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Article(id=1241759328902905869, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406171, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1718121600000, receivedDateStr=2024-06-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773988094782, onlineDateStr=2026-03-20, pubDate=1727193600000, pubDateStr=2024-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773988094782, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773988094782, creator=13701087609, updateTime=1773988094782, updator=13701087609, issue=Issue{id=1241759317016252418, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='18', pageStart='3265', pageEnd='3456', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773988091898, creator=13701087609, updateTime=1773991617194, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774103024174010, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774103024174011, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3442, endPage=3448, ext={EN=ArticleExt(id=1241759329523662867, articleId=1241759328902905869, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between self-care and frailty in Chinese middle-aged and older adults:Depression plays a mediating role, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the mediating effect of depression between life self-care ability and frailty.

Methods

Based on data from the China Health and Retirement Longitudinal Study (CHARLS), Pearson correlation analysis, linear regression model and Bootstrap repeated sampling method were used to analyse the relationships and mediating effects between activity of daily living, depression and frailty.

Results

A total of 1 554 middle-aged and elderly people aged 45 years or older were included. The prevalence of debility was 14.1%, with a self-care score of 5.9±0.4 and a depression score of 9.4±6.0. Activity of daily living was significantly negatively correlated with depression and frailty (r=-0.14, r=-0.23, both P<0.001), and depression and frailty were positively correlated (r=0.34, P< 0.001). Activity of daily living (β=-0.164, P<0.001) and depression (β=0.013, P< 0.001) were influences on frailty, and depression partially mediated the relationship between activity of daily living and frailty, with a mediating effect of 12.17%.

Conclusion

Depression reduces the ameliorative effect of self-care ability on debility.

, correspAuthors=Xian LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Bing-yan CUI, Chen CHEN, Run-zhou MA, Mei-jie ZHENG, Wen-xiu LIU, Wei LI, Xian LI), CN=ArticleExt(id=1241759338503667893, articleId=1241759328902905869, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中国中老年人生活自理能力和衰弱的关系：抑郁起中介作用, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

探讨抑郁在生活自理能力和衰弱之间的中介作用。

方法

基于中国健康与养老追踪调查数据，采用Pearson相关分析、线性回归模型和Bootstrap重复抽样法分析生活自理能力、抑郁和衰弱间的关系和中介效应。

结果

共纳入了1 554名年龄在45岁以上的中老年人，其中衰弱发生率为14.1%，生活自理能力评分为5.9±0.4，抑郁评分为9.4±6.0。生活自理能力和抑郁、衰弱均显著负相关（r=-0.14,r=-0.23,均P<0.001），抑郁和衰弱呈正相关（r=0.34,P<0.0019）。生活自理能力(β=-0.164，P<0.001）和抑郁（β=0.013，P<0.001）是衰弱的影响因素，抑郁在生活自理能力和衰弱之间起部分中介作用，中介效应占比12.17%。

结论

抑郁会降低生活自理能力对衰弱的改善作用。

, correspAuthors=李贤, authorNote=null, correspAuthorsNote=
李贤，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=BPKVc1ZTBB2hG+xzAmiwTg==, magXml=iRpufTpGYYPlM98YXocrKA==, pdfUrl=null, pdf=R39NAaWxE0LvcAJWplKfeA==, pdfFileSize=755947, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=MNMZvT5qfZCYlFNLyahaMA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=jAR8/kvdZtNDF2saGxh/Ug==, mapNumber=null, authorCompany=null, fund=null, authors=

崔冰炎（1999—），男，硕士在读，研究方向：老年护理，慢性病管理

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崔冰炎（1999—），男，硕士在读，研究方向：老年护理，慢性病管理

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崔冰炎（1999—），男，硕士在读，研究方向：老年护理，慢性病管理

