社会网络和自我忽视在老年缺血性脑卒中患者衰弱与认知功能间的链式中介效应

Chain-mediated effects of social network and self-neglect between frailty and cognitive function in elderly patients with ischemic stroke

目的探讨社会网络和自我忽视在老年缺血性脑卒中患者衰弱对认知功能的链式中介作用。方法2022年10月—2023年11月,采用便利抽样法,选取扬州市2家不同等级医院(三级甲等医院和三级乙等医院各1所)的383例老年缺血性脑卒中患者作为研究对象,采用一般资料调查表,中文版Tilburg衰弱量表、Lubben社交网络量表、老年自我忽视量表及蒙特利尔认知评估量表对其进行调查,构建并验证链式中介模型。结果本组老年缺血性脑卒中患者衰弱发生率为64.0%,社交网络总分为(16.14±6.67)分,自我忽视总分为(15.61±6.92)分,认知功能受损发生率为85.9%,且相互间呈两两相关。老年缺血性脑卒中患者衰弱对认知功能的间接效应成立,总间接效应值为36.8%;社会网络的特定中介效应占总间接效应的11.1%;自我忽视的特定中介效应占总间接效应的21.7%;社会网络和自我忽视在衰弱与认知功能间的链式中介效应中占总间接效应的5.2%。结论社会网络和自我忽视在衰弱与认知功能间的多重中介效应成立,医护人员应主动评估老年缺血性脑卒中患者衰弱程度,注意加强社会网络,降低自我忽视,改善认知功能,最终提高患者的生存质量。

Objective To explore the chain-mediated role of social network and self-neglect in the effect of frailty on cognitive function in elderly patients with ischemic stroke.Methods With convenience sampling,383 elderly ischemic stroke patients from 2 hospitals of different grades(1 tertiary grade-A hospital and 1 tertiary grade-B hospital)in Yangzhou City from October 2022 to November 2023 were selected as the study subjects,and were investigated by using the General Information Questionnaire,Chinese version of the Tilburg Frailty Scale,Lubben Social Network Scale,the Scale of Elderly Self-Neglect,and Montreal Cognitive Assessment Scale to construct and validate the chained mediation model.Results The incidence of frailty and impaired cognitive functioning in this group of elderly patients with ischemic stroke was 64.0%and 85.9%,respectively.The score of total social network and self-neglect was 16.14±6.67 and 15.61±6.92,respectively.There were correlations between each pair of the four variables:frailty,social network,self-neglect,and cognitive functioning.The indirect effect of frailty on cognitive function in elderly ischemic stroke patients was established,with a total indirect effect of 36.8%;the specific mediating effect of social network accounted for 11.1%of the total indirect effect;that of self-neglect accounted for 21.7%of the total indirect effect;and the chain mediating effect of social network and self-neglect between frailty and cognitive function accounted for 5.2%.Conclusion Multiple mediating effects of social network and self-neglect between frailty and cognitive function are established.Healthcare professionals should proactively assess the degree of frailty in elderly ischemic stroke patients.Strengthened social networks,reduced self-neglect,and improved cognitive function are beneficial for improving the quality of patients’survival quality.