure(SBP), diastolic blood pressure (DBP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol (HDL-C), serum creatinine(Scr), urinary albumin/creatinine ratio (UACR) and 24 hours urine protein(24hUTP) in both groups before and after treatment were compared. Results During the study, 5 cases fell off in the experiment group, and 4 cases fell off in the control group. After treatment, the levels of FPG, HbA1c, SBP, DBP, TC, TG and LDL-C in both groups were significantly lower than those before treatment (P<0.05 or P<0.01), but there were no statistical differences between the two groups (P>0.05); The levels of Scr, UACR and 24hUTP in both groups were significantly decreased after treatment (P<0.05 or P<0.01), especially in the experiment group (P<0.05). The total effective rate in the experiment group was higher than that in the control group (88.57% vs 55.56%, P<0.01). Conclusions Qi-Kui granules combined with dulaglutide can significantly reduce the levels of Scr and urinary protein in the elderly patients with clinical stage of DKD, and they show protective effect on renal. References | Related Articles | Metrics

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Predictive value of anxiety on adverse cardiovascular events in elderly patients after percutaneous coronary intervention SONG Chun-mei, YIN Ya-juan, LIU Yong-sheng, GUO Qi-feng, CHEN Jie, WEI Mei 2023, 37 (4):  352-355.  doi: 10.3969/j.issn.1003-9198.2023.04.008 Abstract ( 143 )   PDF (1149KB) ( 706 )   Save Objective To investigate the predictive value of anxiety on major adverse cardiovascular events (MACE) in the elderly patients with coronary heart disease(CHD) after percutaneous coronary intervention (PCI). Methods A total of 681 patients aged≥65 years undergoing PCI were enrolled in the study. The clinical data of the patients were collected. Hamilton Anxiety Scale (HAMA) was used to evaluate the anxiety of the patients. The incidence rate of MACE after discharge was recorded. MACE included cardiac death, nonfatal myocardial infarction, re-hospitalization for angina and heart failure. Results There were 96 patients dropping out and 585 patients completing the follow-up, finally. The mean follow-up time was 28.34±10.07 months. MACE occurred in 85 patients during the follow-up. There were significant differences in age, HAMA score and the proportion of smoking, hypertension, diabetes and CHD with different types between MACE group and non-MACE group(P<0.05 or P<0.01). Receiver operating characteristic (ROC) curve analysis showed that HAMA score was a relatively strong predictor of MACE in the elderly patients after PCI, and the area under the curve (AUC) was 0.736 (95%CI: 0.661-0.812, P<0.001). Multivariate Cox proportional risk regression model analysis showed that HAMA score, smoking, diabetes and family history of CHD were the independent risk factors for MACE in the elderly patients after PCI. Conclusions Anxiety is an independent risk factor for MACE in the elderly patients after PCI, and it has a certain predictive value for MACE in those patients. References | Related Articles | Metrics

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Correlation between body composition and branchial-ankle pulse wave velocity in the elderly of different genders LI Qi-yu, XIE Hui, LI Yan-ling, CAI Wei-wei, ZHANG Rui-xin 2023, 37 (4):  356-360.  doi: 10.3969/j.issn.1003-9198.2023.04.009 Abstract ( 212 )   PDF (1011KB) ( 730 )   Save Objective To investigate the relationship between body composition and branchial-ankle pulse wave velocity (baPWV) in the elderly of different genders. Methods A total of 1703 elderly people who participated in community health examination in Dongfeng community of Bengbu City from January to December 2021 were consecutively enrolled. Body composition and baPWV were measured by body composition analyzer and automatic arteriography detector, respectively. Results Among 1703 elderly patients, 1452 (85.3%) presented with atherosclerosis (baPWV≥14.0 m/s). Pearson correlation analysis showed that the levels of waist circumference (WC), body mass index (BMI), body roundness index (BRI), total body water (TBW), body fat porcentage (%BF) and total fat mass (TFM) were positively correlated with the level of baPWV in the elderly women; The ratio of arm muscle mass (RAMM), ratio of arm fat-free mass (RAFFM),ratio of leg muscle mass (RLMM), ratio of leg fat-free mass (RLFFM), ratio of trunk muscle mass (RTMM) and ratio of trunk fat-free mass (RTFFM) were negatively correlated with the level of baPWV in the elderly women. Only the level of %BF was positively correlated with the level of baPWV in the elderly men. Multiple linear stepwise regression analysis showed that systolic blood pressure (SBP), age, heart rate (HR) and %BF were the main influencing factors of baPWV in the elderly men, and SBP, age, HR, %BF, RTMM, BMI, TFM and pulse pressure gap (PP) were the main influencing factors of baPWV in the elderly women. Conclusions The incidence of atherosclerosis in the community elderly is high, and the body composition indexes show effects on baPWV in the elderly women. References | Related Articles | Metrics

