Dynamic Network Analysis of Multidimensional Symptoms in Older Patients with Chronic Gastritis

Dynamic Network Analysis of Multidimensional Symptoms in Older Patients with Chronic Gastritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dynamic Network Analysis of Multidimensional Symptoms in Older Patients with Chronic Gastritis Ying Xin, Xingguo Zuo, Zhenyu Zhu, Wei Cui, Dongjun Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8996155/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Objective : Based on the biopsychosocial model and the Comprehensive Geriatric Assessment framework, this study applied dynamic network analysis to investigate the evolving interrelations among physical and psychological symptom clusters in older patients with chronic gastritis. Methods : A longitudinal design with convenience sampling was used to recruit 360 hospitalized chronic gastritis patients aged ≥ 60 years. Assessments were conducted at admission (T1) and 6 months post-discharge (T2). Data were collected using a general information questionnaire, the Comprehensive Geriatric Assessment, and the Gastrointestinal Symptom Rating Scale. Symptom networks were constructed using R, and centrality indices were calculated to identify core symptoms and structural changes. Results : At T1, anxiety, depression, and cognitive function were the core nodes of the network. At T2, frailty, social participation, and fall risk became dominant. Centrality of gastrointestinal symptoms (abdominal pain, diarrhea, constipation) and activities of daily living (Barthel Index) significantly decreased at T2 (C = −0.176 to −0.824, P 0.05). Global network strength increased from 4.75 (T1) to 5.95 (T2) ( P < 0.001). Conclusion : The network core shifted from psychological-cognitive factors at admission to physical-functional indicators at follow-up, revealing a dynamic psychosomatic interaction pattern centered on psychosocial factors. Chronic gastritis Network analysis Core symptoms Older adults Dynamic evolution Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction As China enters a moderately aging society, health challenges among older adults have become increasingly prominent [1]. Chronic gastritis (CG) is characterized by recurrent gastrointestinal symptoms, including abdominal pain, bloating, nausea, and constipation. The disease is typically long-standing and prone to relapse, and is frequently accompanied by psychological comorbidities such as anxiety and depression, substantially impairing quality of life. Its prevalence and severity generally increase with advancing age [2]. In older populations, the onset and progression of CG are closely associated with age-related physiological decline, multimorbidity, and transitions in social roles. Current conventional treatment models predominantly focus on localized gastric mucosal inflammation, often overlooking the multidimensional health needs of older patients, which may contribute to prolonged disease courses or therapeutic resistance [3]. Comprehensive Geriatric Assessment (CGA), a cornerstone of geriatric medicine, employs a multidisciplinary approach to systematically evaluate physical function, psychological status, social environment, and quality of life in older adults. Based on these assessments, individualized treatment and care plans are developed to maintain and improve functional capacity and overall well-being, emphasizing holistic evaluation of psychosomatic symptoms [4]. However, existing research largely relies on static analyses of physical and psychological symptoms and rarely examines their dynamic interrelationships over time. Therefore, grounded in the biopsychosocial model and the CGA framework, this study conducted a longitudinal investigation of older patients with CG. By integrating dynamic network analysis, we aimed to elucidate the temporal evolution of psychosomatic symptom clusters and provide evidence for individualized, stage-specific intervention strategies to optimize overall health outcomes. Materials and Methods 1.1 Study Design and Participants This longitudinal cohort study consecutively recruited hospitalized older adults with CG from the Departments of Geriatrics and Spleen–Stomach Diseases at a tertiary traditional Chinese medicine hospital in Jiangsu Province, China, between November 2024 and June 2025. A convenience sampling strategy was adopted. Eligible participants met the following criteria: (1) age ≥60 years; (2) diagnosis of CG confirmed by endoscopy and histopathology in accordance with the Chinese Guidelines for the Diagnosis and Treatment of CG (2022, Shanghai) [5,6]. Endoscopic and pathological findings were independently reviewed by at least two senior gastroenterologists (associate chief physician level or above). Traditional Chinese medicine (TCM) syndrome differentiation was independently performed by two senior TCM or integrative gastroenterology physicians. In cases of diagnostic discrepancy, a third senior specialist adjudicated until consensus was achieved; (3) provision of written informed consent and ability to comply with study procedures. Exclusion criteria included: (1) severe primary cardiac, cerebrovascular, hepatic, or renal disease as the principal admission diagnosis; (2) severe psychiatric disorders (e.g., major anxiety or depressive disorders), cognitive disorders requiring psychotropic medication, or other conditions compromising valid assessment; (3) incomplete clinical data. Sample Size Estimation: Twenty-four independent variables were included in the planned network model. Following the recommended ratio of at least 10 participants per variable [7], a minimum sample size of 240 was required. Accounting for a potential 20% attrition or invalid response rate, the estimated minimum sample was 288. Ultimately, 360 participants were enrolled, exceeding the calculated requirement. This study was approved by the Ethics Committee of the Ethics Committee of Hospital (Approval No. [2024]2) and complied with the Declaration of Helsinki. The purpose of the study was explained to all participants before the survey was conducted and informed consent was obtained. 1.2 Measures 1.2.1 Demographic and Clinical Characteristics: A self-designed structured questionnaire collected demographic information (age, sex, marital status, education level, monthly income, medical insurance type) and clinical data (disease duration, family history of gastrointestinal malignancy, smoking and alcohol use, diagnosis, TCM syndrome classification, 13 C urea breath test results, and gastroscopy findings). 1.2.2 Gastrointestinal Symptoms: Gastrointestinal symptom severity was assessed using the Chinese version of the Gastrointestinal Symptom Rating Scale (GSRS) [8]. The GSRS comprises 15 items across five domains: abdominal pain, reflux, dyspepsia, diarrhea, and constipation. Items are rated on a 4-point Likert scale, yielding total scores ranging from 15 to 60, with higher scores indicating greater symptom severity[9]. In this study, internal consistency was acceptable (Cronbach’s α = 0.833). 1.2.3 CGA Domains: A multidimensional CGA framework was applied to systematically evaluate physical, psychological, social, and functional domains[4]. The specific scales are shown as follows: (1) Physical Function Activities of Daily Living (ADL) was assessed using the Barthel Index (BI) [10], which evaluates 10 basic daily activities (total score 0–100). Higher scores reflect greater independence. Cronbach’s α = 0.920. Fall risk was measured using the Falls Risk Assessment Scale for Older People (FRASE) [11], consisting of 35 items across eight domains (score range: 0–53). Higher scores indicate elevated fall risk. Cronbach’s α = 0.759. (2) Psychological Status Symptoms of anxiety were assessed using the Self-Rating Anxiety Scale (SAS) [12], which consists of 20 items rated on a 4-point scale. Raw scores are multiplied by 1.25 to generate standardized scores. Cronbach’s α = 0.991. Depressive symptoms were assessed using the Self-Rating Depression Scale (SDS) [13], also comprising 20 items rated on a 4-point scale, with standardized scoring procedures identical to the SAS. Cronbach’s α = 0.990. Global cognitive performance was evaluated using the Montreal Cognitive Assessment (MoCA) [14]. The MoCA assesses eight cognitive domains, with total scores ranging from 0 to 30. One additional point was added for participants with ≤12 years of formal education. Scores <26 indicated cognitive impairment. Cronbach’s α = 0.980. (3) Quality of Life Subjective well-being was measured using the Memorial University of Newfoundland Scale of Happiness (MUNSH) [15], comprising 24 items across four domains (positive affect, negative affect, positive experience, negative experience). Total scores range from 0 to 48, with higher scores reflecting greater happiness. Cronbach’s α = 0.990. (4) Social Function Social participation was assessed according to the national standard Assessment of Ability of Older Adults (MZ/T001-2013) [16]. Five domains were rated from 0 to 4 (total 0–20), with higher scores indicating greater impairment. Cronbach’s α = 0.998. Role adaptation was evaluated using the Interpersonal Functioning Scale [17], a 16-item measure (score range: 16–48), with lower scores indicating poorer interpersonal functioning. Cronbach’s α = 0.962. Frailty was screened using the FRAIL scale [18], which evaluates fatigue, resistance, ambulation, comorbidity burden, and weight loss. Scores range from 0 to 5: 0 = robust, 1–2 = pre-frail, ≥3 = frail. Cronbach’s α = 0.569. 1.3 Data Collection Procedures Participants were assessed at hospital admission (T1) and at 6-month follow-up post-discharge (T2). Trained research staff administered all questionnaires in a standardized, quiet setting using combined paper-based and electronic formats. Given the potential fatigue and reduced endurance of older participants, assessments were permitted to be completed in multiple sessions. All data were anonymized and coded prior to analysis. Double data entry was independently performed by two investigators, followed by cross-verification to ensure accuracy and minimize transcription errors. 