Article(id=1320442586930729045, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, articleNumber=null, orderNo=null, doi=10.11847/zgggws1148133, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1749052800000, receivedDateStr=2025-06-05, revisedDate=1754150400000, revisedDateStr=2025-08-03, acceptedDate=1760025600000, acceptedDateStr=2025-10-10, onlineDate=1792747645360, onlineDateStr=2026-10-23, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792747645360, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792747645360, creator=13701087609, updateTime=1792747645360, updator=13701087609, issue=Issue{id=1320442558581424898, tenantId=1146029695717560320, journalId=1319373219989389464, year='2026', volume='42', issue='2', pageStart='129', pageEnd='256', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792747638602, creator='13701087609', updateTime=1792748118043, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320444569574031427, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320444569578225732, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=212, endPage=216, ext={EN=ArticleExt(id=1320442587119472726, articleId=1320442586930729045, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Impact of activity frequency on self-care ability of Chinese older adults: an analysis based on 2021 CLHLS data, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the impact of activity frequency on the self-care ability of older adults in China, providing a reference for developing active aging strategies aligned with their activity patterns.

Methods

Data were drawn from the 2021 Chinese Longitudinal Healthy Longevity Survey (CLHLS) covering 14 022 older adults aged ≥ 65 years in 27 provinces (autonomous regions and municipalities). Multivariate ordinal logistic regression models were employed to analyze the associations between activity frequency and two functional outcomes: activities of daily living (ADL) and instrumental activities of daily living (IADL).

Results

Among the 14 022 participants, 9 474 (67.6%), 1 037 (7.4%), and 3 511 (25.0%) showed the ADL status of full independence, requiring partial assistance, and full dependence, respectively; 3 803 (27.1%), 2 104 (15.0%), and 8 115 (57.9%) exhibited the IADL status of full independence, requiring partial assistance, and full dependence, respectively. The activity frequency was low, moderate, and high in 2 830 (20.2%), 143 (1.0%), and 11 049 (78.8%) participants, respectively. After adjustment for sex, age, children′s financial support, marital status, residence, income adequacy, and pension insurance, multivariate ordinal logistic regression analysis revealed that compared with the low-frequency group, the moderate-frequency group had reduced risks of ADL impairment (OR = 0.309, 95%CI: 0.218–0.437) and IADL impairment (OR = 0.175, 95%CI: 0.110–0.280). Furthermore, compared with the low-frequency group, the high-frequency group had decreased risks of ADL impairment (OR = 0.142, 95%CI: 0.129–0.156) and IADL impairment (OR = 0.082, 95%CI: 0.067–0.100).

Conclusions

Increased activity frequency is associated with a reduced risk of ADL and IADL impairment among older adults in China, promoting greater independence.

, authors=Tian WANG1, 4, Wanting YANG2, 4, Tao WANG3, Hongbin CAO1, Yang LIU1, authorsList=Tian WANG, Wanting YANG, Tao WANG, Hongbin CAO, Yang LIU, authorCompany=null, correspAuthors=Tao WANG, authorNote=null, correspAuthorsNote=
WANG Tao, E-mail:
, copyrightStatement=Copyright © 2026 Chinese Journal of Public Health. All rights reserved., 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=1320442588159660127, articleId=1320442586930729045, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=中国老年人不同活动频率对其生活自理能力影响:基于2021年CLHLS数据库, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

探讨中国老年人不同活动频率对其生活自理能力的影响,为制定适合中国老年人活动习惯的积极老龄化策略提供参考依据。

方法

收集2021年中国老年健康影响因素跟踪调查(CLHLS)中27个省(自治区、直辖市)14 022名≥65岁老年人相关数据。采用多元有序logistic回归模型分析老年人不同活动频率对其日常生活活动能力(ADL)和工具性日常生活活动能力(IADL)的影响。

