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Article(id=1241676525242741148, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406428, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1719158400000, receivedDateStr=2024-06-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773968352851, onlineDateStr=2026-03-20, pubDate=1731168000000, pubDateStr=2024-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773968352851, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773968352851, creator=13701087609, updateTime=1773968352851, updator=13701087609, issue=Issue{id=1241676522256388920, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773968352140, creator=13701087609, updateTime=1773968629818, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241677686985249701, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241677686985249702, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3955, endPage=3961, ext={EN=ArticleExt(id=1241676526136127905, articleId=1241676525242741148, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The mediating role of different social activities in the relationship between self-rated health and cognitive function in older adults, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the multiple mediating effects of different types of social activities on the relationship between health status and cognitive function, providing insights for mitigating cognitive impairment in older adults.

Methods

Using data from the 2018 China Health and Retirement Longitudinal Study, 7 991 individuals aged 65 and older were selected to construct a multiple mediation model examining the mediating effects of physical exercise, cultural and recreational activities, interpersonal interactions, and family life on the relationship between self-rated health and cognitive function.

Results

Self-rated health and the four types of social activities were significantly correlated with cognitive function (P < 0.01). Physical exercise, cultural and recreational activities, interpersonal interactions, and family life exhibited partial mediating effects between self-rated health and cognitive function. Specifically, self-rated health directly influenced cognitive function with an effect size of 0.591 (95%CI: 0.471-0.710). Furthermore, self-rated health mediated cognitive function through the four types of social activities. The mediating effect size was 0.010 (95%CI: 0.002-0.018) for physical exercise, 0.083 (95%CI: 0.055-0.113) for recreational activities, 0.061 (95%CI: 0.042-0.080) for interpersonal interactions, and 0.078 (95%CI: 0.054-0.104) for family life.

Conclusion

Self-rated health can delay cognitive decline in older adults by promoting their participation in social activities.

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目的

分析不同社会活动类型在健康状况与认知功能之间的多重中介效应，为减缓老年人认知功能障碍提供参考。

方法

本研究在中国老年健康影响因素跟踪调查2018年数据中选取7 991名65岁以上老年人，构建多重中介效应模型，研究运动健身、文化娱乐、人际交往、家庭生活在自评健康与认知功能之间的多重中介效应。

结果

自评健康、四类社会活动与认知功能均具有相关关系(P<0.01)。运动健身、文化娱乐、人际交往、家庭生活在自评健康与认知功能之间存在部分中介作用。一方面，自评健康可直接影响老年人的认知功能，效应值为0.591(95%CI：0.471～0.710)；另一方面自评健康可通过四类社会活动介导认知功能。其中，运动健身中介作用效应值为0.010(95%CI：0.002～0.018)，文化娱乐的中介作用效应值为0.083(95%CI：0.055～0.113)，人际交往中介作用效应值为0.061(95%CI：0.042～0.080)，家庭生活中介作用效应值为0.078(95%CI：0.054～0.104)。

结论

自评健康可以通过促进老年人社会活动参与进而延缓其认知功能衰退。

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高蕾，E-mail:
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张小帅（2001—），男，硕士在读，研究方向：卫生管理