1.4 Statistical Analysis Statistical analyses were conducted using SPSS version 27.0 and R version 4.3.3. Continuous variables are presented as mean ± standard deviation (SD), and categorical variables as frequencies and percentages. Within-subject changes between T1 and T2 were evaluated using paired t-tests. Between-group comparisons were conducted using independent-samples t-tests or one-way analysis of variance (ANOVA), as appropriate. Weighted symptom networks were estimated using the qgraph package in R. Centrality indices—including strength, closeness, and betweenness—were computed to identify influential nodes within the network. Network accuracy was assessed via nonparametric bootstrapping, generating 95% confidence intervals for edge weights. Stability of centrality indices was evaluated using the correlation stability (CS) coefficient, with CS >0.50 considered indicative of acceptable stability. Structural differences between T1 and T2 networks were examined using the NetworkComparisonTest package, including global strength invariance and network structure invariance testing. Results 2.1 General Characteristics of Elderly Patients with CG Among the 360 elderly patients with CG, 61.67% were male, with a mean age of 71.53 ± 8.26 years. Most participants had primary school education or below (60.00%), and 78.61% reported a monthly income of less than 2,000 RMB. Chronic atrophic gastritis (CAG) accounted for 77.22% of cases. In terms of TCM syndrome differentiation, spleen–stomach deficiency syndrome was the most common (33.33%). The positive rate of Helicobacter pylori infection was 12.50%. Detailed demographic and clinical characteristics are presented in Table 1. Table 1 General demographic data of elderly patients with chronic gastritis (n=360) Variables Groups n % Gender Male 222 61.67% Female 138 38.33% Age Group 60～70 164 45.56% 71～80 130 36.11% >80 66 18.33% Marital Status Married 358 99.44% Unmarried 2 0.56% Education Level Primary school or below 216 60.00% Junior high school 118 32.78% Senior high school 26 7.22% Monthly Income (RMB) <2000 283 78.61% 2000～5000 77 21.39% Disease Duration <2 years 129 35.83% 2～5 years 148 41.11% ≥6 years 83 23.06% Family History of Digestive Tract Cancer Yes 0 0.00% No 360 100.00% Smoking History Yes 27 7.50% No 333 92.50% Drinking History Yes 28 7.78% No 332 92.22% Diagnosis Chronic non-atrophic gastritis 82 22.78% Chronic atrophic gastritis 278 77.22% TCM Diagnosis Liver-stomach disharmony syndrome 87 24.17% Spleen-stomach damp-heat syndrome 68 18.89% Spleen-stomach weakness syndrome 120 33.33% Stomach yin deficiency syndrome 51 14.17% Stomach collateral blood stasis syndrome 34 9.44% 13 C Urea Breath Test Positive 45 12.50% Negative 315 87.50% Gastroscopy Result Other 29 8.06% Superficial gastritis 87 24.17% Atrophic gastritis 244 67.78% 2.2 Descriptive Statistics of Symptom Scores at T1 and T2 Compared with T1, most symptom indicators showed improvement at T2. Scores for abdominal pain, reflux, dyspepsia, and diarrhea syndromes significantly decreased ( P < 0.001). Regarding physical function, the negative Barthel score significantly decreased ( P = 0.017), and frailty screening scores declined ( P = 0.001), indicating improvements in activities of daily living and overall frailty status. However, fall risk scores increased ( P = 0.021). In the psychological domain, anxiety ( P < 0.001), depression ( P < 0.001), and negative Montreal Cognitive Assessment ( P < 0.001) significantly decreased, reflecting improvements in emotional status and cognitive function. Social participation scores showed a slight increase, while negative interpersonal relationship and well-being scores slightly decreased; however, these changes were not statistically significant ( P > 0.05). Detailed results are shown in Table 2. Table 2 Symptom scores of elderly patients with chronic gastritis at T1 and T2 ( n =360) Variables T1 stage T2 stage t value P value Abdominal Pain Syndrome 5.42±1.29 5.24±1.25 8.977 <0.001 Reflux Syndrome 5.79±2.61 5.38±2.55 14.277 <0.001 Dyspepsia Syndrome 5.40±2.12 5.20±2.10 9.556 <0.001 Diarrhea Syndrome 3.61±1.47 3.36±1.36 10.939 <0.001 Constipation Syndrome 8.14±2.13 8.37±3.83 -1.131 0.259 Barthel Index (Negative) 21.01±16.72 17.92±16.59 2.391 0.017 Fall Risk 5.04 ± 3.35 5.96±6.84 -2.313 0.021 Frailty Screening 2.19 ± 1.00 1.81±1.93 3.206 0.001 Anxiety 68.63 ± 16.99 54.58±16.87 14.812 <0.001 Depression 68.91 ± 16.35 54.58±16.23 18.63 <0.001 Montreal Cognitive Assessment (Negative) 13.88 ± 13.53 9.43±8.57 6.274 <0.001 Social Participation 8.74 ± 9.26 9.13±8.20 -0.596 0.551 Interpersonal Relationship (Negative) 33.44 ± 12.85 32.54±9.35 1.075 0.283 Well-being (Negative) 26.83 ± 16.20 25.90±14.22 0.809 0.419 2.3 Symptom Network Analysis in Elderly Patients with CG Network analysis was conducted to explore the structural characteristics of symptom clusters at T1 and T2. At T1, cognitive function (MD11) emerged as the central bridge node, playing a key role in linking psychological status, functional ability, and gastrointestinal symptoms. Anxiety (MD9) and depression (MD10) also demonstrated high closeness centrality and node strength, highlighting the core role of emotional and cognitive factors in the overall health structure during the early stage. At T2, the core network structure shifted markedly. Frailty (MD6) became the primary hub node, exhibiting the highest betweenness centrality. Fall risk (MD7) and social participation (MD8) also showed significant increases in node strength and centrality. These findings suggest that as the disease progressed, frailty and social functioning gradually replaced psychological and cognitive factors as the dominant components influencing the symptom network. Detailed results are illustrated in Figure 1. Comparisons of centrality indices between T1 and T2 revealed dynamic evolution (Figure 2). At T1, cognitive function (MD11) had the highest betweenness centrality (Betweenness = 25), indicating a critical bridging role within the network. Anxiety (MD9), depression (MD10), and cognitive function (MD11) also ranked high in closeness centrality and strength. At T2, frailty screening (MD6) showed the highest betweenness centrality (Betweenness = 17), while role adaptation (MD13) and social participation (MD8) significantly increased. In addition, frailty (MD6), social participation (MD8), and fall risk (MD7) ranked highest in node strength, and all expected influence (EI) values were positive, indicating their integrative and dominant roles in the evolving health structure. Strength difference tests demonstrated that, at T1, diarrhea syndrome (MD4) and constipation syndrome (MD5) exhibited the lowest strength values and were therefore more likely to differ significantly from other symptoms. At T2, significant differences in node strength became more widespread, suggesting increased heterogeneity and intensified differentiation among symptom loads as the disease progressed (Figure 3). Bootstrap analysis of edge weights (95% confidence intervals) showed differences in estimation precision between T1 and T2. At T1, confidence intervals narrowed substantially when edge weights exceeded 0.25, indicating accurate estimation of stronger connections. At T2, this threshold increased to 0.40, suggesting that only stronger associations achieved high estimation stability in the later stage. This pattern reflects strengthened symptom interconnections over time and provides a basis for subsequent centrality stability testing (Figure 4). Subsample bootstrap tests ( n = 1000) were performed to assess centrality stability. At T1, the CS coefficient for strength centrality was 0.75, indicating high stability; closeness centrality showed moderate stability ( CS = 0.361); betweenness centrality demonstrated poor stability ( CS = 0). At T2, strength centrality remained stable ( CS = 0.75), while closeness centrality markedly improved ( CS = 0.75), indicating very high reliability. Betweenness centrality showed moderate stability ( CS = 0.283). Overall, strength centrality demonstrated robust interpretability at both time points; closeness centrality became substantially more stable at T2, whereas betweenness centrality should be interpreted with caution (Figure 5). 2.4 Dynamic Network Analysis of Symptoms in Elderly Patients with CG Comparative network analysis revealed significant dynamic changes in the symptom network structure of elderly patients with CG between T1 and T2 ( P < 0.001). Global strength increased from 4.75 at T1 to 5.95 at T2 ( P < 0.001), indicating that the interconnections among symptoms or functional indicators became more tightly integrated, with enhanced mutual influence over time. Node centrality analysis demonstrated that the centrality of abdominal pain syndrome (MD1; strength C = −0.176, P = 0.004), diarrhea syndrome (MD4; C = −0.666, P = 0.001), constipation syndrome (MD5; C = −0.551, P = 0.001), and the Barthel Index representing functional capacity (MD6; C = −0.824, P = 0.001) significantly decreased. These findings suggest that these variables served as key nodes in the network at T1, whereas their relative importance diminished at T2. This pattern indicates an alleviation of gastrointestinal symptoms and improvement in functional limitations, thereby reducing their driving influence within the overall health network. In contrast, the centrality of psychosocial functioning nodes—including anxiety, depression, social participation, and subjective well-being—showed no significant changes ( P > 0.05). This stability suggests that psychosocial factors maintained a persistent and substantial influence within the health network throughout the disease course, continuing to play a critical role even after the remission of physical symptoms. Detailed results are presented in Table 3. Table 3 Difference test of centrality measures of symptom nodes between T1 and T2 stages (n = 360) Nodes Variables Strength C Strength P value MD1 Abdominal Pain Syndrome -0.176 0.004 MD2 Reflux Syndrome -0.113 0.071 MD3 Dyspepsia Syndrome -0.075 0.097 MD4 Diarrhea Syndrome -0.666 0.001 MD5 Constipation Syndrome -0.551 0.001 MD6 Barthel Index (Negative) -0.824 0.001 MD7 Fall Risk -0.202 0.079 MD8 Frailty Screening 0.110 0.363 MD9 Anxiety 0.061 0.539 MD10 Depression 0.011 0.907 MD11 Montreal Cognitive Assessment (Negative) -0.029 0.710 MD12 Social Participation -0.019 0.811 MD13 Interpersonal Relationship (Negative) 0.052 0.464 MD14 Well-being (Negative) 0.037 0.636 Discussion 3.1 Predominant Spleen–Stomach Deficiency and Elevated Socioeconomic Risk in Elderly CAG: Implications for Comprehensive Intervention In this study, the 360 elderly patients with CG had a relatively advanced mean age at onset (71.53 ± 8.26 years), and CAG accounted for the majority of cases (77.22%). This finding is consistent with the study by Dilaghi et al. [19], which reported an increasing prevalence of atrophic gastritis with advancing age. In terms of TCM syndrome differentiation, spleen–stomach deficiency syndrome accounted for 33.33%, aligning with the physiological characteristics of age-related decline in spleen and stomach function in older adults. Accordingly, treatment should follow the principle of strengthening the spleen and harmonizing the stomach [20]. Most patients exhibited low educational attainment and low income levels, factors that may hinder access to health information and reduce treatment adherence. At T2, the risk of falls increased. Rodrigues et al. [21] demonstrated that elevated fall risk in older adults is associated with sarcopenia, functional decline, reduced resistance training, and poor quality of life. Therefore, clinical management should adopt a comprehensive approach addressing both gastrointestinal symptoms and psychological status. Regular assessments of physical function, nutritional status, and fall risk are warranted, alongside individualized dietary guidance, medication safety education, and appropriate physical exercise, with the aim of improving quality of life and ensuring patient safety. 