基于健康生态学模型的老年慢性阻塞性肺疾病患者社会衰弱现状及其影响因素

Prevalence and influencing factors for social frailty in older patients with chronic obstructive pulmonary disease based on health ecological model

摘要

目的 以健康生态学模型为理论框架,评估老年慢性阻塞性肺疾病(COPD)患者的现状并探究其相关影响因素。方法 通过便利抽样法,选取2025年3月至12月某三级甲等医院呼吸与危重症医学科住院的321例老年COPD患者作为研究对象。采用一般资料问卷、社会衰弱量表(HALFT)、领悟社会支持量表(PSSS)、家庭关怀度指数问卷(APGAR)、改良版英国医学研究会呼吸问卷(mMRC)、简版老年抑郁量表(GDS-15)及匹兹堡睡眠质量指数量表(PSQI)进行横断面调查。结果 老年COPD患者HALFT得分(2.34±1.78)分,PSSS得分52(43,60.5)分,APGAR得分7(5,8)分,GDS-15得分6(3,9)分,PSQI得分8(5,13)分,社会衰弱发生率为45.2%。回归分析显示,年龄、居住方式、mMRC分级、过去一年急性加重次数、家庭关怀度、领悟社会支持、睡眠质量、抑郁是老年COPD患者社会衰弱的影响因素(P<0.05)。结论 老年COPD患者社会衰弱发生率较高,护理人员应重视对患者社会衰弱的早期评估,并基于健康生态学模型构建“个体-心理-家庭-环境”多层次分层干预策略,以降低社会衰弱的发生风险。

Abstract

Objective To assess the status of social frailty among older patients with chronic obstructive pulmonary disease (COPD) and explore its associated factors using the health ecology model as the theoretical framework. Methods A total of 321 older patients with COPD who were hospitalized in the Department of Respiratory and Critical Care Medicine of a tertiary Grade A hospital from March to December 2025 were enrolled via convenience sampling. A cross-sectional survey was conducted using the General Information Questionnaire,Social Frailty Scale (HALFT),Perceived Social Support Scale (PSSS),modified Medical Research Council dyspnea scale (mMRC),Family APGAR Index,15-item Geriatric Depression Scale (GDS-15),and Pittsburgh Sleep Quality Index (PSQI). Results The HALFT score of older patients with COPD was 2.34±1.78,the PSSS score was 52(43,60.5),the APGAR score was 7(5,8),the GDS-15 score was 6(3,9), and the PSQI score was 8(5,13). The prevalence of social frailty was 45.2%. Regression analysis showed that age, living arrangement, mMRC grade, number of acute exacerbations, family function, perceived social support,sleep quality,and depression were associated factors of social frailty among older patients with COPD (P<0.05). Conclusion The prevalence of social frailty is high among older patients with COPD. Nursing staff should attach importance to the early assessment of patients′ social frailty and develop a multi-level stratified intervention strategy covering the individual,psychological,family and environmental dimensions based on the health ecology model, so as to reduce the risk of social frailty.

关键词

老年患者 / 慢性阻塞性肺疾病 / 社会衰弱 / 家庭关怀 / 健康生态学模型 / 横断面研究

Key words

Older patients / Chronic obstructive pulmonary disease / Social frailty / Family care / Health ecological model / Cross-sectional study

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基金资助

安徽省教育厅自然科学类科研项目(2025AHGXZK30083)