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Article(id=1241319154066715066, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408335, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1724342400000, receivedDateStr=2024-08-23, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773883148923, onlineDateStr=2026-03-19, pubDate=1750780800000, pubDateStr=2025-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773883148923, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773883148923, creator=13701087609, updateTime=1773883148923, updator=13701087609, issue=Issue{id=1241319148798669160, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='12', pageStart='2113', pageEnd='2304', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773883147667, creator=13701087609, updateTime=1773885555254, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241329247004971040, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241329247004971041, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2236, endPage=2241, ext={EN=ArticleExt(id=1241319154943324643, articleId=1241319154066715066, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Mediating effect of depressive symptoms between handgrip strength and activities of daily living in older adults, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the mediating effect of depressive symptoms on the relationship between handgrip strength and activities of daily living (ADL) in older adults, so as to provide a reference for the prevention and intervention of ADL impairment in this population.

Methods

Based on the 2015 survey data from the China Health and Retirement Longitudinal Study (CHARLS), a study was conducted involving 2 344 seniors aged 60 and above. Descriptive analysis and partial correlation analysis were conducted using SPSS 25.0, and the PROCESS macro program was employed to test for mediation effects.

Results

The detection rate of low handgrip strength among elderly individuals in our country is 20.09%, the detection rate of depressive symptoms is 34.94%, and the rate of Activities of Daily Living (ADL) impairment is 20.95%. Handgrip strength is negatively correlated with depressive symptoms (r=-0.055, P<0.01); handgrip strength is also negatively correlated with ADL impairment (r=-0.143, P<0.001), while depressive symptoms are positively correlated with ADL impairment (r=0.259, P<0.001). Depressive symptoms have a partial mediating effect between handgrip strength and ADL in the elderly, with the mediation effect accounting for 12.68%.

Conclusion

Handgrip strength can have a significant impact on the activities of daily living (ADL) of older adults due to symptoms of depression, highlighting the importance of self-exercise for this demographic. Interventions that combine improvements in handgrip strength with a reduction in the risk of depressive symptoms may be effective in maintaining the daily living capabilities of older individuals.

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目的

探索抑郁症状在老年人握力与日常生活活动能力（ADL）间的中介效应，为预防和干预老年人ADL受损的发生发展提供参考依据。

方法

基于中国健康与养老追踪调查（CHARLS）2015年的调查数据，将2 344名60岁及以上的老年人作为研究对象，采用 SPSS 25.0进行描述性分析和偏相关分析，使用PROCESS宏程序进行中介效应检验。

结果

我国老年人低握力检出率为20.09%，抑郁症状检出率为34.94%，ADL受损率为20.95%；握力与抑郁症状呈负相关（r=-0.055, P<0.01）；握力与ADL受损呈负相关（r=-0.143, P<0.001），抑郁症状与ADL受损呈正相关（r=0.259, P<0.001）；抑郁症状在老年人握力与ADL之间存在部分中介作用，中介效应占比为12.68%。

结论

握力可通过抑郁症状对老年人ADL产生一定影响，提示老年人自身锻炼的重要性；改善握力与降低抑郁症状发生风险相结合的干预措施可能对维持老年人的日常生活活动能力有较好的效果。

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马桂峰和柳林为共同通信作者。马桂峰，E-mail：
柳林，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=Whip2n2/K7CdNBVZ/Nh5CA==, magXml=HzNTEDf1Nj2IbgG7h9AfSQ==, pdfUrl=null, pdf=MLPyZiEZdXrBt98G8pSCgw==, pdfFileSize=685296, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=3x2Kaehx4FjctUTStIRiRw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=UbPCAWlIrY5UzpirTsSkrw==, mapNumber=null, authorCompany=null, fund=null, authors=

苏文钰（1998—），女，硕士在读，研究方向：流行病与卫生统计，精神卫生，慢性病

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苏文钰（1998—），女，硕士在读，研究方向：流行病与卫生统计，精神卫生，慢性病

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苏文钰（1998—），女，硕士在读，研究方向：流行病与卫生统计，精神卫生，慢性病