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张小帅（2001—），男，硕士在读，研究方向：卫生管理

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张小帅（2001—），男，硕士在读，研究方向：卫生管理

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Chinese Journal of Gerontology, 2018, 38(13): 3160-3164.(In Chinese), articleTitle=The influence of sports activities on the physical health of the elderly in China and abroad, refAbstract=null), Reference(id=1241821873156198599, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, doi=null, pmid=null, pmcid=null, year=2020, volume=40, issue=8, pageStart=1660, pageEnd=1662, url=null, language=null, rfNumber=[24], rfOrder=36, authorNames=王志强, 王辉, journalName=中国老年学杂志, refType=null, unstructuredReference=王志强， 王辉.不同健身方式对社区老年人生活质量和体质健康的影响[J].中国老年学杂志，2020，40（8）：1660-1662., articleTitle=不同健身方式对社区老年人生活质量和体质健康的影响, refAbstract=null), Reference(id=1241821876561973450, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, doi=null, pmid=null, pmcid=null, year=2020, volume=40, issue=8, pageStart=1660, pageEnd=1662, url=null, language=null, rfNumber=[24], rfOrder=37, authorNames=Wang ZQ, Wang H, journalName=Chinese Journal of Gerontology, refType=null, unstructuredReference=Wang ZQ, Wang H. The impact of different fitness modalities on quality of life and physical health of community-dwelling older adults[J]. Chinese Journal of Gerontology, 2020, 40(8): 1660-1662.(In Chinese), articleTitle=The impact of different fitness modalities on quality of life and physical health of community-dwelling older adults, refAbstract=null), Reference(id=1241821876704579789, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, doi=null, pmid=null, pmcid=null, year=2014, volume=33, issue=11, pageStart=1119, pageEnd=1125, url=null, language=null, rfNumber=[25], rfOrder=38, authorNames=陈爱国, 许克云, 朱风书, journalName=中国运动医学杂志, refType=null, unstructuredReference=陈爱国，许克云，朱风书，等.体育运动与老年人认知功能:研究与思考[J].中国运动医学杂志，2014，33（11）：1119-1125., articleTitle=体育运动与老年人认知功能:研究与思考, refAbstract=null), Reference(id=1241821876826214609, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, doi=null, pmid=null, pmcid=null, year=2014, volume=33, issue=11, pageStart=1119, pageEnd=1125, url=null, language=null, rfNumber=[25], rfOrder=39, authorNames=Chen AG, Xu KY, Zhu FS, journalName=Chinese Journal of Sports Medicine, refType=null, unstructuredReference=Chen AG, Xu KY, Zhu FS, et al. Physical activity and cognitive function in the elderly: research and reflections[J]. Chinese Journal of Sports Medicine,2014, 33(11): 1119-1125.(In Chinese), articleTitle=Physical activity and cognitive function in the elderly: research and reflections, refAbstract=null), Reference(id=1241821876964626643, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, doi=null, pmid=null, pmcid=null, year=2022, volume=14, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[26], rfOrder=40, authorNames=Zheng J, Su X, Xu C, journalName=Frontiers in Aging Neuroscience, refType=null, unstructuredReference=Zheng J, Su X, Xu C. Effects of exercise intervention on executive function of middle-aged and elderly People: A systematic review of randomized controlled trials[J]. Frontiers in Aging Neuroscience, 2022, 14: 960817., articleTitle=Effects of exercise intervention on executive function of middle-aged and elderly People: A systematic review of randomized controlled trials, refAbstract=null), Reference(id=1241821877069484245, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, doi=null, pmid=null, pmcid=null, year=2024, volume=39, issue=3, pageStart=1, pageEnd=17, url=null, language=null, rfNumber=[27], rfOrder=41, authorNames=Liu C, Jeong H, Cui H, journalName=Language, Cognition and Neuroscience, refType=null, unstructuredReference=Liu C, Jeong H, Cui H, et al. Effects of social interactions on the neural representation of emotional words in late bilinguals[J].Language, Cognition and Neuroscience, 2024, 39(3): 1-17., articleTitle=Effects of social interactions on the neural representation of emotional words in late bilinguals, refAbstract=null)], funds=[Fund(id=1241821867024126966, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, awardId=71904036, language=CN, fundingSource=国家自然科学基金青年项目(71904036), fundOrder=null, country=null), Fund(id=1241821867154150399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, awardId=20231515020203, language=CN, fundingSource=黑龙江省卫生健康委科研课题(20231515020203), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241821854982279792, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, xref=null, ext=[AuthorCompanyExt(id=1241821854994862707, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, companyId=1241821854982279792, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Health Management, Harbin Medical University, Harbin, Heilongjiang 150081, China), AuthorCompanyExt(id=1241821855309435528, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, companyId=1241821854982279792, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=哈尔滨医科大学卫生管理学院，黑龙江 哈尔滨150081)])], figs=[ArticleFig(id=1241821864293634979, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, language=EN, label=Figure 1, caption=The mediating role of social activity type in the relationship between physical health status and cognitive function, figureFileSmall=blfyfsEgqTW/urMAaDmZyA==, figureFileBig=0daSqyuqnK2rKcZqHXj7SA==, tableContent=null), ArticleFig(id=1241821864557876138, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, language=CN, label=图1, caption=社会活动类型在身体健康状况与认知功能之间的中介作用