结果

中国14 022名老年人中,ADL完全可以自理9 474人(67.6%),部分需要帮助1 037人(7.4%),完全不能自理3 511人(25.0%);IADL完全可以自理3 803人(27.1%),部分需要帮助2 104人(15.0%),完全不能自理8 115人(57.9%);活动频率为低频率2 830人(20.2%),中等频率143人(1.0%),高频率11 049人(78.8%)。在调整了性别、年龄、子女经济支持、婚姻状况、居住地、收入是否够用和有无养老保险等混杂因素后,多元有序logistic回归分析结果显示,中等活动频率的中国老年人ADL和IADL失能风险分别是低活动频率中国老年人的0.309倍(OR=0.309,95%CI=0.218~0.437)和0.175倍(OR=0.175,95%CI=0.110~0.280);高活动频率中国老年人ADL和IADL失能风险分别是低活动频率中国老年人的0.142倍(OR=0.142,95%CI=0.129~0.156)和0.082倍(OR=0.082,95%CI=0.067~0.100)。

结论

高频率活动可改善中国老年人ADL和IADL的失能风险,增强其自理能力。

, authors=望甜1, 4, 杨婉婷2, 4, 王涛3, *, *, 曹宏彬1, 刘洋1, authorsList=望甜, 杨婉婷, 王涛, 曹宏彬, 刘洋, authorCompany=null, correspAuthors=王涛, authorNote=

望甜(1982—),副教授,博士,研究方向:人口学、资源与环境可持续发展

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王涛,E-mail:
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Comparisons of activities of daily living among Chinese older adults with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
特征分组完全可以自理部分需要帮助完全不能自理χ2值P值
人数%人数%人数%
性别男性457473.54106.61 23519.9188.751<0.001
女性490062.86278.02 27629.2
年龄/岁65~742 21493.9652.8803.42 400.000<0.001
75~843 14386.61995.52898.0
≥85411751.37739.63 14239.1
子女经济支持无415863.25207.91 89228.8107.725<0.001
有531671.35176.91 61921.7
婚姻状况非在婚500157.77508.72 90933.61 600.000<0.001
在婚447383.42875.360211.2
居住地城镇669967.07447.42 55725.65.7230.057
农村2 77569.02937.395423.7
收入是否够用不够用1 05757.51508.263134.3186.275<0.001
够用841769.18877.32 88023.6
养老保险无393766.64287.21 54226.16.2030.045
有553768.26097.51 96924.3
活动频率低频率65823.328610.11 88666.63 600.000<0.001
中等频率8055.9117.75236.4
高频率873679.17406.71 57314.2
), ArticleFig(id=1320442591913562259, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586930729045, language=CN, label=表1, caption=

中国不同特征老年人ADL比较

, figureFileSmall=null, figureFileBig=null, tableContent=
特征分组完全可以自理部分需要帮助完全不能自理χ2值P值
人数%人数%人数%
性别男性457473.54106.61 23519.9188.751<0.001
女性490062.86278.02 27629.2
年龄/岁65~742 21493.9652.8803.42 400.000<0.001
75~843 14386.61995.52898.0
≥85411751.37739.63 14239.1
子女经济支持无415863.25207.91 89228.8107.725<0.001
有531671.35176.91 61921.7
婚姻状况非在婚500157.77508.72 90933.61 600.000<0.001
在婚447383.42875.360211.2
居住地城镇669967.07447.42 55725.65.7230.057
农村2 77569.02937.395423.7
收入是否够用不够用1 05757.51508.263134.3186.275<0.001
够用841769.18877.32 88023.6
养老保险无393766.64287.21 54226.16.2030.045
有553768.26097.51 96924.3
活动频率低频率65823.328610.11 88666.63 600.000<0.001
中等频率8055.9117.75236.4
高频率873679.17406.71 57314.2
), ArticleFig(id=1320442591997448340, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586930729045, language=EN, label=Tab.2, caption=

Comparisons of instrumental activities of daily living among Chinese older adults with different characteristics

