Article(id=1324077749303903221, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511222, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1763049600000, receivedDateStr=2025-11-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614335608, onlineDateStr=2026-11-02, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614335608, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614335608, creator=13701087609, updateTime=1793614335608, updator=13701087609, issue=Issue{id=1324077560820282023, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1774368000000', pubDateStr='2026-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614290671, creator='13701087609', updateTime=1793614391469, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324077983656444429, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324077983660638734, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1094, endPage=1098, ext={EN=ArticleExt(id=1324077749555561462, articleId=1324077749303903221, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Longtitudinal effects of informal caregiving on cognitive function among middle-aged and older adults in China, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine the longitudinal association between informal caregiving and cognitive function among middle-aged and older Chinese adults, and to explore its heterogeneity.

Methods

Using five waves of longitudinal data (2011-2020) from the China Health and Retirement Longitudinal Study (CHARLS), this study included 4 841 adults aged 45 and above. Linear mixed-effects models were employed to analyze associations of informal caregiving and caregiving intensity with cognitive function, and investigated caregiving roles in relation to cognition, stratified by marital or cohabitation status.

Results

Compared to non-caregivers, caregivers demonstrated better performance in global cognition (β=0.039, 95% CI:0.001-0.076, P=0.043) and executive function (β=0.040, 95% CI:0.003-0.078, P=0.037). High-intensity caregiving was positively associated with global cognition (β=0.101, 95% CI:0.039-0.164, P=0.001), episodic memory (β=0.076, 95% CI: 0.014-0.138, P=0.016), and executive function (β=0.101, 95% CI:0.039-0.164, P=0.001). Moderate-intensity caregiving was associated with higher episodic memory scores (β=0.123, 95% CI: 0.002-0.244, P=0.047). Spousal caregivers had lower levels of global cognition (β=0.196, 95% CI: 0.351-0.040, P=0.014), whereas grandparent caregivers who were separated, divorced, or widowed showed superior episodic memory (β=0.163, 95% CI:0.013-0.314, P=0.033).

Conclusion

The impact of informal caregiving on cognitive function in middle-aged and older adults varies significantly based on the caregiving role, intensity, and sociodemographic characteristics. Future policies should provide differentiated support for various caregiver groups to optimize their health outcomes.

, authors=Meng-qi ZHOU1, Lin HAN2, Si-ran CHEN1, Rui MA1, Xiao-yue JIANG1, Zi-yi YANG1, Yu-ling DU1, Ke-rui WANG1, Shao-hui SU1, Yi-nuo ZHOU1, Yan-fang YANG1, authorsList=Meng-qi ZHOU, Lin HAN, Si-ran CHEN, Rui MA, Xiao-yue JIANG, Zi-yi YANG, Yu-ling DU, Ke-rui WANG, Shao-hui SU, Yi-nuo ZHOU, Yan-fang YANG, authorCompany=null, correspAuthors=Yan-fang YANG, 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, fund=null), CN=ArticleExt(id=1324077752042783741, articleId=1324077749303903221, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中国中老年人非正式照护与认知功能的纵向关联研究, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨非正式照护与我国中老年人认知功能的纵向关联及其异质性。

方法

基于中国健康与养老追踪调查(CHARLS)2011—2020年五波纵向数据,纳入4 841名45岁及以上中老年人,采用线性混合效应模型分析非正式照护与认知功能的关联,并探讨照护强度及不同婚姻或居住状况下照护角色与认知功能的关系。

结果

与非照护者相比,照护者的总体认知(β=0.039,95% CI:0.001~0.076,P=0.043)与执行功能(β=0.040,95% CI:0.003~0.078,P=0.037)更优。高强度照护与总体认知(β=0.101,95% CI:0.039~0.164,P=0.001)、情景记忆(β=0.076,95% CI:0.014~0.138,P=0.016)及执行功能(β=0.101,95% CI:0.039~0.164,P=0.001)呈正向关联;中强度照护与情景记忆得分较高相关(β=0.123,95% CI:0.002~0.244,P=0.047)。配偶照护者总体认知水平较低(β=-0.196,95% CI:-0.351~-0.040,P=0.014);在分居、离异或丧偶人群中,祖辈照护者情景记忆更优(β=0.163,95% CI:0.013~0.314,P=0.033)。

结论

非正式照护对中老年人认知功能的影响因照护角色、照护强度及社会人口学特征而异。建议未来针对不同照护者实施分类支持,以优化其健康效益。

, authors=周梦琦1, 韩琳2, 陈思燃1, 马蕊1, 蒋晓悦1, 杨子乙1, 杜昱玲1, 王珂瑞1, 苏绍辉1, 周一诺1, 杨艳芳1, authorsList=周梦琦, 韩琳, 陈思燃, 马蕊, 蒋晓悦, 杨子乙, 杜昱玲, 王珂瑞, 苏绍辉, 周一诺, 杨艳芳, authorCompany=null, correspAuthors=杨艳芳, authorNote=

