社区高龄老人握力和生活质量的关系研究

The association between grip strength and quality of life among the community-dwelling oldest old

目的 本研究基于社会隔离和抑郁2个中介变量,构建多重中介模型,探讨高龄老人的握力对其生活质量的影响机制。方法 于2020年10月-2021年4月,利用方便整群抽样法对上海市400名≥80岁社区高龄老人,采用Lubben社会网络量表(LSNS-6)、老年抑郁量表简表(GDS-5)、世界卫生组织生活质量评定量表老年模块(WHOQOL-OLD)和握力计对高龄老人的社会隔离、抑郁、生活质量及握力进行测量。采用SPSS PROCESS程序检验链式中介效应。结果 相关性分析结果显示:握力、社会隔离、抑郁和生活质量间显著相关(P<0.01)。中介效应,分析结果显示:握力可直接影响高龄老人的生活质量[效应值=0.394;95%CI=(0.219,0.532)],还可以通过3条中介效应链对生活质量造成影响:社会隔离[效应值=0.219;95%CI=(0.125,0.328)],抑郁[效应值=0.054;95%CI=(0.029,0.087)],及社会隔离、抑郁的链式作用[效应值=0.054;95%CI=(0.029,0.087)];总中介效应占总效应的51.2%。结论 握力降低是高龄老人生活质量下降的重要风险因素,且社会隔离和抑郁是这一影响的重要解释机制。社区卫生工作者应重视握力对高龄老人生活质量的影响,并基于社会隔离和抑郁的作用路径制定干预策略,以改善高龄老人的生活质量、促进健康老龄化。

Objective To construct a multiple mediating model,and explore the effect mechanism of grip strength on the quality of life(QOL)among community-dwelling oldest old based on the two mediating variables of social isolation and depression.Methods A total of 400 community-dwelling elderly aged 80 years were selected by convenience cluster sampling method from October 2020 to April 2021.Lubben Social Network Scale-6(LSNS-6),Geriatric Depression Scale-5(GDS-5),World Health Organization Quality of Life Instrument Aduts Module(WHOQOL-OLD)and handgrip strength were used to measure social isolation,depression,quality of life,and handgrip strength.The SPSS PROCESS program was used to test the chain mediating effect.Results Correlation analysis showed that grip strength,social isolation,depression,and QOL were significantly associated(P<0.01).Mediating effect analysis showed that grip strength had a direct influence on QOL(effect value=0.394,95%CI was 0.219-0.532),and mediated three mediating effect chains to impact on QOL:the independent mediation of social isolation(effect value=0.219,95%CI was 0.125-0.328),depression(effect value=0.121,95%CI was 0.061-0.192),and social isolation(effect value=0.054,95%CI was 0.029-0.087)on depression.The total mediating effect accounted for 51.2%of the total effect.Conclusion Low grip strength is an important risk factor for declining QOL in the oldest old,and social isolation and depression contributes to the explanation of grip strength in QOL.Primary healthcare providers can develop intervention based on acting paths of grip strength,so as to improve the QOL of community-dwelling oldest old and to ultimately promote healthy aging.