基于ICFM模型的老年脑卒中患者社会支持、抑郁和口腔衰弱的相关性研究

doi:10.3969/j.issn.1003-9198.2026.08.014

摘要/Abstract

摘要： 目的调查老年脑卒中患者口腔衰弱现状,基于衰弱整合模型(ICFM)探讨社会支持、抑郁对口腔衰弱的影响路径,为提高老年脑卒中患者口腔健康水平提供理论依据。方法选取2024年10月至2025年7月于北京老年医院神经内科就诊的400例老年脑卒中患者为研究对象,分别采用老年抑郁量表(GDS-15)、社会支持评定量表(SSRS)和口腔衰弱指标筛查-8量表(OFI-8)评估老年人抑郁、社会支持与口腔衰弱情况;分析不同临床特征患者口腔衰弱得分差异;采用Pearson相关分析描述抑郁、社会支持与口腔衰弱的相关性,并使用Bootstrap法检验抑郁在社会支持与口腔衰弱间的中介效应。结果老年脑卒中患者口腔衰弱平均得分为(4.09±2.34)分,其中206例(51.5%)患者存在口腔衰弱。单因素分析结果显示,性别、年龄、教育水平、婚姻状况、睡眠状况、长期用药史、吸烟史显著影响老年脑卒中患者口腔衰弱水平(P<0.05)。相关分析显示,社会支持与口腔衰弱(r=-0.636,P<0.001)及抑郁(r=-0.458,P<0.001)均呈负相关,抑郁与口腔衰弱呈正相关(r=0.553,P<0.001)。Bootstrap法分析显示,社会支持对口腔衰弱的直接效应为-0.235(95%CI:-0.284~-0.186),占总效应的74.84%;抑郁在社会支持与口腔衰弱间的中介效应为-0.079(95%CI:-0.110~-0.051),占总效应的25.16%。结论老年脑卒中患者是口腔衰弱的重点防控人群,增强社会支持与改善抑郁状态有助于降低其口腔衰弱风险。

关键词: 老年人, 脑卒中, 抑郁, 口腔衰弱, 社会支持

Abstract: Objective To investigate the current status of oral frailty in the elderly patients with stroke, and to explore the influencing mechanism of social support and depression on oral frailty based on the integral conceptual model of frailty (ICFM), so as to provide a theoretical basis for improving the oral health of elderly stroke patients. Methods A total of 400 elderly stroke patients who visited Department of Neurology, Beijing Geratric Hospital were selected from October 2024 to July 2025. The Geriatric Depression Scale (GDS-15), Social Support Rating Scale (SSRS), and Oral Frailty Index-8 (OFI-8) were used to assess depression, social support, and oral frailty, respectively. The differences in oral frailty scores among the patients with varying clinical characteristics were analyzed. Pearson correlation analysis was performed to analyze the correlations of depression and social support with oral frailty. The Bootstrap method was used to test the mediating effect of depression between social support and oral frailty. Results The mean score of oral frailty of the elderly stroke patients was 4.095±2.34, and 206 cases (51.5%) presented with oral frailty. Univariate analysis showed that gender, age, education level, marital status, sleep status, long-term medication history, and smoking history significantly influenced the level of oral frailty (P<0.05). Pearson correlation analysis indicated that social support was negatively correlated with both oral frailty (r=-0.636, P<0.001) and depression (r=-0.458, P<0.001), while depression was positively correlated with oral frailty (r=0.553, P<0.001). Bootstrap analysis revealed that social support directly affected oral frailty, with the direct effect of -0.235 (95%CI:-0.284 to -0.186) accounting for 74.84% of the total effect. Depression partially mediated the relationship between social support and oral frailty, with a mediated effect of -0.079 (95%CI:-0.110 to -0.051) accounting for 25.16% of the total effect. Conclusions Elderly stroke patients have a high prevalence of oral frailty. Enhancing social support and improving depression may help reduce the risk of oral frailty.

Key words: aged, stroke, depression, oral frailty, social support

中图分类号:

毕靓, 王依诺, 于冬梅. 基于ICFM模型的老年脑卒中患者社会支持、抑郁和口腔衰弱的相关性研究[J]. 实用老年医学, 2026, 40(8): 826-830.

BI Jing, WANG Yinuo, YU Dongmei. Study on the correlation of social support and depression with oral frailty in elderly stroke patients based on ICFM model[J]. Practical Geriatrics, 2026, 40(8): 826-830.