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Study on glycemic variability and the relationship between mean amplitude of glycemic excursion and cardiac function in elderly patients with type 2 diabetes mellitus SI Si-cong, YANG Wei, WANG Jie-yu, LUO Hong-yu, MA Yi-xin, ZHAO Huan 2023, 37 (4):  361-364.  doi: 10.3969/j.issn.1003-9198.2023.04.010 Abstract ( 190 )   PDF (1004KB) ( 676 )   Save Objective To explore the glycemic variability (GV) and the relationship between mean amplitude of glycemic excursion (MAGE) and cardiac function in the elderly patients with type 2 diabetes mellitus(T2DM). Methods A total of 48 elderly T2DM patients treated in Geriatric Comprehensive Department in Xuanwu Hospital, Capital Medical University in 2019 were enrolled in this study, and the levels of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), glycated albumin (GA) were measured. The patients were divided into the HbA1c standard group (HbA1c<6.5%, n=16) and the HbA1c substandard group (HbA1c≥6.5%, n=32). Each patient received a 3-day continuous glucose monitoring (CGM) to obtain the blood glucose parameters including mean blood glucose (MBG), MAGE, standard deviations of blood glucose (SDBG), largest amplitude of glycemic excursion (LAGE), coefficient of variation (CV) and glucose target time in range (TIR), target time above range (TAR) and target time below range (TBR), and then the patients were divided into the MAGE standard group (MAGE<3.9 mmol/L, n=22) and the MAGE substandard group (MAGE≥3.9 mmol/L, n=26). Each patient underwent echocardiography detection to obtain the cardiac function indicators including left ventricular ejection fraction (LVEF), stroke volume (SV), end-systolic volume (EDV) and cardiac output (CO). The level of GV was compared between the HbA1c standard group and the HbA1c substandard group. The correlation between MAGE and cardiac function in the elderly T2DM patients was analyzed. Results Compared with the HbA1c substandard group, the substandard rate of FPG, SDBG, TIR, TAR and the duration of T2DM were lower, and substandard rate of TBR was higher in the HbA1c standard group (P<0.05 or P<0.01). Compared with the MAGE substandard group, the levels of SDBG, LAGE and CV were lower, and the levels of TIR, CO and LVEF were higher in the MAGE standard group (P<0.05 or P<0.01). Pearson correlation analysis showed that MAGE was negatively correlated with CO and LVEF (r=-0.340, -0.319; P=0.018, 0.027, respectively). Conclusions The elderly T2DM patients who reach standard HbA1c range still have the problem of GV, and have the risk of hypoglycemia. MAGE is related to the heart function of the elderly patients with T2DM, and the glucose indexes should be comprehensively monitored and GV should be improved in time to prevent and control heart diseases. References | Related Articles | Metrics

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Characteristics of glycometabolism in elderly patients with type 2 diabetes mellitus complicated with diabetic retinopathy and cataract ZHANG Zi-cheng, ZHU Xiang-yu, YANG Long-xuan, XIAO Lei, YU Yun, HUANG Xiao-ping, TANG Wei 2023, 37 (4):  365-368.  doi: 10.3969/j.issn.1003-9198.2023.04.011 Abstract ( 151 )   PDF (1003KB) ( 915 )   Save Objective To investigate the glycometabolic characteristics of the elderly patients with type 2 diabetes mellitus (T2DM) complicated with diabetic retinopathy (DR) and(or) cataract (CAT). Methods A total of 386 elderly patients with T2DM who were hospitalized in the Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University from July 2019 to September 2021 were enrolled in this study. They were divided into CAT group (163 cases), DR group (15 cases) and CAT+DR group (208 cases) according to the diagnosis. The clinical data were collected from information glucose monitoring system and the hospital information system. The differences in demographic data, metabolic indicators and glycemic control indicators among the three groups were compared. Results The control rate of fasting plasma glucose in CAT group (54.6%), DR group (53.3%) and CAT+DR group (50.5%) was low (P=0.730). In DR group and CAT+DR group,the durations of diabetes mellitus, total costs of hospitalization, drug costs, operation costs and the percentages of patients in high CKD stages were significantly higher than those in CAT group (P<0.05). CAT+DR group had fewer control days, higher largest amplitude of glycemic excursions, higher incidene rates of level 1 and level 2 hypoglycemia than CAT group (P<0.05). There were no significant differences in patient-day-weighted mean blood glucose and the rate of hyperglycemic events among the three groups (P＞0.05). Conclusions The elderly patients with T2DM complicated with DR and (or) CAT have large blood glucose fluctuations, low control rate and high rate of hypoglycemic event. It is necessary to avoid the glycemic treatment which might lead to high volatility of glucose or hypoglycemic event. References | Related Articles | Metrics