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A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project[J]. 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JBI Database of Systematic Reviews and Implementation Reports, 2018, 16(1): 140-232., articleTitle=Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults:a systematic review, refAbstract=null)], funds=[Fund(id=1241759355842921381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, awardId=ZF2024006, language=CN, fundingSource=2024年政府资助临床医学优秀人才培养项目(ZF2024006), fundOrder=null, country=null), Fund(id=1241759356010693552, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, awardId=20240083, language=CN, fundingSource=河北省2024年度医学科学研究课题计划项目(20240083), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241759339032150235, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, xref=1., ext=[AuthorCompanyExt(id=1241759339153785059, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, companyId=1241759339032150235, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=College of Nursing, Chengde Medical College, Chengde, Hebei 067000, China), AuthorCompanyExt(id=1241759339191533802, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, companyId=1241759339032150235, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.承德医学院护理学院，河北 承德 067000)]), AuthorCompany(id=1241759339401249018, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, xref=2., ext=[AuthorCompanyExt(id=1241759339422220542, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, companyId=1241759339401249018, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.河北医科大学研究生学院)]), AuthorCompany(id=1241759339531272454, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, xref=3., ext=[AuthorCompanyExt(id=1241759339787125017, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, companyId=1241759339531272454, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.河北省人民医院)])], figs=[ArticleFig(id=1241759352802050839, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, language=EN, label=Fig.1, caption=Diagram of the mediation effect model, figureFileSmall=sBnzxj5yS94LVz0jjxAMvA==, figureFileBig=MNMZvT5qfZCYlFNLyahaMA==, tableContent=null), ArticleFig(id=1241759353036931889, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, language=CN, label=图1, caption=中介效应模型图, figureFileSmall=sBnzxj5yS94LVz0jjxAMvA==, figureFileBig=MNMZvT5qfZCYlFNLyahaMA==, tableContent=null), ArticleFig(id=1241759353385059147, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, language=EN, label=Table 1, caption=

General information table for middle-aged and older participants (n=1 554) [,n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目类别总计中年组（n=833）老年组(n=721)t/χ2P
生活满意度2.0±0.82.0±0.72.1±0.8-3.495<0.001
认知功能10.1±4.410.9±4.19.1±4.58.028<0.001
CES-D9.4±6.09.5±6.29.2±5.90.846<0.333
Katz ADL5.9±0.45.9±0.35.9±0.41.465<0.081
睡眠时长（h）5.9±1.96.0±1.85.9±2.00.3900.728
握力(kg)25.2±8.526.8±8.223.3±8.68.509<0.001
衰弱否1 335(85.9)752(90.3)583(80.9)29.446<0.001
是219(14.1)81( 9.7)138(19.1)
性别女1 295(83.3)728(87.4)567(78.6)20.295<0.001
男259(16.7)105(12.6)154(21.4)
教育水平高中及以上1 274(82.0)710(85.2)564(78.2)36.807<0.001
初中38( 2.4)29( 3.5)9( 1.2)
小学90( 5.8)44( 5.3)46( 6.4)
文盲152( 9.8)50( 6.0)102(14.1)
婚姻状况已婚1 335(85.9)782(93.9)553(76.7)93.428<0.001
未婚219(14.1)51( 6.1)168(23.3)
高血压否1 054(67.8)623(74.8)431(59.8)40.322<0.001
是500(32.2)210(25.2)290(40.2)
癌症否1 530(98.5)817(98.1)713(98.9)1.6600.277
是24( 1.5)16( 1.9)8( 1.1)
糖尿病否1 513(97.4)814(97.7)699(96.9)0.9050.432
是41( 2.6)19( 2.3)22( 3.1)
慢性肺阻塞性疾病否1 401(90.2)753(90.4)648(89.9)0.1910.796
是153( 9.8)80( 9.6)73(10.1)
心脏病否1 266(81.5)703(84.4)563(78.1)9.8940.002
是288(18.5)130(15.6)158(21.9)
中风否1 498(96.4)818(98.2)680(94.3)16.866<0.001
是56( 3.6)15( 1.8)41( 5.7)
精神疾病否1 530(98.5)820(98.4)710(98.5)0.0031.000
是24( 1.5)13( 1.6)11( 1.5)
关节炎或风湿病否862(55.5)468(56.2)394(54.6)0.4040.578
是692(44.5)365(43.8)327(45.4)
血脂异常否1 320(84.9)723(86.8)597(82.8)4.5780.034
是234(15.1)110(13.2)124(17.2)
肝脏疾病否1 471(94.7)793(95.2)678(94.0)1.0510.367
是83( 5.3)40( 4.8)43( 6.0)
肾脏疾病否1 414(91.0)748(89.8)666(92.4)3.0870.093
是140( 9.0)85(10.2)55( 7.6)
消化疾病否1 079(69.4)562(67.5)517(71.7)2.8390.079
是475(30.6)271(32.5)204(28.3)
哮喘否1 501(96.6)813(97.6)688(95.4)6.3380.027
是53( 3.4)20( 2.4)33( 4.6)
饮酒否1 255(80.8)664(79.7)591(82.0)1.3890.289
是299(19.2)169(20.3)130(18.0)
吸烟否1 453(93.5)795(95.4)658(91.3)11.1640.001
是101( 6.5)38( 4.6)63( 8.7)
保险无1 508(97.0)1 296(97.1)212(96.8)0.0420.994
有46( 3.0)39( 2.9)7( 3.2)
睡眠不安稳无636(40.9)333(40.0)303(42.0)5.9480.113
很少264(17.0)129(15.5)135(18.7)
经常261(16.8)153(18.4)108(15.0)
总是393(25.3)218(26.2)175(24.3)
是否抑郁否881(56.7)456(54.7)425(58.9)2.5540.106
是673(43.3)377(45.3)296(41.1)
听力良好548(35.3)315(37.8)233(32.3)10.3280.005
中等762(49.0)408(49.0)354(49.1)
较差244(15.7)110(13.2)134(18.6)
视力良好618(35.8)352(42.4)266(37.1)26.488<0.001
中等554(35.8)320(38.6)234(32.6)
较差375(24.2)154(19.0)217(30.3)
疼痛否816(52.5)434(52.1)382(53.0)0.0740.767
是738(47.5)399(47.9)339(47.0)
), ArticleFig(id=1241759353561219933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, language=CN, label=表1, caption=

