海南高龄老年人日常生活能力与轻度认知损伤的关系^*

Relationship between activities of daily living and mild cognitive impairment in elderly people in Hainan

摘要

目的 分析海南省80岁及以上老年人轻度认知损伤各影响因素间的作用机制, 探索该群体的生活满意度在日常生活能力与认知功能间的中介作用, 以及饮酒对此中介的调节作用。方法 2021年9月—2022年11月, 分别在海南省南部地区 (保亭县) 和北部地区 (澄迈县), 对80岁及以上老年人进行分层整群抽样的横断面调查, 共纳入555例参与者。本研究采用全科医生认知评估量表对认知功能进行评估, 生活满意度量表对生活满意度进行评估, 日常生活能力评估量表对日常生活能力进行评估。首先应用SPSS22.0统计学软件对数据进行统计分析, 然后使用Mplus 8.0统计学软件建立结构方程模型。结果 日常生活能力对认知功能具有显著的负向预测作用 (β = -0.229, 95%CI: -0.284 ~ -0.174, P<0.001); 生活满意度在日常生活能力和认知功能之间起部分中介作用 [日常生活能力对生活满意度具有显著的负向预测作用 (β = -0.625, 95% CI: -1.044 ~ -0.347, P < 0.001), 生活满意度对认知功能具有显著的正向预测作用 (β = 0.261, 95%CI: 0.170 ~ 0.340, P<0.001)]; 相比于不饮酒的老年人, 饮酒老年人日常生活能力对生活满意度的预测更为显著 (饮酒: β = -0.043, 95% CI: -0.070 ~ -0.024, P < 0.001; 不饮酒: β = -0.019, 95%CI: -0.033 ~ -0.009, P = 0.001)。结论 日常生活能力对海南省80岁及以上老年人认知功能的影响是有调节的中介效应, 日常生活能力通过生活满意度影响海南省80岁及以上老年人的认知功能, 而饮酒行为调节了日常生活能力与生活满意度之间的关系。

Abstract

Objective To analyze the mechanism of action between the influencing factors of mild cognitive impairment in octogenarians in Hainan Province, and to explore the mediating effect of life satisfaction in this group between activities of daily living and cognitive function, as well as the regulatory effect of alcohol consumption on this intermediary. Methods From September 2021 to November 2022, a cross-sectional survey of stratified cluster sampling of octogenarians was conducted in the southern region (Baoting County) and the northern region (Chengmai County) of Hainan Province, and a total of 555 participants were included. In this study, cognitive function was assessed using the general practitioner cognitive assessment scale, life satisfaction was assessed using the life satisfaction scale, and activities of daily living were assessed using the activities of daily living assessment scale. The data were first statistically analyzed using SPSS22.0 statistical software, and then a structural equation model was developed using Mplus 8.0 statistical software. Results Activities of daily living had a significant negative predictive effect on cognitive function (β = -0.229, 95% CI: -0.284 to -0.174, P<0.001); life satisfaction played a partial mediating role between activities of daily living and cognitive function [activities of daily living had a significant negative predictive effect on life satisfaction (β= -0.625, 95% CI: -1.044 to -0.347, P<0.001), and life satisfaction had a significant positive predictive effect on cognitive function (β = 0.261, 95% CI: 0.170 to 0.340, P<0.001)]; compared with non-drinkers, activities of daily living predicted life satisfaction more significantly in drinkers (drinkers: β= -0.043, 95% CI: -0.070 to -0.024, P<0.001; non-drinkers: β = -0.019, 95% CI: -0.033 to -0.009, P = 0.001). Conclusion The effect of activities of daily living on cognitive function of the elderly aged 80 years and above in Hainan Province is a mediating effect of regulation. Activities of daily living affect the cognitive function of the elderly aged 80 years and above in Hainan Province through life satisfaction, while drinking behavior regulates the relationship between activities of daily living and life satisfaction.

关键词

日常生活能力 / 生活满意度 / 认知功能

Key words

Activities of daily living / Life satisfaction / Cognitive function

参考文献

[1] Li G, Li K. Turning point of cognitive decline for Chinese older adults from a longitudinal analysis: protective factors and risk factors[J]. Healthcare (Basel), 2022, 10(11): 2304.

[2] Zeng Y, Feng Q S, Hesketh T, et al. Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest—old in China: a cohort study[J]. Lancet, 2017, 389(10079): 1619-1629.

[3] Xu X, Byles J E, Shi Z, et al. Evaluation of older Chinese people's macronutrient intake status: results from the China health and nutrition survey [J]. Br J Nutr, 2015, 113(1): 159-171.

[4] 董昱, 王桦, 叶光明, 等. 长寿地区90岁及以上人群认知功能、营养状况与日常生活活动自理的关系研究[J]. 临床内科杂志, 2021, 38(5): 339-342.

