社区老年人自评健康与衰弱的关联:淡漠的调节作用  

Association between Self-rated Health and Frailty among Community-dwelling Older Adults:the Moderating Role of Apathy

作　　者：陶璐 李莎[1] 丁亚萍[1] 宗前兴 高诗瀛 聂作婷 陈龙 吴延 杨如美 TAO Lu;LI Sha;DING Yaping;ZONG Qianxing;GAO Shiying;NIE Zuoting;CHEN Long;WU Yan;YANG Rumei(Nanjing Medical University School of Nursing,Nanjing 211166,China)

机构地区：[1]南京医科大学护理学院,江苏省南京市211166

出　　处：《中国全科医学》2023年第28期3513-3519,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(72004098);江苏高校哲学社会科学研究一般项目(2020SJA0302);南京医科大学高层次引进人才项目(NMUR2020006);南京医科大学研究生优质教育资源建设项目(2021F005);江苏高校优势学科建设工程项目“护理学”(苏政办发〔2018〕87号);“十四五”高等教育科学研究规划课题(苏高教会〔2021〕16号YB009);南京医科大学内涵建设专项护理学优势学科资助项目(南医大护〔2022〕12号)。

摘　　要：背景既往研究表明,自评健康状况能够作为衰弱的简易评估指标,自评健康状况差的个体衰弱风险更高。然而在淡漠老年人群中,自评健康状况与衰弱间的关联强度可能不同,健康状况自我评价法在衰弱评估中的应用效果可能存在差异。目的探讨淡漠在社区老年人自评健康状况与衰弱关联中的调节作用,旨在为健康状况自我评价法在淡漠老年人衰弱评估中的应用提供理论指导。方法2021年11月—2022年3月,采用便利抽样法,抽取南京市和连云港市社区老年人共384名作为调查对象(其中179名来自南京市江宁区东山街道东山社区,205名来自连云港市东海县青湖社区),采用一般资料调查表、衰弱评估量表(FFP)、老年人抑郁量表淡漠分量表(GDS-3)、自评健康条目对其进行问卷调查。采用广义线性模型分析社区老年人自评健康状况对衰弱的影响,采用Hayes编制的SPSS宏程序Process的模型1分析淡漠在社区老年人自评健康状况和衰弱关系中的调节作用,并进行简单斜率分析、绘制简单斜率图。结果384名社区老年人中位FFP、自评健康条目得分分别为1.00(2.00)、4.00(1.00)分,淡漠检出率为55.5%(213/384)。广义线性模型结果显示,社区老年人自评健康状况对衰弱有影响(b=0.310,P<0.001)。调节效应检验结果显示,淡漠在社区老年人自评健康状况和衰弱的关系中起调节作用(b=0.355,t=3.074,P=0.002)。简单斜率分析结果显示,非淡漠组的简单斜率为0.100(t=1.209,P=0.228),淡漠组的简单斜率为0.455(t=5.206,P<0.001)。结论社区老年人自评健康状况与衰弱之间存在关联,健康状况自我评价法的应用可以帮助社区医务人员评估老年人的衰弱情况。淡漠在社区老年人自评健康状况和衰弱的关系中发挥调节作用,相较于非淡漠老年人,淡漠老年人自评健康状况与衰弱之间存在明显的关联,在淡漠老年人中加强其对自身健康状况Background Previous studies have shown that self-rated health would be used as a simple assessment indicator for frailty,and individuals with poor self-rated health status are at higher risk of frailty.However,the association between self-rated health and frailty may be different and the effectiveness of self-rated health in frailty assessment may vary in apathetic older adults.Objective To explore the moderating role of apathy in the association between self-rated health and frailty among community-dwelling older adults,so as to provide theoretical guidance for the application of the self-rated health in the assessment of frailty in apathetic older adults.Methods From November 2021 to March 2022,a total of 384 community-dwelling older adults were selected as respondents by convenience sampling method,including 179 cases in Nanjing Dongshan Community and 205 cases in Lianyungang Qinghu Community.Questionnaire surveys were conducted using the General Information Questionnaire,Fried Frailty Phenotyp(FFP),Geriatric Depression Scale(GDS-3),and the self-reported health(SRH).Generalized linear model was used to analyze the association between self-rated health and frailty of community-dwelling older adults.The model 1 of the SPSS macro program process compiled by Hayes was used to analyze the moderating role of apathy on the association between the self-rated health and frailty,with simple slope analyze performed and simple slope graphs plotted.Results The median FFP and SRH item scores of 384 community-dwelling older adults were 1.00(2.00)and 4.00(1.00),respectively,with the detection rate of apathy of 55.5%(213/384).The results of the generalized linear model showed that the relationship between the self-rated health and frailty of community-dwelling older adults was significant(b=0.310,P<0.001).The results of the moderating effect test showed that apathy played a moderating role in the relationship between self-rated health status and frailty in community-dwelling older adults(b=0.355,t=3.074,P=0.002),and the result

关 键 词：老年人 衰弱 情感淡漠 自评健康 调节效应 社区卫生服务 

分 类 号：R364[医药卫生—病理学] R395[医药卫生—基础医学]