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Article(id=1241676526429729189, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406126, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1718035200000, receivedDateStr=2024-06-11, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773968353135, onlineDateStr=2026-03-20, pubDate=1731168000000, pubDateStr=2024-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773968353135, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773968353135, creator=13701087609, updateTime=1773968353135, 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=3967, endPage=3973, ext={EN=ArticleExt(id=1241676526773662134, articleId=1241676526429729189, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the impact of social participation on cognitive decline in the elderly, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To verify the relationship between social participation and cognitive decline in the elderly, and to explore the effects of different types of social participation on cognitive decline based on data from the China Health and Retirement Longitudinal Study.

Methods

A total of 3 016 individuals aged 60 and above, who were followed across all five waves and did not have Alzheimer’s disease, was selected from the database to construct a balanced panel dataset. A fixed-effects Logit model controlling for individual-level characteristics was established.

Results

The prevalence of cognitive decline among the elderly at baseline was 6.4%, which increased to 30.7% by the fifth wave. The proportion of cognitively declined elderly individuals engaging in social participation was 3.2% to 10.5% lower than those not participating. In the fixed-effects Logit analysis, the odds ratio (OR) was 0.575 (95%CI: 0.502-0.658), indicating an impact magnitude of approximately 40%. Among different types of social participation, social engagement significantly affected cognitive decline, with an OR of 0.640 (95%CI: 0.494-0.828).

Conclusion

The government should implement the concept of active aging, improve participation mechanisms, effectively ensure the rights of the elderly to engage in social participation, and encourage their involvement in social activities.

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目的

利用中国健康与养老追踪调查共五期的调研数据，验证社会参与对老年人认知衰弱的影响关系，并探讨不同类型社会参与对老年人认知衰弱的影响。

方法

筛选数据库中五期都被随访的60岁以上非患有阿尔兹海默病的老年人3 016人，构建平衡面板数据，建立控制个体层面的固定效应logit模型。

结果

基期存在认知衰弱的老年人为6.4%，第五期增长到了30.7%，进行社会参与的老年人发生认知衰弱的比例低于不进行社会参与的老年人3.2%～10.5%，固定效应logit分析中，OR=0.575（95%CI：0.502～0.658），影响程度为40%左右。不同类型社会参与中社交参与显著影响老年人认知衰弱，OR=0.640（95%CI：0.494～0.828）。

结论

政府应贯彻积极老龄化的理念，完善参与机制，切实保障老年人进行社会参与的权益，鼓励老年人进行社会参与。

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李玲，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=7E80f4GBu/nS1OZD7aB0Fg==, magXml=QEZU/HxOYS+B9hqzVZNXYA==, pdfUrl=null, pdf=swSEVCvCMcdPBH5RxyWpOQ==, pdfFileSize=688707, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=KH6+mJJg85SzGSdsb/EZNA==, mapNumber=null, authorCompany=null, fund=null, authors=

曾浩锋（2003—），男，本科在读，研究方向：公共管理

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曾浩锋（2003—），男，本科在读，研究方向：公共管理

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Journal of Huazhong University of Science and Technology(Social Science Edition), 2023, 37(5):55-68.(In Chinese), articleTitle=The effect of re-employment on the health of retired elderly: empirical analysis based on CHARLS, refAbstract=null)], funds=[Fund(id=1241821866550170587, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, awardId=21JD022, language=CN, fundingSource=2021年度湖南省哲学社会科学基金项目(21JD022), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241821854990668402, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, xref=null, ext=[AuthorCompanyExt(id=1241821854994862708, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, companyId=1241821854990668402, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China), AuthorCompanyExt(id=1241821855007445621, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, companyId=1241821854990668402, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=湖南中医药大学人文与管理学院，湖南 长沙 410208)])], figs=[ArticleFig(id=1241821859965113189, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=EN, label=Table 1, caption=

Variable and codes of social participation

, figureFileSmall=null, figureFileBig=null, tableContent=
变量定义赋值
经济参与您过去一个月有没有炒股？无=0，有=1
上周您是否工作了至少一小时？无=0，有=1
社交参与您过去一个月有没有串门、跟朋友交往？无=0，有=1
您过去一个月有没有打麻将、下棋、打牌、去社区活动室？无=0，有=1
您过去一个月有没有去公园或者其他场所跳舞、健身、练气功等？无=0，有=1
您过去一个月有没有参加社团组织活动？无=0，有=1
您过去一个月有没有上学或参加培训课程？无=0，有=1
您过去一个月有没有上网？无=0，有=1
家庭参与过去一年，您是否花时间照看了您的孙子女或重孙子女？无=0，有=1
志愿参与您过去一个月有没有无偿向朋友或者邻居提供帮助？无=0，有=1
您过去一个月有没有参加志愿活动或慈善活动？无=0，有=1
您过去一个月有没有无偿照顾与您不住在一起的病人或残疾人？无=0，有=1
), ArticleFig(id=1241821863450579824, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=CN, label=表1, caption=