注：性别、年龄、居住地、居住方式、上学年限、经济状况、婚姻状况、吸烟、饮酒作为控制变量；a1表示自评健康对运动健身的效应值，a2表示自评健康对文化娱乐的效应值，a3表示自评健康对人际交往的效应值，a4表示自评健康对家庭生活的效应值，b1表示运动健身对认知功能的效应值，b2表示文化娱乐对认知功能的效应值，b3表示人际交往对认知功能的效应值，b4表示家庭生活对认知功能的效应值，c1表示自评健康对认知功能的总效应值，c2表示自评健康对认知功能的直接效应值。

, figureFileSmall=blfyfsEgqTW/urMAaDmZyA==, figureFileBig=0daSqyuqnK2rKcZqHXj7SA==, tableContent=null), ArticleFig(id=1241821866025882550, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, language=EN, label=Table 1, caption=

Participation of older people in social activities and their cognitive function ［n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数运动健身(分)文化娱乐(分)人际交往(分)家庭生活(分)认知功能(分)
性别
男3 670（45.93）2.34±1.724.28±1.393.02±1.683.39±1.8526.75±4.86
女4 321（54.07）2.10±1.633.66±1.742.93±1.723.55±1.8524.59±6.33
F/ta值6.449***17.244***2.399*-3.695***16.877***
年龄（岁）
65～803 289（41.16）2.57±1.774.49±1.173.47±1.574.35±1.3628.27±2.64
>804 702（58.84）1.96±1.563.56±1.182.63±1.702.86±1.9023.70±6.62
F/ta值16.126***26.459***22.554***38.535***37.586***
上学年限（年）
03 448（43.15）1.80±1.463.27±1.822.78±1.733.10±1.9223.16±6.70
1～62 779（34.78）2.27±1.694.31±1.343.11±1.693.72±1.7826.98±4.48
≥71 764（22.07）2.94±1.804.68±0.943.15±1.623.83±1.8028.11±3.56
F/tb值286.906***644.084***41.585***129.402***634.420***
婚姻状态
有配偶3 781（47.32）2.50±1.764.41±1.263.23±1.644.03±1.6027.62±3.67
无配偶4 210（52.68）1.96±1.563.52±1.782.75±1.722.98±1.9223.75±6.70
F/ta值14.407***25.347***12.677***26.388***31.517***
经济状况
富裕1 610（20.15）2.55±1.804.33±1.363.03±1.723.43±1.8626.44±5.07
一般5 603（70.12）2.16±1.653.90±1.642.99±1.693.48±1.8525.54±5.79
贫困778（9.74）1.88±1.503.43±1.792.76±1.703.52±1.8624.13±6.90
F/tb值50.851***87.864***7.371***0.66642.567***
居住地
城市2 117（26.49）2.79±1.794.43±1.262.67±1.633.34±1.8726.41±5.46
乡镇5 874（73.51）2.01±1.583.77±1.693.08±1.713.52±1.8425.28±5.90
F/ta值18.744***16.580***-9.755***-3.847***7.689***
居住方式
家人6 389（79.95）2.22±1.684.00±1.592.93±1.703.43±1.8525.66±5.88
独居1 312（16.42）2.18±1.663.73±1.713.28±1.684.12±1.5925.66±5.12
养老机构290（3.63）2.21±1.703.71±1.702.56±1.741.46±1.2223.42±6.59
F/tb值0.34217.893***31.986***270.949***20.890***
吸烟
是1 239（15.50）2.28±1.704.36±1.313.15±1.683.59±1.8026.86±4.54
否6 752（84.50）2.20±1.673.87±1.662.94±1.703.45±1.8625.35±5.98
F/ta值1.47210.016***3.857***2.412*8.472***
饮酒
是1 202（15.04）2.34±1.724.40±1.283.22±1.663.72±1.7626.92±4.45
否6 789（84.96）2.19±1.673.86±1.662.93±1.703.43±1.8625.34±5.98
F/ta值2.795*10.614***5.532***4.995***8.707***
), ArticleFig(id=1241821866168488892, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, language=CN, label=表1, caption=