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Frontiers in Public Health, 2023, 11: 1200821., articleTitle=Bidirectional association between handgrip strength and ADLs disability: a prospective cohort study, refAbstract=null)], funds=[Fund(id=1241319164611195886, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, awardId=LH2022GG06, language=CN, fundingSource=国家食品安全风险中心联合攻关计划项目(LH2022GG06), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241319156159672882, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, xref=1., ext=[AuthorCompanyExt(id=1241319156163867187, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, companyId=1241319156159672882, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China), AuthorCompanyExt(id=1241319156172255796, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, companyId=1241319156159672882, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山东第二医科大学公共卫生学院，山东 潍坊 261053)]), AuthorCompany(id=1241319157640262207, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, xref=2., ext=[AuthorCompanyExt(id=1241319157648650815, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, companyId=1241319157640262207, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.沂源县疾病预防控制中心检验科)]), AuthorCompany(id=1241319157766091337, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, xref=3., ext=[AuthorCompanyExt(id=1241319157778674250, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, companyId=1241319157766091337, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.山东第二医科大学第一附属医院（潍坊市人民医院）内分泌科)])], figs=[ArticleFig(id=1241319162988000128, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=EN, label=Fig.1, caption=The mediating effect model of depression symptoms between grip strength and activities of daily living (ADL), figureFileSmall=WppnCDHZNzVY7ouE6HzUew==, figureFileBig=3x2Kaehx4FjctUTStIRiRw==, tableContent=null), ArticleFig(id=1241319163159966607, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=CN, label=图1, caption=抑郁症状在握力与ADL之间的中介效应模型, figureFileSmall=WppnCDHZNzVY7ouE6HzUew==, figureFileBig=3x2Kaehx4FjctUTStIRiRw==, tableContent=null), ArticleFig(id=1241319163457762212, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=EN, label=Table 1, caption=

Analysis of the occurrence and characteristics differences of ADL impairment in the elderly

, figureFileSmall=null, figureFileBig=null, tableContent=
变量无ADL受损存在ADL受损t/χ2值P值
年龄（岁）67.03±5.6368.28±5.94-4.347<0.001
握力（kg）29.07±8.7824.97±8.149.350<0.001
认知功能（分）11.73±3.2210.35±3.528.316<0.001
抑郁症状得分（分）7.58±5.8710.99±6.759-11.068<0.001
夜晚睡眠时长（h）6.25±1.795.98±2.112.8870.004
性别25.400<0.001
男988(53.32)199(40.53)
女865(46.68)292(59.47)
户口类型13.341<0.001
农村1 245(67.19)372(75.76)
城镇608(32.81)119(24.24)
婚姻状态4.0870.130
未婚8(0.43)5(1.02)
已婚同居1 570(84.73)402(81.87)
分居/离异/丧偶275(14.84)84(17.11)
地理分布1.2900.525
东部647(34.92)158(32.18)
中部518(27.95)143(29.12)
西部688(37.13)190(38.70)
教育程度58.115<0.001
未受过教育269(14.52)140(28.51)
小学1 063(57.37)259(52.75)
初中353(19.05)63(12.83)
高中及以上168(9.06)29(5.91)
吸烟4.8950.027
否949(51.21)279(56.82)
是904(48.79)212(43.18)
饮酒21.195<0.001
否1 184(63.90)368(74.95)
是669(36.10)123(25.05)
社交活动17.238<0.001
无745(40.69)251(51.12)
有1 099(59.31)240(48.88)
体质指数17.296<0.001
偏瘦96(5.18)42(8.55)
正常917(49.49)214(43.58)
超重597(32.22)147(29.94)
肥胖243(13.11)88(17.92)
慢性病数量6.7970.033
0448(24.18)98(19.96)
1482(26.01)117(23.83)
≥2923(49.81)276(56.21)
低握力40.660<0.001
否1 531(82.62)342(69.65)
是322(17.38)149(30.35)
抑郁症状73.340<0.001
否1 286(69.40)239(48.68)
是567(30.60)252(51.32)
), ArticleFig(id=1241319163591979950, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=CN, label=表1, caption=