社会参与变量定义及赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量定义赋值
经济参与您过去一个月有没有炒股？无=0，有=1
上周您是否工作了至少一小时？无=0，有=1
社交参与您过去一个月有没有串门、跟朋友交往？无=0，有=1
您过去一个月有没有打麻将、下棋、打牌、去社区活动室？无=0，有=1
您过去一个月有没有去公园或者其他场所跳舞、健身、练气功等？无=0，有=1
您过去一个月有没有参加社团组织活动？无=0，有=1
您过去一个月有没有上学或参加培训课程？无=0，有=1
您过去一个月有没有上网？无=0，有=1
家庭参与过去一年，您是否花时间照看了您的孙子女或重孙子女？无=0，有=1
志愿参与您过去一个月有没有无偿向朋友或者邻居提供帮助？无=0，有=1
您过去一个月有没有参加志愿活动或慈善活动？无=0，有=1
您过去一个月有没有无偿照顾与您不住在一起的病人或残疾人？无=0，有=1
), ArticleFig(id=1241821863593186167, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=EN, label=Table 2, caption=

Sample characteristics ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量基期第二期第三期第四期第五期
性别
男1 463(48.5)1 463(48.5)1 463(48.5)1 463(48.5)1 463(48.5)
女1 553(51.5)1 553(51.5)1 553(51.5)1 553(51.5)1 553(51.5)
年龄（岁）
60～702 405(79.7)2 111(70.0)1 778(59.0)1 034(34.3)381(12.6)
>70～80572(19.0)824(27.3)1 093(36.2)1 661(55.1)2 166(71.8)
>8039(1.30)81(2.70)145(4.80)321(10.6)469(15.6)
婚姻状况
有配偶2 537(84.1)2 480(82.2)2 392(79.3)2 227(73.8)2 119(70.3)
无配偶479(15.9)536(17.8)624(20.7)789(26.2)897(29.7)
居住地
农村2 529(83.9)2 765(91.7)2 341(77.6)2 447(81.1)2 271(75.3)
城镇487(16.1)251(8.30)675(22.4)569(18.9)745(24.7)
受教育程度
小学及以上2 448(81.2)2 448(81.2)2 435(80.7)2 373(78.7)2 373(78.7)
初中384(12.7)384(12.7)395(13.1)444(14.7)444(14.7)
高中（中专）142(4.70)142(4.70)143(4.70)152(5.00)152(5.00)
本科（大专）及以上42(1.40)42(1.40)43(1.40)47(1.60)47(1.60)
经济收入
有1 318(43.7)2 544(84.4)760(25.2)2 731(90.6)2 662(88.3)
无1 698(56.3)464(15.4)2 256(74.8)285(9.40)354(11.7)
吸烟
是942(31.2)930(30.8)809(26.8)822(27.3)671(22.2)
否2 074(68.8)2 086(69.2)2 207(73.2)2 194(72.7)2 345(77.8)
饮酒
是945(31.3)982(32.6)989(32.8)925(30.7)965(32.0)
否2 071(68.7)2 034(67.4)2 027(67.2)2 091(69.3)2 051(68.0)
情感支持
一年以上340(11.3)167(5.50)155(5.10)144(4.80)159(5.30)
一年至少一次578(19.2)585(19.4)563(18.7)601(19.9)536(17.8)
一月至少一次495(16.4)448(14.9)535(17.7)609(20.2)703(23.3)
一周至少一次1 603(53.1)1 818(60.3)1 763(58.5)1 662(55.1)1 618(53.6)
经济支持
有754(25.0)686(22.7)933(30.9)935(31.0)1 448(48.0)
无2 262(75.0)2 330(77.3)2 083(69.1)2 081(69.0)1 568(52.0)
生活照料
有1 990(66.0)1 943(64.4)1 912(63.4)2 104(69.8)2 000(66.3)
无1 026(34.0)1 073(35.6)1 104(36.6)912(30.2)1 016(33.7)
), ArticleFig(id=1241821863735792510, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=CN, label=表2, caption=