老年人参与社会活动及其认知功能情况［n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数运动健身(分)文化娱乐(分)人际交往(分)家庭生活(分)认知功能(分)
性别
男3 670（45.93）2.34±1.724.28±1.393.02±1.683.39±1.8526.75±4.86
女4 321（54.07）2.10±1.633.66±1.742.93±1.723.55±1.8524.59±6.33
F/ta值6.449***17.244***2.399*-3.695***16.877***
年龄（岁）
65～803 289（41.16）2.57±1.774.49±1.173.47±1.574.35±1.3628.27±2.64
>804 702（58.84）1.96±1.563.56±1.182.63±1.702.86±1.9023.70±6.62
F/ta值16.126***26.459***22.554***38.535***37.586***
上学年限（年）
03 448（43.15）1.80±1.463.27±1.822.78±1.733.10±1.9223.16±6.70
1～62 779（34.78）2.27±1.694.31±1.343.11±1.693.72±1.7826.98±4.48
≥71 764（22.07）2.94±1.804.68±0.943.15±1.623.83±1.8028.11±3.56
F/tb值286.906***644.084***41.585***129.402***634.420***
婚姻状态
有配偶3 781（47.32）2.50±1.764.41±1.263.23±1.644.03±1.6027.62±3.67
无配偶4 210（52.68）1.96±1.563.52±1.782.75±1.722.98±1.9223.75±6.70
F/ta值14.407***25.347***12.677***26.388***31.517***
经济状况
富裕1 610（20.15）2.55±1.804.33±1.363.03±1.723.43±1.8626.44±5.07
一般5 603（70.12）2.16±1.653.90±1.642.99±1.693.48±1.8525.54±5.79
贫困778（9.74）1.88±1.503.43±1.792.76±1.703.52±1.8624.13±6.90
F/tb值50.851***87.864***7.371***0.66642.567***
居住地
城市2 117（26.49）2.79±1.794.43±1.262.67±1.633.34±1.8726.41±5.46
乡镇5 874（73.51）2.01±1.583.77±1.693.08±1.713.52±1.8425.28±5.90
F/ta值18.744***16.580***-9.755***-3.847***7.689***
居住方式
家人6 389（79.95）2.22±1.684.00±1.592.93±1.703.43±1.8525.66±5.88
独居1 312（16.42）2.18±1.663.73±1.713.28±1.684.12±1.5925.66±5.12
养老机构290（3.63）2.21±1.703.71±1.702.56±1.741.46±1.2223.42±6.59
F/tb值0.34217.893***31.986***270.949***20.890***
吸烟
是1 239（15.50）2.28±1.704.36±1.313.15±1.683.59±1.8026.86±4.54
否6 752（84.50）2.20±1.673.87±1.662.94±1.703.45±1.8625.35±5.98
F/ta值1.47210.016***3.857***2.412*8.472***
饮酒
是1 202（15.04）2.34±1.724.40±1.283.22±1.663.72±1.7626.92±4.45
否6 789（84.96）2.19±1.673.86±1.662.93±1.703.43±1.8625.34±5.98
F/ta值2.795*10.614***5.532***4.995***8.707***
), ArticleFig(id=1241821866315289545, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, language=EN, label=Table 2, caption=

Correlations between self-rated health, type of social activity and cognitive function

, figureFileSmall=null, figureFileBig=null, tableContent=
变量123456
1.自评健康1.000
2.运动健身0.086**1.000
3.文化娱乐0.099**0.256**1.000
4.人际交往0.088**0.296**0.219**1.000
5.家庭生活0.058**0.223**0.291**0.356**1.000
6.认知功能0.143**0.380**0.281**0.370**0.370**1.000
), ArticleFig(id=1241821866445312977, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, language=CN, label=表2, caption=

自评健康、社会活动类型和认知功能的相关关系

, figureFileSmall=null, figureFileBig=null, tableContent=
变量123456
1.自评健康1.000
2.运动健身0.086**1.000
3.文化娱乐0.099**0.256**1.000
4.人际交往0.088**0.296**0.219**1.000
5.家庭生活0.058**0.223**0.291**0.356**1.000
6.认知功能0.143**0.380**0.281**0.370**0.370**1.000
), ArticleFig(id=1241821866550170584, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, language=EN, label=Table 3, caption=

Analysis of mediating effect of different social activities between self-rated health and cognitive function