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Influencing factors of intravenous thrombolysis efficacy of urokinase in the treatment of ischemic stroke at hyperacute stage in elderly patients CHEN Yi-sheng, CHEN Feng-lan, XIE Yu-ying, XIAO Zhao-xiang, SONG Zheng-hong, QIN Jie-xing, GAO Li 2023, 37 (4):  369-372.  doi: 10.3969/j.issn.1003-9198.2023.04.012 Abstract ( 195 )   PDF (984KB) ( 900 )   Save Objective To explore the related factors affecting the efficacy of urokinase intravenous thrombolysis in the treatment of ischemic stroke at hyperacute stage in the elderly patients. Methods The clinical data of 185 elderly patients with hyperacute ischemic stroke who received intravenous thrombolytic therapy with urokinase in our hospital from 2009 to 2019 were retrospectively analyzed. The score of National Institute of Health stroke scale (NIHSS) decreased ≥1 point on the 7th day of admission than that at admission was defined as thrombolysis improvement, the patients were divided into the improvement group (n=62) and the non-improvement group (n=123). The influencing factors that affect the efficacy of intravenous thrombolysis with urokinase were evaluated by multivariate Logistic regression analysis. Results The median NIHSS score of the patients before thrombolysis was 8.90, compard with 6.03 on the 7th day after thrombolysis (P<0.05). There was a significant difference in the proportion of patients with atrial fibrillation (AF) between the improvement group and the non-improvement group (P<0.05). Multivariate Logistic regression analysis showed that AF and hyperglycemia before thrombolysis were the independent risk factors for poor efficacy of urokinase intravenous thrombolysis in the elderly patients with acute ischemic stroke (OR=4.71,95％CI: 2.26-10.18,P＜0.01;OR=1.10,95％CI: 1.01-1.20,P＝0.02). Conclusions Intravenous thrombolytic therapy with urokinase shows effects in the elderly patients with hyperacute ischemic stroke, but shows no effects in the patients with AF or hyperglycemia before thrombolysis. References | Related Articles | Metrics

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Protein post-translational modification of coronary artery in elderly patients with acute myocardium infarction ZHANG Sheng, JIA En-zhi, WANG Lian-sheng 2023, 37 (4):  373-377.  doi: 10.3969/j.issn.1003-9198.2023.04.013 Abstract ( 144 )   PDF (1015KB) ( 684 )   Save Objective To explore the role of protein post-translational modification (PTM) in human coronary artery atherosclerosis. Methods Twenty coronary artery segments were collected from two elderly subjects dying from acute myocardium infarction. The hematoxylin and eosin (HE) staining was performed for pathological classification, and the human coronary arterial proteome and proteomics features were detected by means of mass spectrometry (MS) analysis. By means of Peaks Studio X+, further quantitative analysis was conducted. The STRING website was used for bioinformatics analysis, such as network cluster, reactome pathways and gene ontology (GO) functional enrichment analysis. Results A total of 2819 proteins and 233 types of PTM were identified in the 20 coronary artery segments. There were 123 differentially expressed proteins and 22 PTM modification sites, and the modifications of 22 sites included oxidation, acetylation and deamidation. Bioinformatics analysis showed that differential proteins and differential PTM sites were mainly highly correlated with mitochondrial energy metabolism. Cluster analysis of protein network showed that the mitochondrial adenosine triphosphate (ATP) synthesis coupled proton transport network was the most enriched, which included ATP5A1, ATP5B, ATP5H and ATP5O. The abundance of PTM of the four proteins was higher in the early stage of atherosclerosis. Conclusions Protein PTM may affect the development of human coronary atherosclerosis through mitochondrial energy metabolism and plays an important role in the early stage of atherosclerosis. References | Related Articles | Metrics