样本人群基本信息［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量基期第二期第三期第四期第五期
性别
男1 463(48.5)1 463(48.5)1 463(48.5)1 463(48.5)1 463(48.5)
女1 553(51.5)1 553(51.5)1 553(51.5)1 553(51.5)1 553(51.5)
年龄（岁）
60～702 405(79.7)2 111(70.0)1 778(59.0)1 034(34.3)381(12.6)
>70～80572(19.0)824(27.3)1 093(36.2)1 661(55.1)2 166(71.8)
>8039(1.30)81(2.70)145(4.80)321(10.6)469(15.6)
婚姻状况
有配偶2 537(84.1)2 480(82.2)2 392(79.3)2 227(73.8)2 119(70.3)
无配偶479(15.9)536(17.8)624(20.7)789(26.2)897(29.7)
居住地
农村2 529(83.9)2 765(91.7)2 341(77.6)2 447(81.1)2 271(75.3)
城镇487(16.1)251(8.30)675(22.4)569(18.9)745(24.7)
受教育程度
小学及以上2 448(81.2)2 448(81.2)2 435(80.7)2 373(78.7)2 373(78.7)
初中384(12.7)384(12.7)395(13.1)444(14.7)444(14.7)
高中（中专）142(4.70)142(4.70)143(4.70)152(5.00)152(5.00)
本科（大专）及以上42(1.40)42(1.40)43(1.40)47(1.60)47(1.60)
经济收入
有1 318(43.7)2 544(84.4)760(25.2)2 731(90.6)2 662(88.3)
无1 698(56.3)464(15.4)2 256(74.8)285(9.40)354(11.7)
吸烟
是942(31.2)930(30.8)809(26.8)822(27.3)671(22.2)
否2 074(68.8)2 086(69.2)2 207(73.2)2 194(72.7)2 345(77.8)
饮酒
是945(31.3)982(32.6)989(32.8)925(30.7)965(32.0)
否2 071(68.7)2 034(67.4)2 027(67.2)2 091(69.3)2 051(68.0)
情感支持
一年以上340(11.3)167(5.50)155(5.10)144(4.80)159(5.30)
一年至少一次578(19.2)585(19.4)563(18.7)601(19.9)536(17.8)
一月至少一次495(16.4)448(14.9)535(17.7)609(20.2)703(23.3)
一周至少一次1 603(53.1)1 818(60.3)1 763(58.5)1 662(55.1)1 618(53.6)
经济支持
有754(25.0)686(22.7)933(30.9)935(31.0)1 448(48.0)
无2 262(75.0)2 330(77.3)2 083(69.1)2 081(69.0)1 568(52.0)
生活照料
有1 990(66.0)1 943(64.4)1 912(63.4)2 104(69.8)2 000(66.3)
无1 026(34.0)1 073(35.6)1 104(36.6)912(30.2)1 016(33.7)
), ArticleFig(id=1241821863878398857, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=EN, label=Table 3, caption=

Cognitive frailty and social participation of the elderly ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量基期第二期第三期第四期第五期
认知衰弱
有194(6.40)245(8.10)349(11.6)634(21.0)925(30.7)
无2 822(93.6)2 771(91.9)2 667(88.4)2 382(79.0)2 091(69.3)
经济参与
有184(6.10)200(6.60)219(7.30)250(8.30)228(7.60)
无2 832(93.9)2 816(93.4)2 797(92.7)2 766(91.7)2 788(92.4)
社交参与
有1 335(44.3)1 545(51.2)1 340(44.4)1 275(42.3)1 354(44.9)
无1 681(55.7)1 471(48.8)1 676(55.6)1 741(57.7)1 662(55.1)
家庭参与
有1 062(35.2)1 191(39.5)1 209(40.1)1 004(33.3)—
无1 211(40.2)1 446(47.9)1 444(47.9)2 012(66.7)—
志愿参与
有168(5.60)362(12.0)391(13.0)308(10.2)283(9.40)
无2 848(94.4)2 654(88.0)2 625(87.0)2 708(89.8)2 733(90.6)
社会参与
有2 039(67.6)2 230(73.9)2 104(69.8)1 961(65.0)1 558(51.7)
无977(32.4)786(26.1)912(30.2)1 055(35.0)1 458(48.3)
), ArticleFig(id=1241821864012616593, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=CN, label=表3, caption=