老年人ADL受损发生情况及特征差异分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量无ADL受损存在ADL受损t/χ2值P值
年龄（岁）67.03±5.6368.28±5.94-4.347<0.001
握力（kg）29.07±8.7824.97±8.149.350<0.001
认知功能（分）11.73±3.2210.35±3.528.316<0.001
抑郁症状得分（分）7.58±5.8710.99±6.759-11.068<0.001
夜晚睡眠时长（h）6.25±1.795.98±2.112.8870.004
性别25.400<0.001
男988(53.32)199(40.53)
女865(46.68)292(59.47)
户口类型13.341<0.001
农村1 245(67.19)372(75.76)
城镇608(32.81)119(24.24)
婚姻状态4.0870.130
未婚8(0.43)5(1.02)
已婚同居1 570(84.73)402(81.87)
分居/离异/丧偶275(14.84)84(17.11)
地理分布1.2900.525
东部647(34.92)158(32.18)
中部518(27.95)143(29.12)
西部688(37.13)190(38.70)
教育程度58.115<0.001
未受过教育269(14.52)140(28.51)
小学1 063(57.37)259(52.75)
初中353(19.05)63(12.83)
高中及以上168(9.06)29(5.91)
吸烟4.8950.027
否949(51.21)279(56.82)
是904(48.79)212(43.18)
饮酒21.195<0.001
否1 184(63.90)368(74.95)
是669(36.10)123(25.05)
社交活动17.238<0.001
无745(40.69)251(51.12)
有1 099(59.31)240(48.88)
体质指数17.296<0.001
偏瘦96(5.18)42(8.55)
正常917(49.49)214(43.58)
超重597(32.22)147(29.94)
肥胖243(13.11)88(17.92)
慢性病数量6.7970.033
0448(24.18)98(19.96)
1482(26.01)117(23.83)
≥2923(49.81)276(56.21)
低握力40.660<0.001
否1 531(82.62)342(69.65)
是322(17.38)149(30.35)
抑郁症状73.340<0.001
否1 286(69.40)239(48.68)
是567(30.60)252(51.32)
), ArticleFig(id=1241319163722003379, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=EN, label=Table 2, caption=

Partial correlation analysis of grip strength, depressive symptoms, and ADL in elderly people

, figureFileSmall=null, figureFileBig=null, tableContent=
变量握力抑郁症状ADL
握力1.000
抑郁症状-0.055a1.000
ADL-0.143a0.259a1.000
), ArticleFig(id=1241319163847832510, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=CN, label=表2, caption=

老年人握力、抑郁症状及ADL的偏相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量握力抑郁症状ADL
握力1.000
抑郁症状-0.055a1.000
ADL-0.143a0.259a1.000
), ArticleFig(id=1241319164023993291, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=EN, label=Table 3, caption=

Regression analysis results of grip strength and depressive symptoms on ADL in elderly people

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量整体拟合指数回归方程显著性
因变量自变量RR2Fβt
模型1ADL握力0.2740.07517.255a-0.071-7.534a
模型2抑郁症状握力0.3640.13232.299a-0.063-3.386a
模型3ADL抑郁症状0.3790.14332.499a0.13713.609a
握力-0.062-6.855a
), ArticleFig(id=1241319164166599632, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=CN, label=表3, caption=

握力和抑郁症状对老年人ADL的回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量整体拟合指数回归方程显著性
因变量自变量RR2Fβt
模型1ADL握力0.2740.07517.255a-0.071-7.534a
模型2抑郁症状握力0.3640.13232.299a-0.063-3.386a
模型3ADL抑郁症状0.3790.14332.499a0.13713.609a
握力-0.062-6.855a
), ArticleFig(id=1241319164313400280, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=EN, label=Table 4, caption=

Bootstrap mediated effect test of depressive symptoms between grip strength and ADL in elderly individuals

, figureFileSmall=null, figureFileBig=null, tableContent=
变量效应值标准误LICIULCI效应量（%）
总效应-0.0710.009-0.089-0.053
直接效应-0.0620.009-0.080-0.04587.32
中介效应-0.0090.003-0.015-0.00312.68
), ArticleFig(id=1241319164451812323, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154066715066, language=CN, label=表4, caption=

