社区主观认知下降老年人日常生活活动能力现状及影响因素分析

doi:10.3969/j.issn.1003-9198.2024.11.007

摘要/Abstract

摘要： 目的了解社区主观认知下降(SCD)老年人日常生活活动能力(ADL),并分析其影响因素。方法采用便利抽样法,于2019年1月至2022年1月对北京市某社区1054例老年人进行调查,根据纳入及排除标准选择459例老年人为研究对象。采用自设问卷收集病人人口学资料、焦虑抑郁情况、生活方式、运动习惯、营养及疾病史、用药史等;分别采用Barthel 指数评定量表评估基础性日常生活活动能力(BADL)、Lawton-IADL量表评估工具性日常生活活动能力(IADL)。采用单因素及多因素二元Logistic回归分析ADL依赖的影响因素。结果 BADL总分有依赖者209例(45.5%),功能下降频率较高的为上下楼梯和小便;IADL总分有依赖者256例(55.8%);功能下降频率较高的为外出、上街购物及服用药物。二元Logistic回归分析结果显示,年龄、视力下降、BMI及体力活动时间是 BADL发生依赖的独立影响因素;性别、听力下降、焦虑、饮酒、营养是 IADL发生依赖的独立影响因素(P<0.05)。结论社区SCD老年人ADL依赖发生率较高,但程度较轻;社区工作者应重点关注高龄、男性、视力听力下降、肥胖、低体力活动、焦虑、饮酒及存在营养不良风险的老年人,协助其建立健康的生活方式,从而改善或延缓老年人认知情况。

关键词: 主观认知下降, 老年人, 日常生活活动能力

Abstract: Objective To investigate the activities of daily living (ADL) of the community elderly with subjective cognitive decline (SCD) and to analyze the influencing factors. Methods Convenient sampling method was used to enroll a total of 459 elderly people in a community in Beijing from January 2019 to January 2022 in this study. The patients’ demographic data, anxiety and depression status, lifestyle, exercise style, nutrition, disease history and medication history were collected by self-designed questionnaire; And barthel index rating scale was used to evaluate the level of basic activities of daily living (BADL), Lawton instrumental activities of daily living (IADL) scale was used to evaluate the level of IADL. Univariate analysis and multivariate Logistic regression analysis were used to explore the influencing factors of ADL. Results A total of 209 cases (45.5%) presented with dependence on BADL, with a higher frequency of functional decline in ascending and descending stairs and urination; 256 cases (55.8%) presented with dependence on IADL; The frequency of functional decline is higher when going out, shopping and taking medication. Logistic regression analysis showed that age, decreased vision, BMI and physical activity time were the independent influencing factors of BADL dependence; Gender, hearing loss, anxiety, alcohol consumption, and nutrition were independent influencing factors of IADL dependence (P<0.05). Conclusions The incidence of ADL dependence in the elderly with SCD in community is high, but the degree is light; Community healthcare workers should focus on the elderly people being elderly, male, obesity, anxious, having decreased vision and hearing, having low physical activity, drinking alcohol, and having a risk of malnutrition, and should assist the elderly in establishing a healthy lifestyle to improve or delay their cognitive impairment.

Key words: subjective cognitive decline, aged, activities of daily living

中图分类号:

R 749.13

杨存美, 胡亦新, 刘翠娥, 马虹颖, 闫瑾, 徐秋利, 邢丹, 张天一. 社区主观认知下降老年人日常生活活动能力现状及影响因素分析[J]. 实用老年医学, 2024, 38(11): 1110-1115.

YANG Cunmei, HU Yixin, LIU Cuie, MA Hongying, YAN Jin, XU Qiuli, XING Dan, ZHANG Tianyi. Analysis of current situation and influencing factors of activities of daily living in the elderly with decreased subjective cognition in community[J]. Practical Geriatrics, 2024, 38(11): 1110-1115.