老年人各期认知衰弱及社会参与情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量基期第二期第三期第四期第五期
认知衰弱
有194(6.40)245(8.10)349(11.6)634(21.0)925(30.7)
无2 822(93.6)2 771(91.9)2 667(88.4)2 382(79.0)2 091(69.3)
经济参与
有184(6.10)200(6.60)219(7.30)250(8.30)228(7.60)
无2 832(93.9)2 816(93.4)2 797(92.7)2 766(91.7)2 788(92.4)
社交参与
有1 335(44.3)1 545(51.2)1 340(44.4)1 275(42.3)1 354(44.9)
无1 681(55.7)1 471(48.8)1 676(55.6)1 741(57.7)1 662(55.1)
家庭参与
有1 062(35.2)1 191(39.5)1 209(40.1)1 004(33.3)—
无1 211(40.2)1 446(47.9)1 444(47.9)2 012(66.7)—
志愿参与
有168(5.60)362(12.0)391(13.0)308(10.2)283(9.40)
无2 848(94.4)2 654(88.0)2 625(87.0)2 708(89.8)2 733(90.6)
社会参与
有2 039(67.6)2 230(73.9)2 104(69.8)1 961(65.0)1 558(51.7)
无977(32.4)786(26.1)912(30.2)1 055(35.0)1 458(48.3)
), ArticleFig(id=1241821864146834330, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=EN, label=Table 4, caption=

The proportion of elderly people with cognitive frailty who engage in social participation (%)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量第一期第二期第三期第四期第五期
有社会参与5.46.310.517.327.9
无社会参与8.613.214.027.933.6
), ArticleFig(id=1241821864289440671, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=CN, label=表4, caption=

不同社会参与情况存在认知衰弱的比例对比（%）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量第一期第二期第三期第四期第五期
有社会参与5.46.310.517.327.9
无社会参与8.613.214.027.933.6
), ArticleFig(id=1241821864566264748, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=EN, label=Table 5, caption=

Occurrence of cognitive frailty in the following year among elderly people who have engaged in social participation in the previous year

, figureFileSmall=null, figureFileBig=null, tableContent=
观察期（年）前一年无认知衰弱后一年存在认知衰弱的比例（%）
前一年有社会参与前一年无社会参与
2011—20134.37.8
2013—20156.78.7
2015—201812.923.5
2018—202020.319.7
), ArticleFig(id=1241821866009105333, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=CN, label=表5, caption=

前一年不同社会参与状况的老年人后一年发生认知衰弱的情况

, figureFileSmall=null, figureFileBig=null, tableContent=
观察期（年）前一年无认知衰弱后一年存在认知衰弱的比例（%）
前一年有社会参与前一年无社会参与
2011—20134.37.8
2013—20156.78.7
2015—201812.923.5
2018—202020.319.7
), ArticleFig(id=1241821866160100284, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=EN, label=Table 6, caption=

Results of fixed effects model of social participation on cognitive frailty in the elderly ［OR（95%CI）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3模型4模型5模型6
社会参与0.575***0.684***0.701***
(0.502～0.658)(0.590～0.793)(0.603～0.816)
经济参与0.9000.9600.787
(0.506～1.592)(0.535～1.721)(0.431～1.437)
社交参与0.640***0.623***0.626***
(0.494～0.828)(0.475～0.818)(0.473～0.828)
家庭参与1.0271.1541.138
(0.788～1.388)(0.876～1.521)(0.857～1.511)
志愿参与1.2721.2611.216
(0.906～1.756)(0.906～1.756)(0.865～1.710)
N5 8155 8155 8112 6002 6002 598
组数1 1631 1631 163710710710
LR检验χ264.705***748.532***864.808***17.264**185.617***280.821***
), ArticleFig(id=1241821866311095242, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676526429729189, language=CN, label=表6, caption=

社会参与对老年人认知衰弱影响的固定效应模型结果分析［OR（95%CI）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3模型4模型5模型6
社会参与0.575***0.684***0.701***
(0.502～0.658)(0.590～0.793)(0.603～0.816)
经济参与0.9000.9600.787
(0.506～1.592)(0.535～1.721)(0.431～1.437)
社交参与0.640***0.623***0.626***
(0.494～0.828)(0.475～0.818)(0.473～0.828)
家庭参与1.0271.1541.138
(0.788～1.388)(0.876～1.521)(0.857～1.511)
志愿参与1.2721.2611.216
(0.906～1.756)(0.906～1.756)(0.865～1.710)
N5 8155 8155 8112 6002 6002 598
组数1 1631 1631 163710710710
LR检验χ264.705***748.532***864.808***17.264**185.617***280.821***
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老年人社会参与对认知衰弱的影响研究
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曾浩锋 , 刘银晴 , 李玲
现代预防医学 | 健康与社会行为 2024,51(21): 3967-3973
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现代预防医学 | 健康与社会行为 2024, 51(21): 3967-3973
老年人社会参与对认知衰弱的影响研究
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曾浩锋, 刘银晴, 李玲
作者信息
  • 湖南中医药大学人文与管理学院，湖南 长沙 410208

