日常生活活动能力在养老机构老年人营养与衰弱间的中介作用

The mediating effect of activities of daily living in the nutrition and frailty of the elderly in nursing homes

目的:探讨日常生活活动能力在养老机构老年人营养与衰弱间的中介作用。方法:采用横断面研究,运用便利抽样法在成都市8家养老机构中纳入符合标准的436名老年人。采用一般情况调查表、微型营养评估量表(MNA-SF)、日常生活活动能力量表(ADLs)和衰弱表型(FP)进行调查。结果:436名养老机构老年人营养得分分别与衰弱(r=-0.335,P<0.05)、日常生活活动能力得分(r=-0.341,P<0.05)呈负相关,日常生活活动能力得分与衰弱得分呈正相关(r=0.416,P<0.05)。进一步采用回归分析对日常生活活动能力在营养与衰弱间的中介效应进行分析,结果显示,方程1中营养得分可以负向预测衰弱得分(β=-0.266,P<0.001),可解释因变量22.8%的变异;方程2中营养得分可负向预测日常生活活动能力得分(β=-0.289,P<0.001),可解释因变量26.8%的变异;方程3中营养得分(β=-0.188,P<0.001)与日常生活活动能力得分(β=0.269,P<0.001)分别对衰弱得分的负向与正向预测作用显著,可联合解释因变量28.1%的变异。Bootstrap法检验结果显示,营养到衰弱路径的总效应、直接效应及中介效应的95%CI均不包括0,日常生活活动能力在营养与衰弱之间的中介作用显著,且中介效应的效应值占总效应值的29.2%。结论:营养和日常生活活动能力均与衰弱相关,日常生活活动能力是养老机构老年人营养与衰弱间的中介变量。

Objective:To explore the mediating effect of activities of daily living in the nutrition and frailty of the elderly in nursing homes.Methods:A cross-sectional study was used to collect 436 the elderly who meet the criteria in the eight nursing homes in Chengdu by using convenience sampling method.The self-made general situation questionnaire,Mini-Nutritional Assessment Short Form(MNA-SF),Activities of Daily Living Scale(ADLs)and Frailty Phenotype(FP)were used for the investigation.Results:The nutrition score of 436 the elderly in nursing homes was negatively correlated with the frailty score(r=-0.335,P<0.05)and the activities of daily living score(r=-0.341,P<0.05),respectively,and the activities of daily living score was positively correlated with the frailty score(r=0.416,P<0.05).Further regression analysis was used to analyze the mediating effect of activities of daily living between the nutrition and frailty.The results showed that the nutrition score in Equation 1 could negatively predict the frailty score(β=-0.266,P<0.001),and the dependent variable could be explained by 22.8%variation.The nutrition score in Equation 2 can negatively predict the score of activities of daily living(β=-0.289,P<0.001),and the dependent variable can be explained by 26.8%variation.In Equation 3,the nutrition score(β=-0.188,P<0.001)and the score of activities of daily living(β=0.269,P<0.001)had significant effects on the negative and positive predictions of the frailty score,respectively,and the dependent variable could be explained jointly by 28.1%variation.The Bootstrap test results showed that the 95%CI of total effects,direct effects,and mediating effects of the path from nutrition to frailty did not include 0.The mediating effect of activities of daily living between nutrition and frailty was significant,and the effect value of the mediating effect accounts for 29.2%of the total effect value.Conclusions:Both nutrition and activities of daily living are related to frailty,and activities of daily living are the mediating variables between the nutrition and fraity of the elderly in nursing homes.