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型路径标准误非标准化效应值（95%CI）标准化效应值
总效应c10.0650.822***(0.695～0.950)0.127
直接效应c20.0610.591***(0.471～0.710)0.091
a10.0210.138***(0.098～0.178)0.074
a20.0190.115***(0.078～0.152)0.064
a30.0210.151***(0.110～0.192)0.080
a40.0220.141***(0.099～0.183)0.068
b10.0350.071*(0.003～0.139)0.021
b20.0380.723***(0.649～0.796)0.201
b30.0350.400***(0.332～0.469)0.117
b40.0360.555***(0.490～0.621)0.177
总中介效应0.0260.232***(0.180～0.283)0.036
中介效应1自评健康-运动健身-认知能力0.0040.010**(0.002～0.018)0.002
中介效应2自评健康-文化娱乐-认知能力0.0150.083**(0.055～0.113)0.013
中介效应3自评健康-人际交往-认知能力0.0100.061**(0.042～0.080)0.009
中介效应4自评健康-家庭生活-认知能力0.0130.078**(0.054～0.104)0.012
), ArticleFig(id=1241821866671805409, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676525242741148, language=CN, label=表3, caption=

不同社会活动在自评健康与认知功能之间的中介效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型路径标准误非标准化效应值（95%CI）标准化效应值
总效应c10.0650.822***(0.695～0.950)0.127
直接效应c20.0610.591***(0.471～0.710)0.091
a10.0210.138***(0.098～0.178)0.074
a20.0190.115***(0.078～0.152)0.064
a30.0210.151***(0.110～0.192)0.080
a40.0220.141***(0.099～0.183)0.068
b10.0350.071*(0.003～0.139)0.021
b20.0380.723***(0.649～0.796)0.201
b30.0350.400***(0.332～0.469)0.117
b40.0360.555***(0.490～0.621)0.177
总中介效应0.0260.232***(0.180～0.283)0.036
中介效应1自评健康-运动健身-认知能力0.0040.010**(0.002～0.018)0.002
中介效应2自评健康-文化娱乐-认知能力0.0150.083**(0.055～0.113)0.013
中介效应3自评健康-人际交往-认知能力0.0100.061**(0.042～0.080)0.009
中介效应4自评健康-家庭生活-认知能力0.0130.078**(0.054～0.104)0.012
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不同社会活动在老年人自评健康与认知功能关联中的中介作用
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张小帅 , 张远航 , 周瑾 , 张琳 , 高蕾
现代预防医学 | 健康与社会行为 2024,51(21): 3955-3961
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现代预防医学 | 健康与社会行为 2024, 51(21): 3955-3961
不同社会活动在老年人自评健康与认知功能关联中的中介作用
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张小帅, 张远航, 周瑾, 张琳, 高蕾
作者信息
  • 哈尔滨医科大学卫生管理学院，黑龙江 哈尔滨150081

    • 张小帅（2001—），男，硕士在读，研究方向：卫生管理

通讯作者:

高蕾，E-mail:
The mediating role of different social activities in the relationship between self-rated health and cognitive function in older adults
Xiao-shuai ZHANG, Yuan-hang ZHANG, Jin ZHOU, Lin ZHANG, Lei GAO
Affiliations
  • School of Health Management, Harbin Medical University, Harbin, Heilongjiang 150081, China
出版时间: 2024-11-10 doi: 10.20043/j.cnki.MPM.202406428
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摘要
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目的

分析不同社会活动类型在健康状况与认知功能之间的多重中介效应，为减缓老年人认知功能障碍提供参考。

方法

本研究在中国老年健康影响因素跟踪调查2018年数据中选取7 991名65岁以上老年人，构建多重中介效应模型，研究运动健身、文化娱乐、人际交往、家庭生活在自评健康与认知功能之间的多重中介效应。

结果

自评健康、四类社会活动与认知功能均具有相关关系(P<0.01)。运动健身、文化娱乐、人际交往、家庭生活在自评健康与认知功能之间存在部分中介作用。一方面，自评健康可直接影响老年人的认知功能，效应值为0.591(95%CI：0.471～0.710)；另一方面自评健康可通过四类社会活动介导认知功能。其中，运动健身中介作用效应值为0.010(95%CI：0.002～0.018)，文化娱乐的中介作用效应值为0.083(95%CI：0.055～0.113)，人际交往中介作用效应值为0.061(95%CI：0.042～0.080)，家庭生活中介作用效应值为0.078(95%CI：0.054～0.104)。

结论

自评健康可以通过促进老年人社会活动参与进而延缓其认知功能衰退。

自评健康  /  社会参与  /  认知功能  /  中介效应  /  CLHLS数据库
Objective

To analyze the multiple mediating effects of different types of social activities on the relationship between health status and cognitive function, providing insights for mitigating cognitive impairment in older adults.