周梦琦(2001—),女,硕士在读,研究方向:慢性病流行病学

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杨艳芳,E-mail:
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Brain Commun, 2021, 3(3): fcab125., articleTitle=The role of the medial prefrontal cortex in cognition, ageing and dementia, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1324077752344773630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, xref=1., ext=[AuthorCompanyExt(id=1324077752357356543, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, companyId=1324077752344773630, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1324077752369939456, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, companyId=1324077752344773630, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/华西第四医院 流行病与卫生统计学系,四川 成都 610041)]), AuthorCompany(id=1324077752462213120, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, xref=2., ext=[AuthorCompanyExt(id=1324077752483184641, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, companyId=1324077752462213120, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西第四医院 神经内科)])], figs=[ArticleFig(id=1324077758468456515, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, language=EN, label=Table 1, caption=

Characteristics of participants at baseline (n=4,841) [(),n(%) ]

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变量总体非照护者(n=3 193,65.96%)祖辈照护者(n=624,12.89%)配偶照护者(n=67,1.38%)子女照护者(n=47,0.97%)多重照护者(n=910,18.80%)P 值
认知Z分数
总分0.03±0.960.05±0.960.19±0.90-0.55±0.950.34±0.73-0.13±0.96<0.001
情景记忆0.03±0.940.05±0.960.14±0.88-0.40±0.840.22±0.84-0.09±0.92<0.001
执行功能0.02±0.980.04±0.970.18±0.93-0.53±1.110.36±0.74-0.14±1.00<0.001
年龄组<0.001
45~54岁1 433(29.60)1 065(33.35)146(23.40)8(11.94)22(46.81)192(21.10)
55~64岁2 065(42.66)1 255(39.30)360(57.69)36(53.73)18(38.30)396(43.52)
65~74岁1 075(22.21)704(22.05)104(16.67)21(31.34)6(12.77)240(26.37)
≥75岁268(5.54)169(5.29)14(2.24)2(2.99)1(2.13)82(9.01)
性别(男性)2 128(43.96)1 337(41.87)290(46.47)27(40.30)23(48.94)451(49.56)0.001
受教育水平<0.001
无正式教育1 444(29.83)939(29.41)156(25.00)33(49.25)4(8.51)312(34.29)
小学教育1 861(38.44)1 190(37.27)264(42.31)22(32.84)21(44.68)364(40.0)
中学教育1 474(30.45)1 019(31.91)197(31.57)12(17.91)20(42.55)226(24.84)
高等教育62(1.28)45(1.41)7(1.12)0(0.0)2(4.26)8(0.88)
婚姻与居住状况<0.001
已婚/同居4 464(92.21)2 972(93.08)486(77.88)67(100.0)38(80.85)901(99.01)
分居/离婚/丧偶376(7.77)220(6.89)138(22.12)0(0.00)9(19.15)9(0.99)
未婚1(0.02)1(0.03)0(0.00)0(0.00)0(0.00)0(0.00)
居住地(乡村地区)1 786(36.89)1 162(36.39)271(43.43)24(35.82)18(38.30)311(34.18)0.005
家庭规模<0.001
小型(1~2人)1 942(40.12)1 318(41.28)180(28.85)42(62.69)19(40.43)383(42.09)
中型(3~4人)1 540(31.81)1 066(33.39)178(28.53)14(20.90)16(34.04)266(29.23)
大型(5~6人)1 136(23.47)687(21.52)219(35.10)10(14.93)8(17.02)212(23.30)
超大型(≥7人)223(4.61)122(3.82)47(7.53)1(1.49)4(8.51)49(5.38)
家庭经济状况<0.001
水平1(最贫困)1 024(21.15)669(21.95)116(18.59)22(32.84)9(19.15)208(22.86)
水平21 153(23.82)737(23.08)122(19.55)20(29.85)10(21.28)264(29.01)
水平31 258(25.99)824(25.81)158(25.32)20(29.85)12(25.53)244(26.81)
水平4(最富裕)1 406(29.04)963(30.16)228(36.54)5(7.46)16(34.04)194(21.32)
抑郁症状(CES-D)8.45±6.217.85±5.838.45±6.3013.57±8.028.28±6.4210.23±6.76<0.001
), ArticleFig(id=1324077758585897028, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, language=CN, label=表1, caption=