中老年参与者一般情况表（n=1 554) [,n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目类别总计中年组（n=833）老年组(n=721)t/χ2P
生活满意度2.0±0.82.0±0.72.1±0.8-3.495<0.001
认知功能10.1±4.410.9±4.19.1±4.58.028<0.001
CES-D9.4±6.09.5±6.29.2±5.90.846<0.333
Katz ADL5.9±0.45.9±0.35.9±0.41.465<0.081
睡眠时长（h）5.9±1.96.0±1.85.9±2.00.3900.728
握力(kg)25.2±8.526.8±8.223.3±8.68.509<0.001
衰弱否1 335(85.9)752(90.3)583(80.9)29.446<0.001
是219(14.1)81( 9.7)138(19.1)
性别女1 295(83.3)728(87.4)567(78.6)20.295<0.001
男259(16.7)105(12.6)154(21.4)
教育水平高中及以上1 274(82.0)710(85.2)564(78.2)36.807<0.001
初中38( 2.4)29( 3.5)9( 1.2)
小学90( 5.8)44( 5.3)46( 6.4)
文盲152( 9.8)50( 6.0)102(14.1)
婚姻状况已婚1 335(85.9)782(93.9)553(76.7)93.428<0.001
未婚219(14.1)51( 6.1)168(23.3)
高血压否1 054(67.8)623(74.8)431(59.8)40.322<0.001
是500(32.2)210(25.2)290(40.2)
癌症否1 530(98.5)817(98.1)713(98.9)1.6600.277
是24( 1.5)16( 1.9)8( 1.1)
糖尿病否1 513(97.4)814(97.7)699(96.9)0.9050.432
是41( 2.6)19( 2.3)22( 3.1)
慢性肺阻塞性疾病否1 401(90.2)753(90.4)648(89.9)0.1910.796
是153( 9.8)80( 9.6)73(10.1)
心脏病否1 266(81.5)703(84.4)563(78.1)9.8940.002
是288(18.5)130(15.6)158(21.9)
中风否1 498(96.4)818(98.2)680(94.3)16.866<0.001
是56( 3.6)15( 1.8)41( 5.7)
精神疾病否1 530(98.5)820(98.4)710(98.5)0.0031.000
是24( 1.5)13( 1.6)11( 1.5)
关节炎或风湿病否862(55.5)468(56.2)394(54.6)0.4040.578
是692(44.5)365(43.8)327(45.4)
血脂异常否1 320(84.9)723(86.8)597(82.8)4.5780.034
是234(15.1)110(13.2)124(17.2)
肝脏疾病否1 471(94.7)793(95.2)678(94.0)1.0510.367
是83( 5.3)40( 4.8)43( 6.0)
肾脏疾病否1 414(91.0)748(89.8)666(92.4)3.0870.093
是140( 9.0)85(10.2)55( 7.6)
消化疾病否1 079(69.4)562(67.5)517(71.7)2.8390.079
是475(30.6)271(32.5)204(28.3)
哮喘否1 501(96.6)813(97.6)688(95.4)6.3380.027
是53( 3.4)20( 2.4)33( 4.6)
饮酒否1 255(80.8)664(79.7)591(82.0)1.3890.289
是299(19.2)169(20.3)130(18.0)
吸烟否1 453(93.5)795(95.4)658(91.3)11.1640.001
是101( 6.5)38( 4.6)63( 8.7)
保险无1 508(97.0)1 296(97.1)212(96.8)0.0420.994
有46( 3.0)39( 2.9)7( 3.2)
睡眠不安稳无636(40.9)333(40.0)303(42.0)5.9480.113
很少264(17.0)129(15.5)135(18.7)
经常261(16.8)153(18.4)108(15.0)
总是393(25.3)218(26.2)175(24.3)
是否抑郁否881(56.7)456(54.7)425(58.9)2.5540.106
是673(43.3)377(45.3)296(41.1)
听力良好548(35.3)315(37.8)233(32.3)10.3280.005
中等762(49.0)408(49.0)354(49.1)
较差244(15.7)110(13.2)134(18.6)
视力良好618(35.8)352(42.4)266(37.1)26.488<0.001
中等554(35.8)320(38.6)234(32.6)
较差375(24.2)154(19.0)217(30.3)
疼痛否816(52.5)434(52.1)382(53.0)0.0740.767
是738(47.5)399(47.9)339(47.0)
), ArticleFig(id=1241759353724797804, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, language=EN, label=Table 2, caption=