Methods

Using data from the 2018 China Health and Retirement Longitudinal Study, 7 991 individuals aged 65 and older were selected to construct a multiple mediation model examining the mediating effects of physical exercise, cultural and recreational activities, interpersonal interactions, and family life on the relationship between self-rated health and cognitive function.

Results

Self-rated health and the four types of social activities were significantly correlated with cognitive function (P < 0.01). Physical exercise, cultural and recreational activities, interpersonal interactions, and family life exhibited partial mediating effects between self-rated health and cognitive function. Specifically, self-rated health directly influenced cognitive function with an effect size of 0.591 (95%CI: 0.471-0.710). Furthermore, self-rated health mediated cognitive function through the four types of social activities. The mediating effect size was 0.010 (95%CI: 0.002-0.018) for physical exercise, 0.083 (95%CI: 0.055-0.113) for recreational activities, 0.061 (95%CI: 0.042-0.080) for interpersonal interactions, and 0.078 (95%CI: 0.054-0.104) for family life.

Conclusion

Self-rated health can delay cognitive decline in older adults by promoting their participation in social activities.

Self-rated health  /  Social participation  /  Cognitive function  /  Mediating effect  /  CLHLS database
张小帅, 张远航, 周瑾, 张琳, 高蕾. 不同社会活动在老年人自评健康与认知功能关联中的中介作用. 现代预防医学, 2024 , 51 (21) : 3955 -3961 . DOI: 10.20043/j.cnki.MPM.202406428
Xiao-shuai ZHANG, Yuan-hang ZHANG, Jin ZHOU, Lin ZHANG, Lei GAO. The mediating role of different social activities in the relationship between self-rated health and cognitive function in older adults[J]. Modern Preventive Medicine, 2024 , 51 (21) : 3955 -3961 . DOI: 10.20043/j.cnki.MPM.202406428
正文
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随着我国人口预期寿命的延长和人口老龄化进程的加剧，中国65岁以上老人轻度认知障碍(MCI)的患病率为13.3%[1]，痴呆症患病率为5.6%[2]，老年人的认知健康状况不容乐观。认知障碍不仅严重损害老年人群健康，降低老年人群晚年生活质量，也对其家庭和社会造成严重负担[3-4]，如果早期就对轻度认知障碍老年人进行干预，可有效延缓病情发展，延缓痴呆症的形成[5]。老年人认知功能受多种因素影响，其中健康状况和社会参与是重要影响因素[6-8]，老年人健康状况、社会参与和认知能力三者密切相关，具体表现为拥有较好健康状况、参与社会交往的老年人具有更好的抵御认知下降的能力[9]。健康状况良好不仅是老年人有更高水平社会参与，较低的死亡率的重要因素[10-11]，还能够延缓记忆丧失和知觉速度的下降[12]，并降低痴呆患病风险[13]。
自评健康状况、社会参与、认知能力三者可能存在相互影响，但有关不同类型社会参与在老年人自评健康和认知功能之间如何发挥作用、影响程度如何尚不明确。本研究假设不同类型社会参与会介导自评健康与认知功能之间的关联，探讨老年人自评健康状况、社会参与类型与认知功能的关系及内在作用路径。