3.2 Evolution of the Symptom Network in Elderly Chronic Gastritis from Psychological Dominance to Physical–Functional Core Network analysis revealed that at T1, anxiety (MD9), depression (MD10), and cognitive function (MD11) demonstrated prominent closeness centrality (0.0102–0.0109) and strength centrality (2.762–2.908), indicating that negative emotions may trigger gastrointestinal dysfunction through activation of the hypothalamic–pituitary–adrenal (HPA) axis via the brain–gut axis. Schneider et al. [22] reported that this mechanism promotes cortisol release, increases gastric mucosal permeability, and induces sympathetic excitation and gastrointestinal dysregulation, clinically manifesting as abdominal pain, bloating, and belching. At T2, the centrality of these psychological nodes did not significantly decrease, suggesting the relative stability of psychological factors and the need for long-term targeted psychological interventions rather than reliance solely on conventional gastrointestinal treatment. Cognitive function (MD11) exhibited the highest betweenness centrality (MD11 = 25), indicating its critical bridging role between physical and psychosocial domains. This may be related to reduced social engagement and functional decline secondary to persistent gastrointestinal discomfort, leading to cognitive impairment, misinterpretation of disease information, decreased adherence, and amplification of somatic perceptions. This finding is consistent with Liang et al. [23], who demonstrated that specific gut microbiota characteristics may influence hippocampal volume and cognitive function, further supporting the brain–gut interaction mechanism. At T2, the network core shifted toward physical function and social participation nodes. Frailty screening (MD6) exhibited the highest betweenness centrality (MD6 = 17) and, together with social participation (MD8) and fall risk (MD7), formed the cluster with the strongest strength centrality (MD6 = 4.824; MD8 = 4.538). This shift indicates that disease impact gradually transitioned from the psychological level to the physical-functional level. This pattern is consistent with the findings of Zhu et al. [24], who reported interrelationships among sarcopenia, depression, cognitive impairment, and frailty incidence, demonstrating progressive frailty and declining functional capacity with disease progression in older adults. These findings align with the clinical characteristics of frailty syndrome, wherein social isolation and frailty mutually reinforce one another. Hanlon et al. [25] further confirmed that long-term social isolation may accelerate physical functional decline by reducing physical activity, while frailty further limits social participation. Meanwhile, the strength centrality of gastrointestinal symptom clusters significantly decreased (negative strength C values), suggesting that integrated Chinese and Western pharmacotherapy [26], application of appropriate TCM techniques, and lifestyle interventions effectively alleviated gastrointestinal symptoms and reduced their influence within the network. These findings indicate that clinical intervention should shift from symptom-centered gastrointestinal treatment toward comprehensive management focusing on frailty prevention, physical function maintenance, and promotion of social participation. The symptom and functional network structure of elderly CG patients evolved significantly between T1 and T2, with a marked increase in global network strength (T2 = 5.95 vs. T1 = 4.75, P < 0.001). This suggests that with disease progression and clinical intervention, interconnections among symptoms and functional domains became more closely integrated, reflecting increased complexity in overall health status. In early stages, digestive symptoms predominated; as the disease progressed, physical functional decline, reduced quality of life, and psychosocial problems gradually emerged, forming a complex multisystem interaction network. At T2, the strength centrality of gastrointestinal symptom clusters (abdominal pain, diarrhea, constipation) and the Barthel Index significantly decreased (Strength C = −0.176 to −0.824, P 0.05), suggesting their sustained influence. This persistence may relate to stable psychosocial stressors in older adults, such as role transition and loneliness, which are unlikely to resolve rapidly with short-term treatment. In later stages of disease, psychosocial factors replaced gastrointestinal symptoms as the dominant determinants of health. Significant differences in network structure ( P < 0.001) indicate dynamic associations between symptoms and physical function, jointly regulated by physiological adaptation, clinical treatment, disease progression, and psychosocial factors. These findings are consistent with the brain–gut axis theory proposed by Schalla et al. [27], which posits progressively strengthened bidirectional interactions between physiological and psychological pathways, linking anxiety, depression, cognitive function, and social adaptation, thereby facilitating the formation of psychosomatic symptom clusters. At T1, anxiety and depression demonstrated high closeness centrality, suggesting that negative emotions may precipitate gastrointestinal symptoms. This dynamic evolution underscores that, in later stages, psychosocial factors become the core determinants of overall health in elderly CG patients, further validating the regulatory role of the brain–gut axis. Clinical management should therefore transition from merely controlling gastrointestinal symptoms to strengthening psychological support and promoting social participation to improve long-term prognosis. The dynamic network analysis further indicates that as CG progresses in older adults, the network core shifts from predominantly digestive symptoms to a structure increasingly influenced by psychological and social factors. Consequently, clinical treatment should extend beyond symptom control to encompass psychological status, social participation, and daily functional capacity. Based on the psychological–somatic dynamic trajectory observed, stage-specific interventions are recommended. At T1, priority should be given to emotional regulation and stabilization of the brain–gut axis, with routine screening for anxiety, depression, and cognitive function (MD9, MD10, MD11). At T2, emphasis should shift toward maintaining physical function, including combating sarcopenia, providing nutritional support, promoting social participation, and assessing frailty, social engagement, and fall risk (MD6, MD8, MD7). Through such comprehensive management, the goal is to delay frailty progression, enhance social participation, and embody the concept of “active aging,” thereby more comprehensively improving health outcomes in elderly patients with CG. This study has certain limitations. The sample was derived from a single source, limiting representativeness. Future studies should expand sampling sources and further investigate the longitudinal dynamic changes of core symptoms. Conclusions Using CGA, this study explored the dynamic evolution of psychosomatic symptom networks in elderly patients with CG at T1 (admission) and T2 (6 months post-discharge). The findings indicate that the network core shifted from predominantly psychological–emotional indicators (e.g., anxiety and depression) at T1 to predominantly physical-functional indicators (e.g., frailty, social participation, and fall risk) at T2. Overall, the results reveal a psychosocial-centered pattern of mind–body interaction, highlighting the dynamic and integrative nature of symptom evolution in elderly CG. Declarations Funding Henan Province Higher Education Teaching Reform Research and Practice Project (Graduate Education Category) (2023SJGLX235Y). Acknowledgments All the authors wish to thank all the participants and all the study assistants. Declaration of competing interest The authors declare that have no conflicts of interest. Data availability statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Ethics Committee of Hospital (Approval No. [2024]2) and complied with the Declaration of Helsinki. The purpose of the study was explained to all participants before the survey was conducted and informed consent was obtained. CRediT authorship contribution statement Y.Xin and X.G.Zuo contributed to the conception and design of the study, and were major contributors in writing the manuscript.Z.Y.Zhu and W.Wei were responsible for data collection.D.J.Zhang made substantial revisions to the manuscript.All authors read and approved the final manuscript. References The Writing Committee of the Report on Cardiovascular Health and Diseases in China, & Hu, S. S. (2023). Report on cardiovascular health and diseases in China 2021: An updated summary. 