研究对象的基线特征(n=4 841) [(),n(%) ]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体非照护者(n=3 193,65.96%)祖辈照护者(n=624,12.89%)配偶照护者(n=67,1.38%)子女照护者(n=47,0.97%)多重照护者(n=910,18.80%)P 值
认知Z分数
总分0.03±0.960.05±0.960.19±0.90-0.55±0.950.34±0.73-0.13±0.96<0.001
情景记忆0.03±0.940.05±0.960.14±0.88-0.40±0.840.22±0.84-0.09±0.92<0.001
执行功能0.02±0.980.04±0.970.18±0.93-0.53±1.110.36±0.74-0.14±1.00<0.001
年龄组<0.001
45~54岁1 433(29.60)1 065(33.35)146(23.40)8(11.94)22(46.81)192(21.10)
55~64岁2 065(42.66)1 255(39.30)360(57.69)36(53.73)18(38.30)396(43.52)
65~74岁1 075(22.21)704(22.05)104(16.67)21(31.34)6(12.77)240(26.37)
≥75岁268(5.54)169(5.29)14(2.24)2(2.99)1(2.13)82(9.01)
性别(男性)2 128(43.96)1 337(41.87)290(46.47)27(40.30)23(48.94)451(49.56)0.001
受教育水平<0.001
无正式教育1 444(29.83)939(29.41)156(25.00)33(49.25)4(8.51)312(34.29)
小学教育1 861(38.44)1 190(37.27)264(42.31)22(32.84)21(44.68)364(40.0)
中学教育1 474(30.45)1 019(31.91)197(31.57)12(17.91)20(42.55)226(24.84)
高等教育62(1.28)45(1.41)7(1.12)0(0.0)2(4.26)8(0.88)
婚姻与居住状况<0.001
已婚/同居4 464(92.21)2 972(93.08)486(77.88)67(100.0)38(80.85)901(99.01)
分居/离婚/丧偶376(7.77)220(6.89)138(22.12)0(0.00)9(19.15)9(0.99)
未婚1(0.02)1(0.03)0(0.00)0(0.00)0(0.00)0(0.00)
居住地(乡村地区)1 786(36.89)1 162(36.39)271(43.43)24(35.82)18(38.30)311(34.18)0.005
家庭规模<0.001
小型(1~2人)1 942(40.12)1 318(41.28)180(28.85)42(62.69)19(40.43)383(42.09)
中型(3~4人)1 540(31.81)1 066(33.39)178(28.53)14(20.90)16(34.04)266(29.23)
大型(5~6人)1 136(23.47)687(21.52)219(35.10)10(14.93)8(17.02)212(23.30)
超大型(≥7人)223(4.61)122(3.82)47(7.53)1(1.49)4(8.51)49(5.38)
家庭经济状况<0.001
水平1(最贫困)1 024(21.15)669(21.95)116(18.59)22(32.84)9(19.15)208(22.86)
水平21 153(23.82)737(23.08)122(19.55)20(29.85)10(21.28)264(29.01)
水平31 258(25.99)824(25.81)158(25.32)20(29.85)12(25.53)244(26.81)
水平4(最富裕)1 406(29.04)963(30.16)228(36.54)5(7.46)16(34.04)194(21.32)
抑郁症状(CES-D)8.45±6.217.85±5.838.45±6.3013.57±8.028.28±6.4210.23±6.76<0.001
), ArticleFig(id=1324077758707531845, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, language=EN, label=Table 2, caption=

Longitudinal associations between informal caregiving and cognitive function

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预测变量总体认知情景记忆
β(95%CI)P值β(95%CI)P值
照护状态
截距-0.223(-0.330, -0.117)<0.001-0.304(-0.410, -0.198)<0.001
照护者(参照:非照护者)0.039(0.001, 0.076)0.0430.031(-0.006, 0.068)0.106
随访时间(年)-0.034(-0.037, -0.031)<0.0010.001(-0.003, 0.004)0.751
照护强度
截距0.200(0.034, 0.365)0.018-0.363(-0.529, -0.197)<0.001
低强度(n=422, 42.37%)-0.017(-0.084, 0.050)0.619-0.020(-0.087, 0.046)0.547
中强度(n=107, 10.74%)0.117(-0.005, 0.239)0.0610.123(0.002, 0.244)0.047
高强度(n=467, 46.89%)0.101(0.039, 0.164)0.0010.076(0.014, 0.138)0.016
随访时间(年)-0.034(-0.037, -0.030)<0.0010.001(-0.003, 0.005)0.571
预测变量执行功能
β(95%CI)P值
照护状态
截距-0.093(-0.201, 0.014)0.089
照护者(参照:非照护者)0.040(0.003, 0.078)0.037
随访时间(年)-0.057(-0.060, -0.054)<0.001
照护强度
截距0.731(0.546, 0.880)<0.001
低强度(n=422, 42.37%)0.001(-0.066, 0.068)0.970
中强度(n=107, 10.74%)0.064(-0.059, 0.186)0.311
高强度(n=467, 46.89%)0.101(0.039, 0.164)0.001
随访时间(年)-0.057(-0.060, -0.054)<0.001
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非正式照护与认知功能的纵向关联

