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
he Relationship between Multi-dimensional Frailty and Impairment of Activities of Daily Living in Rural Elderly
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 livingADL in the elderlybut 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 of Guizhou province and the correlation of dimensions with ADL impairmentso as to provide evidence for preventing disability rural older adults. Methods A cross-sectional study was conductedolder adults aged ≥ 60 years from 30 administrative villages in 2 cities of Guizhou Province were selected for the study from July to September 2021n=1 298 by using a multi-stage cluster sampling method. The demographic characteristicsprevalence of chronic diseases and sleep quality of the subjects were collected by questionnaireand the multi-dimensional frailty of the elderly was assessed by Chinese version of Tilburg debilitating scaleADL scale was used to assess the impairment of ADL in the elderlymultivariate Logistic regression was used to analyze the effects of multi-dimensional frailty and its dimensions on the impairment of ADL in the elderlyand the multifactor-adjusted population attributable risk percentagePARc% was calculated. Results Of the 1 298 older adults49838.37% were with ADL impairment403.08% were with BADL impairment49438.06% were with IADL impairment38229.43% were with multi-dimensional frailty31924.58% were with physical frailty567 43.68% were with psychological frailtyand 695.32% were with social frailty. After adjusting for confounding factors of agegendereducation levelmarital statusand sleep qualitythe results of binary Logistic regression analysis showed that multi-dimensional frailtyphysical frailtyand psychological frailty in older adults had effects on and ADLBADL and IADL impairmentsP<0.05. Further analysis of the population attribution risk of multi-dimensional frailtyphysical frailty and psychological frailty for ADL showed that multi-dimensional frailty had the greatest population attributable risk for BALD impairmentPARc%95%CI=24.619.127.1psychological frailty had a relatively high population attributable risk for ADL impairmentPARc%95%CI=18.412.124.5BADL impairmentPARc%95%CI=23.63.233.7and IADL impairmentPARc%95%CI=19.412.424.7. Conclusion The multi-dimensional frailtyphysical frailty and psychological frailty of the rural elderly in Guizhou province are related to the impairment of ADLBADL and IADLwith greater attribution of psychological frailty for disability. Enhancing screening and interventions for multi-dimensional frailty in older adultsparticularly psychological frailtymay reduce the risk of disability in older adults.
杨敬源、赵奕、蒋芸、杨星、周全湘、黄慧、朱宇杰
10.12114/j.issn.1007-9572.2023.0428
预防医学医学研究方法
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
FrailtyMulti-dimensional frailtyctivities of daily livinggedRural healthLogistic modelPopulation attributable risk
杨敬源,赵奕,蒋芸,杨星,周全湘,黄慧,朱宇杰.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[EB/OL].(2023-09-01)[2025-07-16].https://chinaxiv.org/abs/202309.00023.点此复制
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