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A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: A cross-sectional study. BMC Psychiatry , 21(1), 485. https://doi.org/10.1186/s12888-021-03495-6 Kozma, A., & Stones, M. J. (1980). The measurement of happiness: Development of the Memorial University of Newfoundland Scale of Happiness (MUNSH). Journal of Gerontology , 35(6), 906–912. https://doi.org/10.1093/geronj/35.6.906 Ma, L. P. (2023). Introduction of the national standard “Specification for ability assessment of older adults” to promote high-quality development of elderly care services. China Social Work, (5), 28–30. [In Chinese]. Song, Y. T. (Ed.). (2019). Comprehensive geriatric assessment (pp. 277–278). Beijing: Peking Union Medical College Press . Yu, R., Tong, C., Leung, G., & Woo, J. (2021). Assessment of the validity and acceptability of the online FRAIL scale in identifying frailty among older people in community settings. Maturitas , 145, 18–23. https://doi.org/10.1016/j.maturitas.2020.12.003 Dilaghi, E., Dottori, L., Pivetta, G., Dalla Bella, M., Esposito, G., Ligato, I., Pilozzi, E., Annibale, B., & Lahner, E. (2023). Incidence and Predictors of Gastric Neoplastic Lesions in Corpus-Restricted Atrophic Gastritis: A Single-Center Cohort Study. The American journal of gastroenterology , 118(12), 2157–2165. https://doi.org/10.14309/ajg.0000000000002327 Qian, J. N., Kang, Y. L., He, Y. C., & Hu, H. Y. (2024). Topic Modeling Analysis of Chinese Medicine Literature on Gastroesophageal Reflux Disease: Insights into Potential Treatment. Chinese journal of integrative medicine , 30(12), 1128–1136. https://doi.org/10.1007/s11655-024-3800-y Rodrigues, F., Domingos, C., Monteiro, D., & Morouço, P. (2022). A Review on Aging, Sarcopenia, Falls, and Resistance Training in Community-Dwelling Older Adults. International journal of environmental research and public health , 19(2), 874. https://doi.org/10.3390/ijerph19020874 Schneider, E., O'Riordan, K. J., Clarke, G., & Cryan, J. F. (2024). Feeding gut microbes to nourish the brain: unravelling the diet-microbiota-gut-brain axis. Nature metabolism , 6(8), 1454–1478. https://doi.org/10.1038/s42255-024-01108-6 Liang, X., Fu, Y., Cao, W. T., Wang, Z., Zhang, K., Jiang, Z., Jia, X., Liu, C. Y., Lin, H. R., Zhong, H., Miao, Z., Gou, W., Shuai, M., Huang, Y., Chen, S., Zhang, B., Chen, Y. M., & Zheng, J. S. (2022). Gut microbiome, cognitive function and brain structure: a multi-omics integration analysis. Translational neurodegeneration , 11(1), 49. https://doi.org/10.1186/s40035-022-00323-z Zhu, Y., Yin, H., Zhong, X., Zhang, Q., Wang, L., Lu, R., & Jia, P. (2025). Exploring the mediating roles of depression and cognitive function in the association between sarcopenia and frailty: A Cox survival analysis approach. Journal of advanced research , 76, 605–613. https://doi.org/10.1016/j.jare.2024.12.021 Hanlon, P., Wightman, H., Politis, M., Kirkpatrick, S., Jones, C., Andrew, M. K., Vetrano, D. L., Dent, E., & Hoogendijk, E. O. (2024). The relationship between frailty and social vulnerability: a systematic review. The lancet. Healthy longevity , 5(3), e214–e226. https://doi.org/10.1016/S2666-7568(23)00263-5 Chen, L., Wei, S., He, Y., Wang, X., He, T., Zhang, A., Jing, M., Li, H., Wang, R., & Zhao, Y. (2023). Treatment of Chronic Gastritis with Traditional Chinese Medicine: Pharmacological Activities and Mechanisms. Pharmaceuticals (Basel, Switzerland) , 16(9), 1308. https://doi.org/10.3390/ph16091308 Schalla, M. A., & Stengel, A. (2022). Risk factors for anxiety and depression in patients with gastrointestinal disorders-the role of the gut-brain axis. Annals of palliative medicine , 11(12), 3603–3606. https://doi.org/10.21037/apm-22-1190 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8996155","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619232196,"identity":"88704944-b911-4465-8c96-ea4af1b8eeae","order_by":0,"name":"Ying Xin","email":"","orcid":"","institution":"Binhai Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Xin","suffix":""},{"id":619232197,"identity":"308efb2b-d2e1-4ddb-8d08-26954a659efd","order_by":1,"name":"Xingguo Zuo","email":"","orcid":"","institution":"Binhai Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xingguo","middleName":"","lastName":"Zuo","suffix":""},{"id":619232198,"identity":"f08d5fc2-5de4-4ebd-b683-d60712f147a0","order_by":2,"name":"Zhenyu Zhu","email":"","orcid":"","institution":"Binhai Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhenyu","middleName":"","lastName":"Zhu","suffix":""},{"id":619232199,"identity":"c5d9c7b1-a65e-4e1c-98ef-ca4cb1b34c8e","order_by":3,"name":"Wei Cui","email":"","orcid":"","institution":"Henan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Cui","suffix":""},{"id":619232200,"identity":"f39ba093-672d-4b5a-8ab4-9bae4ef0921f","order_by":4,"name":"Dongjun Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACNmbGhgMSBjYwLhFa+NibGx9YFKSRoEWO53izQcWHwyRoYZNIbJO4YXA+ccO1MwYMH8oOM/DPbiCsRXKGwW1jydk5Bowzzh1mkLhzgLAWaQmD23L80jkGzLxthxkMJBKI0PLH4BwPG0jLX6K08BxsNpAwOACxhZEoLeyNjQ8kDJKBfkkrONhzLp1H4gYBLfLN7A8OSPyxS9xwO3njgx9l1nL8MwhoQQEHgJiHBPWjYBSMglEwCnABAEZVPrDscx7oAAAAAElFTkSuQmCC","orcid":"","institution":"Henan Medical University","correspondingAuthor":true,"prefix":"","firstName":"Dongjun","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-02-28 14:38:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8996155/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8996155/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106536120,"identity":"d01301a9-bf66-490e-a7e4-63671e89703e","added_by":"auto","created_at":"2026-04-09 15:11:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":592030,"visible":true,"origin":"","legend":"\u003cp\u003eCross-sectional network of symptom clusters in T1 and T2 stages among older adults with chronic gastritis\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-8996155/v1/fd9e6928c53b8588680bc220.png"},{"id":106536039,"identity":"ce6f909f-bad1-4a1d-8033-1899324ce9f9","added_by":"auto","created_at":"2026-04-09 15:11:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":151030,"visible":true,"origin":"","legend":"\u003cp\u003eCentrality measures of symptom nodes in T1 and T2 stages\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-8996155/v1/772988b0e30f9f65650a2006.png"},{"id":106535994,"identity":"95004fae-e7c3-40f5-ae24-52c6b0b9b5f1","added_by":"auto","created_at":"2026-04-09 15:10:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":75978,"visible":true,"origin":"","legend":"\u003cp\u003eDifference test of symptom node strength between T1 and T2 stages\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-8996155/v1/d3289e35fc22dacb2a4d02ab.png"},{"id":106536123,"identity":"d7429afd-f884-46b4-a8de-391e218fefd6","added_by":"auto","created_at":"2026-04-09 15:11:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":260246,"visible":true,"origin":"","legend":"\u003cp\u003eBootstrap 95% confidence intervals showing edge weights of the network in T1 and T2 stages\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-8996155/v1/2fec39a6b5f5f4ae7c2d874f.png"},{"id":106536040,"identity":"b1ce50e3-dee4-4e40-8c8d-d7389c318438","added_by":"auto","created_at":"2026-04-09 15:11:12","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":154085,"visible":true,"origin":"","legend":"\u003cp\u003eResults of subsample Bootstrap test for the symptom network in T1 and T2 stages\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-8996155/v1/79ff8cc5610a2a5cb8728683.png"},{"id":106536403,"identity":"fcf7b3e7-db1c-4dc3-8e62-58bee52a8d78","added_by":"auto","created_at":"2026-04-09 15:12:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2153302,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8996155/v1/f85f7239-8842-468b-9c9b-ad753ec3c726.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dynamic Network Analysis of Multidimensional Symptoms in Older Patients with Chronic Gastritis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs China enters a moderately aging society, health challenges among older adults have become increasingly prominent [1]. Chronic gastritis (CG) is characterized by recurrent gastrointestinal symptoms, including abdominal pain, bloating, nausea, and constipation. The disease is typically long-standing and prone to relapse, and is frequently accompanied by psychological comorbidities such as anxiety and depression, substantially impairing quality of life. Its prevalence and severity generally increase with advancing age [2]. In older populations, the onset and progression of CG are closely associated with age-related physiological decline, multimorbidity, and transitions in social roles. Current conventional treatment models predominantly focus on localized gastric mucosal inflammation, often overlooking the multidimensional health needs of older patients, which may contribute to prolonged disease courses or therapeutic resistance [3].\u003c/p\u003e\n\u003cp\u003eComprehensive Geriatric Assessment (CGA), a cornerstone of geriatric medicine, employs a multidisciplinary approach to systematically evaluate physical function, psychological status, social environment, and quality of life in older adults. Based on these assessments, individualized treatment and care plans are developed to maintain and improve functional capacity and overall well-being, emphasizing holistic evaluation of psychosomatic symptoms [4].\u003c/p\u003e\n\u003cp\u003eHowever, existing research largely relies on static analyses of physical and psychological symptoms and rarely examines their dynamic interrelationships over time. Therefore, grounded in the biopsychosocial model and the CGA framework, this study conducted a longitudinal investigation of older patients with CG. By integrating dynamic network analysis, we aimed to elucidate the temporal evolution of psychosomatic symptom clusters and provide evidence for individualized, stage-specific intervention strategies to optimize overall health outcomes.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 Study Design and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis longitudinal cohort study consecutively recruited hospitalized older adults with CG from the Departments of Geriatrics and Spleen–Stomach Diseases at a tertiary traditional Chinese medicine hospital in Jiangsu Province, China, between November 2024 and June 2025. A convenience sampling strategy was adopted.\u003c/p\u003e\n\u003cp\u003eEligible participants met the following criteria: (1) age\u0026nbsp;≥60 years; (2) diagnosis of CG confirmed by endoscopy and histopathology in accordance with the Chinese Guidelines for the Diagnosis and Treatment of CG (2022, Shanghai) [5,6]. Endoscopic and pathological findings were independently reviewed by at least two senior gastroenterologists (associate chief physician level or above). Traditional Chinese medicine (TCM) syndrome differentiation was independently performed by two senior TCM or integrative gastroenterology physicians. In cases of diagnostic discrepancy, a third senior specialist adjudicated until consensus was achieved; (3) provision of written informed consent and ability to comply with study procedures.