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预测变量总体认知情景记忆
β(95%CI)P值β(95%CI)P值
照护状态
截距-0.223(-0.330, -0.117)<0.001-0.304(-0.410, -0.198)<0.001
照护者(参照:非照护者)0.039(0.001, 0.076)0.0430.031(-0.006, 0.068)0.106
随访时间(年)-0.034(-0.037, -0.031)<0.0010.001(-0.003, 0.004)0.751
照护强度
截距0.200(0.034, 0.365)0.018-0.363(-0.529, -0.197)<0.001
低强度(n=422, 42.37%)-0.017(-0.084, 0.050)0.619-0.020(-0.087, 0.046)0.547
中强度(n=107, 10.74%)0.117(-0.005, 0.239)0.0610.123(0.002, 0.244)0.047
高强度(n=467, 46.89%)0.101(0.039, 0.164)0.0010.076(0.014, 0.138)0.016
随访时间(年)-0.034(-0.037, -0.030)<0.0010.001(-0.003, 0.005)0.571
预测变量执行功能
β(95%CI)P值
照护状态
截距-0.093(-0.201, 0.014)0.089
照护者(参照:非照护者)0.040(0.003, 0.078)0.037
随访时间(年)-0.057(-0.060, -0.054)<0.001
照护强度
截距0.731(0.546, 0.880)<0.001
低强度(n=422, 42.37%)0.001(-0.066, 0.068)0.970
中强度(n=107, 10.74%)0.064(-0.059, 0.186)0.311
高强度(n=467, 46.89%)0.101(0.039, 0.164)0.001
随访时间(年)-0.057(-0.060, -0.054)<0.001
), ArticleFig(id=1324077758892081223, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, language=EN, label=Table 3, caption=

Longitudinal associations between caregiver roles and cognitive function across marital and residential subgroups

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预测变量总体认知情景记忆
β(95%CI)P值β(95%CI)P值
已婚/同居
截距0.900(0.770,1.030)<0.0010.481(0.352,0.610)<0.001
祖辈照护者0.049(-0.012,0.110)0.1140.030(-0.030,0.090)0.331
配偶照护者-0.196(-0.351,-0.040)0.014-0.212(-0.366,-0.058)0.007
子女照护者0.085(-0.116,0.285)0.4080.049(-0.149,0.248)0.626
多重照护者0.054(0.005,0.104)0.0310.048(-0.001,0.097)0.053
随访时间(年)-0.029(-0.032,-0.026)<0.0010.005(0.002,0.009)0.002
分居/离婚/丧偶
截距0.766(0.157,1.376)0.0140.130(-0.440,0.700)0.654
祖辈照护者0.154(-0.007,0.315)0.0610.163(0.013,0.314)0.033
子女照护者0.239(-0.212,0.690)0.2980.257(-0.166,0.682)0.233
多重照护者0.010(-0.432,0.453)0.9630.038(-0.373,0.449)0.857
随访时间(年)-0.048(-0.058,-0.038)<0.001-0.014(-0.026,-0.002)0.019
预测变量执行功能
β(95%CI)P值
已婚/同居
截距1.056(0.926,1.184)<0.001
祖辈照护者0.054(-0.006,0.115)0.078
配偶照护者-0.117(-0.271,0.036)0.134
子女照护者0.097(-0.101,0.296)0.337
多重照护者0.045(-0.004,0.094)0.071
随访时间(年)-0.054(-0.057,-0.051)<0.001
分居/离婚/丧偶
截距1.182(0.551,1.812)<0.001
祖辈照护者0.009(-0.068,0.265)0.244
子女照护者0.138(-0.328,0.605)0.561
多重照护者-0.014(-0.472,0.444)0.950
随访时间(年)-0.066(-0.076,-0.056)<0.001
), ArticleFig(id=1324077758988550216, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077749303903221, language=CN, label=表3, caption=