抑郁症状在老年人握力、ADL之间的Bootstrap中介效应检验

, figureFileSmall=null, figureFileBig=null, tableContent=
变量效应值标准误LICIULCI效应量（%）
总效应-0.0710.009-0.089-0.053
直接效应-0.0620.009-0.080-0.04587.32
中介效应-0.0090.003-0.015-0.00312.68
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抑郁症状在老年人握力和日常生活活动能力间的中介效应
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苏文钰 1 , 贾蕙毓 1 , 常雯静 1 , 姜姗 1 , 于洁 2 , 马桂峰 1 , 柳林 3
现代预防医学 | 健康与社会行为 2025,52(12): 2236-2241
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现代预防医学 | 健康与社会行为 2025, 52(12): 2236-2241
抑郁症状在老年人握力和日常生活活动能力间的中介效应
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苏文钰1, 贾蕙毓1, 常雯静1, 姜姗1, 于洁2, 马桂峰1 , 柳林3
作者信息
  • 1.山东第二医科大学公共卫生学院，山东 潍坊 261053
  • 2.沂源县疾病预防控制中心检验科
  • 3.山东第二医科大学第一附属医院（潍坊市人民医院）内分泌科

    • 苏文钰（1998—），女，硕士在读，研究方向：流行病与卫生统计，精神卫生，慢性病

通讯作者:

马桂峰和柳林为共同通信作者。马桂峰，E-mail：
柳林，E-mail：
Mediating effect of depressive symptoms between handgrip strength and activities of daily living in older adults
Wen- yu SU1, Hui-yu JIA1, Wen-jing CHANG1, Shan JIANG1, Jie YU2, Gui-feng MA1 , Lin LIU3
Affiliations
  • School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China
出版时间: 2025-06-25 doi: 10.20043/j.cnki.MPM.202408335
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摘要
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目的

探索抑郁症状在老年人握力与日常生活活动能力（ADL）间的中介效应，为预防和干预老年人ADL受损的发生发展提供参考依据。

方法

基于中国健康与养老追踪调查（CHARLS）2015年的调查数据，将2 344名60岁及以上的老年人作为研究对象，采用 SPSS 25.0进行描述性分析和偏相关分析，使用PROCESS宏程序进行中介效应检验。

结果

我国老年人低握力检出率为20.09%，抑郁症状检出率为34.94%，ADL受损率为20.95%；握力与抑郁症状呈负相关（r=-0.055, P<0.01）；握力与ADL受损呈负相关（r=-0.143, P<0.001），抑郁症状与ADL受损呈正相关（r=0.259, P<0.001）；抑郁症状在老年人握力与ADL之间存在部分中介作用，中介效应占比为12.68%。

结论

握力可通过抑郁症状对老年人ADL产生一定影响，提示老年人自身锻炼的重要性；改善握力与降低抑郁症状发生风险相结合的干预措施可能对维持老年人的日常生活活动能力有较好的效果。

老年人  /  握力  /  抑郁症状  /  日常生活活动能力  /  中介效应
Objective

To explore the mediating effect of depressive symptoms on the relationship between handgrip strength and activities of daily living (ADL) in older adults, so as to provide a reference for the prevention and intervention of ADL impairment in this population.

Methods

Based on the 2015 survey data from the China Health and Retirement Longitudinal Study (CHARLS), a study was conducted involving 2 344 seniors aged 60 and above. Descriptive analysis and partial correlation analysis were conducted using SPSS 25.0, and the PROCESS macro program was employed to test for mediation effects.

Results

The detection rate of low handgrip strength among elderly individuals in our country is 20.09%, the detection rate of depressive symptoms is 34.94%, and the rate of Activities of Daily Living (ADL) impairment is 20.95%. Handgrip strength is negatively correlated with depressive symptoms (r=-0.055, P<0.01); handgrip strength is also negatively correlated with ADL impairment (r=-0.143, P<0.001), while depressive symptoms are positively correlated with ADL impairment (r=0.259, P<0.001). Depressive symptoms have a partial mediating effect between handgrip strength and ADL in the elderly, with the mediation effect accounting for 12.68%.

Conclusion

Handgrip strength can have a significant impact on the activities of daily living (ADL) of older adults due to symptoms of depression, highlighting the importance of self-exercise for this demographic. Interventions that combine improvements in handgrip strength with a reduction in the risk of depressive symptoms may be effective in maintaining the daily living capabilities of older individuals.

