认知状况对高龄老年人生活自理能力影响的多水平分析

Multilevel Analysis of Cognitive Status on Activities of Daily Living among the Chinese Oldest-old

目的本研究致力于分析认知状况对高龄老年人生活自理能力动态变化的多层面影响效应。方法基于CLHLS 2008、2011和2014年3期纵向追踪调查,以80岁及以上高龄老年人为目标人群,将时间变量纳入层一,认知状况纳入层二,通过构建两水平模型,分析认知状况对生活自理能力影响的多层效应。结果在零模型,组内相关系数ICC为0.1684,代表组间异质性的u;有统计学差异(P<0.001);在随机系数回归模型,时间、年龄、城乡和经济自评对高龄老年人生活自理能力均有统计学差异(P<0.001),其中,时间呈显著的负向影响,模型系数为-0.379。加入认知状况后,模型的解释力度由30.2%提高至38.72%,认知状况对高龄老年人生活自理能力呈显著的正向影响(P<0.001),模型系数为0.121;在完整模型,认知状况和时间的相互效应对高龄老年人生活自理能力有统计学差异,模型系数为0.119,模型的解释力度提高至45.11%。结论时间效应和认知障碍对高龄老年人生活自理能力均具有负向影响,良好的认知状况对高龄老年人生活自理能力的时间变动效应具有正向调节作用。

Objective To analyze the multilevel effects of cognitive status on the dynamic changes of the Oldest-old′s ADL.Methods Based on the Chinese Longitudinal Healthy Longevity Survey(2008,2011,2014),incorporate the time into the first variable, and the cognitive status into the second variable, a multilevel model is constructed to analyze the multilevel influence of cognitive status on ADL of the elderly over 80 years old.Results In the null model, the ICC was 0.168,and u;representing heterogeneity between groups is statistically different(P<0.001).In model 2,time, age, residence, and economic self-assessment on the ADL had significant effects, among which the coefficient of time was negative effect(-0.379).In model 3,the cognitive status had a significant positive effect on the ADL(0.121).The explanatory power of the model increased from 30.2% to 38.72%.In model 4,the mutual effect of cognitive status and time had a significant effect on the ADL(0.119).The interpretation of the model increased to 45.11%.Conclusion Both time and cognitive impairment have a negative effect on the ADL.Good cognition has a positive adjustment effect on the time change effect of ADL of the elderly.