不同婚姻及居住状况亚组中照护角色与认知功能的纵向关联

, figureFileSmall=null, figureFileBig=null, tableContent=
预测变量总体认知情景记忆
β(95%CI)P值β(95%CI)P值
已婚/同居
截距0.900(0.770,1.030)<0.0010.481(0.352,0.610)<0.001
祖辈照护者0.049(-0.012,0.110)0.1140.030(-0.030,0.090)0.331
配偶照护者-0.196(-0.351,-0.040)0.014-0.212(-0.366,-0.058)0.007
子女照护者0.085(-0.116,0.285)0.4080.049(-0.149,0.248)0.626
多重照护者0.054(0.005,0.104)0.0310.048(-0.001,0.097)0.053
随访时间(年)-0.029(-0.032,-0.026)<0.0010.005(0.002,0.009)0.002
分居/离婚/丧偶
截距0.766(0.157,1.376)0.0140.130(-0.440,0.700)0.654
祖辈照护者0.154(-0.007,0.315)0.0610.163(0.013,0.314)0.033
子女照护者0.239(-0.212,0.690)0.2980.257(-0.166,0.682)0.233
多重照护者0.010(-0.432,0.453)0.9630.038(-0.373,0.449)0.857
随访时间(年)-0.048(-0.058,-0.038)<0.001-0.014(-0.026,-0.002)0.019
预测变量执行功能
β(95%CI)P值
已婚/同居
截距1.056(0.926,1.184)<0.001
祖辈照护者0.054(-0.006,0.115)0.078
配偶照护者-0.117(-0.271,0.036)0.134
子女照护者0.097(-0.101,0.296)0.337
多重照护者0.045(-0.004,0.094)0.071
随访时间(年)-0.054(-0.057,-0.051)<0.001
分居/离婚/丧偶
截距1.182(0.551,1.812)<0.001
祖辈照护者0.009(-0.068,0.265)0.244
子女照护者0.138(-0.328,0.605)0.561
多重照护者-0.014(-0.472,0.444)0.950
随访时间(年)-0.066(-0.076,-0.056)<0.001
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中国中老年人非正式照护与认知功能的纵向关联研究
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周梦琦 1 , 韩琳 2 , 陈思燃 1 , 马蕊 1 , 蒋晓悦 1 , 杨子乙 1 , 杜昱玲 1 , 王珂瑞 1 , 苏绍辉 1 , 周一诺 1 , 杨艳芳 1
现代预防医学 | 健康与社会行为 2026,53(6): 1094-1098
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现代预防医学 |健康与社会行为 2026 , 53 (6) : 1094 -1098
中国中老年人非正式照护与认知功能的纵向关联研究
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周梦琦(2001—),女,硕士在读,研究方向:慢性病流行病学

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周梦琦1, 韩琳2, 陈思燃1, 马蕊1, 蒋晓悦1, 杨子乙1, 杜昱玲1, 王珂瑞1, 苏绍辉1, 周一诺1, 杨艳芳1
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院 流行病与卫生统计学系,四川 成都 610041
  • 2.四川大学华西第四医院 神经内科
通讯作者:
杨艳芳,E-mail:
作者简介:

周梦琦(2001—),女,硕士在读,研究方向:慢性病流行病学

Longtitudinal effects of informal caregiving on cognitive function among middle-aged and older adults in China
Meng-qi ZHOU1, Lin HAN2, Si-ran CHEN1, Rui MA1, Xiao-yue JIANG1, Zi-yi YANG1, Yu-ling DU1, Ke-rui WANG1, Shao-hui SU1, Yi-nuo ZHOU1, Yan-fang YANG1
Affiliations
  • Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China
出版时间: 2026-03-25 doi: 10.20043/j.cnki.MPM.202511222
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目的

探讨非正式照护与我国中老年人认知功能的纵向关联及其异质性。

方法

基于中国健康与养老追踪调查(CHARLS)2011—2020年五波纵向数据,纳入4 841名45岁及以上中老年人,采用线性混合效应模型分析非正式照护与认知功能的关联,并探讨照护强度及不同婚姻或居住状况下照护角色与认知功能的关系。

结果

与非照护者相比,照护者的总体认知(β=0.039,95% CI:0.001~0.076,P=0.043)与执行功能(β=0.040,95% CI:0.003~0.078,P=0.037)更优。高强度照护与总体认知(β=0.101,95% CI:0.039~0.164,P=0.001)、情景记忆(β=0.076,95% CI:0.014~0.138,P=0.016)及执行功能(β=0.101,95% CI:0.039~0.164,P=0.001)呈正向关联;中强度照护与情景记忆得分较高相关(β=0.123,95% CI:0.002~0.244,P=0.047)。配偶照护者总体认知水平较低(β=-0.196,95% CI:-0.351~-0.040,P=0.014);在分居、离异或丧偶人群中,祖辈照护者情景记忆更优(β=0.163,95% CI:0.013~0.314,P=0.033)。

结论

非正式照护对中老年人认知功能的影响因照护角色、照护强度及社会人口学特征而异。建议未来针对不同照护者实施分类支持,以优化其健康效益。

非正式照护  /  认知功能  /  中老年人  /  照护强度  /  照护角色
Objective

To examine the longitudinal association between informal caregiving and cognitive function among middle-aged and older Chinese adults, and to explore its heterogeneity.