Elderly people  /  Grip strength  /  Depressive symptoms  /  Activities of daily living  /  Mediating effect
苏文钰, 贾蕙毓, 常雯静, 姜姗, 于洁, 马桂峰, 柳林. 抑郁症状在老年人握力和日常生活活动能力间的中介效应. 现代预防医学, 2025 , 52 (12) : 2236 -2241 . DOI: 10.20043/j.cnki.MPM.202408335
Wen- yu SU, Hui-yu JIA, Wen-jing CHANG, Shan JIANG, Jie YU, Gui-feng MA, Lin LIU. Mediating effect of depressive symptoms between handgrip strength and activities of daily living in older adults[J]. Modern Preventive Medicine, 2025 , 52 (12) : 2236 -2241 . DOI: 10.20043/j.cnki.MPM.202408335
正文
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日常生活活动能力（activity of daily living, ADL）是指人们为了保持自立而必须完成的自我照顾活动，而ADL受损不仅会限制老年人的日常生活和社交活动，严重时还会导致老年人生活自理困难[1]。此外，ADL受损与抑郁症状的关系也较为密切[2]，抑郁情绪的存在被认为是增加ADL受损风险的重要因素[3-4]。到2060年中国ADL有障碍的老年人预计增加到2 390万，估计每年增长12.2%[5]，这表明ADL受损已成为危害老年人身心健康的重要社会问题。握力（Handgrip Strength, HGS）是老年人衰老程度的一种反映形式，也是评估肌肉力量和肌肉质量的关键指标之一[6]。已有研究显示，随着握力的提升，非酒精性脂肪性肝病[7]、心血管疾病[8]、帕金森病[9]以及ADL障碍的发生风险会降低[10]，且高握力水平可以改善中老年人的抑郁症状[11]。目前对握力、抑郁症状、ADL三者作用关系的研究相对较少，本研究旨在进一步分析老年人握力与ADL的关联，并探讨抑郁症状的中介作用，从而为老年人ADL受损的干预提供理论依据。
1　对象与方法
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1.1　研究对象
本研究采用《中国健康与养老追踪调查》（CHARLS）2015年的调查数据。CHARLS数据涉及全国450个村级单位的中老年人群基本信息、家庭信息、健康状况与功能、医疗保健与保险、工作退休与养老金、收入支出与资产、住房情况等方面的内容，且2015年数据还包括详细的体检和血液检查信息[12]。本研究研究对象纳入标准：（1）年龄≥60岁；（2）所需人口学资料、健康相关资料、体检信息无异常或缺失。最终有2 344名老年人纳入研究。
1.2　研究方法
1.2.1　控制变量
本研究的控制变量包括年龄、性别、户口类型、婚姻状态、地理分布、教育程度、吸烟、饮酒、体质指数、慢性病数量、夜晚睡眠时长、社交活动、认知功能。
1.2.2　解释变量
本研究的解释变量握力是使用手持式握力计（中国南通跃健体质测定仪器有限公司）进行测量的，每只手测2次，取最大值为握力值。根据握力大小可以衡量老年人肌肉力量，男性握力水平<28 kg或女性握力水平<18 kg定义为肌肉力量不足（低握力）[13]。
1.2.3　中介变量
本研究的中介变量是抑郁症状，采用CHARLS调查问卷中提供的流调中心抑郁量表（CESD-10）对老年人的抑郁状况进行评定，该量表共 10个条目，每条目评分范围为0~3分（第5、8条目需要反向计分），总分范围为 0~30，分数越高表示抑郁症状越严重，且将分数≥10 分判定为存在抑郁症状[14]。在本研究中，此量表Cronbach α系数为0.768。
1.2.4　被解释变量
被解释变量ADL是基于CHARLS问卷中提供的基础性日常活动能力（BADL）和工具性日常活动能力（IADL）进行判定的。其中BADL包括上厕所、吃饭、穿衣服、控制大小便、上下床和洗澡6项活动，IADL中包括做家务、做饭、购物、打电话、吃药与管钱6项活动，每项活动的完成情况有没有困难；有困难但仍可以完成；有困难，需要帮助；无法完成4个选项并依次计1~4分，总分范围为12~48分，分数越高日常生活活动能力越差。若12项活动全部选择没有困难或有困难但仍可以完成，判定为无ADL受损，至少有一项活动选择有困难，需要帮助或无法完成判定为ADL受损[15]。本研究中，该量表的Cronbach α系数为0.852。
