天津市65岁及以上社区居民老年期痴呆患病率及其影响因素与功能状况

Prevalence,related factors and general function of dementia among community residents aged 65 and above in Tianjin

目的:了解天津市65岁及以上社区老年人痴呆患病率及其影响因素,评估痴呆患者的功能状况。方法:数据来自天津市精神卫生流行病学调查,该调查采用多阶段与规模成比例的概率抽样,先使用一般健康问卷扩展版进行筛查,再由精神科医师根据DSM-IV(the diagnostic and statistical manual of mental disorders, fourth edition)进行包括痴呆在内的精神障碍的诊断,收集社会人口学、躯体疾病史、家族史等相关因素,采用功能大体评估量表(global assessment of functioning,GAF)评估研究对象功能状况。描述天津市社区老年期痴呆的患病率,并采用基于复杂抽样的Logistic回归分析患病的相关影响因素,通过GAF得分描述患者功能状况。结果:有4438人完成诊断,其中65岁及以上老年人1023名,140人患有痴呆,加权患病率7.78%(95%CI:5.88%~10.23%)。与年龄在65~69岁者相比,年龄在75~79岁(OR=4.60,95%CI:1.57~13.52)和80岁及以上(OR=14.48,95%CI:4.46~47.04)是痴呆患病的危险因素,受教育年限不足1年(OR=2.30,95%CI:1.06~5.01)、存在2种及以上心理社会环境问题(OR=3.42,95%CI:1.65~7.08),脑血管疾病(OR=9.19,95%CI:4.62~18.30)也是痴呆的危险因素。痴呆患者近1个月加权GAF得分(54.2±16.5)分,加权致残率63.65%(95%CI:50.11%~75.33%)。结论:天津市社区老年期痴呆患病率略高于全国,年龄大、未接受过至少1年正规教育、存在较多心理社会环境问题、脑血管疾病为痴呆患病的危险因素,痴呆患者功能水平不佳。采取针对性措施降低痴呆患病率并为患者提供更好的治疗和康复服务至关重要。

Objective:To investigate the prevalence of dementia and its related factors among community-dwelling elderly aged 65 years and above in Tianjin,and the general function of the dementia patients.Methods:Data were derived from the Tianjin Mental Health Survey which employed a multi-stage,probability-proportional-to-size sampling method.Screening was initially conducted using expanded version of the General Health Questionnaire(GHQ-12),followed by diagnosis of mental disorders including dementia by a psychiatrist based on the DSM-IV(The Diagnostic and Statistical Manual of Mental Disorders,fourth edition).Additionally,information on sociodemographic characteristics,physical illnesses,and family history was collected.The GAF(Global Assessment of Functioning)scale was used to evaluate the general function of the subjects.The prevalence of dementia among community elderly individuals aged 65 years and above in Tianjin was reported.Logistic regression based on complex sampling was used to identify factors associated with dementia.GAF score were used to describe the general function of community dementia patients.Results:Of the 4438 community residents who completed the diagnostic interview,1023 were aged 65 and above,of whom 140 were diagnosed with dementia,resulting in a weighted prevalence of 7.78%(95%CI:5.88%~10.23%).Compared with residents aged 65~69,age 75~79(OR=4.60,95%CI:1.57~13.52)and age 80 and older(OR=14.48,95%CI:4.46~47.04)were risk factors for dementia.Less than 1 year of education(OR=2.30,95%CI:1.06~5.01),presence of two or more social environmental problems(OR=3.42,95%CI:1.65~7.08),having cerebrovascular disease(OR=9.19,95%CI:4.62~18.30)were also risk factors for dementia.The weighted GAF score of dementia patients was 54.2±16.5 and the weighted disability rate was 63.65%(95%CI:50.11%~75.33%)in the past month.Conclusion:The prevalence of dementia among community-dwelling elderly individuals aged 65 years and above in Tianjin is slightly higher than the national average.Risk factors for dementia include old age,without at least one year formal education,more social environment problems,and cerebrovascular disease.The disability rate of dementia patients in Tianjin communities is high.Targeted interventions should be implemented to reduce the prevalence of dementia and provide better services for the treatment and rehabilitation of dementia patients.