    • 曾浩锋（2003—），男，本科在读，研究方向：公共管理

通讯作者:

李玲，E-mail:
Research on the impact of social participation on cognitive decline in the elderly
Hao-feng ZENG, Yin-qing LIU, Ling LI
Affiliations
  • School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China
出版时间: 2024-11-10 doi: 10.20043/j.cnki.MPM.202406126
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摘要
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目的

利用中国健康与养老追踪调查共五期的调研数据，验证社会参与对老年人认知衰弱的影响关系，并探讨不同类型社会参与对老年人认知衰弱的影响。

方法

筛选数据库中五期都被随访的60岁以上非患有阿尔兹海默病的老年人3 016人，构建平衡面板数据，建立控制个体层面的固定效应logit模型。

结果

基期存在认知衰弱的老年人为6.4%，第五期增长到了30.7%，进行社会参与的老年人发生认知衰弱的比例低于不进行社会参与的老年人3.2%～10.5%，固定效应logit分析中，OR=0.575（95%CI：0.502～0.658），影响程度为40%左右。不同类型社会参与中社交参与显著影响老年人认知衰弱，OR=0.640（95%CI：0.494～0.828）。

结论

政府应贯彻积极老龄化的理念，完善参与机制，切实保障老年人进行社会参与的权益，鼓励老年人进行社会参与。

积极老龄化  /  社会参与  /  认知衰弱  /  老年人  /  因果关系
Objective

To verify the relationship between social participation and cognitive decline in the elderly, and to explore the effects of different types of social participation on cognitive decline based on data from the China Health and Retirement Longitudinal Study.

Methods

A total of 3 016 individuals aged 60 and above, who were followed across all five waves and did not have Alzheimer’s disease, was selected from the database to construct a balanced panel dataset. A fixed-effects Logit model controlling for individual-level characteristics was established.

Results

The prevalence of cognitive decline among the elderly at baseline was 6.4%, which increased to 30.7% by the fifth wave. The proportion of cognitively declined elderly individuals engaging in social participation was 3.2% to 10.5% lower than those not participating. In the fixed-effects Logit analysis, the odds ratio (OR) was 0.575 (95%CI: 0.502-0.658), indicating an impact magnitude of approximately 40%. Among different types of social participation, social engagement significantly affected cognitive decline, with an OR of 0.640 (95%CI: 0.494-0.828).

Conclusion

The government should implement the concept of active aging, improve participation mechanisms, effectively ensure the rights of the elderly to engage in social participation, and encourage their involvement in social activities.