[5] Dong Y, Wang H, Ye G M, et al. Study on the relationship between cognitive function, nutritional status and self—care of daily living activities in people aged 90 years and above in the longevity area [J]. J Clin Int Med, 2021, 38(5): 339-342.

[6] Ratigan A, Kritz—Silverstein D, Barrett—Connor E. Sex differences in the association of physical function and cognitive function with life satisfaction in older age: the Rancho Bernardo study[J]. Maturitas, 2016, 89: 29-35.

[7] 鲍超. 中国老年人群认知功能下降和日常生活活动能力关联的队列研究[D]. 合肥:安徽医科大学, 2022.

[8] Bao C. A cohort study on the association between cognitive decline and activities of daily living in the elderly Chinese population [D]. Hefei: Anhui Medical University, 2022.

[9] Dewitte L, Vandenbulcke M, Dezutter J. Meaning in life matters for older adults with Alzheimer's disease in residential care: associations with life satisfaction and depressive symptoms[J]. Int Psychogeriatr, 2019, 31(5): 607-615.

[10] Chan A M, von Mühlen D, Kritz—Silverstein D, et al. Regular alcohol consumption is associated with increasing quality of life and mood in older men and women: the Rancho Bernardo study [J]. Maturitas, 2009, 62(3): 294-300.

[11] Brodaty H, Connors M H, Loy C, et al. Screening for dementia in primary care: a comparison of the GPCOG and the MMSE[J]. Dement Geriatr Cogn Disord, 2016, 42(5—6): 323-330.

[12] Li X, Xiao S, Fang Y, et al. Validation of the general practitioner assessment of cognition — Chinese version (GPCOG—C) in China[J]. Int Psychogeriatr, 2013, 25(10): 1649-1657.

[13] Cheung F, Lucas R E. Assessing the validity of single—item life satisfaction measures: results from three large samples[J]. Qual Life Res, 2014, 23(10): 2809-2818.

[14] Goh W, Wong L. Dealing with confounders in omics analysis[J]. Trends Biotechnol, 2018, 36(5): 488-498.

[15] Francis G. Equivalent statistics and data interpretation[J]. Behav Res Methods, 2017, 49(4): 1524-1538.

[16] Valente M J, Rijnhart J, Smyth H L, et al. Causal mediation programs in R, Mplus, SAS, SPSS, and Stata[J]. Struct Equ Modeling, 2020, 27(6): 975-984.

[17] 王珺. 潜调节结构方程法下频率学派方法与贝叶斯方法的比较[D]. 广州:中山大学, 2021.

[18] Wang J. Comparison between the frequency school Method and the Bayesian Method under Latent regulation Structural Equation Method [D]. Guangzhou: Sun Yat—sen University, 2021.

[19] Hayes A F, Preacher K J. Statistical mediation analysis with a multicategorical independent variable [J]. Br J Math Stat Psychol, 2014, 67(3): 451-470.

[20] Panza F, Frisardi V, Seripa D, et al. Alcohol consumption in mild cognitive impairment and dementia: harmful or neuroprotective? [J]. Int J Geriatr Psych, 2012, 27(12): 1218-1238.

[21] Peters R, Peters J, Warner J, et al. Alcohol, dementia and cognitive decline in the elderly: a systematic review[J]. Age Ageing, 2008, 37(5): 505-512.

[22] Zhuang L, Yang Y, Gao J. Cognitive assessment tools for mild cognitive impairment screening [J]. J Neurol, 2021, 268(5): 1615-1622.

[23] Neumann—Böhme S, Attema A E, Brouwer W, et al. Life satisfaction: the role of domain—specific reference points[J]. Health Econ, 2021, 30(11): 2766-2779.

[24] Siddiquee A T, Kadota A, Fujiyoshi A, et al. Alcohol consumption and cognitive function in elderly Japanese men[J]. Alcohol, 2020, 85: 145-152.

[25] Zhang Q L, Wu Y L, Han T K, et al. Changes in cognitive function and risk factors for cognitive impairment of the elderly in China: 2005—2014[J]. Int J Environ Res Public Health, 2019, 16(16): 2847.

[26] Sulander T, Martelin T, Rahkonen O, et al. Associations of functional ability with health—related behavior and body mass index among the elderly[J]. Arch Gerontol Geriatr, 2005, 40(2): 185-199.

[27] Qiu C, Qi Y, Yin Y. Multiple intermediary model test of adolescent physical exercise and internet addiction[J]. Int J Environ Res Public Health, 2023, 20(5): 4030.

[28] Xu X, Zhao L. Social capital and the realization of mutual assistance for the elderly in rural areas—based on the intermediary role of psychological capital[J]. Int J Environ Res Public Health, 2022, 20(1): 415.

基金资助

^*国家重点研发计划(2018YFC2000400)