体育活动对养老院老年人生活质量影响的纵向观察

Longitudinal observation of the effects of physical activity on the quality of life of the elderly in rest home

目的:旨在发现影响养老院老年人生活质量的因素,分析体育活动在改善老年人生活质量中的作用。方法:于2004-01/03选择广州市最具代表性养老院--广州寿星大厦老年人234人为调查对象。选择其中意识清楚且具有自理能力,年龄>60岁,无严重痴呆、意识障碍或明显生理缺陷、重大疾病者,并自愿接受调查的老年人218人,男88人,女130人,年龄60～90岁,平均(73.9±5.8)岁。根据老年人的体育活动状况(是否参与规律性锻炼)分为活动组(n=165)和不活动组(n=53)。采用调查问卷进行基线调查,调查内容包括:文化程度、职业、婚姻状况、经济状况、患病状况以及体育活动状况。生活质量的测试采用SF-36生活质量量表,包含8个分测验共35个项目。分别为体育能力(10项)、生理职能(4项)、身体疼痛(2项)、总体健康(5项)、活力(4项)、社会功能(2项)、情感职能(3项)、心理健康(5项)。评分标准:每一维度最大可能评分为100分,最小可能评分为0分,8个维度评分之和的均值为综合评分,得分越高,所代表的功能损害越轻,生活质量越好,反之则越差。生活质量总分60分以下为不合格,60～70分为合格,71～79分良好,80分以上为优秀。于2005-01/03期间的双休日进行了随访。主要观察体育活动与老年人生活质量的关系及老年人生活质量的影响因素,分别采用单因素方差分析、重测资料的双因素协方差分析及多元逐步回归分析。结果:基线状况的横断面分析,纳入老年人218人,全部进入结果分析,1年后随访时3人因严重疾病住院而退出,另有83人由于调查安排在双休日时回家等原因而失访,随访132人。①体育活动与养老院老年人生活质量关系的单因素分析:除身体疼痛、总体健康2项外,活动组生活质量其它各项皆优于不活动组(P<0.01～0.05)。②养老院老年人生活质量影响因素的多元逐步回归分析:疾病尤其是脑及脑血管病和是否体育活动是影响生活质量的主要因素,经济收入、职业也是影响总体生活质量的重要因素,而体育锻炼年限却不是独立影响因素。③体育活动与养老院老年人生活质量关系的重测资料双因素协方差分析:效正相应混淆因素后活动组生活质量各项仍优于不活动组,但组间比较无显著性意义(P>0.05)。结论:单因素分析显示体育活动与老年人的生活质量密切相关,影响老年人生活质量的主要因素有疾病尤其是脑及脑血管病、体育活动、经济收入及职业因素,而体育锻炼年限却不是独立影响因素。1年后随访效正相应混淆因素后活动组与不活动组比较差异不显著。这可能与调查者对规律锻炼的认识不一致及失访比例较高有关,但仍可能说明体育活动本身并不是改善老年人生活质量的最主要原因。

AIM：To explore the factors which affect the quality of life （QOL） of the elderly in the old people＇s home, and to analyze the role of physical activity on QOL of the elderly. METHODS： 234 the elderly, who lived in the Guangzhou Shouxingdasha that was the most representative elderly apartment in Guangzhou, were selected to be interviewed from January to March 2004. 218 people, who had clear consciousness and self-care ability, over 60 years old, without severe dementia, consciousness, disorder obvious physical defection or fateful disease, and accepted the survey voluntarily, were collected, including 88 males and 130 females, at 60-90 years old, averagely （73.9±5.8） years old. They were assigned into activity group （n=165） and non-activity group （n=53） according to the physical activity status of the elderly. The base line investigation was done by survey questionnaire, the content of investigation including： educational degree, profession, marriage status, economic status, symptom of a disease and the physical activity status. The QOL was measured by SF-36 QOL, including 8 suh-test, 35 items,including 10 items of physical education ability, 4 items of physiological function, 2 items of body ache, 5 items of general health, 4 items of activity, 2 items of social function, 3 items of feeling function and 5 items of mental health. Score standard： The maximum score of each dimension was 100 points, and the minimum was 0 point. The average value of the sum of the 8 dimensions was compesitive value. The higher the score, the lighter the representative functional lesion was, and the better the QOL was, conversely the worse. The general score of QOL; less than 60 points was not qualification; between 60 and 70 was qualification; between 71 and 79 was good; over 80 were excellent. The follow-up was done in the weekends between January and March 2005. The relationship of physical activity and the QOL of the elderly and the effect factors of the QOL of the elderly were mainly observed with single factors analysis of variance, two ways covariance analysis and multiple stepwise regression analysis. RESULTS： The cross section analysis of base line, 218 the elderly was included and were all involved in the result analysis. At follow-up one year later, 3 people exited, because of the serious disease. Other 83 people were lost to follow up, because the investigation was arranged at the weekends and they had gone home, thus, 132 were followed up.① The single factor analysis of the relationship of physical activity and the QOL of the elderly in old people＇s home： Except body ache and general health, other items of the QOL in the activity group were better than that in the non-activity group （P 〈 0.01-0.05）. ② The multiple stepwise regression analysis of the effect factor of the QOL of the elderly in old people＇s home： The disease, especially the brain and cerebral vessels disease and the physical activity were the main factors affecting the QOF. The economic earning and profession were all the important factors affecting the general QOL, while the time limit of physical training was not the independent effect factor. ③ The two way analysis of covariance of the relationship of physical activity and the QOL of the elderly in old people＇s home： The each item of the QOL in the activity group after the correcting of corresponding confounding factors was better than that in the non-activity group, but the comparison among the groups had insignificant significance （P 〉 0.05）. CONCLUSION： The single factor analysis indicates that the physical activity has closely relation with the QOL of the elderly, and the main factors affect the QOL of the elderly were diseases, especially brain and cerebral vessels diseases, physical activity, economic earnings and profession, while the time limit of the physical activity is not the independent effect factor. The difference between the activity group and the nonactivity group is in- significant after the correcting of the follow-up corresponding confoundingfactors, This maybe has relationship with the incongruous cognition on the law exercises of investigator and the high lost to follow-up proportion, however, it still can clarify that the physical activity is not the most important factors of improving the QOL of the elderly,