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included: (1) severe primary cardiac, cerebrovascular, hepatic, or renal disease as the principal admission diagnosis; (2) severe psychiatric disorders (e.g., major anxiety or depressive disorders), cognitive disorders requiring psychotropic medication, or other conditions compromising valid assessment; (3) incomplete clinical data.\u003c/p\u003e\n\u003cp\u003eSample Size Estimation: Twenty-four independent variables were included in the planned network model. Following the recommended ratio of at least 10 participants per variable [7], a minimum sample size of 240 was required. Accounting for a potential 20% attrition or invalid response rate, the estimated minimum sample was 288. Ultimately, 360 participants were enrolled, exceeding the calculated requirement.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of\u0026nbsp;the Ethics Committee of Hospital (Approval No. [2024]2)\u0026nbsp;and complied with the Declaration of Helsinki. The purpose of the study was explained to all participants before the survey was conducted and informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.2.1 Demographic and Clinical Characteristics: A self-designed structured questionnaire collected demographic information (age, sex, marital status, education level, monthly income, medical insurance type) and clinical data (disease duration, family history of gastrointestinal malignancy, smoking and alcohol use, diagnosis, TCM syndrome classification, \u003csup\u003e13\u003c/sup\u003eC urea breath test results, and gastroscopy findings).\u003c/p\u003e\n\u003cp\u003e1.2.2 Gastrointestinal Symptoms: Gastrointestinal symptom severity was assessed using the Chinese version of the Gastrointestinal Symptom Rating Scale (GSRS) [8]. The GSRS comprises 15 items across five domains: abdominal pain, reflux, dyspepsia, diarrhea, and constipation. Items are rated on a 4-point Likert scale, yielding total scores ranging from 15 to 60, with higher scores indicating greater symptom severity[9]. In this study, internal consistency was acceptable (Cronbach’s α = 0.833).\u003c/p\u003e\n\u003cp\u003e1.2.3 CGA Domains: A multidimensional CGA framework was applied to systematically evaluate physical, psychological, social, and functional domains[4]. The specific scales are shown as follows:\u003c/p\u003e\n\u003cp\u003e(1) Physical Function\u003c/p\u003e\n\u003cp\u003eActivities of Daily Living (ADL) was assessed using the Barthel Index (BI) [10], which evaluates 10 basic daily activities (total score 0–100). Higher scores reflect greater independence. Cronbach’s α = 0.920.\u003c/p\u003e\n\u003cp\u003eFall risk was measured using the Falls Risk Assessment Scale for Older People (FRASE) [11], consisting of 35 items across eight domains (score range: 0–53). Higher scores indicate elevated fall risk. Cronbach’s α = 0.759.\u003c/p\u003e\n\u003cp\u003e(2) Psychological Status\u003c/p\u003e\n\u003cp\u003eSymptoms of anxiety were assessed using the Self-Rating Anxiety Scale (SAS) [12], which consists of 20 items rated on a 4-point scale. Raw scores are multiplied by 1.25 to generate standardized scores. Cronbach’s α = 0.991.\u003c/p\u003e\n\u003cp\u003eDepressive symptoms were assessed using the Self-Rating Depression Scale (SDS) [13], also comprising 20 items rated on a 4-point scale, with standardized scoring procedures identical to the SAS. Cronbach’s α = 0.990.\u003c/p\u003e\n\u003cp\u003eGlobal cognitive performance was evaluated using the Montreal Cognitive Assessment (MoCA) [14]. The MoCA assesses eight cognitive domains, with total scores ranging from 0 to 30. One additional point was added for participants with\u0026nbsp;≤12 years of formal education. Scores \u0026lt;26 indicated cognitive impairment. Cronbach’s α = 0.980.\u003c/p\u003e\n\u003cp\u003e(3) Quality of Life\u003c/p\u003e\n\u003cp\u003eSubjective well-being was measured using the Memorial University of Newfoundland Scale of Happiness (MUNSH) [15], comprising 24 items across four domains (positive affect, negative affect, positive experience, negative experience). Total scores range from 0 to 48, with higher scores reflecting greater happiness. Cronbach’s α = 0.990.\u003c/p\u003e\n\u003cp\u003e(4) Social Function\u003c/p\u003e\n\u003cp\u003eSocial participation was assessed according to the national standard Assessment of Ability of Older Adults (MZ/T001-2013) [16]. Five domains were rated from 0 to 4 (total 0–20), with higher scores indicating greater impairment. Cronbach’s α = 0.998.\u003c/p\u003e\n\u003cp\u003eRole adaptation was evaluated using the Interpersonal Functioning Scale [17], a 16-item measure (score range: 16–48), with lower scores indicating poorer interpersonal functioning. Cronbach’s α = 0.962.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrailty was screened using the FRAIL scale [18], which evaluates fatigue, resistance, ambulation, comorbidity burden, and weight loss. Scores range from 0 to 5: 0 = robust, 1–2 = pre-frail,\u0026nbsp;≥3 = frail. Cronbach’s α = 0.569.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Data Collection Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were assessed at hospital admission (T1) and at 6-month follow-up post-discharge (T2). Trained research staff administered all questionnaires in a standardized, quiet setting using combined paper-based and electronic formats. Given the potential fatigue and reduced endurance of older participants, assessments were permitted to be completed in multiple sessions. All data were anonymized and coded prior to analysis. Double data entry was independently performed by two investigators, followed by cross-verification to ensure accuracy and minimize transcription errors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were conducted using SPSS version 27.0 and R version 4.3.3. Continuous variables are presented as mean ± standard deviation (SD), and categorical variables as frequencies and percentages. Within-subject changes between T1 and T2 were evaluated using paired t-tests. Between-group comparisons were conducted using independent-samples t-tests or one-way analysis of variance (ANOVA), as appropriate.\u003c/p\u003e\n\u003cp\u003eWeighted symptom networks were estimated using the qgraph package in R. Centrality indices—including strength, closeness, and betweenness—were computed to identify influential nodes within the network. Network accuracy was assessed via nonparametric bootstrapping, generating 95% confidence intervals for edge weights. Stability of centrality indices was evaluated using the correlation stability (CS) coefficient, with CS \u0026gt;0.50 considered indicative of acceptable stability.\u003c/p\u003e\n\u003cp\u003eStructural differences between T1 and T2 networks were examined using the NetworkComparisonTest package, including global strength invariance and network structure invariance testing.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 General Characteristics of Elderly Patients with CG\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 360 elderly patients with CG, 61.67% were male, with a mean age of 71.53 \u0026plusmn; 8.26 years. Most participants had primary school education or below (60.00%), and 78.61% reported a monthly income of less than 2,000 RMB. Chronic atrophic gastritis (CAG) accounted for 77.22% of cases. In terms of TCM syndrome differentiation, spleen\u0026ndash;stomach deficiency syndrome was the most common (33.33%). The positive rate of Helicobacter pylori infection was 12.50%. Detailed demographic and clinical characteristics are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 General demographic data of elderly patients with chronic gastritis (n=360)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e61.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e38.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAge Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e60～70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e45.56%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e71～80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e36.11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026gt;80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e99.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.56%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003ePrimary school or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e60.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e32.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eSenior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMonthly Income (RMB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026lt;2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e78.61%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e2000～5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e21.39%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDisease Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026lt;2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e35.83%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e2～5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e41.11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026ge;6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e23.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFamily History of Digestive Tract Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e100.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSmoking History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e92.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDrinking History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e92.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDiagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eChronic non-atrophic gastritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e22.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eChronic atrophic gastritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e77.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eTCM Diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eLiver-stomach disharmony syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e24.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eSpleen-stomach damp-heat syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18.89%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eSpleen-stomach weakness syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e33.