首页|农村老年人多维度衰弱与日常生活活动能力受损的关联性研究

农村老年人多维度衰弱与日常生活活动能力受损的关联性研究

The Relationship between Multi-dimensional Frailty and Impairment of Activities of Daily Living in Rural Elderly

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背景 既往研究发现老年人身体衰弱和日常生活活动能力(ADL)受损之间存在关联,但老年人心理衰弱和社会衰弱与其ADL受损之间是否存在关联仍不明确.目的 探讨农村老年人多维度衰弱及其各维度与老年人ADL受损之间的关联,为预防农村老年人失能提供依据.方法 采用现况研究设计,于 2021 年 7-9 月,通过多阶段整群抽样的方法选取贵州省 2 个市(州)共 30 个行政村的≥60 岁老年人为研究对象(n=1 298).采用问卷调查的方式收集纳入老年人的人口学特征、患慢性病情况、睡眠质量,采用中文版Tilburg衰弱(TFI)量表评估老年人的多维度衰弱情况,采用ADL量表评估老年人的ADL受损情况.采用二分类Logistic回归模型分析老年人多维度衰弱及其各维度衰弱对ADL受损的影响,并计算多因素调整的人群归因危险度百分比(PARc%).结果 1 298 名老年人中,存在ADL受损 498 名(38.37%),存在基础性日常生活活动能力(BADL)受损 40 名(3.08%),存在工具性日常生活活动能力(IADL)受损 494 名(38.06%);存在多维度衰弱 382 名(29.43%),存在身体衰弱 319 名(24.58%),存在心理衰弱567名(43.68%),存在社会衰弱69名(5.32%).二分类Logistic回归分析结果显示:在调整了混杂因素(性别、年龄、文化程度、婚姻状况、睡眠质量)后,老年人多维度衰弱、身体衰弱、心理衰弱对ADL、IADL、BADL受损均有影响(P<0.05).进一步分析老年人多维度衰弱、身体衰弱、心理衰弱对ADL受损的人群归因危险度,发现多维度衰弱对BADL的人群归因危险度最大[PARc%(95%CI)=24.6(19.1~27.1)],心理衰弱对ADL、BADL、IADL受损的人群归因危险度相对较大[PARc%(95%CI)分别为18.4(12.1~24.5)、23.6(3.2~33.7)、19.4(12.4~24.7)].结论 农村老年人多维度衰弱及其身体衰弱、心理衰弱对ADL受损、BADL受损及IADL受损均有影响,失能归因于心理衰弱较大.加强老年人多维度衰弱的筛查与干预,尤其是心理衰弱,可能会降低老年人失能风险.
Background Previous studies have confirmed a correlation between physical frailty and impairment of activities of daily living(ADL)in the elderly,but it is still unclear whether there is a correlation of psychological and social frailty in the elderly with their ADL impairment.Objective To investigate the multi-dimensional frailty of the elderly in rural areas and the correlation of dimensions with ADL impairment,so as to provide evidence for preventing disability rural older adults.Methods A cross-sectional study was conducted,older adults aged≥60 years from 30 administrative villages in 2 cities of Guizhou Province were selected for the study from July to September 2021(n=1 298)by using a multi-stage cluster sampling method.The demographic characteristics,prevalence of chronic diseases and sleep quality of the subjects were collected by questionnaire,and the multi-dimensional frailty of the elderly was assessed by Chinese version of Tilburg debilitating scale,ADL scale was used to assess the impairment of ADL in the elderly,multivariate Logistic regression was used to analyze the effects of multi-dimensional frailty and its dimensions on the impairment of ADL in the elderly,and the multifactor-adjusted population attributable risk percentage(PARc%)was calculated.Results Of the 1 298 older adults,498(38.37%)were with ADL impairment,40(3.08%)were with BADL impairment,494(38.06%)were with IADL impairment;382(29.43%)were with multi-dimensional frailty,319(24.58%)were with physical frailty,567(43.68%)were with psychological frailty,and 69(5.32%)were with social frailty.After adjusting for confounding factors of age,gender,education level,marital status,and sleep quality,the results of binary Logistic regression analysis showed that multi-dimensional frailty,physical frailty,and psychological frailty in older adults had effects on and ADL,BADL and IADL impairments(P<0.05).Further analysis of the population attribution risk of multi-dimensional frailty,physical frailty,and psychological frailty for ADL showed that multi-dimensional frailty had the greatest population attributable risk for BALD impairment[PARc%(95%CI)=24.6(19.1-27.1)],psychological frailty had a relatively high population attributable risk for ADL impairment[PARc%(95%CI)=18.4(12.1-24.5)],BADL impairment[PARc%(95%CI)=23.6(3.2-33.7)],and IADL impairment[PARc%(95%CI)=19.4(12.4-24.7)].Conclusion The multi-dimensional frailty,physical frailty and psychological frailty of the rural elderly in Guizhou province are related to the impairment of ADL,BADL and IADL,with greater attribution of psychological frailty for disability.Enhancing screening and interventions for multi-dimensional frailty in older adults,particularly psychological frailty,may reduce the risk of disability in older adults.

FrailtyMulti-dimensional frailtyActivities of daily livingAgedRural healthLogistic modelPopulation attributable risk

赵奕、杨敬源、杨星、周全湘、蒋芸、黄慧、朱宇杰

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550025 贵州省贵阳市,贵州医科大学公共卫生与健康学院 环境污染与疾病监控教育部重点实验室贵州省卫生发展研究院

550025 贵州省贵阳市,贵州医科大学医药卫生管理学院

558000 贵州省黔南布依族苗州自治州都匀市,贵州黔南民族医学高等专科学校

衰弱 多维度衰弱 日常生活活动能力 老年人 农村卫生 Logistic模型 人群归因危险度

国家自然科学基金资助项目

81860598

2024

中国全科医学
中国医院协会

中国全科医学

CSTPCD北大核心
影响因子:2.04
ISSN:1007-9572
年,卷(期):2024.27(1)
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