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Effect and safety of mechanical thrombectomy with retrievable stent in advanced aged patients with acute ischemic stroke TIAN Wei, YANG Zhang-chao, MA Wen-qun, LI Xia, WANG Jing-mei, WU Yi-ping 2023, 37 (4):  378-381.  doi: 10.3969/j.issn.1003-9198.2023.04.014 Abstract ( 134 )   PDF (996KB) ( 776 )   Save Objective To observe the effect and safety of mechanical thrombectomy with retrievable stent in the advanced aged patients with acute ischemic stroke. Methods A total of 133 elderly patients with acute inchemic stroke admitted to our hospital from June 2018 to December 2020 were selected as the research objects. According to the age, the patients aged≥90 years old were enrolled in the advanced aged group (47 cases) and the patients aged <90 years old were enrolled in the elderly group (86 cases). All the patients received intravenous thrombolysis and mechanical thrombectomy with retrievable stents. The clinical efficacy,the scores of Chinese Stroke Scale (CSS) at different treatment points,the time of thrombectomy, times of thrombectomy, stent implantation, vascular recanalization rate,the grade of modified thrombolysis in cerebral infarction (mTICI), the incidence rate of postoperative complications and the mortality rate in 3 months after operation were compared between the two groups. Results There was no significant difference in the total effective rate between the two groups(74.47% vs 84.88%, P>0.05). From 3 days to 4 weeks after treatment, CSS score showed a downward trend in both groups(P<0.05), but showing no significant differences between the two groups (P>0.05). There were no significant differences in vascular recanalization rate and the grade of mTICI between the two groups (P>0.05). Compared with the elderly group, the advanced aged group had longer thrombectomy time, fewer thrombectomy times and higher stent implantation rate (P<0.05). There was no significant difference in the incidence rate of postoperative complications between the two groups (P>0.05). Within 3 months after operation, 7 cases (14.89%) died in the advanced aged group, and 10 cases (11.63%) died in the elderly group. There was no significant difference in mortality between the two groups within 3 months after surgery (P>0.05). Conclusions The advanced aged patients with acute ischemic stroke can also undergo the treatment of mechanical thrombectomy with retrievable stent, and the treatment should not be abandoned just because of age. References | Related Articles | Metrics

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Correlations of APRI with right ventricular function and prognosis in elderly patients with heart failure with preserved ejection fraction WANG Chun-yan, SONG Ya-ling, REN Hai-xia 2023, 37 (4):  382-385.  doi: 10.3969/j.issn.1003-9198.2023.04.015 Abstract ( 136 )   PDF (1044KB) ( 654 )   Save Objective To investigate the association of aspartate aminotransferase-to-platelet ratio index (APRI) with right heart function and major adverse cardiovascular events (MACE) in the elderly patients with heart failure with preserved ejection fraction (HFpEF). Methods A total of 115 elderly patients with HFpEF admitted to our hospital from January 2018 to June 2020 were retrospectively enrolled. All the patients were followed up for 12 months. According to whether MACE occurred during the follow-up period, they were divided into MACE group (n=36) and control group (n=79). The clinical data were collected. The correlation of APRI with right heart function indicators [tricuspid annular plane systolic excursion (TAPSE), tricuspid annulus peak systolic velocity (S′)], risk factors for MACE and the predictive value of APRI for MACE in the elderly patients 12 months after discharge were analyzed. Results The levels of APRI, total bilirubin (TBiL) and N-terminal pro-brain natriuretic peptide (NT-proBNP), and the proportion of atrial fibrillation and NYHA grade Ⅳ in MACE group were higher, and the levels of albumin (ALB), TAPSE, S′ and LVEF were lower than those in the control group (P<0.05). APRI was negatively correlated with TAPSE, S′ and LVEF in the elderly patients with HFpEF (r=-0.513, -0.438, -0.596; P<0.05). Atrial fibrillation, APRI and NT-proBNP were the independent influencing factors of MACE in the elderly patients with HFpEF 12 months after discharge (P<0.05). The area under the curve of APRI to predict MACE in the elderly patients with HFpEF 12 months after discharge was 0.779, and showed no significant difference from NT-proBNP (Z=0.653, P>0.05). Conclusions Increased APRI is associated with impaired right heart function and MACE in the elderly patients with HFpEF, which is a new potential prognostic index for elderly patients with HFpEF. References | Related Articles | Metrics

