衰弱在老年血液透析患者跌倒恐惧及社会参与间的中介效应  

Mediating effect of the frailty on the fear of falling and social participation in elderly patients with hemodialysis

作　　者：蒋婷婷 郭林林 单岩 杨瑾[1] 李艳艳 杜理平 JIANG Tingting;GUO Linlin;SHAN Yan;YANG Jin;LI Yanyan;DU Liping(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China;Medical College of Zhengzhou University,Zhengzhou 450052,Henan,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450000 [2]郑州大学医学院,河南郑州450052

出　　处：《护士进修杂志》2022年第14期1273-1277,共5页Journal of Nurses Training

摘　　要：目的探讨跌倒恐惧及衰弱对老年血液透析患者社会参与的影响,并分析衰弱在老年血液透析患者跌倒恐惧与社会参与间的中介作用,为提高患者社会参与水平提供参考。方法2019年6-11月,采用Tilburg衰弱量表(TFI)、修订版跌倒效能量表(MFES)与自主参与问卷(IPA)对221例老年血液透析患者进行调查,利用Pearson相关法分析衰弱、跌倒恐惧、生活质量三者之间的相关性,采用逐步回归法检验衰弱在跌倒恐惧和社会参与间的中介作用,并使用Bootstrap法对中介效应进行验证。结果老年血液透析患者社会参与总分为(50.91±13.26)分。患者跌倒恐惧水平越高,衰弱程度越重(r=-0.526,P<0.01);衰弱程度和社会参与水平呈正相关(r=0.675,P<0.01);跌倒恐惧水平越高,社会参与水平越低(r=-0.680,P<0.01)。中介效应模型拟合良好(χ^(2)/df=1.323,P=0.161,CFI=0.991,TLI=0.985,AGFI=0.943,RMSEA=0.038),衰弱在跌倒恐惧与社会参与间起部分中介作用,中介效应占总效应的44.90%。结论老年血液透析患者社会参与水平较低,衰弱是患者跌倒恐惧与社会参与间的中介变量,医务人员应关注患者社会参与情况,制定措施时可考虑以衰弱为切入点,提高老年血液透析患者的社会参与水平。Objective To explore the influence of the fear of falling and the frailty on social participation in elderly hemodialysis patients,and to analyze the mediating effect of the frailty on the fear of falling and social participation in elderly hemodialysis patients,so as to provide reference for improving the level of social participation of patients.Methods Two hundred and twenty-one cases of elderly hemodialysis patients were investigated by the Tilburg Frailty Indicator(TFI),Modified Fall Efficacy Scale(MFES),and Impact on Participation and Autonomy Questionnaire(IPA)from June to November in 2019.The Pearson correlation method was used to analyze the correlation between the frailty,the fear of falling,and quality of life.The stepwise regression method was used to test the mediating effect of frailty between fear of falling and social participation,and the mediating effect was verified by the Bootstrap method.Results The total social participation score of elderly hemodialysis patients was(50.91±13.26)points.The higher the fear of falling,the worse the frailty(r=-0.526,P<0.01).The degree of the frailty was positively correlated with the level of social participation(r=0.675,P<0.01).The higher the fear of falling,the lower the level of social participation(r=-0.680,P<0.01).The mediating effect model was well fitted(χ^(2)/df=1.323,P=0.161,CFI=0.991,TLI=0.985,AGFI=0.943,RMSEA=0.038),and the frailty partially mediated the relationship between the fear of falling and social participation in elderly hemodialysis patients,and the mediating effect accounted for 44.90%of the total effect.Conclusion Elderly hemodialysis patients have a low level of social participation,and the frailty is an intermediary variable between the fear of falling and social participation.Medical staff should pay attention to social participation of patients,and take frailty as a starting point to improve the level of social participation when formulating measures.

关 键 词：老年 肾透析 血液透析 跌倒恐惧 衰弱 社会参与 

分 类 号：R471[医药卫生—护理学]