Correlation analysis of ADL、depression and frailty in middle-aged and elderly patients

, figureFileSmall=null, figureFileBig=null, tableContent=
生活自理能力抑郁衰弱
生活自理能力1.00
抑郁-0.14a1.00
衰弱-0.23a0.34a1.00
), ArticleFig(id=1241759353905152887, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, language=CN, label=表2, caption=

中老年患者生活自理能力、抑郁和衰弱的相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
生活自理能力抑郁衰弱
生活自理能力1.00
抑郁-0.14a1.00
衰弱-0.23a0.34a1.00
), ArticleFig(id=1241759354081313671, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, language=EN, label=Table 3, caption=

Linear regression analyses of the mediating effect of depression on ADL and frailty in middle-aged and elderly people

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2（含中介因素）
β95%CIPβ95%CIP
KatzADL-0.182-0.230~-0.135<0.001-0.164- 0.211~- 0.117<0.001
CES-D---0.0130.009~0.016<0.001
年龄（岁）-0.002-0.001~0.0030.0800.0020.001~0.0040.025
性别（参考女性）0.0570.001~0.1130.0480.0700.014~0.1240.013
教育水平为文盲（参考高中及以上）0.0860.029~0.1420.0030.0890.034~0.1460.002
生活满意度-0.055-0.077~-0.033<0.001-0.029- 0.052~- 0.0050.011
糖尿病（参考未患病）0.1710.072~0.270<0.0010.1540.058~0.2530.002
关节炎或风湿病（参考未患病）0.0530.020~0.086<0.0010.0420.010~0.0750.011
心脏病（参考未患病）0.0770.033~0.1210.0010.0690.027~0.1130.002
睡眠不安稳（参考“无”）
经常0.0620.014~0.109<0.0010.009-0.039~0.0590.719
总是0.0830.037~0.129<0.0010.007-0.042~0.0570.777
认知功能-0.008-0.012~-0.004<0.001-0.005-0.009~-0.0010.011
握力-0.006-0.008~-0.003<0.001-0.005-0.008~-0.003<0.001
), ArticleFig(id=1241759355578680208, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759328902905869, language=CN, label=表3, caption=

抑郁在中老年人生活自理能力和衰弱的中介效应的线性回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2（含中介因素）
β95%CIPβ95%CIP
KatzADL-0.182-0.230~-0.135<0.001-0.164- 0.211~- 0.117<0.001
CES-D---0.0130.009~0.016<0.001
年龄（岁）-0.002-0.001~0.0030.0800.0020.001~0.0040.025
性别（参考女性）0.0570.001~0.1130.0480.0700.014~0.1240.013
教育水平为文盲（参考高中及以上）0.0860.029~0.1420.0030.0890.034~0.1460.002
生活满意度-0.055-0.077~-0.033<0.001-0.029- 0.052~- 0.0050.011
糖尿病（参考未患病）0.1710.072~0.270<0.0010.1540.058~0.2530.002
关节炎或风湿病（参考未患病）0.0530.020~0.086<0.0010.0420.010~0.0750.011
心脏病（参考未患病）0.0770.033~0.1210.0010.0690.027~0.1130.002
睡眠不安稳（参考“无”）
经常0.0620.014~0.109<0.0010.009-0.039~0.0590.719
总是0.0830.037~0.129<0.0010.007-0.042~0.0570.777
认知功能-0.008-0.012~-0.004<0.001-0.005-0.009~-0.0010.011
握力-0.006-0.008~-0.003<0.001-0.005-0.008~-0.003<0.001
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中国中老年人生活自理能力和衰弱的关系：抑郁起中介作用
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崔冰炎 1 , 陈晨 1 , 马润州 2 , 郑美洁 3 , 刘文秀 3 , 李伟 3 , 李贤 3, *
现代预防医学 | 临床与预防 2024,51(18): 3442-3448
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现代预防医学 | 临床与预防 2024, 51(18): 3442-3448
中国中老年人生活自理能力和衰弱的关系：抑郁起中介作用
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崔冰炎1, 陈晨1, 马润州2, 郑美洁3, 刘文秀3, 李伟3, 李贤3, *
作者信息
  • 1.承德医学院护理学院，河北 承德 067000
  • 2.河北医科大学研究生学院
  • 3.河北省人民医院