Active aging  /  Social participation  /  Cognitive decline  /  Elderly  /  Causal relationship
曾浩锋, 刘银晴, 李玲. 老年人社会参与对认知衰弱的影响研究. 现代预防医学, 2024 , 51 (21) : 3967 -3973 . DOI: 10.20043/j.cnki.MPM.202406126
Hao-feng ZENG, Yin-qing LIU, Ling LI. Research on the impact of social participation on cognitive decline in the elderly[J]. Modern Preventive Medicine, 2024 , 51 (21) : 3967 -3973 . DOI: 10.20043/j.cnki.MPM.202406126
正文
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21世纪是人口老龄化的时代，随着银发浪潮的来临，多个国家都相继进入人口老龄化阶段，我国也是人口老龄化形势最严峻的国家之一[1]。为解决人口老龄问题，世界卫生组织提出了“积极老龄化”的概念，其中社会参与是积极老龄化的精髓与核心内容。社会参与是指老年人在家庭、社区、社会层面所参与的有关经济、社会、政治和家庭等一系列正式和非正式活动[2]。经常进行社会参与不仅能提高老年人的身体健康，还能使老年人获得心理慰藉、提高生活满意度。除此之外，国家治理现代化、社会经济可持续发展、基层社区治理及重塑老年文化等都离不开老年人社会参与，老年人社会参与是老龄化社会可持续发展的必要条件[3]。
健康长寿是人类文明的标志，健康使人长寿，但长寿不一定健康，我国老年人“长寿不健康”的形势严峻，解决老年人健康问题是积极应对人口老龄化、推动健康中国建设的一项重要议题[4]。认知衰弱作为健康老龄领域研究的新概念，已经成为了老龄研究和政策干预的新靶点[5]。认知衰弱不仅能直接影响老年人的生命质量，还能增加痴呆、跌倒、死亡等不良健康结局的发生[6]，但认知衰弱的发展具有可逆性，采取适当的措施能延缓甚至恢复认知衰弱的发展进程[7]。社会因素是老年人认知衰弱的重要影响因素，社会资本[4]、社会参与[8]等在老年人健康方面发着积极作用。已有研究表明社会参与对老年人认知衰弱存在一定影响[8]，但尚未有研究证实社会参与同老年人认知衰弱存在因果关系。在积极老龄化的背景下，研究社会参与同认知衰弱的关系对改善老年人认知衰弱、提高老年人身心健康水平等方面具有着重要意义。
本研究基于中国健康与养老追踪调查（CHARLS）共五期数据，以60岁及以上非患有阿尔兹海默病的老年人为调查对象，构建五期平衡面板数据，验证老年人社会参与同认知衰弱之间的关系，并基于研究提出符合积极老龄化战略的相应政策建议和配套措施，以期更好地为实现积极老龄化国家战略提供实证支撑。
1　资料与方法
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1.1　资料来源
本研究实证数据来源于北京大学国家发展研究院主持实施的中国健康与养老追踪调查（China Health and Retirement Longitudinal Survey,CHARLS），包括2011年基线调查，2013、2015、2018和2020年四期随访调查，共五期数据，选取数据库中均被调查的老年人作为目标样本。研究对象纳入标准为：（1）2011年基线调查年龄为60岁及以上的老年人；（2）意识清楚，非患有阿尔兹海默症，无沟通障碍；（3）均参与了2011年的基线调查以及四次随访调查。共纳入3 016个有效样本。
1.2　研究方法
1.2.1　因变量
本研究的因变量为认知衰弱。参考以往研究，本文利用CHARLS问卷中的衰弱指数（FI）衡量老年人的衰弱情况，利用问卷自带的简易精神状态量表（MMSE）衡量老年人是否存在认知功能障碍，同时存在衰弱和认知功能障碍的老年人被认为存在认知衰弱[9]。CHARLS前四期问卷中的衰弱指数（FI）量表共纳入衰弱衡量指标39项，第五期问卷调查中的衰弱量表部分进行了简化处理，删掉了功能障碍部分。衰弱指数（FI）为各项得分相加之和除以总项数，取回范围为0～1，据以往研究，分值大于0.21被视为存在个体衰弱[10]。
简易精神状态量表（MMSE）包括时间定向力、记忆力、注意力及计算力、回忆能力、语言能力五大部分，CHARLS数据库中前三期的量表分值为0～31分，第四期与第五期对MMSE量表有所修改，第四期分值为0～30分，第五期的简化量表只衡量了定向力、计算力及语言能力三个部分，分值为0～11分。为统一测量标准，本研究以第四期MMSE量表各部分的比重和分值作为参照，将前三期与第五期的量表各部分进行加权处理，将分值统一为0～30分，得分小于27分被认为存在认知功能障碍[8]。定义有认知功能障碍赋值为1，无赋值为0。
1.2.2　自变量