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特征分组完全可以自理部分需要帮助完全不能自理χ2值P值
人数%人数%人数%
性别男性2 32337.495715.42 93947.3650.038<0.001
女性1 48019.01 14714.7517666.3
年龄/岁65~741 55165.738716.442117.94 400.000<0.001
75~841 55242.878321.61 29635.7
≥857008.793411.6639879.7
子女经济支持无1 57023.985213.0414863.1140.745<0.001
有2 23330.01 25216.8396753.2
婚姻状况非在婚1 27614.71 13913.2624572.12 100.000<0.001
在婚2 52747.196518.01 87034.9
居住地城镇2 79027.91 44814.5576257.614.577<0.001
农村1 01325.265616.32 35358.5
收入是否够用不够用34518.823412.71 25968.5102.944<0.001
够用345828.41 87015.3685656.3
养老保险无1 59327.085914.5345558.52.2170.330
有2 21027.21 24515.3466057.4
活动频率低频率321.1802.82 71896.12 200.000<0.001
中等频率2014.0128.411177.6
高频率375134.02 01218.2528647.8
), ArticleFig(id=1320442592093917333, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586930729045, language=CN, label=表2, caption=

中国不同特征老年人IADL比较

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特征分组完全可以自理部分需要帮助完全不能自理χ2值P值
人数%人数%人数%
性别男性2 32337.495715.42 93947.3650.038<0.001
女性1 48019.01 14714.7517666.3
年龄/岁65~741 55165.738716.442117.94 400.000<0.001
75~841 55242.878321.61 29635.7
≥857008.793411.6639879.7
子女经济支持无1 57023.985213.0414863.1140.745<0.001
有2 23330.01 25216.8396753.2
婚姻状况非在婚1 27614.71 13913.2624572.12 100.000<0.001
在婚2 52747.196518.01 87034.9
居住地城镇2 79027.91 44814.5576257.614.577<0.001
农村1 01325.265616.32 35358.5
收入是否够用不够用34518.823412.71 25968.5102.944<0.001
够用345828.41 87015.3685656.3
养老保险无1 59327.085914.5345558.52.2170.330
有2 21027.21 24515.3466057.4
活动频率低频率321.1802.82 71896.12 200.000<0.001
中等频率2014.0128.411177.6
高频率375134.02 01218.2528647.8
), ArticleFig(id=1320442592186192022, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586930729045, language=EN, label=Tab.3, caption=

Multivariable ordinal logistic regression analysis of factors influencing activities of daily living among Chinese older adults

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因素比较组参照组β $ {S}_{x}^{\_} $Wald χ2值P值OR值95%CI
性别女性男性0.1260.0517.8400.0051.1341.038~1.238
年龄/岁75~8465~740.7390.21154.023<0.0012.0951.720~2.551
≥852.0500.741462.250<0.0017.7726.447~9.370
婚姻状况在婚非在婚–0.2070.04414.364<0.0010.8130.731~0.905
居住地城镇农村0.2100.05720.430<0.0011.2341.126~1.352
子女经济支持有无–0.1810.03518.923<0.0010.8340.769~0.905
收入是否够用够用不够用–0.5680.03489.114<0.0010.5670.504~0.638
活动频率中等频率低频率–1.1750.05543.957<0.0010.3090.218~0.437
高频率–1.9490.0071 590.617<0.0010.1420.129~0.156
), ArticleFig(id=1320442592261689495, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586930729045, language=CN, label=表3, caption=

中国老年人ADL影响因素多因素有序logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素比较组参照组β $ {S}_{x}^{\_} $Wald χ2值P值OR值95%CI
性别女性男性0.1260.0517.8400.0051.1341.038~1.238
年龄/岁75~8465~740.7390.21154.023<0.0012.0951.720~2.551
≥852.0500.741462.250<0.0017.7726.447~9.370
婚姻状况在婚非在婚–0.2070.04414.364<0.0010.8130.731~0.905
居住地城镇农村0.2100.05720.430<0.0011.2341.126~1.352
子女经济支持有无–0.1810.03518.923<0.0010.8340.769~0.905
收入是否够用够用不够用–0.5680.03489.114<0.0010.5670.504~0.638
活动频率中等频率低频率–1.1750.05543.957<0.0010.3090.218~0.437
高频率–1.9490.0071 590.617<0.0010.1420.129~0.156
), ArticleFig(id=1320442592383324312, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586930729045, language=EN, label=Tab.4, caption=