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eStomach yin deficiency syndrome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eStomach collateral blood stasis syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003csup\u003e13\u003c/sup\u003eC Urea Breath Test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e12.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e87.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003eGastroscopy Result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eSuperficial gastritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e24.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAtrophic gastritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 90px;\"\u003e\n \u003cp\u003e67.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Descriptive Statistics of Symptom Scores at T1 and T2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with T1, most symptom indicators showed improvement at T2. Scores for abdominal pain, reflux, dyspepsia, and diarrhea syndromes significantly decreased (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Regarding physical function, the negative Barthel score significantly decreased (\u003cem\u003eP\u003c/em\u003e = 0.017), and frailty screening scores declined (\u003cem\u003eP\u003c/em\u003e = 0.001), indicating improvements in activities of daily living and overall frailty status. However, fall risk scores increased (\u003cem\u003eP\u003c/em\u003e = 0.021).\u003c/p\u003e\n\u003cp\u003eIn the psychological domain, anxiety (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), depression (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), and negative Montreal Cognitive Assessment (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) significantly decreased, reflecting improvements in emotional status and cognitive function. Social participation scores showed a slight increase, while negative interpersonal relationship and well-being scores slightly decreased; however, these changes were not statistically significant (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). Detailed results are shown in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Symptom scores of elderly patients with chronic gastritis at T1 and T2 (\u003cem\u003en\u003c/em\u003e=360)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1 stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2 stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eAbdominal Pain Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5.42\u0026plusmn;1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5.24\u0026plusmn;1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e8.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eReflux Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5.79\u0026plusmn;2.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5.38\u0026plusmn;2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e14.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eDyspepsia Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5.40\u0026plusmn;2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5.20\u0026plusmn;2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e9.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eDiarrhea Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3.61\u0026plusmn;1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3.36\u0026plusmn;1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e10.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eConstipation Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e8.14\u0026plusmn;2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e8.37\u0026plusmn;3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-1.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eBarthel Index (Negative)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e21.01\u0026plusmn;16.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e17.92\u0026plusmn;16.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eFall Risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5.04 \u0026plusmn; 3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5.96\u0026plusmn;6.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-2.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eFrailty Screening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2.19 \u0026plusmn; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1.81\u0026plusmn;1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e68.63 \u0026plusmn; 16.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e54.58\u0026plusmn;16.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e14.812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e68.91 \u0026plusmn; 16.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e54.58\u0026plusmn;16.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e18.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eMontreal Cognitive Assessment (Negative)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e13.88 \u0026plusmn; 13.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e9.43\u0026plusmn;8.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e6.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eSocial Participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e8.74 \u0026plusmn; 9.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e9.13\u0026plusmn;8.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eInterpersonal Relationship (Negative)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e33.44 \u0026plusmn; 12.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e32.54\u0026plusmn;9.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 37px;\"\u003e\n \u003cp\u003eWell-being (Negative)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 17px;\"\u003e\n \u003cp\u003e26.83 \u0026plusmn; 16.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e25.90\u0026plusmn;14.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc22784\"\u003e\u003cstrong\u003e2.3 Symptom Network Analysis in Elderly Patients with CG\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNetwork analysis was conducted to explore the structural characteristics of symptom clusters at T1 and T2. At T1, cognitive function (MD11) emerged as the central bridge node, playing a key role in linking psychological status, functional ability, and gastrointestinal symptoms. Anxiety (MD9) and depression (MD10) also demonstrated high closeness centrality and node strength, highlighting the core role of emotional and cognitive factors in the overall health structure during the early stage.\u003c/p\u003e\n\u003cp\u003eAt T2, the core network structure shifted markedly. Frailty (MD6) became the primary hub node, exhibiting the highest betweenness centrality. Fall risk (MD7) and social participation (MD8) also showed significant increases in node strength and centrality. These findings suggest that as the disease progressed, frailty and social functioning gradually replaced psychological and cognitive factors as the dominant components influencing the symptom network. Detailed results are illustrated in Figure 1.\u003c/p\u003e\n\u003cp\u003eComparisons of centrality indices between T1 and T2 revealed dynamic evolution (Figure 2). At T1, cognitive function (MD11) had the highest betweenness centrality (Betweenness = 25), indicating a critical bridging role within the network. Anxiety (MD9), depression (MD10), and cognitive function (MD11) also ranked high in closeness centrality and strength. At T2, frailty screening (MD6) showed the highest betweenness centrality (Betweenness = 17), while role adaptation (MD13) and social participation (MD8) significantly increased. In addition, frailty (MD6), social participation (MD8), and fall risk (MD7) ranked highest in node strength, and all expected influence (EI) values were positive, indicating their integrative and dominant roles in the evolving health structure.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eStrength difference tests demonstrated that, at T1, diarrhea syndrome (MD4) and constipation syndrome (MD5) exhibited the lowest strength values and were therefore more likely to differ significantly from other symptoms. At T2, significant differences in node strength became more widespread, suggesting increased heterogeneity and intensified differentiation among symptom loads as the disease progressed (Figure 3).\u003c/p\u003e\n\u003cp\u003eBootstrap analysis of edge weights (95% confidence intervals) showed differences in estimation precision between T1 and T2. At T1, confidence intervals narrowed substantially when edge weights exceeded 0.25, indicating accurate estimation of stronger connections. At T2, this threshold increased to 0.40, suggesting that only stronger associations achieved high estimation stability in the later stage. This pattern reflects strengthened symptom interconnections over time and provides a basis for subsequent centrality stability testing (Figure 4).\u003c/p\u003e\n\u003cp\u003eSubsample bootstrap tests (\u003cem\u003en\u003c/em\u003e = 1000) were performed to assess centrality stability. At T1, the CS coefficient for strength centrality was 0.75, indicating high stability; closeness centrality showed moderate stability (\u003cem\u003eCS\u003c/em\u003e = 0.361); betweenness centrality demonstrated poor stability (\u003cem\u003eCS\u003c/em\u003e = 0). At T2, strength centrality remained stable (\u003cem\u003eCS\u003c/em\u003e = 0.75), while closeness centrality markedly improved (\u003cem\u003eCS\u003c/em\u003e = 0.75), indicating very high reliability. Betweenness centrality showed moderate stability (\u003cem\u003eCS\u003c/em\u003e = 0.283). Overall, strength centrality demonstrated robust interpretability at both time points; closeness centrality became substantially more stable at T2, whereas betweenness centrality should be interpreted with caution (Figure 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Dynamic Network Analysis of Symptoms in Elderly Patients with CG\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparative network analysis revealed significant dynamic changes in the symptom network structure of elderly patients with CG between T1 and T2 (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Global strength increased from 4.75 at T1 to 5.95 at T2 (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), indicating that the interconnections among symptoms or functional indicators became more tightly integrated, with enhanced mutual influence over time.