社区独居与共居老年人轻度认知障碍发生情况及其影响因素研究

Study on the Status and Influencing Factors of Mild Cognitive Impairment among the Cohabitation and Solitude lderly in Communities

目的:基于长期队列调查研究,分析社区独居与共居老年人轻度认知障碍发生情况及其风险因素,以期从社区早期干预措施的角度,为重点人群筛查和个体防治提供理论依据。方法:基于上海市J区某街道自2013年所开展的老年照护需求调查跟踪数据队列,采用方便抽样法抽取连续五年参与RBANS神经心理测试的独居和共居的60岁以上老年人827人,其中独居老人(n=423),共居老人(n=404)。采用单因素和多因素logistic回归分析对独居与共居MCI发生的影响因素进行分析。结果:827名社区老年人群在随访期间出现MCI结局的有182人(22.01%),其中独居老人100人。在非高龄阶段(≤79岁),独居老人的MCI发生率显著高于共居老人,而在高龄(≥80岁)阶段则相反。在年龄、性别、文化程度等人口统计学特征、日常生活能力、心理健康因素、疾病(高血压、糖尿病)因素方面,独居与共居老人MCI发生率比较有显著差异(P<0.05)。多因素分析结果显示日常生活自理能力下降、工具性日常生活活动能力下降、照护需求与独居老年人轻度认知障碍发生显著相关(OR=3.84、4.12、2.19,P<0.05)。结论:社区非高龄独居老年人群的轻度认知障碍发生率高于共居老年人,差异体现在人口统计学特征,心理健康状况、疾病等各方面因素,尤其需要关注日常生活自理能力和工具性日常生活活动能力下降的独居老人,可通过提供适当的认知训练和生活照护等措施以延缓老年人日常生活能力丧失的进程,从而延缓认知功能下降。

Objective To analyze the status and risk factors of mild cognitive impairment(MCI)in elderly people living alone and living together in the community,and provide a theoretical basis for key population screening and individual prevention and treatment from the perspective of community early intervention.Methods Based on the Unified Needs Assessment Form for Elderly Care tracking data conducted from 2013 in J District,Shanghai,convenience sampling method was used to select 827 elderly peo-ple over 60 years old who participated in the RBANS neuropsychological test for five consecutive years,including elderly living a-lone(n=423)and elderly people living together(n=404).Single-factor and multi-factor logistic regression analysis were used to analyze the factors influencing the occurrence of MCI between the elderly living alone and living together.Results 182(22.01%)of the 827 elderly people in the community developed MCI outcomes during the follow-up period,including 100 eld-erly people living alone.In the non-elderly stage(≤79 years old),the incidence of MCI among elderly people living alone was significantly higher than that among elderly people living together,while the opposite was true in the advanced age stage(≥80 years old).In terms of age,gender,education background and other demographic characteristics,daily living abilities,mental and health factors,and disease(hypertension,diabetes)factors,there was a significant difference in the incidence of Mild Cogni-tive Impairment between them(P<0.05).Multivariate analysis results showed that Activity of Daily Living(ADL)decline,In-strumental Activities of Daily Living(IADL)decline,and care needs were significantly related to the occurrence of MCI in the eld-erly living alone(OR=3.84,4.12,2.19,P<0.05).Conclusion The incidence of MCI among non-elderly elderly people liv-ing alone in the community was higher than that among elderly people living together.The difference was reflected in various fac-tors such as demographic characteristics,mental and health conditions,diseases,etc.It is especially necessary to pay attention to the elderly living alone with reduced ADL and IADL.Measures should be taken as early as possible to delay the loss of their daily living abilities,which may help delay the decline of their cognitive functions.