参考文献

[1] JOHNSON C O, NGUYEN M, ROTH G A, et al. Global, regional, and national burden of stroke, 1990—2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet Neurol, 2019, 18(5): 439-458.
[2] 唐春花, 郭露, 张莉莉. 2025年全球卒中报告数据解读: 卒中疾病负担的梯度演变与精准治理[J]. 诊断学理论与实践, 2025, 24(5): 485-497.
[3] LIMPUANGTHIP N, KOMIN O.Association between oral hypofunction and general health:a systematic review[J]. BMC Oral Health, 2023, 23(1): 591.
[4] CHEONG E, ALDABE D, THIYAHUDDIN N, et al. The effects of stroke on oral function and oral health: a qualitative study[J]. Gerodontology, 2026. doi: 10.1111/ger.70081. Online ahead of print.
[5] 赵佳月, 刘雨佳, 张晴, 等. 老年脑卒中病人口腔衰弱研究进展[J]. 全科护理, 2025, 23(15): 563-572.
[6] YANG W, LIU Z, GAO S, et al. Oral health literacy and oral frailty: a parallel mediation model of self-efficacy and health-related quality of life among older adult stroke patients[J]. Front Public Health, 2025, 13:1720294.
[7] GOBBENS R J J, LUIJKX K G, WIJNEN-SPONSELEE M T, et al. Towards an integral conceptual model of frailty[J]. J Nutr Health Aging, 2010, 14(3): 175-181.
[8] 王敏, 王丹, 叶芳, 等. 口腔衰弱与老年抑郁的相关性研究进展[J]. 医药高职教育与现代护理, 2025, 8(3): 268-272.
[9] 赵佳月, 刘雨佳, 周敏敏, 等. 老年脑卒中病人口腔衰弱变化轨迹及影响因素[J]. 护理研究, 2026, 40(4): 563-572.
[10] NAING L, BIN NORDIN R, ABDUL RAHMAN H, et al. Sample size calculation for prevalence studies using Scalex and ScalaR calculators[J]. BMC Med Res Methodol, 2022, 22(1): 209.
[11] 王琳, 鞠梅, 王婷, 等. 社区老年人口腔衰弱风险现状及影响因素分析[J]. 护理学杂志, 2023, 38(18): 112-116.
[12] YESAVAGE J A, BRINK T L, ROSE T L, et al. Development and validation of a geriatric depression screening scale: a preliminary report[J]. J Psychiatr Res, 1983, 17(1): 37-49.
[13] 肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994,4(2): 98-100.
[14] TANAKA T, HIRANO H, OHARA Y, et al. Oral Frailty Index-8 in the risk assessment of new-onset oral frailty and functional disability among community-dwelling older adults[J]. Arch Gerontol Geriatr, 2021, 94: 104340.
[15] 裔华, 吴进, 陈晓艳, 等. 老年糖尿病病人口腔衰弱现况调查及影响因素分析[J]. 实用老年医学, 2025, 39(7): 723-726, 731.
[16] 屠杭佳, 张书怡, 方雨慧, 等. 社区老年人口腔衰弱现状及影响因素分析[J]. 中华护理杂志, 2023, 58(11): 1351-1356.
[17] HOLTKAMP A, BEUER F, WOLF T G, et al. Sex-specific oral health: a narrative review of hormonal influences and disease patterns[J]. Dent J, 2026, 14(3): 147.
[18] JIAYUE Z, YUJIA Y, DANDAN X, et al. Factors associated with oral frailty in elderly stroke patients in Eastern China[J]. Rev Esc Enferm USP, 2025, 59: e20250020.
[19] LEE S C, LAI H R, LEE P I, et al. Prevalence and factors influencing cognitive impairment among older adult stroke survivors in Taiwan: a national cross-sectional study[J]. J Psychosom Res, 2026, 202:112541.
[20] STROKE ASSOCIATION. Emotional support[EB/OL].(2025)[2026-05-10]. https://www.stroke.org.uk/professionals/life-after-stroke-services/emotional-support.
[21] DIBELLO V, CUSTODERO C, CAVALCANTI R, et al. Impact of periodontal disease on cognitive disorders, dementia, and depression: a systematic review and meta-analysis[J]. Geroscience, 2024, 46(5): 5133-5169.
[22] 仇小敏, 张伟三. 口腔衰弱与认知障碍关系的研究进展[J]. 实用老年医学, 2024, 38(9): 880-883, 892.
[23] KIM Y R, SON M, NAM S H. Association between depressive mood and chronic periodontitis among senior residents using the National Health Insurance Service-Senior Cohort Database[J]. J Periodontol, 2023, 94(6): 742-750.
[24] SIEBERT G T, SCHWERZ P C S, FAGUNDES M L B, et al. Depressive symptoms and self-reported oral health in Brazilian older adults: a population-based study[J]. Int J Dent Hyg, 2026. doi: 10.1111/idh.70051. Online ahead of print.