\u003c/p\u003e\n\u003cp\u003eNode centrality analysis demonstrated that the centrality of abdominal pain syndrome (MD1; strength \u003cem\u003eC\u003c/em\u003e = \u0026minus;0.176, \u003cem\u003eP\u003c/em\u003e = 0.004), diarrhea syndrome (MD4; \u003cem\u003eC\u003c/em\u003e = \u0026minus;0.666, \u003cem\u003eP\u003c/em\u003e = 0.001), constipation syndrome (MD5; \u003cem\u003eC\u003c/em\u003e = \u0026minus;0.551, \u003cem\u003eP\u003c/em\u003e = 0.001), and the Barthel Index representing functional capacity (MD6; \u003cem\u003eC\u003c/em\u003e = \u0026minus;0.824, \u003cem\u003eP\u003c/em\u003e = 0.001) significantly decreased. These findings suggest that these variables served as key nodes in the network at T1, whereas their relative importance diminished at T2. This pattern indicates an alleviation of gastrointestinal symptoms and improvement in functional limitations, thereby reducing their driving influence within the overall health network.\u003c/p\u003e\n\u003cp\u003eIn contrast, the centrality of psychosocial functioning nodes\u0026mdash;including anxiety, depression, social participation, and subjective well-being\u0026mdash;showed no significant changes (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). This stability suggests that psychosocial factors maintained a persistent and substantial influence within the health network throughout the disease course, continuing to play a critical role even after the remission of physical symptoms. Detailed results are presented in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Difference test of centrality measures of symptom nodes between T1 and T2 stages (n = 360)\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNodes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrength C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrength \u003cem\u003eP\u0026nbsp;\u003c/em\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eAbdominal Pain Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eReflux Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eDyspepsia Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eDiarrhea Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eConstipation Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eBarthel Index (Negative)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eFall Risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eFrailty Screening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eMontreal Cognitive Assessment (Negative)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.710\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eSocial Participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.811\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eInterpersonal Relationship (Negative)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 73px;\"\u003e\n \u003cp\u003eMD14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eWell-being (Negative)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e3.1 Predominant Spleen–Stomach Deficiency and Elevated Socioeconomic Risk in Elderly CAG: Implications for Comprehensive Intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the 360 elderly patients with CG had a relatively advanced mean age at onset (71.53 ± 8.26 years), and CAG accounted for the majority of cases (77.22%). This finding is consistent with the study by Dilaghi et al. [19], which reported an increasing prevalence of atrophic gastritis with advancing age. In terms of TCM syndrome differentiation, spleen–stomach deficiency syndrome accounted for 33.33%, aligning with the physiological characteristics of age-related decline in spleen and stomach function in older adults. Accordingly, treatment should follow the principle of strengthening the spleen and harmonizing the stomach [20].\u003c/p\u003e\n\u003cp\u003eMost patients exhibited low educational attainment and low income levels, factors that may hinder access to health information and reduce treatment adherence. At T2, the risk of falls increased. Rodrigues et al. [21] demonstrated that elevated fall risk in older adults is associated with sarcopenia, functional decline, reduced resistance training, and poor quality of life. Therefore, clinical management should adopt a comprehensive approach addressing both gastrointestinal symptoms and psychological status. Regular assessments of physical function, nutritional status, and fall risk are warranted, alongside individualized dietary guidance, medication safety education, and appropriate physical exercise, with the aim of improving quality of life and ensuring patient safety.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Evolution of the Symptom Network in Elderly Chronic Gastritis from Psychological Dominance to Physical–Functional Core\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNetwork analysis revealed that at T1, anxiety (MD9), depression (MD10), and cognitive function (MD11) demonstrated prominent closeness centrality (0.0102–0.0109) and strength centrality (2.762–2.908), indicating that negative emotions may trigger gastrointestinal dysfunction through activation of the hypothalamic–pituitary–adrenal (HPA) axis via the brain–gut axis. Schneider et al. [22] reported that this mechanism promotes cortisol release, increases gastric mucosal permeability, and induces sympathetic excitation and gastrointestinal dysregulation, clinically manifesting as abdominal pain, bloating, and belching.\u003c/p\u003e\n\u003cp\u003eAt T2, the centrality of these psychological nodes did not significantly decrease, suggesting the relative stability of psychological factors and the need for long-term targeted psychological interventions rather than reliance solely on conventional gastrointestinal treatment. Cognitive function (MD11) exhibited the highest betweenness centrality (MD11 = 25), indicating its critical bridging role between physical and psychosocial domains. This may be related to reduced social engagement and functional decline secondary to persistent gastrointestinal discomfort, leading to cognitive impairment, misinterpretation of disease information, decreased adherence, and amplification of somatic perceptions. This finding is consistent with Liang et al. [23], who demonstrated that specific gut microbiota characteristics may influence hippocampal volume and cognitive function, further supporting the brain–gut interaction mechanism.\u003c/p\u003e\n\u003cp\u003eAt T2, the network core shifted toward physical function and social participation nodes. Frailty screening (MD6) exhibited the highest betweenness centrality (MD6 = 17) and, together with social participation (MD8) and fall risk (MD7), formed the cluster with the strongest strength centrality (MD6 = 4.824; MD8 = 4.538). This shift indicates that disease impact gradually transitioned from the psychological level to the physical-functional level. This pattern is consistent with the findings of Zhu et al. [24], who reported interrelationships among sarcopenia, depression, cognitive impairment, and frailty incidence, demonstrating progressive frailty and declining functional capacity with disease progression in older adults. These findings align with the clinical characteristics of frailty syndrome, wherein social isolation and frailty mutually reinforce one another. Hanlon et al. [25] further confirmed that long-term social isolation may accelerate physical functional decline by reducing physical activity, while frailty further limits social participation.\u003c/p\u003e\n\u003cp\u003eMeanwhile, the strength centrality of gastrointestinal symptom clusters significantly decreased (negative strength C values), suggesting that integrated Chinese and Western pharmacotherapy [26], application of appropriate TCM techniques, and lifestyle interventions effectively alleviated gastrointestinal symptoms and reduced their influence within the network. These findings indicate that clinical intervention should shift from symptom-centered gastrointestinal treatment toward comprehensive management focusing on frailty prevention, physical function maintenance, and promotion of social participation.\u003c/p\u003e\n\u003cp\u003eThe symptom and functional network structure of elderly CG patients evolved significantly between T1 and T2, with a marked increase in global network strength (T2 = 5.95 vs. T1 = 4.75, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). This suggests that with disease progression and clinical intervention, interconnections among symptoms and functional domains became more closely integrated, reflecting increased complexity in overall health status. In early stages, digestive symptoms predominated; as the disease progressed, physical functional decline, reduced quality of life, and psychosocial problems gradually emerged, forming a complex multisystem interaction network. At T2, the strength centrality of gastrointestinal symptom clusters (abdominal pain, diarrhea, constipation) and the Barthel Index significantly decreased (Strength C = −0.176 to −0.824, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), indicating weakened driving effects after treatment. In contrast, anxiety, depression, and social participation nodes showed no significant change in strength (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05), suggesting their sustained influence. This persistence may relate to stable psychosocial stressors in older adults, such as role transition and loneliness, which are unlikely to resolve rapidly with short-term treatment.\u003c/p\u003e\n\u003cp\u003eIn later stages of disease, psychosocial factors replaced gastrointestinal symptoms as the dominant determinants of health. Significant differences in network structure (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) indicate dynamic associations between symptoms and physical function, jointly regulated by physiological adaptation, clinical treatment, disease progression, and psychosocial factors. These findings are consistent with the brain–gut axis theory proposed by Schalla et al. [27], which posits progressively strengthened bidirectional interactions between physiological and psychological pathways, linking anxiety, depression, cognitive function, and social adaptation, thereby facilitating the formation of psychosomatic symptom clusters. At T1, anxiety and depression demonstrated high closeness centrality, suggesting that negative emotions may precipitate gastrointestinal symptoms.