自变量为老年人社会参与及不同社会参与类型，参考以往研究，结合CHARLS问卷特点，本研究将社会参与划分为经济参与、社交参与、家庭参与、志愿参与四种类型。受访者回答参与过某种类型下的任意一项活动便被认为存在该种类型的社会参与，至少参与过一种类型的社会参与便定义为受访者进行过社会参与活动。由于CHARLS 2020年问卷进行了修改，删掉了“过去一个月有没有炒股”“过去一年，您是否花时间照看了您的孙子女和重孙子女”两个题项，故本文将第五期的经济参与由“上周您是否工作了至少一小时”来衡量，将第五期家庭参与定义为变量缺失。定义有各种类型的社会参与赋值为1，无赋值为0。见表1。
1.2.3　控制变量
本文的控制变量由基本人口学特征、社会经济地位、家庭支持、健康生活方式四个部分组成。基本人口学特征包括老年人的年龄、性别、婚姻状况、居住地类型；社会经济地位包括受教育程度、经济收入；家庭支持部分包括情感支持、经济支持、生活照料；健康生活分为吸烟和饮酒两个方面。
1.2.4　模型设计
本研究选择的数据样本为五期面板数据，其中被解释变量是二分类变量，故本文使用二分类logit模型进行估计。在数据分析前，首先确定不可观测因素属于随机效应还是固定效应，本文进行了Hausman检验，输出结果显示χ2（13）统计量为175.00，P值小于0.05，说明模型中的不可观测因素属于固定效应，故采用固定效应logit模型进行回归。模型设定如下：
其中CFit指受访者i在t时间内发生认知衰弱的概率，SPit指受访者i在t时间内进行社会参与的概率，xit指本研究选择的控制变量，δi代表个体效应，εi代表随机误差项。
2　结果
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2.1　描述性分析
2.1.1　样本人群基本信息
本研究共纳入3 016名老年人，其中男性1 463名，占比48.5%，女性1 553名，占比51.5%；基期年龄为60～70岁的老年人有79.7%，>70～80岁的19.0%，80岁以上的1.30%，随着年龄的增长，受访者在第五期处于60～70岁的占比12.6%，>70～80岁的增加到了71.8%；基期婚姻状况为已婚的84.1%，未婚的15.9%，在后期的随访中婚姻状况为已婚的占比逐期下降；居住地为农村的老年人占比较高，基期为83.9%。见表2。
2.1.2　老年人认知衰弱及社会参与情况
基期存在认知衰弱的老年人有6.4%，从时间趋势上来看，存在认知衰弱的老年人占比不断提高，第五期已有30.7%存在认知衰弱，说明随着年龄的增长，老年人出现认知衰弱的可能性在增加。有社会参与的老年人比没有社会参与的老年人占比要高，总体上逐期呈现下降的趋势，且第五期因受疫情的影响下降幅度较大。各期不同类型的社会参与中有社交参与的老年人占比较多，其次是家庭参与。见表3。
2.1.3　不同社会参与情况老年人的认知衰弱比例对比
为考察老年人社会参与与认知衰弱的简单相关关系，对两者之间的关系有一个总体认知，表4为各期有无社会参与的老年人存在认知衰弱的比例对比，由结果可知，在五个调查时点上，有社会参与的老年人发生认知衰弱的构成比均低于无社会参与的老年人，可见在同一时期，无社会参与的老年人更可能出现认知衰弱的情况，老年人社会参与对认知衰弱可能存在一定的影响关系。
此外，考察期初不同社会参与状态的老年人期末时的认知衰弱状况对深入的了解社会参与与认知衰弱之间存在的影响关系有着重要作用。将五期的调查数据分为2011—2013、2013—2015、2015—2018和2018—2020年四个观察期，分别观察四个观察期中前一年无认知衰弱的老年人不同社会参与情况和后一年发生认知衰弱的变化情况。由结果可见，前三个观察期中老年人在前一年有社会参与的情况下后一年发生认知衰弱的比例要低于无社会参与的老年人，该结果再次验证了社会参与对老年人认知衰弱的发生情况可能存在一定的影响，且该影响可能存在一定的时间效应。虽然第四个观察期并未出现该种情况，可能是个体及其他因素导致的结果，不能否定老年人社会参与对认知衰弱的影响关系。见表5。
2.2　社会参与对老年人认知衰弱的影响
2.2.1　社会参与对老年人认知衰弱的影响
通过前文已经了解到老年人社会参与同认知衰弱之间可能存在影响关系，但前文并未控制个体及可观测因素的影响。固定效应模型可以消除不可观测的个体差异对因变量的影响[11]。为了控制其它潜在因素的影响，考察老年人社会参与同认知衰弱之间可能存在的因果关系，将五期的调查数据汇总为平衡面板数据，本研究共纳入3 016名老年人，经过五期调查共构成了15 080人年的调查数据。以认知衰弱为因变量，社会参与为自变量，在控制个体的层面上做固定效应logit回归分析。结果如表6，其中模型1未加入控制变量，模型2只控制了人口学特征，模型3为控制了人口学特征、社会经济地位、家庭支持、健康生活方式后的全模型。由于在样本期内因变量状态不变的个体不会被固定效应logit模型纳入估计，所以模型中认知衰弱从未发生变化的样本会有所损失[12-13]。
模型1的回归结果显示，在没有加入控制变量的情况下，社会参与对老年人认知衰弱具有显著影响，OR值为0.575，影响程度达40%以上；模型2和模型3的结果显示，在加入了控制变量之后，虽然二者之间的相关关系有点减弱，社会参与对认知衰弱的发生情况仍然有着显著的负向影响，由此可知，在控制了潜在干扰变量的影响之后，两变量间存在显著的因果关系。