1.3　统计分析
在SPSS 25.0 软件中，计量资料用均数±标准差表示，组间比较用t检验；计数资料采用频数和百分比表示，利用χ2检验对不同特征的老年人ADL受损情况进行组间比较；对握力、抑郁症状及ADL进行偏相关分析；使用 Hayes 编制的 PROCESS 程序中的模型 4分析抑郁症状在老年人握力与ADL之间的中介效应；采用Bootstrap方法进行中介效应检验，设置抽样次数为5 000，置信区间为95%。检验水准α=0.05。
2　结果
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2.1　不同特征老年人ADL受损发生比较
共2 344名老年人被纳入本研究，其中男性1 187名（50.64%），女性1 157名（49.36%），老年人ADL受损率为20.95%；此外，样本抑郁症状平均得分为8.29，其中存在抑郁症状的老年人有819名（34.94%）；共有471名老年人出现低握力，占比为20.09%。单因素分析表明，不同年龄、性别、户口类型、教育程度、吸烟情况、饮酒情况、体质指数、慢性病数量、夜晚睡眠时长、社交活动参与情况、认知功能、握力、抑郁症状得分的老年人ADL受损存在显著差异（P<0.05），具体见表1。
2.2　老年人握力、抑郁症状与ADL的偏相关分析
在控制了年龄、性别、户口类型、教育程度、吸烟、饮酒、体质指数、慢性病数量、夜晚睡眠时长、社交活动、认知功能进行偏相关分析。结果显示ADL受损与握力呈负相关（r=-0.143, P<0.001），与抑郁症状呈正相关（r=0.259, P<0.001）。握力与抑郁症状呈负相关（r=-0.055,P<0.01）。见表2。
2.3　抑郁症状在握力与ADL之间的中介效应分析
在控制相关变量后，对抑郁在老年人握力与ADL之间的中介作用进行分析。表3中的模型1表明，握力对于ADL的影响显著（β=-0.071,t=-7.534,P<0.001）；模型2结果显示，握力对抑郁症状的影响显著（β=-0.063, t=-3.386, P<0.001）；模型3结果显示，在加入中介变量抑郁症状之后，抑郁症状对ADL影响显著（β=0.137, t=13.609, P<0.001），握力对于ADL的影响依然显著（β=-0.062, t=-6.855, P<0.001）。具体中介模型见图1，模型中握力对日常生活活动能力总效应值为 -0.071，直接效应值为-0.062，且ab与c′同号，认为老年人抑郁症状在ADL与握力间存在部分中介效应。
2.4　中介效应检验
采用Bootstrap法进行中介效应检验，结果显示，抑郁症状在老年人握力和ADL之间的中介效应为-0.009，95%CI为（-0.015, -0.003），不包含0，表明抑郁症状的中介作用显著；握力直接影响老年人ADL路径的置信区间为（-0.080, -0.045），也不包含0，说明直接效应显著，直接效应值为-0.062。该模型为部分中介模型，握力不仅可以直接影响老年人的ADL，还可以通过抑郁症状间接影响ADL，中介效应占比12.68%。具体见表4。
3　讨论
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3.1　我国老年人ADL受损率
本研究结果显示，我国老年人ADL受损率为20.95%，低于李珽君等[16]的研究结果（26.34%），也低于刘建康[17]采用2017-2018年CLHLS数据分析的结果（59.70%），但高于邢贤晋等[18]的研究结果（18.90%）。在一项中国老年人ADL受损率Meta分析的研究中也表明，2010—2017年ADL受损率范围为11.7%~73.1%[19]。究其原因可能是，ADL受损有多种判定标准，例如：（1）BADL和IADL均正常，视为ADL正常，否则视为ADL受损；（2）躯体生活自理能力(PADL)与IADL，总分范围14~56分，高于14分即视为ADL有受损[4]；（3）对洗澡、穿衣、上厕、室内活动、大小便、吃饭6个项目的测量总分范围为6~18分，总分>7分表示ADL受损[20]。另外不同的抽样方法、数据收集方式等会导致样本的代表性和结果的可靠性有所不同，从而引起结果差异。
3.2　老年人握力、抑郁症状与ADL的相关性分析