\u003c/p\u003e\n\u003cp\u003eThis dynamic evolution underscores that, in later stages, psychosocial factors become the core determinants of overall health in elderly CG patients, further validating the regulatory role of the brain–gut axis. Clinical management should therefore transition from merely controlling gastrointestinal symptoms to strengthening psychological support and promoting social participation to improve long-term prognosis. The dynamic network analysis further indicates that as CG progresses in older adults, the network core shifts from predominantly digestive symptoms to a structure increasingly influenced by psychological and social factors. Consequently, clinical treatment should extend beyond symptom control to encompass psychological status, social participation, and daily functional capacity.\u003c/p\u003e\n\u003cp\u003eBased on the psychological–somatic dynamic trajectory observed, stage-specific interventions are recommended. At T1, priority should be given to emotional regulation and stabilization of the brain–gut axis, with routine screening for anxiety, depression, and cognitive function (MD9, MD10, MD11). At T2, emphasis should shift toward maintaining physical function, including combating sarcopenia, providing nutritional support, promoting social participation, and assessing frailty, social engagement, and fall risk (MD6, MD8, MD7). Through such comprehensive management, the goal is to delay frailty progression, enhance social participation, and embody the concept of “active aging,” thereby more comprehensively improving health outcomes in elderly patients with CG.\u003c/p\u003e\n\u003cp\u003eThis study has certain limitations. The sample was derived from a single source, limiting representativeness. Future studies should expand sampling sources and further investigate the longitudinal dynamic changes of core symptoms.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eUsing CGA, this study explored the dynamic evolution of psychosomatic symptom networks in elderly patients with CG at T1 (admission) and T2 (6 months post-discharge). The findings indicate that the network core shifted from predominantly psychological–emotional indicators (e.g., anxiety and depression) at T1 to predominantly physical-functional indicators (e.g., frailty, social participation, and fall risk) at T2. Overall, the results reveal a psychosocial-centered pattern of mind–body interaction, highlighting the dynamic and integrative nature of symptom evolution in elderly CG.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHenan Province Higher Education Teaching Reform Research and Practice Project (Graduate Education Category) (2023SJGLX235Y).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors wish to thank all the participants and all the study assistants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of\u0026nbsp;the Ethics Committee of Hospital (Approval No. [2024]2)\u0026nbsp;and complied with the Declaration of Helsinki. The purpose of the study was explained to all participants before the survey was conducted and informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.Xin and X.G.Zuo contributed to the conception and design of the study, and were major contributors in writing the manuscript.Z.Y.Zhu and W.Wei were responsible for data collection.D.J.Zhang made substantial revisions to the manuscript.All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThe Writing Committee of the Report on Cardiovascular Health and Diseases in China, \u0026amp; Hu, S. S. (2023). 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The measurement of happiness: Development of the Memorial University of Newfoundland Scale of Happiness (MUNSH). \u003cem\u003eJournal of Gerontology\u003c/em\u003e, 35(6), 906\u0026ndash;912. https://doi.org/10.1093/geronj/35.6.906\u003c/li\u003e\n\u003cli\u003e Ma, L. P. (2023). Introduction of the national standard \u0026ldquo;Specification for ability assessment of older adults\u0026rdquo; to promote high-quality development of elderly care services. China Social Work, (5), 28\u0026ndash;30. [In Chinese].\u003c/li\u003e\n\u003cli\u003e Song, Y. T. (Ed.). (2019). Comprehensive geriatric assessment (pp. 277\u0026ndash;278). Beijing:\u003cem\u003e Peking Union Medical College Press\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003e Yu, R., Tong, C., Leung, G., \u0026amp; Woo, J. (2021). 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Feeding gut microbes to nourish the brain: unravelling the diet-microbiota-gut-brain axis. \u003cem\u003eNature metabolism\u003c/em\u003e, 6(8), 1454\u0026ndash;1478. https://doi.org/10.1038/s42255-024-01108-6\u003c/li\u003e\n\u003cli\u003e Liang, X., Fu, Y., Cao, W. T., Wang, Z., Zhang, K., Jiang, Z., Jia, X., Liu, C. Y., Lin, H. R., Zhong, H., Miao, Z., Gou, W., Shuai, M., Huang, Y., Chen, S., Zhang, B., Chen, Y. M., \u0026amp; Zheng, J. S. (2022). Gut microbiome, cognitive function and brain structure: a multi-omics integration analysis. \u003cem\u003eTranslational neurodegeneration\u003c/em\u003e, 11(1), 49. https://doi.org/10.1186/s40035-022-00323-z\u003c/li\u003e\n\u003cli\u003e Zhu, Y., Yin, H., Zhong, X., Zhang, Q., Wang, L., Lu, R., \u0026amp; Jia, P. (2025). Exploring the mediating roles of depression and cognitive function in the association between sarcopenia and frailty: A Cox survival analysis approach. \u003cem\u003eJournal of advanced research\u003c/em\u003e, 76, 605\u0026ndash;613. https://doi.org/10.1016/j.jare.2024.12.021\u003c/li\u003e\n\u003cli\u003e Hanlon, P., Wightman, H., Politis, M., Kirkpatrick, S., Jones, C., Andrew, M. K., Vetrano, D. L., Dent, E., \u0026amp; Hoogendijk, E. O. (2024). The relationship between frailty and social vulnerability: a systematic review. \u003cem\u003eThe lancet. Healthy longevity\u003c/em\u003e, 5(3), e214\u0026ndash;e226. https://doi.org/10.1016/S2666-7568(23)00263-5\u003c/li\u003e\n\u003cli\u003e Chen, L., Wei, S., He, Y., Wang, X., He, T., Zhang, A., Jing, M., Li, H., Wang, R., \u0026amp; Zhao, Y. (2023). Treatment of Chronic Gastritis with Traditional Chinese Medicine: Pharmacological Activities and Mechanisms. \u003cem\u003ePharmaceuticals (Basel, Switzerland)\u003c/em\u003e, 16(9), 1308. https://doi.org/10.3390/ph16091308\u003c/li\u003e\n\u003cli\u003e Schalla, M. A., \u0026amp; Stengel, A. (2022). Risk factors for anxiety and depression in patients with gastrointestinal disorders-the role of the gut-brain axis. \u003cem\u003eAnnals of palliative medicine\u003c/em\u003e, 11(12), 3603\u0026ndash;3606. https://doi.org/10.21037/apm-22-1190\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic gastritis, Network analysis, Core symptoms, Older adults, Dynamic evolution","lastPublishedDoi":"10.21203/rs.3.rs-8996155/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8996155/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: Based on the biopsychosocial model and the Comprehensive Geriatric Assessment framework, this study applied dynamic network analysis to investigate the evolving interrelations among physical and psychological symptom clusters in older patients with chronic gastritis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A longitudinal design with convenience sampling was used to recruit 360 hospitalized chronic gastritis patients aged ≥ 60 years. Assessments were conducted at admission (T1) and 6 months post-discharge (T2). Data were collected using a general information questionnaire, the Comprehensive Geriatric Assessment, and the Gastrointestinal Symptom Rating Scale. Symptom networks were constructed using R, and centrality indices were calculated to identify core symptoms and structural changes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: At T1, anxiety, depression, and cognitive function were the core nodes of the \u0026nbsp;network. At T2, frailty, social participation, and fall risk became dominant. Centrality of gastrointestinal symptoms (abdominal pain, diarrhea, constipation) and activities of daily living (Barthel Index) significantly decreased at T2 (C = −0.176 to −0.824, \u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05), whereas psychosocial factors (anxiety, depression, well-being) remained stable (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). Global network strength increased from 4.75 (T1) to 5.95 (T2) (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The network core shifted from psychological-cognitive factors at admission \u0026nbsp;to physical-functional indicators at follow-up, revealing a dynamic psychosomatic interaction pattern centered on psychosocial factors.\u003c/p\u003e","manuscriptTitle":"Dynamic Network Analysis of Multidimensional Symptoms in Older Patients with Chronic Gastritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 15:09:09","doi":"10.21203/rs.3.rs-8996155/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-24T18:04:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-20T09:59:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-20T07:20:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T20:58:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T14:53:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96618835494287505878164430460166693101","date":"2026-04-15T08:29:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144146830621353951346000500438581064562","date":"2026-04-13T22:52:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205150094228624236894970534516899807210","date":"2026-04-12T05:30:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5759588293514085237148562248509077011","date":"2026-04-09T18:22:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112189645118698102124131098670910143969","date":"2026-04-08T05:31:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179698330377585264265598291729504115029","date":"2026-04-02T17:14:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-02T17:04:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T05:55:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-05T09:10:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-04T16:09:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-03-04T10:10:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"61ebaa37-1ed9-4525-a535-889ec4b9fd3a","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T15:09:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 15:09:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8996155","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8996155","identity":"rs-8996155","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}