    • 崔冰炎（1999—），男，硕士在读，研究方向：老年护理，慢性病管理

通讯作者:

李贤，E-mail：
Relationship between self-care and frailty in Chinese middle-aged and older adults:Depression plays a mediating role
Bing-yan CUI1, Chen CHEN1, Run-zhou MA2, Mei-jie ZHENG3, Wen-xiu LIU3, Wei LI3, Xian LI3, *
Affiliations
  • College of Nursing, Chengde Medical College, Chengde, Hebei 067000, China
出版时间: 2024-09-25 doi: 10.20043/j.cnki.MPM.202406171
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摘要
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目的

探讨抑郁在生活自理能力和衰弱之间的中介作用。

方法

基于中国健康与养老追踪调查数据，采用Pearson相关分析、线性回归模型和Bootstrap重复抽样法分析生活自理能力、抑郁和衰弱间的关系和中介效应。

结果

共纳入了1 554名年龄在45岁以上的中老年人，其中衰弱发生率为14.1%，生活自理能力评分为5.9±0.4，抑郁评分为9.4±6.0。生活自理能力和抑郁、衰弱均显著负相关（r=-0.14,r=-0.23,均P<0.001），抑郁和衰弱呈正相关（r=0.34,P<0.0019）。生活自理能力(β=-0.164，P<0.001）和抑郁（β=0.013，P<0.001）是衰弱的影响因素，抑郁在生活自理能力和衰弱之间起部分中介作用，中介效应占比12.17%。

结论

抑郁会降低生活自理能力对衰弱的改善作用。

生活自理能力  /  中老年人  /  衰弱  /  中介效应
Objective

To explore the mediating effect of depression between life self-care ability and frailty.

Methods

Based on data from the China Health and Retirement Longitudinal Study (CHARLS), Pearson correlation analysis, linear regression model and Bootstrap repeated sampling method were used to analyse the relationships and mediating effects between activity of daily living, depression and frailty.

Results

A total of 1 554 middle-aged and elderly people aged 45 years or older were included. The prevalence of debility was 14.1%, with a self-care score of 5.9±0.4 and a depression score of 9.4±6.0. Activity of daily living was significantly negatively correlated with depression and frailty (r=-0.14, r=-0.23, both P<0.001), and depression and frailty were positively correlated (r=0.34, P< 0.001). Activity of daily living (β=-0.164, P<0.001) and depression (β=0.013, P< 0.001) were influences on frailty, and depression partially mediated the relationship between activity of daily living and frailty, with a mediating effect of 12.17%.

Conclusion

Depression reduces the ameliorative effect of self-care ability on debility.