本研究显示低握力人群中ADL受损率为31.63%，且握力水平越低，日常活动活动能力越差，此结果与已有研究结果相似[21-22]。原因可能是握力在某种程度上代表肌肉力量和身体机能，与老年人的身体功能密切相关。其次，肌少症会增加老年人跌倒的风险，从而影响他们的日常生活活动（ADL）[23]，而握力作为评估肌少症的一个重要指标，也与跌倒风险存在一定的关联[24]。本研究发现，老年人握力与抑郁症状呈负相关，这与国内外研究结果均一致[25-26]。一方面，老年人不可避免出现的活动能力下降、社会支持缺乏等现象，使得老年人对低握力这种身体体能的下降更为敏感，引起失落与恐慌，长时间便会演化为抑郁症状；另一方面，低握力导致个体运动功能受限，会诱发炎症，而大量促进炎症反应的细胞因子如白细胞介素和肿瘤凋亡因子，会影响神经递质、神经调节剂等的神经回路，从而产生抑郁症状[27]。抑郁症状也会促使或加重ADL受损的发生。抑郁症状不仅会引起或加重炎症过程，所引发的疲劳也会降低老年人的身体机能，从而削弱老年人的日常活动能力[28]。
3.3　抑郁症状在老年人握力与ADL间起中介作用
本研究结果表明，握力对老年人ADL有直接影响，同时还通过抑郁症状间接影响ADL。具体而言，抑郁症状在老年人握力与ADL这一影响关系中发挥了中介作用，且中介效应占总效应的12.68%。这表明，增加握力可以直接缓解老年人的ADL受损情况，也可以通过减缓老年人的抑郁症状以减少低握力对老年人ADL的影响。老年人握力低下表明老年人肌肉力量不足、肌肉功能减退及身体健康状况衰退[29]。当老年人出现握力低下时，不仅增加了跌倒风险，还易伴随疼痛与高水平的炎症，从而直接影响日常生活活动能力[30]；握力低下也会降低老年人参与体育活动的兴趣和频率、打击老年人对生活控制的自信心，使老年人产生负面情绪，长此以往的自我怀疑与情绪低落极易引发老年人抑郁症状。抑郁症状加重了老年人的身体健康问题，进一步影响老年人的活动能力和自我保健意识，从而增加了ADL受损的风险。值得强调的是，握力对老年人ADL的直接影响效应值大于通过抑郁症状产生的间接效应，握力在老年人日常生活能力受损中的作用更加显著，突出了提升握力的重要性。因此，低握力的早期监测与预防是延缓ADL受损的重要途径，也提示将低握力作为ADL受损的简便筛查工具。医护工作者应强调自身锻炼的重要性，充分调动老年个体的能动性，同时政府应增加基础设施的建设，倡导老年人进行适当的体育锻炼，避免低握力的发生，延缓ADL受损；家庭成员也应对老年人提供更多的关怀和帮助，避免老年人的低落情绪导致抑郁症状的发生发展，从而引起ADL受损。
本研究结果显示，握力通过抑郁症状对老年人ADL的间接效应具有统计学显著性，提示改善握力与降低抑郁症状风险的干预措施可能有助于维持老年人的日常生活能力。然而，研究的总效应、直接效应和中介效应的标准化系数绝对值均较小，虽然这在观察性研究中并不罕见，但表明现有的简单中介模型可能过于简化真实世界的交互网络。因此，未来研究应引入调节中介分析。此外，因本研究采用横断面设计，未排除既往患有抑郁或有抑郁症状的个体进行纵向分析，这可能影响结果的解释性和稳健性。为更好地理解这些变量的相互作用及其影响机制，未来研究应考虑采用纵向方法。
基金
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  • 国家食品安全风险中心联合攻关计划项目(LH2022GG06)
文献
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文章信息
doi: 10.20043/j.cnki.MPM.202408335
  • 接收时间：2024-08-23
  • 首发时间：2026-03-19
  • 出版时间：2025-06-25
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  • 收稿日期：2024-08-23
基金
国家食品安全风险中心联合攻关计划项目(LH2022GG06)
作者信息
    1.山东第二医科大学公共卫生学院，山东 潍坊 261053
    2.沂源县疾病预防控制中心检验科
    3.山东第二医科大学第一附属医院（潍坊市人民医院）内分泌科

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柳林，E-mail：
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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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