心理韧性对失能老年人长期生存的影响  

Effect of psychological resilience on long-term survival in older adults with disability

作　　者：张驰[1] 白安颖 李哲林 孟晓庆 韩怡文[1] 李瑞奇 杨苏瑞 曾平[1] Zhang Chi;Bai Anying;Li Zhelin;Meng Xiaoqing;Han Yiwen;Li Ruiqi;Yang Surui;Zeng Ping(The Key Laboratory of Geriatrics,Beijing Institute of Geriatrics,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing Hospital,National Center of Gerontology of National Health Commission,Beijing 100730,China;School of Design,South China University of Technology,Guangzhou 510006,China;Department of Personnel,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院,国家老年医学中心,国家卫生健康委北京老年医学研究所,国家卫生健康委,老年医学重点实验室,中国医学科学院老年医学研究院,北京100730 [2]北京协和医学院群医学及公共卫生学院,北京100730 [3]华南理工大学设计学院,广州510006 [4]北京医院人事处,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2024年第6期752-758,共7页Chinese Journal of Geriatrics

基　　金：国家重点研发计划(2022YFF0607000,2022YFC2010100);"十四五"广西科技重大专项(AA22096018)。

摘　　要：目的:探索在失能老年人群中,心理韧性与全因死亡风险的关联。方法:利用Katz指数进行筛查后,在中国老年健康追踪调查(1998—2018年)中纳入8089名失能老年人。使用7条目自评量表来测量基线时的心理韧性水平,所有受试者被随访至2018年,期间收集生存信息。使用限制性立方样条回归和Cox比例风险模型分析心理韧性和全因死亡风险间的关系,并检验心理韧性和失能程度间的交互作用。结果:在校正潜在混杂因素后,心理韧性水平与全因死亡风险呈线性负相关(非线性P=0.781)。按失能程度进行分层后发现,心理韧性每升高1个标准差,轻度失能老年人的死亡风险降低12%(HR=0.88,95%CI:0.83~0.94)。但在严重失能老年人中,未发现心理韧性与死亡风险的显著关联,心理韧性与失能程度存在显著的交互作用(交互项P=0.026)。结论:维持良好的心理韧性有助于降低失能老年人的死亡风险,轻度失能老年人更容易从中获益。本研究在不同程度功能减退老年人中实施心理干预方面提供了观察性证据。Objective To investigate the correlation between psychological resilience and the risk of all-cause mortality in disabled older individuals.Methods A total of 8,089 disabled older adults were selected from the Chinese Longitudinal Healthy Longevity Survey(1998-2018)after screening with the Katz index.Psychological resilience was assessed at baseline using a seven-item self-rating scale.Participants were followed up until 2018,with survival data being recorded.Restricted cubic spline regression and Cox proportional hazard models were employed to analyze the association between psychological resilience and all-cause mortality,as well as to explore the potential interaction between psychological resilience and levels of disability.Results After adjusting for potential confounding factors,a linearly negative relationship was found between levels of psychological resilience and mortality risk(P-nonlinear 0.781).Stratified analyses by degree of disability revealed that for older adults with mild disability,a 1 standard deviation increase in psychological resilience was associated with a 12%decrease in mortality risk(HR=0.88,95%CI:0.83-0.94).However,no significant association was observed between psychological resilience and mortality risk in severely disabled participants.A significant interaction was noted between resilience levels and degree of disability(P-interaction=0.026).Conclusions This study offers observational evidence supporting the importance of maintaining psychological resilience in reducing mortality risk among disabled older individuals,particularly those with mild disability.The findings highlight the potential benefits of psychological interventions for older adults with varying levels of functional decline.

关 键 词：韧性 失能 死亡率 

分 类 号：R161.7[医药卫生—公共卫生与预防医学]