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学科主题: 护理学
题名:
社区老年人衰弱状况及其相关因素的研究
作者: 奚兴
答辩日期: 2014-05-27
导师: 郭桂芳
专业: 护理学
授予单位: 北京大学
授予地点: 北京大学护理学院
学位: 硕士
关键词: 社区老年人 衰弱 影响因素 不良健康结局
其他题名: A Study of Frailty and Its Related Factors among Community-dwelling Elders
分类号: R473.2
摘要: 背景:我国老龄化问题日益严峻,老年人慢性病患病率逐年增高,常伴有多种健康问题。老年人对不良健康结局的易感程度不同,年龄和疾病并不能完全解释老年人健康状况的异质性,衰弱概念的提出正是为了解决这一问题。目前衰弱在我国老年人群中的研究尚处于起步阶段,国际上较为常用的衰弱表型评估方法在我国社区老年人中的应用鲜见报道。衰弱与老年人多种不良健康结局关系密切,这些不良结局可对家庭、社会造成沉重的照护负担,因此社区老年人衰弱状况及其相关因素成为老年学科广泛关注的焦点,进一步了解社区衰弱状况及其相关因素可为今后开展社区老年人衰弱干预性研究奠定基础。目的:(1)调查并描述社区老年人衰弱的发生特点;(2)从多个维度分析社区老年人衰弱发生的影响因素;(3)探讨社区老年人衰弱与自理能力障碍、衰弱与生活质量不佳之间的关系。 方法:本研究为横断面描述性研究。采用便利抽样于2013年7月~11月选取来自北京某社区卫生服务中心和某城区街道的老年人为研究对象。由接受过培训的调查小组采用统一的方法收集研究对象人口统计学、生理健康状况、精神心理健康状况、社会支持、生活行为方式、日常生活活动能力、生活质量等资料,并进行身体评估。采用Fried的衰弱表型评估法进行衰弱状况的诊断与评估。主要统计方法包括Logistic回归、多重线性回归等。 结果: (1)本研究共获得有效样本683例。根据衰弱等级进行划分,本研究对象中不衰弱的占43.2%,衰弱前期的占45.7%,衰弱的占11.1%。衰弱的主要表现为握力低(33.1%),身体活动量低(21.7%),疲乏(19%),步速缓慢(15.8%),体质量下降(8.9%)。 (2) 衰弱状况的单因素分析结果显示,不同人口学特征(年龄、性别、文化程度和月收入)、不同的生理状况(视力问题、听力问题、胃肠道不适、睡眠质量、疼痛、尿失禁、共病)、不同的精神心理状况(抑郁、焦虑、认知障碍、自评健康状况)、不同的社会支持状况(家庭支持、朋友支持、其他人支持)、不同的生活行为方式(饮食种类、饮水量)均可能影响衰弱状况(衰弱前期和衰弱)的发生(P<0.05)。 (3) 衰弱状况的多因素分析结果显示,对于衰弱前期而言,年龄在80岁以上、男性、睡眠质量差、自评健康状况差、有抑郁症状的老年人衰弱前期发生风险较大(P<0.05)。对于衰弱而言,年龄在80岁以上、男性、文盲、有抑郁症状、轻度认知障碍、尿失禁、饮食健康状况一般、自评健康状况差或一般的老年人衰弱发生风险较大(P<0.05)。 (4) 在排除了可能的混杂因素后,衰弱前期和衰弱老年人发生自理障碍风险分别是不衰弱老年人的2.721倍和20.632倍(P<0.05)。存在步速缓慢、握力低、身体活动量低问题的老年人发生自理能力障碍的风险分别是正常老年人的2.101、2.943、3.090倍(P<0.05)。而是否存在体质量下降和疲乏问题的老年人发生自理能力障碍风险的差异无统计学意义(P>0.05)。 (5) 在排除了可能的混杂因素后,衰弱前期和衰弱老年人的生理维度生活质量得分较低(P<0.05),而不同衰弱状况老年人心理维度生活质量差异无统计学意义(P>0.05)。在生理维度,除体质量下降外,存在其他任一衰弱指标问题的老年人生活质量得分均较低(P<0.05);在心理维度,仅存在疲乏的老年人生活质量得分低,差异有统计学意义(P<0.05)。结论:(1)社区老年人中衰弱的发生率与以往研究结果类似,处于较高水平,值得关注。(2)老年人的人口统计学特征、生理状况、精神心理状况、社会支持和生活行为方式等方面的因素会影响老年人的衰弱状况,提示可设计多维度、学科间合作的衰弱干预措施,改善老年人衰弱状况。(3)衰弱前期的老年人可发生自理能力障碍、生活质量得分低等不良结局,提示今后可考虑从衰弱角度预测老年人发生不良健康结局的风险,并可通过衰弱管理指导不良结局的早期预防和干预措施。
英文摘要: Background:As population aging in China, a lot of elders are suffering from morbidity and chronic health conditions. It is noticeable that elders age in different pace and their vulnerability to adverse outcomes is different. The heterogeneity among elders could not be totally explained by age and illness. Under this condition, gerontologists identified the concept of frailty. Frailty is highly associated with adverse health outcomes which may result in heavy burden for the family and society. Therefore, frailty and its related factors and adverse outcomes among community-dwelling elders have always been a focus among the gerontological field. Up to now, few studies have been focused on frailty in Chinese population and Fried’s frailty phenotype has seldom been utilized to assess frailty among Chinese community-dwelling elders. Further understanding of the characteristics of frailty among Chinese community-dwelling elders could provide with the foundation for intervention targeted at frailty in the future. Objectives: (1) To investigate and describe the characteristics of frailty among community-dwelling elders. (2) To analysis multiple dimensional factors related to frailty among community-dwelling elders. (3) To explore the relationship of frailty, disability and quality of life among community-dwelling elders. Methods: A cross-sectional study design was used. Study subjects were selected by convenience sampling from July to November in 2013 in a community healthcare center and a local community. A trained research group interviewed samples by the same procedure including the assessment of socio-demographic information, physical and