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Consistency asscessment of global leadership initiative on malnutrition criteria and patient-generated subjective global assessment in diagnosing malnutrition among elderly patients with advanced cancer JI Lin-lin, ZHANG Xin-yue, JIN Chao, LI Shi-yang, YANG Qin-bing 2023, 37 (4):  386-390.  doi: 10.3969/j.issn.1003-9198.2023.04.016 Abstract ( 206 )   PDF (1013KB) ( 891 )   Save Objective To compare the effects of global leadership initiative on malnutrition (GLIM) criteria and patient-generated subjective global assessment (PG-SGA) in evaluating malnutrition among the elderly patients with advanced cancer. Methods A total of 288 elderly patients with advanced cancer were screened by nutritional risk screening 2002 (NRS2002) and PG-SGA, then those patients with NRS2002 score≥3 were evaluated with GLIM.The consistency of GLIM criteria and PG-SGA in diagnosing malnutrition among the elderly patients with advanced cancer was analyzed. Results The NRS2002 score of the patients was 3.33±1.34, and the incidence rate of nutritional risk was 71.18% (205/288).There were significant differences in the incidence rates of nutritional risk among the patients with different genders, ages, tumor locations and stages (P<0.05).The incidence rate of malnutrition assessed by GLIM criteria was 58.33% (168/288), which was 69.79% assessed by PG-SGA.According to PG-SGA or GLIM criteria, gender, age, tumor location and stage were the influencing factors of malnutrition in the elderly patients with advanced cancer (P<0.05). Kappa test showed that GLIM criteria and PG-SGA had good consistency in the diagnosis of malnutrition among the elderly patients with advanced cancer (Kappa=0.71,P<0.01).Stratified by the general condition of the patients, GLIM criteria and PG-SGA had good consistency in diagnosing malnutrition in different genders, ages, tumor locations and stages, and their Kappa values ranged from 0.63 to 0.78. Conclusions The incidence rates of nutritional risk and malnutrition are high among the elderly patients with advanced cancer. GLIM criteria and PG-SGA have good consistency in diagnosing malnutrition among the elderly patients with advanced cancer. References | Related Articles | Metrics

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Clinical observation of thalidomide combined with concurrent chemoradiotherapy in elderly patients with esophageal carcinoma XU Zhi-chen, SU Bao-an, HUANG Zhen-he, LI Jian-cheng, CHEN Ju-hui 2023, 37 (4):  391-394.  doi: 10.3969/j.issn.1003-9198.2023.04.017 Abstract ( 143 )   PDF (986KB) ( 638 )   Save Objective To observe the effect of thalidomide on the short-term effect and therapy-related adverse reactions in the elderly patients with esophageal carcinoma treated with concurrent chemoradiotherapy. Methods A total of 100 elderly patients with esophageal carcinoma treated in Quanzhou First Hospital from June 2018 to February 2021 were randomly divided into the control group and the experimental group.Both groups were treated with IMRT(intensity modulated radiotherapy) and the same chemotherapy protocol: Paclitaxel 135 mg/m2, day 1;Cisplatin, 25 mg/m2,day 1-3, once every three weeks for two cycles. The experimental group was given 100 mg of thalidomide orally before bedtime from the beginning to the end of radiotherapy.The efficacy and related adverse reactions were compared between the two groups. Results There were no significant differences in objective effective rate and disease control rate between the two groups (92% vs 90%, 98% vs 96%; P>0.05). The incidence rates of nausea, vomiting, and muscle and joint pain in the experimental group were significantly lower than those in the control group(P＜0.05). There were no significant differences in the incidence rates of leukopenia, thrombocytopenia, decreased hemoglobin, abnormal liver function and peripheral neurotoxicity between the two groups (P>0.05).The incidence rates of radiation esophagitis of grade Ⅰ-Ⅱ and Ⅲ-Ⅳ in the experimental group were lower than those in the control group (P＜0.05). Conclusions Thalidomide can significantly reduce the incidence of radiation esophagitis, nausea, vomiting, and muscle and joint pain during concurrent chemoradiotherapy. References | Related Articles | Metrics

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Construction of home-based exercise program for elderly patients with frailty and osteoporosis based on Delphi method ZONG Xiao-yan, WANG Xue-fei, ZONG Qian-xing, LIU Huan, MO Yong-zhen, XU Jia-ren 2023, 37 (4):  416-421.  doi: 10.3969/j.issn.1003-9198.2023.04.023 Abstract ( 149 )   PDF (1023KB) ( 981 )   Save Objective To construct the home-based exercise program for elderly patients with frailty and osteoporosis, so as to provide evidence for the home-based exercise management. Methods Through systematically searching domestic and foreign literatures about exercise intervention for osteoporosis and frailty in the elderly, the scheme was constructed through literature research, study group discussion and 2 rounds of Delphi consultation among 15 experts. Results The effective response rates of 2 rounds of consultations were 100%. The experts authority coefficient was 0.905. After 2 rounds of consultations, the importance score of the indicators was 4.43-5.00, and the coefficient of variation was 0-0.23, Kendall’s W coefficient was 0.359 (P<0.001). Finally, a home-based exercise program for elderly patients with frailty and osteoporosis was formed, including 3 first-level indicators, 11 second-level indicators and 46 third-level indicators. Conclusions The home-based exercise program constructed in this study is scientific and reliable, which can provide references for home exercise management in the elderly patients with osteoporosis and frailty in the future. References | Related Articles | Metrics