1　资料与方法
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1.1　资料
本研究采用中国老年人健康长寿影响因素调查(CLHLS)2018年数据，CLHLS是一项覆盖23省市自治区的全国性的老年人健康随访调查，每2～3年随访一次，该数据具有良好的代表性。根据研究目的，经变量合并、筛选等处理后共7 991个有效样本。
1.2　变量选择
自变量为自评健康。自评健康指标能有效地测量我国老年人的健康状况[14]，依据问题：“您觉得现在您自己的健康状况怎么样？1.很好；2.好；3.一般；4.不好；5.很不好”。对该问题进行反向赋值为1～5分，即得分越高健康状况越好。
因变量为认知功能。采用简易精神状态量表(MMSE)评估认知功能。MMSE包括五个方面：一般能力（12分），反应能力（3分），注意力和计算能力（6分），回忆（3分），语言、理解与自我协调能力（6分）。MMSE总分为各维度得分之和（30分）。得分越高，表示认知功能越好。
中介变量为运动健身、文化娱乐、人际交往、家庭生活。CLHLS数据库中有关社会参与活动的问题有：从事家务劳动、太极拳、广场舞、户外活动、串门与朋友交往、种花养植物、阅读书报、饲养家禽家畜、打牌或打麻将等、看电视听广播、参加有组织的社会活动，共计11项。赋值为1～5分，得分越高，活动参与频率越高。本研究参考文静等[15]学者的研究，将老年人社会参与活动分为运动健身、文化娱乐、人际交往、家庭生活四种类型，运动健身由从事太极拳、广场舞、户外活动三个问题衡量；人际交往由从事串门与朋友交往、参加有组织的社会活动两个问题衡量；家庭生活由从事家务劳动、种花养植物、饲养家禽家畜三个问题衡量。为体现老年人不同活动参与度的差异性，避免得分的累积效应，研究取每个维度中问题的最高得分作为该项活动的得分。
控制变量借鉴前人研究，融入了能显著影响个人认知功能的人口统计学、社会经济和健康行为因素，包括性别、年龄、居住地、居住方式、上学年限、经济状况、婚姻状况、吸烟、饮酒等因素[9，16]。本研究将其作为控制变量加以控制。
1.3　统计学方法
采用SPSS26.0进行统计分析。计量资料符合正态分布采用（）表示，两组间比较采用独立样本t检验，多组间比较采用单因素方差分析，变量间关系采用斯皮尔曼相关分析。使用SPSS 26.0中的PROCESS（version3.5）插件中的模型4进行中介作用分析，bootstrap方法进行中介效应检验(bootstrap样本量为5 000，95%CI)，检验水准α=0.05。
2　结果
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2.1　人口学特征
在本研究中的7 991名老年人中，男性3 672人，占比45.93%，女性4 321人，平均年龄（83.21±11.30）岁；自评健康的均值为（2.54±0.90）分，运动健身活动均值为（2.21±1.68）分，文化娱乐活动均值为（3.94±1.62）分，人际交往活动均值为（2.97±1.70）分，家庭生活活动均值为（3.48±1.85）分，认知功能得分的均值为（25.58±5.81）分。见表1。
2.2　老年人参与社会活动及其认知功能情况
研究结果显示，年龄较低、上学时间更长、有配偶、经济状况更好的老年人参与各种类型社会活动的频率更高。性别、年龄、上学年限、婚姻状况、居住地、吸烟、饮酒对老年人认知功能得分的差异存在统计学意义（P<0.001）。男性、年龄较低、上学年限更长、有配偶、经济状况富裕、居住在城市的老年人认知功能得分较高。见表1。
2.3　研究变量相关性分析
本研究中部分变量不服从正态分布，故采用斯皮尔曼相关分析，结果显示，自评健康与认知功能呈正相关，相关系数r=0.143(P<0.01)；运动健身、文化娱乐、人际交往、家庭生活与认知功能之间为正相关关系，相关系数分别为r=0.258(P<0.01)、r=0.380(P<0.01)、r=0.281(P<0.01)、r=0.370(P<0.01)。见表2。
2.4　不同社会参与类型在健康状况与认知功能之间的中介效应
在控制相关变量的情况下，中介效应检验结果显示，健康状况显著正向预测认知功能(β=0.822，P<0.001)，即便控制了健康状况对认知功能的作用，4种类型的社会参与对认知功能均有显著性影响(分别为b1、b2、b3、b4)，当4种社会参与活动进入回归方程模型作为认知功能的共同预测变量时，模型的各项系数(R=0.592，R2=0.351，F=307.711，P<0.001)显示模型拟合度良好，健康状况对认知功能影响有所降低，但仍处于显著水平(β=0.591，P<0.001)。健康状况对于认知功能的直接效应为0.591，占总效应的比重为71.84%，运动健身、文化娱乐、人际交往与家庭生活在身体健康与认知功能之间均起部分中介作用，中介效应占总中介效应比重分别为4.23%、35.85%、26.18%、33.74%，总中介效应占总效应的比重为28.16%。见表3、图1。
3　讨论
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3.1　自评健康对认知功能的影响