Methods

Using five waves of longitudinal data (2011-2020) from the China Health and Retirement Longitudinal Study (CHARLS), this study included 4 841 adults aged 45 and above. Linear mixed-effects models were employed to analyze associations of informal caregiving and caregiving intensity with cognitive function, and investigated caregiving roles in relation to cognition, stratified by marital or cohabitation status.

Results

Compared to non-caregivers, caregivers demonstrated better performance in global cognition (β=0.039, 95% CI:0.001-0.076, P=0.043) and executive function (β=0.040, 95% CI:0.003-0.078, P=0.037). High-intensity caregiving was positively associated with global cognition (β=0.101, 95% CI:0.039-0.164, P=0.001), episodic memory (β=0.076, 95% CI: 0.014-0.138, P=0.016), and executive function (β=0.101, 95% CI:0.039-0.164, P=0.001). Moderate-intensity caregiving was associated with higher episodic memory scores (β=0.123, 95% CI: 0.002-0.244, P=0.047). Spousal caregivers had lower levels of global cognition (β=0.196, 95% CI: 0.351-0.040, P=0.014), whereas grandparent caregivers who were separated, divorced, or widowed showed superior episodic memory (β=0.163, 95% CI:0.013-0.314, P=0.033).

Conclusion

The impact of informal caregiving on cognitive function in middle-aged and older adults varies significantly based on the caregiving role, intensity, and sociodemographic characteristics. Future policies should provide differentiated support for various caregiver groups to optimize their health outcomes.