Activity of daily living  /  The middle-aged and the elderly  /  Frailty  /  Mediating effect
崔冰炎, 陈晨, 马润州, 郑美洁, 刘文秀, 李伟, 李贤. 中国中老年人生活自理能力和衰弱的关系：抑郁起中介作用. 现代预防医学, 2024 , 51 (18) : 3442 -3448 . DOI: 10.20043/j.cnki.MPM.202406171
Bing-yan CUI, Chen CHEN, Run-zhou MA, Mei-jie ZHENG, Wen-xiu LIU, Wei LI, Xian LI. Relationship between self-care and frailty in Chinese middle-aged and older adults:Depression plays a mediating role[J]. Modern Preventive Medicine, 2024 , 51 (18) : 3442 -3448 . DOI: 10.20043/j.cnki.MPM.202406171
正文
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人口老龄化已成为全球性问题，中国是老年人口最多的国家[1]。据统计，2023年末我国60岁及以上人口为29 697万人，占总人口的21.1%[2]。随着全球老年人口的增加，衰弱问题日益引起国际社会的关注[3]。衰弱是一种与增龄相关的老年综合征，表现为对应激的应对能力降低，发生跌倒、失能和死亡的风险增加[1]。衰弱的特征涉及多个生理系统功能下降，同时更容易受到压力因素的影响[4]。在其发展过程中，身体和社会心理因素都发挥着重要作用[5]。生活自理能力（Activity of Daily Living, ADL）作为反映身体功能状态的指标，是抑郁的重要影响因素[6]，同时也可以预测衰弱的发生[7]。研究表明，老年人的ADL与抑郁存在显著相关性，ADL受损的老年人抑郁的可能性是ADL正常老年人的1.521倍[8]。此外，既往研究表明，ADL是中老年人衰弱的重要影响因素[9]。同时，抑郁作为老年人最易罹患的心理疾病[10]，且Deng等[11]研究从遗传学角度证实抑郁和衰弱之间存在因果关系。研究ADL通过抑郁对衰弱发生的潜在关系有助于进一步了解两者间的关系，因此，本研究通过Bootstrap方法检验抑郁在ADL和衰弱间的中介效应，同时将研究人群范围制定为45岁以上的中老年人，旨在为及早预防中老年人衰弱提供参考。
1　对象与方法
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1.1　理论基础和研究假设
1978年，“健康心理学”理论由美国心理学会正式提出，该理论关注生活质量、生活方式及各种心理因素在健康中的影响机制和作用，并关注心理与健康的相互关系[12]。本研究将生活自理能力作为反映生活相关因素，抑郁作为心理因素，衰弱作为反映健康状况因素，探究抑郁在中老年人生活自理能力和衰弱之间的中介效应。本研究重点关注中老年人的衰弱状况，故只对生活自理能力、抑郁和衰弱之间的单向作用进行了探究。
研究假设：抑郁在中老年人生活自理能力和衰弱之间的起中介作用。
1.2　样本与研究设计
本文数据来源为中国健康与养老追踪调查（China Health and Retirement Longitudinal Study,CHARLS）2013年Wave2[13]。CHARLS Wave2获得了北京大学生物医学伦理委员会的批准：IRB00001052-11015，并在所有参与者知情同意后进行调查。CHARLS 2013年Wave2包括18 605名参与者，在确定研究变量后对数据进行筛选，纳入标准：（1）年龄≥45岁，（2）完成衰弱、抑郁和ADL测量；排除标准：（1）主要研究变量不完整；（2）协变量关键信息缺失者。共排除17 051例在一般资料、研究变量存在缺失数据参与者。对纳入数据进行整理分析，最终共纳入1 554名参与者。
1.3　研究方法
1.3.1　研究变量及部分评估工具
（1）衰弱：衰弱的定义由Fried等[14]提出，包括体重减轻、自我报告的疲惫、虚弱、步行速度慢和体力活动少。本研究根据上述标准结合Charls数据库提供的信息，修改标准为虚弱程度、行走缓慢、精神疲惫、低体力活动、体重减轻五项内容，Bu等[15]研究已经证明此项标准对衰弱同样有效。本项研究将衰弱定义为二分类变量，满足下列三项内容及以上判定为衰弱。评估具体内容包括：虚弱程度：采用自我报告的“您提10 斤重的东西，有困难吗？”项目进行测量。行走缓慢：采用自我报告的“您走100 米，有困难吗？”项目结果进行测量。精神疲惫：采用中文版流调中心抑郁量表中任意一项回答出现“经常（3~4 天）”或“总是 （5~7 天）”进行评估。低体力活动：采用对参与者体力活动或步行时间小于10分钟进行评估。体重减轻：采用“过去一年有没有增重10斤以上，或减轻 10 斤以上？（怀孕除外）”进行评估。