2.2.2　不同类型社会参与对老年人认知衰弱的影响
为了解不同类型社会参与对老年人认知衰弱影响的差异，以认知衰弱为因变量，以经济参与、社交参与、家庭参与、志愿参与为自变量进行控制个体层面的固定效应logit回归分析。表6中的模型4、模型5、模型6分别为没有控制变量及加入控制变量后的回归结果。可以发现，四种类型的社会参与中只有社交参与对老年人认知衰弱存在显著影响，且在加入控制变量后结果仍然显著。
3　讨论
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研究表明，老年人认知衰弱的发生会随着年龄的增加而增加，而老年人进行社会参与能显著降低认知衰弱的发生，进行社会参与的老年人发生认知衰弱的比例相较于不进行社会参与的老年人低3.2%～10.5%，且前一年进行社会参与的老年人后一年发生认知衰弱的比例要低于不进行社会参与的老年人。位秀平[14]在研究老年人社会参与同健康的关系时已经得出社会参与与健康存在因在前果在后的因果关系，韩佳滢[8]通过横断面数据分析认为老年人社会参与同认知衰弱存在显著相关，本研究所得出的结果同以往的研究结论较为一致。
不同类型的社会参与中，社交参与对老年人认知衰弱存在显著影响，说明老年人进行社交参与能显著缓解认知衰弱的发生。已有研究表明亲密的社交网络关系能给予老年人心理支持，提升老年人生活幸福感，降低其认知功能下降的发生，提升老年人的认知程度[15]。对空巢老年人的健康状况的影响尤为明显[16]。至于其它类型社会参与为何没有对老年人认知衰弱造成显著影响，笔者认为是由于如今国内暂未形成老年人参与志愿活动的良好氛围，存在“高意愿、低参与”的现象[17]，所以志愿参与暂未对老年人认知衰弱造成很大的影响；而家庭参与的类型和程度不同，对老年人认知衰弱可能存在不同的影响。有的老年人可能因此减少走出家门接触社会的机会，更有甚者可能身心俱疲，对其身心健康产生负向影响；同样，经济参与可能会给老年人的心理带来负面压力，负向影响老年人的精神健康状态[18]，且样本群体中老年人活动能力受限，进行经济参与的较少，一定程度上也会对研究结果造成影响。所以本文虽利用固定效应logit模型分析得出了除社交参与外三种类型的社会参与对认知衰弱不存在显著影响的结论，但受限于CHARLS数据库的问卷设计，衡量三种类型社会参与的问题可能不够全面，从而会造成信息偏倚，所以三种类型的社会参与是否会影响到老年人的认知衰弱仍然有待探讨。
总的来说，本文研究表明社会参与活动能显著缓解老年人的认知衰弱发生情况，该结论为改善老年人健康水平、推进积极老龄化具有着重要意义。政府应当贯彻积极老龄化的理念，提供相应的法律政策支持，如鼓励企业聘用老年人进行生产，增加老年人进行经济参与的机会，加大财政补贴力度，建造老年人健身、跳舞、社交的公共设施，为老年人社交参与提供场所保障等，为老年人参与社会生活、创造社会价值提供机会与良好环境，保障老年人再次进入社会的合法权益。
本研究仍然存在以下局限：（1）受限于数据库的问卷设置，不同类型社会参与的衡量不够全面，可能会造成信息偏倚；（2）利用固定效应模型一定程度上解释了社会参与对老年人认知衰弱的因果关系，但无法排除该种模型本身可能存在的误差相关问题对结果造成的影响。受限于问卷设置，本研究未能探讨社会参与程度对老年人认知衰弱的影响，这可能成为后续的研究方向。
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  • 2021年度湖南省哲学社会科学基金项目(21JD022)
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2024年第51卷第21期
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doi: 10.20043/j.cnki.MPM.202406126
  • 接收时间：2024-06-11
  • 首发时间：2026-03-20
  • 出版时间：2024-11-10
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  • 收稿日期：2024-06-11
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2021年度湖南省哲学社会科学基金项目(21JD022)
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    湖南中医药大学人文与管理学院，湖南 长沙 410208

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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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
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