Informal caregiving  /  Cognitive function  /  Middle-aged and older adults  /  Caregiving intensity  /  Caregiver roles
周梦琦, 韩琳, 陈思燃, 马蕊, 蒋晓悦, 杨子乙, 杜昱玲, 王珂瑞, 苏绍辉, 周一诺, 杨艳芳. 中国中老年人非正式照护与认知功能的纵向关联研究. 现代预防医学, 2026 , 53 (6) : 1094 -1098 . DOI: 10.20043/j.cnki.MPM.202511222
Meng-qi ZHOU, Lin HAN, Si-ran CHEN, Rui MA, Xiao-yue JIANG, Zi-yi YANG, Yu-ling DU, Ke-rui WANG, Shao-hui SU, Yi-nuo ZHOU, Yan-fang YANG. Longtitudinal effects of informal caregiving on cognitive function among middle-aged and older adults in China[J]. Modern Preventive Medicine, 2026 , 53 (6) : 1094 -1098 . DOI: 10.20043/j.cnki.MPM.202511222
随着人口老龄化及家庭结构变迁,我国中老年人对长期照护的需求持续增长。尽管独生子女政策自2015年起逐步放宽,其造成的家庭规模缩小与中老年人照护负担加重等结构性影响依然存在[1]。在孝道文化影响与正式照护体系尚不完善的背景下,非正式照护作为由家庭成员或亲密社会关系提供的、非机构化且无报酬的照护方式,仍为我国主要照护形式[2]。中老年人承担着照看孙辈、赡养年迈父母及照护配偶等多重照护任务,构成非照护体系中的核心人群。既往研究表明,适度参与非正式照护可能带来一定健康与认知收益[3],诸如通过日常活动与社交刺激延缓认知功能衰退[4];但长期高强度照护所伴随的身心负担亦可能损害照护者健康并加速认知衰退[5]。照护任务涵盖情感支持、日常照料与资源协调等多样化任务,当超出个体应对能力易致认知受损[6]。因此,照护时间强度与照护角色是影响照护者认知结局的重要因素[7-8]。研究表明,祖辈或代际照护对照护者认知的影响通常优于照护配偶[8-9],这可能与任务内容、情感投入及社会支持差异有关。此外,婚姻及居住状况作为重要的社会情境因素,可能影响非正式照护者可获得的支持资源及照护体验,从而在一定程度上调节照护与健康结局之间的关系[10]。
目前关于非正式照护对中老年照护者认知功能的研究仍存在不足。既有研究多关注照护的生理心理效应[11]或将中老年人作为被照护对象,如探讨家庭照护对痴呆或残障老人认知健康的影响[12],而对照护者自身的关注不足,且照护角色、强度及人口学特征对认知影响的差异尚未得到充分阐明。因此,本研究基于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据,分析非正式照护与照护者认知功能的关联,评估照护强度的影响,并进一步关注在不同婚姻或居住状况下,照护角色与认知功能关系的差异,以期为完善照护支持体系、推进健康老龄化提供参考。
CHARLS是一项针对中国45岁及以上人群的全国代表性调查。基线于2011年采用多阶段概率抽样在全国28个省共招募了17 708名受访者,此后每隔2~3年进行一次随访。本研究使用CHARLS第1~5轮(2011—2020年)数据,纳入标准:①基线年龄≥45岁;②完成基线调查并至少参加一次随访,且完成认知功能评估;③非正式照护信息完整。排除标准:①主要研究变量不完整者;②关键协变量缺失者。本研究最终共纳入4 841名受访者,形成20 874人次随访观测;个体重复调查次数的中位数及四分位数为5(4,5)次。
采用简易精神状态检查量表(Mini-Mental State Examination,MMSE)评估认知功能,包括情景记忆(即时与延迟词语回忆,0~10分)和执行功能(时间定向、计算能力与图形绘制,0~11分)两个维度[13]。总体认知得分为两维度之和(0~21分),得分越高表明认知功能越好。为统一不同认知测量维度的量纲并便于纵向比较,各维度得分均基于基线均值和标准差进行Z分数标准化处理(即每次得分减去基线均值后除以基线标准差)[14],并以各维度Z分数的平均值构建总体认知Z分数[15]。
主要自变量为受访者过去一年是否为家庭成员提供非正式照护。根据照护状态将受访者分为照护者(包含隔代、代际或配偶照护)与非照护者,进而细分为四类角色:①祖辈照护者:仅照顾孙辈;②子女照护者:仅照顾父母;③配偶照护者:当配偶在日常生活活动(ADL)或工具性日常生活活动(IADL)中至少一项需要协助时,受访者为其主要照护者;④多重照护者:同时承担两类及以上照护任务。此外,参考中国劳动法关于兼职与全职工作时间的标准,根据平均每周照护时间将照护强度分为三类:①低强度(<24小时/周);②中等强度(24~44小时/周);③高强度(>44小时/周)。
基于专业考虑并参考既往文献[16],本研究纳入年龄、性别、受教育程度、婚姻状况、居住地、抑郁症状、家庭规模及家庭经济状况作为协变量。
采用R 4.4.2软件进行数据整理及统计分析。连续变量以()表示,分类变量以频数和百分比表示;连续变量组间比较视分布特征采用单因素方差分析(ANOVA)或Kruskal–Wallis检验,分类变量采用χ2检验。构建线性混合效应模型(Linear Mixed-effects Model, LMM),模型在个体水平设置随机截距以刻画基线认知差异,并针对随访时间设置随机斜率,以允许个体间认知变化速率的异质性。固定效应包含照护变量、随访时间及协变量等;模型估计采用限制最大似然(Restricted Maximum Likelihood, REML)方法,并以AIC/BIC或似然比检验评估拟合。本研究主要关注照护者与非照护者在随访期间认知功能平均水平的差异。作为探索性分析,曾纳入照护×随访时间交互项以检验照护对认知变化速率的影响,但该项未显著改善拟合且引起收敛问题。基于研究目的及模型稳定性考量,最终结果基于不含交互项的模型报告。补充分析包括:检验照护强度与认知功能的关联;在不同婚姻及居住状况亚组中,对照护角色与认知功能关系进行分析,以探讨不同社会情境下照护角色与认知功能关联的异质性;并通过采用简化模型(仅含随机截距)开展敏感性分析。采用双侧检验,检验水准α=0.05。