（2）生活自理能力：采用Katz日常生活活动独立指数（The Katz Index of Independence in Activities of Daily Living ，Katz ADL）[16]进行评估。包括进食、穿衣、上下床、上厕所、洗澡和大便失禁6个条目，回答“没有困难”和“有困难但仍能做到”评分为1分，回答“有困难需要帮助”和“我做不到”评分为0分，得分范围为0~6分，得分越高，生活自理能力越强。
（3）抑郁：采用中文版流调中心抑郁量表（center for epidemiological survey，depression scale，CES-D）进行评估。各条目均采用Likert四级评分法进行评分，回答内容:无，很少（1~2天），经常（3~4天），总是（5~7天）。其中两个条目为反向计分，其余均为正向计分，各条目得分范围为0~3，总分30分，得分越高，抑郁程度越严重，大于等于10分判定为抑郁。CES-D已被验证在中国老年人群中显示出良好的信效度[17]。
（4）协变量：包括社会人口学因素（年龄；教育水平包括文盲、小学、初中、高中及以上四个等级；婚姻状况包括已婚未婚；是否有医疗保险）。健康习惯（是否吸烟、是否喝酒、睡眠时长）。疾病情况（高血压、癌症、糖尿病、心脏病、慢性阻塞性肺疾病、中风、精神疾病、关节炎或风湿病、血脂异常、肝脏疾病、肾脏疾病、消化系统疾病、哮喘，均为自我报告的是否患有疾病）。
视力情况：通过“询问您通常是否戴眼镜（包括矫正视力镜片）？”和“您看远处的东西怎么样？比如说能不能隔着马路认出朋友 （包括戴着眼镜）。是极好，很好，好，一般还是不好？”，“良好”、“中等”和“较差”。
听力情况：通过询问您的听力如何？（如果您经常戴助听器，那么戴助听器时听力如何？如果您不经常戴助听器，那么不戴助听器时听力如何？） 是极好，很好，好，一般还是不好？
睡眠质量：通过询问参与者“最近一周是否睡眠不安稳？”，Likert四级评分法进行评分，回答包括无，很少（1~2天），经常（3~4天），总是（5~7天），得分范围1~4分，分数越高表示睡眠质量越不好。
握力：取两次左手和右手的握力值的平均值。
认知功能[18]：包含情景记忆和精神完整两个维度，其中，情景记忆通过向参与者朗读10个词语并在朗诵完毕（瞬时记忆）和10分钟后（延迟记忆）分别让参与者回忆词语，根据回忆词语数量评分，每个1分，得分为瞬时记忆加延迟记忆得分除以2，得分范围0-10；精神完整包括画一个重叠得五边形，回答当日的日期、季节和星期几，以及连续计算5次100减7，每回答对1次加1分，精神完整维度总分为11分；认知功能得分范围为0~21分，得分越高表示整体认知功能越好。生活满意度：采用“总体来看，您对自己的生活是否感到满意？是极其满意，非常满意，比较满意，不太满意还是一点也不满意？”进行评估，利用likert 5级评分法进行评分，得分范围为0~4分，分数越高表示生活满意度越高。
1.3.2　统计学方法
连续变量使用均数±标准差（）表示，组间比较采用t检验；分类变量使用频数（百分比）n （%）表示，组间比较采用卡方检验。采用Pearson相关分析生活自理能力、抑郁和衰弱之间的相关性。采用中介效应模型分析抑郁在中老年人生活自理能力和衰弱之间的中介作用：（1）采用线性回归分析检验生活自理能力和衰弱之间的关系；（2）将抑郁作为中介因素纳入线性回归方程，进一步分析生活自理能力和衰弱的关系。采用bootstrap进行1 000次重复采样检验总效应、间接效应和直接效应是否显著。所有分析均采用RStudio 4.4.1软件进行分析，检验水准α=0.05。
2　结果
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2.1　中年人和老年人一般资料差异情况
将中年组定义为：60岁>中年组≥45岁，共有833名中年人，老年组定义为：老年组≥60岁，共有721名老年人。共纳入1 554名参与者，其中83.3%为女性，平均年龄为60.4±9.6岁，具体情况分析详见表1。
2.2　中老年人生活自理能力、抑郁和衰弱的相关性分析
Pearson相关性分析结果显示，中老年人的生活自理能力、抑郁和衰弱显著相关，生活自理能力和抑郁程度、衰弱呈负相关（r=-0.14,r=-0.23, 均P<0.001），抑郁和衰弱呈正相关（r=0.34,P<0.001）。见表2。
2.3　抑郁在中老年人生活自理能力和衰弱的中介效应分析
通过方差膨胀因子和容忍度结果确定回归分析中的协变量，纳入变量的方差膨胀因子均小于10，且容忍度均大于0.1，表明自变量之间不存在共线性问题。模型1的线性回归结果显示，生活自理能力和衰弱显著相关（β=-1.781，P<0.001）。当在模型2中纳入抑郁作为中介因素时，生活自理能力与衰弱依然显著相关（β=-0.164，P<0.001），提示抑郁在生活自理能力和衰弱之间起部分中介作用。Bootstrap分析结果显示，生活自理能力对衰弱的总效应为-0.186（95%CI：-0.241~-0.140）,通过抑郁对衰弱的间接效应为-0.023（95%CI：-0.036~-0.010），95%置信区间不包括0，表示中介效应显著。结果显示，中介效应占总效应的12.17%，进一步验证本研究假设。见图1、表3。
