跌倒恐惧在农村老年人日常生活活动能力与衰弱间中介效应

Mediating effect of fear of falling on association between activities of daily living and frailty among rural older adults in Shandong province,China

目的探讨农村老年人跌倒恐惧在日常生活活动能力与衰弱关系间的中介效应,为老年人的衰弱预防提供参考依据。方法于2019年5—7月采取多阶段分层随机抽样方法在山东省乳山县、曲阜县和乐陵县抽取3600名≥60周岁常住农村老年人进行问卷调查。结果山东省最终纳入分析的3242名农村老年人的衰弱得分为(1.52±1.08)分,其中无衰弱558人(17.21%),衰弱前期2097人(64.68%),衰弱587人(18.11%);日常生活活动能力得分为(16.99±4.37)分,其中无日常生活活动能力下降2849人(87.88%),有日常生活活动能力下降393人(12.12%);无跌倒恐惧1357人(41.86%),有跌倒恐惧1885人(58.14%)。Spearman相关分析结果显示,山东省农村老年人日常生活活动能力下降和跌倒恐惧均与衰弱呈正相关(r=0.265、0.161,均P<0.001),日常生活活动能力下降与跌倒恐惧亦呈正相关(r=0.112,P<0.001)。多因素logistic回归分析结果显示,日常生活活动能力下降增加了农村老年人衰弱(OR=3.06,95%CI=2.40~3.90,P<0.001)和跌倒恐惧(OR=1.70,95%CI=1.32~2.20,P<0.001)的发生风险;跌倒恐惧增加了农村老年人衰弱的发生风险(OR=1.37,95%CI=1.17~1.60,P<0.001),且减弱了日常生活活动能力与衰弱的关系强度(OR=2.98,95%CI=2.33~3.80,P<0.001)。中介效应检验结果显示,中介作用的95%CI为0.08~0.27,跌倒恐惧在农村老年人日常生活活动能力与衰弱之间起部分中介作用。结论跌倒恐惧是农村老年人日常生活活动能力与衰弱之间的中介因素;对于日常生活活动能力下降的老年人,疏导其跌倒恐惧的心理可使其保持乐观积极的心态,并减缓其衰弱的发生。

Objective To explore mediating effect of fear of falling(FoF)on the association between activities of daily living(ADL)and frailty among rural elderly for providing references to frailty prevention in the elderly.Methods Using a multistage stratified random sampling method,we conducted a questionnaire survey among 3600permanent rural residents aged≥60 years in three counties of Shandong province from May to July 2019.The Frail Scale,10-Item Kessler Psychological Distress Scale(K10),Mini-Mental State Examination(MMSE),Activities of Daily Living Scale(ADL),and a self-designed questionnaire were adopted in the survey.Statistical analyses were performed on the data collected from 3242 valid respondents and the RMediation program of R 3.6.1 software was used to evaluate mediating effect of FoF.Results For all the valid respondents,the frailty score was 1.52±1.08,and 18.11%(587),64.68%(2097),and 17.21%(558)of the respondents were assessed in the frail,pre-frail,and non-frail condition,respectively.The respondents had an average ADL score of 16.99±4.37,with 87.88%(2849)and 12.12%(393)having normal and decreased ADL.More than a half of the respondents(58.14%,1885)reported FoF.Spearman correlation analysis showed that decreased ADL and FoF were positively associated with frailty(r=0.265 and r=0.161,both P<0.001),and declined ADL was also positively associated with FoF(r=0.112,P<0.001).Multivariate logistic regression analysis indicated that decreased ADL could increase the risk of frailty[odds ratio(OR)=3.06,95% confidence interval(95%CI):2.40-3.90]and FoF(OR=1.70,95%CI:1.32-2.20);FoF was a risk factor for both frailty(OR=1.37,95%CI:1.17-1.60)and weakened relationship between ADL and frailty(OR=2.98,95%CI:2.33-3.80).The results of mediating effect analysis revealed that FoF played a partial mediation effect on the association between ADL and frailty and the 95%CI was 0.08-0.27 for the effect value.Conclusion Among rural elderly in Shandong province,FoF is a mediator between ADL and frailty and psychological intervention on FoF needs to be promoted among the elderly with decreased ADL for attenuating frail condition of the elderly.