基于结构方程模型宁波市海曙区社区老年人认知功能影响因素分析

Cognitive function and its influencing factors among community-dwelling elderly in Haishu district of Ningbo city:a cross-sectional and structural equation model-based analysis

目的了解浙江省宁波市海曙区社区老年人认知功能影响因素,为老年痴呆的预防及早期干预提供参考依据。方法于2022年4—9月采用分层比例抽样方法在宁波市海曙区抽取3850名≥60岁社区老年人进行问卷调查,采用简易智力状态检查量表(MMSE)评估社区老年人的认知功能,并应用结构方程模型分析当地社区老年人认知功能影响因素的作用路径及效应。结果宁波市海曙区社区老年人MMSE得分为0~30分,MMSE平均得分为(26.38±4.14)分;Spearman相关分析结果显示,MMSE得分与文化程度、睡眠质量、家庭月均收入、体育锻炼情况、饮酒情况和吸烟情况均呈正相关(r=0.551、0.242、0.237、0.145、0.110和0.064,均P<0.001),与年龄、听觉减退、非在婚、嗅觉减退、女性和退休前职业为农民均呈负相关(r=–0.379、–0.378、–0.224、–0.199、–0.116和–0.089,均P<0.001);结构方程模型分析结果显示,χ^(2)/df为7.359,适配度指数(GFI)为0.995,调整后适配度指数(AGFI)为0.983,规准适配指数(NFI)为0.985,非规准适配指数(TLI)为0.965,比较适配指数(CFI)为0.987,增值适配指数(IFI)为0.987,渐进残差均方和平方根(RMSEA)为0.041,模型的拟合度较好;直接效应结果显示,文化程度较高、睡眠质量较好、参加体育锻炼和家庭月均收入较高老年人的MMSE得分均较高(β=0.355、0.108、0.068和0.062,均P<0.001),听觉减退、年龄较高和嗅觉减退老年人的MMSE得分均较低(β=–0.227、–0.213和–0.112,均P<0.001);此外,年龄、文化程度、家庭月均收入还对老年人MMSE得分产生间接效应,其间接效应值和总效应值分别为–0.257和–0.470、0.056和0.411、0.012和0.074。结论宁波市海曙区社区老年人认知功能受年龄、文化程度、家庭月均收入、睡眠质量、体育锻炼情况、听觉和嗅觉减退等多种因素的影响。

Objective To analyze the factors influencing the cognitive function of community-dwelling elderly in Haishu district of Ningbo city,Zhejiang province,in order to provide a reference for the prevention and early intervention of dementia in the elderly.Methods A total of 3850 residents aged 60 years and older were recruited from urban/township communities in Haishu district of Ningbo city,Zhejiang province using a stratified proportional sampling method for a face-to-face survey from April to September 2022.The participants'information was collected using a selfdesigned questionnaire,and the Mini-Mental State Examination(MMSE)was used to assess the participants'cognitive function.The structural equation model was used to analyze the pathway and the effect of the influencing factors on the cognitive function of the participants.Results The mean MMSE score of the participants was 26.38±4.14 with a range of 0 to 30.The Spearman correlation analysis showed that MMSE score was positively correlated with educational level(r=0.551),sleep quality(r=0.242),family monthly income(r=0.237),physical activity(r=0.145),alcohol consumption(r=0.110)and smoking(r=0.064)(all P<0.001),but inversely correlated with age(r=–0.379),hearing loss(r=–0.378),being unmarried(r=–0.224),hyposmia(r=–0.199),being female(r=–0.116),and being a farmer before retirement(r=–0.089),(all P<0.001).The constructed structural equation model was of good fitness to the data,with theχ^(2)/df of 7.359,the goodness-of-fit index of 0.995,the adjusted goodness-of-fit index of 0.983,the normed fit index of 0.985,the Tacker-Lewis index of 0.965,the comparative fit index of 0.987,the incremental fit index of 0.987,and the root mean square error of approximation of 0.041,respectively.Direct effect analysis revealed that higher education(β=0.355),good sleep quality(β=0.108),participation in physical activity(β=0.068),and higher monthly household income(β=0.062)were significantly associated with higher MMSE scores(all P<0.001),whereas hearing loss(β=–0.227),older age(β=–0.213),and hyposmia(β=–0.112)were associated with lower MMSE scores(all P<0.001).In addition,age,education level,family monthly income also indirectly affected MMSE scores,with indirect and total effect coefficients of–0.257 and–0.470,0.056 and 0.411,and 0.012 and 0.074,respectively.Conclusion The cognitive function of elderly people in Haishu district,Ningbo city is affected by various factors such as age,education level,family monthly income,sleep quality,physical activity,and hearing loss and hyposmia.