3　讨论
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本研究发现，中老年人衰弱发生率为14.1%。其中45~60岁的中年人衰弱发生率为9.7%，而60岁以上的老年人衰弱发生率为19.1%。与Ma等[19]研究结论一致，衰弱的发生率随年龄增长而增加。结合本研究一般资料中差异有统计学意义因素，分析老年组衰弱发生率高于中年组的原因可能是因为老年组参与者运动耐力随着年龄增长而下降，表现在握力显著低于中年组；同时，自身基础疾病和视力听力障碍也加速了衰弱的发展；其次，受教育程度相对较低以及认知功能的衰退进一步恶化了衰弱的情况；最后，一些不良习惯，例如吸烟，也加重了衰弱的恶化。提示医务人员可以从纠正老年人不良习惯开始，通过认知行为疗法提高老年人对衰弱的认知水平，增加适当的体力活动以增强运动耐力，以及减少吸烟次数从而延缓衰弱的发展。然而，本研究还发现，与中年组相比，老年组的生活满意度更高。这与骆为祥等[20]研究结果一致，即随着年龄增长，生活满意度水平也越高。分析原因可能是中年人是家庭的主要劳动力，照顾负担较重[21]。相比之下，老年人享受退休津贴和医疗保险相关政策的补贴[22]，同时也得到了来自家庭和社会的支持[23]，这促使老年人的生活满意度处于较高水平。
本研究结果显示抑郁水平越高，衰弱发生风险越高。Deng等[11]研究通过孟德尔随机化方法探究了抑郁和衰弱之间存在双向因果关系，指出衰弱会加重抑郁的程度，同时，抑郁也是衰弱发生的危险因素。抑郁和衰弱互相影响，导致中老年人衰弱和抑郁程度恶化形成恶性循环。提示未来研究人员可以考虑心理干预作为衰弱干预的一部分，通过减轻抑郁程度，从而延缓衰弱的发展。
本研究发现，生活自理能力对衰弱具有间接和直接的显著影响，与Chen等研究结果一致[24]。本研究结果显示，生活自理能力与衰弱呈负相关关系，即生活自理能力越高，越不容易发生衰弱。分析原因可能是因为生活自理能力强的中老年人通常具有较好的身体功能，包括肌肉力量、灵活性和耐力等[25-26]，从而延缓其衰弱进展。此外，本研究还发现，抑郁在生活自理能力和衰弱之间起部分中介作用。在本研究中，生活自理能力和抑郁呈负相关，即生活自理能力越强，抑郁程度越低，衰弱发生可能性越小，与以往研究结果一致[9]。生活自理能力预测衰弱的效应值在抑郁加入线性回归模型后降低，提示抑郁调节了生活自理能力对衰弱的负向影响，即抑郁水平减弱了生活自理能力改善衰弱的能力。这可能是因为良好的生活自理能力与较高的心理健康水平相关联[27]。对生活自理能力的掌控和满足感可能提升个体的心理幸福感，减少焦虑和抑郁情绪，从而间接改善了衰弱程度。研究表明，渐进式阻力训练、体育锻炼计划等方法可在短期内改善衰弱[28]。长期（6个月以上）使用认知行为疗法可通过改善心理健康水平，减少抑郁情绪，达到维持改善衰弱的效果[29]。提示医疗卫生工作者应注意患者从体能锻炼方面提高患者生活自理能力，同时通过心理干预，减少患者抑郁情绪，从而降低衰弱发生风险。
本研究基于CHARLS数据库分析出中老年人生活自理能力对衰弱具有直接和间接的影响，抑郁在生活自理能力和衰弱间起部分中介作用。建议关注并干预中老年人的生活自理能力，不仅有助于减轻抑郁情绪，还有助于延缓衰弱进程，增强其生活满意度，从而实现成功老龄化。由于本研究选择横断面研究，可能导致因果关系论证能力有限，未来可以通过纵向研究进一步探讨衰弱的相关因素及影响路径。
基金
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  • 2024年政府资助临床医学优秀人才培养项目(ZF2024006)
  • 河北省2024年度医学科学研究课题计划项目(20240083)
文献
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2024年第51卷第18期
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doi: 10.20043/j.cnki.MPM.202406171
  • 接收时间：2024-06-12
  • 首发时间：2026-03-20
  • 出版时间：2024-09-25
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  • 收稿日期：2024-06-12
基金
2024年政府资助临床医学优秀人才培养项目(ZF2024006)
河北省2024年度医学科学研究课题计划项目(20240083)
作者信息
    1.承德医学院护理学院，河北 承德 067000
    2.河北医科大学研究生学院
    3.河北省人民医院

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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