本研究发现，在老年人群中，自评健康状况可正向影响认知功能，同时，自评健康状况可通过影响不同类型的社会参与进而影响认知功能。前人研究表明，自评健康状况能够在一定程度上反映研究对象的心理健康和身体健康状况[17-18]。心理健康问题被视为认知障碍的危险因素之一[19]，如抑郁会导致大脑结构和功能性损害，造成老人认知能力下降低，抑郁也是自评健康、孤独的重要影响因素[20-21]，患有抑郁症的老年人其社会参与会大幅减少，认知刺激减少进而加速老年人认知功能的衰退。身体健康问题也是认知障碍影响因素，一方面，身体健康问题如糖尿病、失能等会造成神经病理性损伤，提高老年人罹患痴呆症的风险；另一方面，身体健康是参与社会活动的基石，决定着个体的参与社会活动的能力与机会，身体健康欠佳也会导致其社会参与的减少。值得关注的是，心理问题、身体健康既是认知障碍危险因素，也可能是认知障碍的后果。自评健康与认知功能的相互作用需要进一步深入研究。
此外本研究还发现，自评健康较好的老年人较之自评健康较差的的老年人，其社会参与活动的参与频率更高，认知功能得分也更高。且在自评健康较差的老年人中，社会活动参与频率更高的其认知功能水平更高。提示我们对于身体状况较好或是欠佳的老人，可以鼓励其积极参与力所能及的社会活动，以达到锻炼机体功能，延缓认知功能下降的目的。
3.2　不同社会参与类型对自评健康和认知功能的中介作用
本研究发现，文化娱乐的中介路径作用最大，占总中介效应的35.85%，文化娱乐在促进自评健康与认知功能之间的正向关系中起着重要作用。可能的解释是，文化娱乐活动能够影响老年人的定向力、回忆力、注意力与计算能力、语言能力四个认知维度[22]，刺激大脑的多个区域，增强神经可塑性，从而有助于老年人认知功能的维持和提升。
相比之下，运动健身的中介路径作用最小占比4.23%，运动活动虽对身体健康有显著益处[23-24]，但在本研究中其对认知功能的直接影响较小。这可能是因为运动活动对认知功能益处需要更长时间才能显现[25]，也可能是因为调查对象年龄较高，其运动强度和运动频率较低未达到影响认知功能的阈值[26]。
家庭生活活动和人际交往活动的中介效应也不容忽视，分别占比33.74%和26.18%，这反映了家庭环境和社会支持在认知健康中的重要性。家庭生活与人际交往是老人日常的重要组成部分，开展这些活动的同时其认知功能也得到充分运用。在良好的家庭互动和人际交往中，老人可以得到认可、尊重、帮助与鼓励，缓解压力、孤独、抑郁，并提供了必要的认知刺激，保持大脑活跃[27]，这对于预防老年人认知衰退和促进心理健康十分重要。
综上所述，自评健康可直接正向影响认知功能，社会参与在自评健康与认知功能之间存在部分中介作用，研究结果说明了社会参与干预可能在延缓老年人认知功能衰退上的重要性，基层社区应完善公共设施，为老人提供社会活动场所，子女也应当在日常生活之中与高龄父母多沟通多交流，给予老年人情感上的支持以及足够的认知刺激，这对延缓认知功能下降，提高认知储备，提升生活质量有重要意义。
本研究也存在一定不足。其一，心理问题、身体健康既是认知障碍危险因素，也可能是认知障碍的后果，本研究并没有反向研究。其二，本研究为横断面研究，欠缺对各变量之间的因果关系的验证，未来可以结合多年数据进行纵向研究以确定因果关系。
基金
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  • 国家自然科学基金青年项目(71904036)
  • 黑龙江省卫生健康委科研课题(20231515020203)
文献
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2024年第51卷第21期
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doi: 10.20043/j.cnki.MPM.202406428
  • 接收时间：2024-06-24
  • 首发时间：2026-03-20
  • 出版时间：2024-11-10
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  • 收稿日期：2024-06-24
基金
国家自然科学基金青年项目(71904036)
黑龙江省卫生健康委科研课题(20231515020203)
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    哈尔滨医科大学卫生管理学院，黑龙江 哈尔滨150081

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2种不同金属材料的力学参数
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species		 占总种数比例
Percentage of
total species (%)		 属
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Number of
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Percentage of total
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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
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