参考文献

[1] 世界卫生组织.痴呆症[EB/OL].[2020-10-31] (2023-12-01).https://www.whoi.nt/zh/newsGroom/factGshets/detail/dementia.
[2] LIN Y, SHAN P Y, JIANG W J, et al. Subjective cognitive decline:preclinical manifestation of Alzheimer’s disease[J].Neurol Sci, 2019, 40(1):41-49.
[3] 杨清,王雨欣,田翀,等.主观认知减退问卷汉化及信效度研究[J].护理学杂志, 2021, 36(2):68-71.
[4] DESAI A K, GROSSBERG G T, SHETH D N. Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment[J].CNS Drugs, 2004, 18(13): 853-875.
[5] 易雅研.长期护理机构老年痴呆患者基础性日常生活活动能力及其影响因素[D].广州:南方医科大学, 2020.
[6] 马新成.老年人生活自理能力评估方法研究[D].北京:北京理工大学,2016.
[7] 周滢,甘珊,李峥.社区老年人主观认知下降现状及影响因素分析[J].解放军护理杂志, 2021, 38(4):21-24.
[8] LAU H, MAT LUDIN A F, SHAHAR S, et al. Factors associated with motoric cognitive risk syndrome among low-income older adults in Malaysia[J]. BMC Public Health, 2019, 19(Suppl 4):462.
[9] 中国痴呆与认知障碍指南写作组,中国医师协会神经内科医师分会认知障碍疾病专业委员会.2018中国痴呆与认知障碍诊治指南(一):痴呆及其分类诊断标准[J].中华医学杂志, 2018, 98(13):965-970.
[10] 中国痴呆与认知障碍诊治指南写作组,中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(五):轻度认知障碍的诊断与治疗[J].中华医学杂志, 2018, 98(17):1294-1301.
[11] 郭飏,王丽娟,付雪连,等.社区失能老人健康管理现状调查[J].护理学杂志, 2014, 29(7):73-75.
[12] BIER N, BELCHIOR PDA, PAQUETTE G, et al. The instrumental activity of daily living profile in aging: a feasibility study[J]. J Alzheimers Dis, 2016, 52(4): 1361-1371.
[13] 刘硕,朱鸣雷,刘晓红. 老年住院患者衰弱和抑郁的相关性[J]. 中华老年多器官疾病杂志,2020,19(6):419-423.
[14] SPITZER R L,KROENKE K,WILLIAMS J B. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire[J].JAMA,1999,282(18):1737-1744.
[15] 仇军.中国体育人口的理论探索与实证研究[D].北京:北京体育大学,1999.
[16] 董杰,董群,张保国.山东省不同体育参与水平老年人的体质状况[J].中国老年学杂志, 2014,34(8):2216-2218.
[17] 中华医学会老年医学分会. 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志,2017,36(3): 251-256.
[18] RUBENSTEIN L Z,HARKEI J O,SALVA A,et al. Screening for under nutrition in geritric practice: developing the Short-Form Mini Nutritional Assessment(MNA-SF)[J].J Gerontol A Biol Sci Med Sci,2001,56(6): M366-M372.
[19] 王佳,贾音,王慧丽.老年慢性病患者多重用药及用药安全性的研究现状[J].继续医学教育,2021,35(11):157-159.
[20] FERRUCCI L, GURALNIK J M, CECCHI F, et al. Constant hierarchic patterns of physical functioning across seven populations in five countries[J]. Gerontologist, 1998, 38(3): 286-294.
[21] 彭陪陪.失能老人照批需求及质量评价体系构建研究[D].北京:解放军医学院,2015.
[22] 张晗,王志会,王丽敏,等.中国社区老年居民日常生活活动能力失能状况调查[J].中华流行病学杂志,2019,40(3):266-271.
[23] 钱佳慧,吴侃,罗会强,等.中国老年人日常生活活动能力损失现况及影响因素分析[J].中华流行病学杂志,2016, 37(9): 1272-1276.
[24] 党俊武.中国城乡老年人生活状况调查报告-2018[M].北京:社会科学文献出版社,2018:144.
[25] ĆWÍRLEJ-SOZAŃSKA A, WIŚNIOWSKA-SZURLEJ A,WILMOWSKA-PIETRUSZYŃSKA A,et al. Determinants of ADL and IADL disability in older adults in southeastern Poland[J]. BMC Geriatr, 2019, 19(1): 297.
[27] CREWS J E, CHOU C F, SEKAR S, et al. The prevalence of chronic conditions and poor health among people with and without vision impairment,aged ≥65 years,2010—2014[J]. Am J Ophthalmol, 2017,182:18-30.
[28] 于普林,高超,雷平,等. 预防老年人失能核心信息中国专家共识 (2019)[J].中华老年医学杂志,2019,38(10):1073-1074.
[29] 蔡敏, 张耀光, 谢学勤,等. 我国 60 岁及以上居家老年人失能情况及影响因素分析[J].中国医院统计,2021,28(5):389-394,400.
[30] TSAI H J, CHANG F K. Associations between body mass index, mid-arm circumference, calf circumference, and functional ability over time in an elderly Taiwanese population[J]. PLoS One, 2017, 12(4): e0175062.
[31] KERAMAT S A, ALAM K, SATHI N J, et al. Self-reported disability and its association with obesity and physical activity in Australian adults: results from a longitudinal study[J]. SSM Popul Health, 2021, 14: 100765.
[32] CHENG I F, KUO L C, TSAI Y J, et al. The comparisons of physical functional performances between older adults with and without regular physical activity in two different living settings[J]. Int J Environ Res Public Health, 2021, 18(7):3561.
[33] KRAMER A F, COLCOMBE S J, MCAULEY E, et al. Fitness, aging and neurocognitive function[J]. Neurobiol Aging, 2005, 26 (Suppl 1): 124-127.
[34] 龙敏.中国老年人日常生活自理能力的影响因素研究[D].上海:华东师范大学,2013.
[35] 王嘉慧.中国老年人膳食多样性评分变化与认知功能受损及日常生活自理能力失能的队列研究[D].广州:南方医科大学,2022.
[36] GALLACHER J, BAYER A, FISH M, et al. Does anxiety afect risk of dementia?Findings from the Caerphily prospective study[J].Psychosom Med,2009,71(6):659-666.