mental health status, social support, life style as well as disability, health-related quality of life and physical examination. Frailty was defined by Fried’s phenotype. Logistic regression and multiple linear regression and other statistic analysis were conducted. Results: (1) A total of 683 subjects were interviewed with complete information. According to Fried’s frailty criteria, 43.2% were robust, 45.7% were pre-frail, and 11.1% were frail. As for each frailty indicators, 33.1% were weakness, 21.7% were low physical activity, 19% were exhausted, 15.8% were slowness, and 8.9% were unintentional weight loss. (2)According to the univariable logistic regression results, social-demographic factors (age, gender, education level, monthly income), physical factors (vision problem, hearing problem, gastrointestinal uncomfort, sleep disorder, pain, urinary incontinence and comorbidiy), mental factors (depressive symptoms, anxiety, congnitive impairment, self-report health), social support (from family, friends or others), life style (diet pattern, water drinking volume) were correlated with frailty and pre-frailty (P<0.05). (3) Multinominal logistic regression analysis were employed, elders with poor sleep quality, aged over 80 years old, being male, with depressive symptoms and lower self-reported health were significantly correlated with being pre-frail (P<0.05). As for frailty, aged over 80, with depressive symptoms and urinary incontinence, poor cognitive function, being male, less-educated, unbalanced eating pattern, and lower self-reported health were the main risk factors (P<0.05). (4) After adjusting for the confounders, frail and pre-frail elders had a greater risk of disability than robust ones (P<0.05). Elders with gait slowness, grip weakness or low physical aciticiy had a greater risk of disability than others (P<0.05). Unintentional weight loss and exhaustion were not predictors for disability (P>0.05).. (5) After adjusting for the confounders, elders with pre-frailty and frailty were found to be more significantly associated with lower scores on physical health-related quality of life scales compared with robustness (P<0.01), but no association was found between frailty and mental health-related quality of life summary scales (P>0.05). All the frailty indicators were associated with lower scores on physical health-related quality of life scales except for the unintentional weight loss(P<0.05). Meanwhile only exhaustion was associated with lower scores on mental health-related quality of life scales(P<0.05). Conclusion: (1) Similar to existing studies, the prevalence of frailty among community-dwelling elders is high and reached a noticeable level that requires more attention. (2) Socio-demographic factors, physical health status, mental and emotional health status, social support and life style are correlated with frailty of elders. It is suggested that multi-dimensional and interdisciplinary intervention strategy might be effective for frail elders. (3) Frailty is highly associated with disability and lower level of health-related quality of life, which indicated that adverse health outcomes might be predicted by frailty, and early prevention strategy could be planned under the guidance of frailty management.
语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/108192
Appears in Collections:北京大学护理学院_学位论文

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作者单位: 北京大学护理学院

Recommended Citation:
奚兴. 社区老年人衰弱状况及其相关因素的研究[D]. 北京大学护理学院. 北京大学. 2014.
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