慢性病共病对老年人失能的影响研究:基于倾向性评分匹配

Influence of multimorbidity on disability among older adults:based on propensity score matching

目的探讨老年人慢性病共病对失能的影响,为制订老年人慢性病共病与失能的管理及护理策略提供参考依据。方法采用横断面调查研究方法,于2023年7月提取2018年中国老年人健康长寿影响因素追踪调查数据库中60岁及以上老年人的数据资料,包括基本情况、慢性病患病情况、基础性日常生活活动能力(BADL)和工具性日常生活活动能力(IADL)失能情况。依据是否患有2种及以上慢性病将其分为共病组和非共病组。采用倾向性评分匹配法将2组老年人的基本情况进行1∶1匹配,应用二元Logistic回归分析慢性病共病对BADL失能和IADL失能的影响。结果6469例老年人中,男2882例,女3587例,年龄60~84岁3158例,>84岁3311例。BADL失能占26.5%(1712/6469),IADL失能占66.8%(4324/6469),共病组患者2335例,非共病组患者4134例。二元Logistic回归分析显示,共病组老年人BADL失能风险是非共病组的1.511倍(95%CI 1.317~1.734,P<0.01);共病组老年人IADL失能风险是非共病组的1.618倍(95%CI 1.426~1.835,P<0.01)。结论老年人慢性病共病会增加失能风险,有关部门应当制订相关的干预措施及照护对策,增强对老年人慢性病共病和失能的预防和管理。

Objective To explore the impact of multimorbidity on disability in older adults,providing a reference for formulating strategies for the management and nursing of multimorbidity and disability in older adults.Methods Adopting the method of cross-sectional survey research,the data of 6469 older adults(≥60 years old)were collected from the 2018 Chinese Longitudinal Healthy Longevity Survey database in July 2023,including basic information,chronic disease prevalence,and disability measured by basic activities of daily living(BADL),and instrumental activities of daily living(IADL).They were divided into multimorbidity and non-multimorbidity groups based on whether they had two or more chronic diseases.The propensity score matching(PSM)method was used to match the basic conditions of the two groups of older adults with the proportion of 1∶1.Binary logistic regression was applied to analyze the effects of multimorbidity on BADL disability and IADL disability.Results Among 6469 older adults,there were 2882 males and 3582 females,with 3158 aged 60-84 years old and 3311 aged over 84 years old.BADL disability accounted for 26.5%(1712/6469),while IADL disability accounted for 66.8%(4324/6469).There were 2335 patients in the multimorbidity group and 4134 patients in the non-multimorbidity group.Binary Logistic regression analysis showed that the risk of BADL disability in older adults in multimorbidity group was 1.511 times higher than that in the non-multimorbidity group(95%CI 1.317-1.734,P<0.01);the risk of IADL disability in older adults in the multimorbidity group was 1.618 times higher than that in the non-multimorbidity group(95%CI 1.426-1.835,P<0.01).Conclusions Multimorbidity would increase the risk of disability in older adults.Relevant authorities should develop relevant interventions and nursing responses to enhance the prevention and management of multimorbidity and disability in older adults.