本研究共纳入4 841名研究对象,平均年龄(60.99±9.81)岁,男性占43.94%,非照护者占65.96%,多重照护者与祖辈照护者为主要照护群体。非照护者的总体认知Z分数(0.05±0.96)略高于整体样本(0.03±0.96),配偶照护者显著较低(-0.55±0.95)。年龄、性别、受教育水平、婚姻与居住状况、居住地、家庭规模、家庭经济状况、抑郁症状、认知得分在组间存在差异(P<0.05)。其余见表1。
表2显示,照护者在总体认知(β=0.039,95% CI: 0.001~0.076,P=0.043)和执行功能(β=0.040,95% CI: 0.003~0.078,P=0.037)上优于非照护者,情景记忆无显著差异。在照护者子样本中进一步按照护强度分析发现,高强度照护与三项认知指标的较高得分相关,组间差异具有统计学意义;中强度仅与情景记忆得分较高相关(β=0.123,95% CI: 0.002~0.244,P=0.047);低强度未观察到明显关联。
亚组分析显示,不同照护角色在认知结局上存在差异(表3)。在已婚或同居人群中,配偶照护者总体认知(β=-0.196,95% CI:-0.351~-0.040,P=0.014)和情景记忆(β=-0.212,95% CI:-0.366~-0.058,P=0.007)得分较低,而多重照护者的总体认知得分较高(β=0.054,95% CI: 0.005~0.104,P=0.031);在分居、离异或丧偶人群中,祖辈照护者的情景记忆得分较高(β=0.163,95% CI: 0.013~0.314,P=0.033)。
基于替代模型的敏感性分析验证了结果的稳健性:照护状态与总体认知(β=0.047,95% CI: 0.009~0.086,P=0.016)和执行功能(β=0.045,95% CI: 0.007~0.083,P=0.021)得分之间的差异仍具有统计学意义;配偶照护始终与较差总体认知相关(β=-0.186,95% CI:-0.291~-0.080,P=0.001),而祖辈照护与总体认知得分较高相关(β=0.052,95% CI: 0.011~0.093,P=0.013)。
本研究基于CHARLS 2011—2020年的数据,探讨了非正式照护状态、强度和角色与中国中老年人认知功能的长期关联。结果显示,照护者在总体认知与执行功能上较非照护者略有优势,但情景记忆无显著差异;中高强度照护与较佳认知相关;配偶照护者的认知较差,无伴侣支持的祖辈照护者情景记忆表现更优,而多重照护者在已婚或同居人群中总体认知更佳。这些发现共同揭示非正式照护具有认知刺激与压力暴露的双重属性。
非正式照护与认知功能的正向关联支持“认知储备假说”。照护过程的复杂决策与问题处理能激活多种认知加工,促进神经可塑性和代偿机制,从而改善认知[17-18]。德国一项研究亦表明,认知参与度高的照护活动有助于减缓认知衰退[19],与本研究的结果一致。非照护者的较差认知表现则可能与社会隔离及认知刺激不足有关,这符合社会互动作为认知保护因素的既有结论[20]。认知和老化的脚手架理论(The Scaffolding Theory of Aging and Cognition,STAC)进一步为该机制提供解释框架。该理论强调,大脑通过建立补偿性神经网络以缓解脑老化带来的认知下降[21],而家庭照护可能通过提升问题解决能力及带来成就感促进该过程[22]。
然而,非正式照护对认知的影响存在显著异质性。本研究发现中高强度照护与认知表现更优相关,提示适度负荷可能通过激活额叶、海马等脑区产生认知效益[23]。但既有研究结论尚存分歧,有研究认为任何照护强度均与较高认知水平相关[24],而更多证据提示高强度照护常伴随主观负担与认知损害[25-26]。这种差异可能与样本特征及文化背景密切相关,提示其受多重因素调节。在不同照护角色中,配偶照护者因长期面对日常生活能力受损的配偶,承受持续身心压力,慢性应激可能通过影响海马功能损害认知[27];祖辈照护者则可能从代际互动中获得情感支持与认知刺激[24];多重照护者的认知优势可能与多任务引发的额叶刺激有关[28],婚姻或同居关系提供的情感支持与资源共享亦可缓解照护压力,体现了照护角色与社会情境共同塑造认知结局的复杂性。
本研究为理解中低收入国家背景下非正式照护与中老年认知功能的关系提供了重要证据。通过细分照护状态、强度与角色等,研究揭示了非正式照护对认知功能的影响存在异质性,并对传统“负担导向”的模型作出修正,表明在适当强度与特定角色下,非正式照护可能通过认知刺激产生积极效应,这为理解照护与认知的关系提供了辩证视角。政策层面需在维护家庭照护功能的同时,重点关注高负担照护者(如配偶照护者),加强家庭与社区照护体系建设,为其提供针对性支持。
本研究仍存在一定局限。首先,尽管采用纵向设计有助于刻画时间序列关系,但作为观测性研究,仍难以完全排除残余混杂及反向因果的可能性,包括照护者自身健康状况可能同时影响其参与非正式照护的可能性及认知功能水平。其次,认知功能评估依赖于MMSE量表,对于认知的测量深度有限。最后,本研究中占比最高的照护角色为祖辈照护者与多重照护者,其余角色样本量较小,相关亚组分析为探索性结果,统计效力有限,需在更大样本中予以进一步验证。

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2026年第53卷第6期
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doi: 10.20043/j.cnki.MPM.202511222
  • 接收时间:2025-11-14
  • 首发时间:2026-11-02
  • 出版时间:2026-03-25
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    1.四川大学华西公共卫生学院/华西第四医院 流行病与卫生统计学系,四川 成都 610041
    2.四川大学华西第四医院 神经内科

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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
栓菌属 Trametes 5 2.39
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