Multivariable ordinal logistic regression analysis of factors influencing instrumental activities of daily living in Chinese older adults

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因素比较组参照组β $ {S}_{x}^{\_} $Wald χ2值P值OR值95%CI
性别女性男性0.6490.078257.282<0.0011.9191.772~2.078
年龄/岁75~8465~740.8820.133256.961<0.0012.4162.169~2.691
≥852.4270.6681 695.792<0.00111.32610.090~12.713
子女经济支持有无–0.1860.03222.944<0.0010.8290.767~0.895
婚姻状况在婚非在婚–0.3890.03076.913<0.0010.6790.623~0.741
收入是否够用够用不够用–0.7310.030137.358<0.0010.4810.426~0.544
活动频率中等频率低频率–1.7420.04253.290<0.0010.1750.110~0.280
高频率–2.5030.008596.825<0.0010.0820.067~0.100
), ArticleFig(id=1320442592504959129, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442586930729045, language=CN, label=表4, caption=

中国老年人IADL影响因素多因素有序logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素比较组参照组β $ {S}_{x}^{\_} $Wald χ2值P值OR值95%CI
性别女性男性0.6490.078257.282<0.0011.9191.772~2.078
年龄/岁75~8465~740.8820.133256.961<0.0012.4162.169~2.691
≥852.4270.6681 695.792<0.00111.32610.090~12.713
子女经济支持有无–0.1860.03222.944<0.0010.8290.767~0.895
婚姻状况在婚非在婚–0.3890.03076.913<0.0010.6790.623~0.741
收入是否够用够用不够用–0.7310.030137.358<0.0010.4810.426~0.544
活动频率中等频率低频率–1.7420.04253.290<0.0010.1750.110~0.280
高频率–2.5030.008596.825<0.0010.0820.067~0.100
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中国老年人不同活动频率对其生活自理能力影响:基于2021年CLHLS数据库
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望甜 1, 4 , 杨婉婷 2, 4 , 王涛 3, *, * , 曹宏彬 1 , 刘洋 1
中国公共卫生 | 调查报告与分析 2026,42(2): 212-216
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中国公共卫生 |调查报告与分析 2026 , 42 (2) : 212 -216
中国老年人不同活动频率对其生活自理能力影响:基于2021年CLHLS数据库
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望甜(1982—),副教授,博士,研究方向:人口学、资源与环境可持续发展

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望甜1, 4, 杨婉婷2, 4, 王涛3, *, * , 曹宏彬1, 刘洋1
作者信息
  • 1湖北汽车工业学院汽车商学院,十堰 442002
  • 2湖北汽车工业学院数字经济学院,十堰 442002
  • 3吉林大学东北亚研究院,长春 130012
  • 4湖北汽车工业学院绿色低碳研究院,十堰 442002
通讯作者:
王涛,E-mail:
作者简介:

望甜(1982—),副教授,博士,研究方向:人口学、资源与环境可持续发展

Impact of activity frequency on self-care ability of Chinese older adults: an analysis based on 2021 CLHLS data
Tian WANG1, 4, Wanting YANG2, 4, Tao WANG3 , Hongbin CAO1, Yang LIU1
Affiliations
  • 1School of Automotive Business, Hubei University of Automotive Technology, Shiyan 442002, China
  • 2School of Digital Economy, Hubei University of Automotive Technology, Shiyan 442002, China
  • 3Northeast Asian Studies College, Jilin University, Changchun 130012, China
  • 4Green and Low-Carbon Research Institute, Hubei University of Automotive Technology‌, Shiyan 442002
  • Corresponding Author:
    WANG Tao, E-mail:
出版时间: 2026-02-10 doi: 10.11847/zgggws1148133
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目的

探讨中国老年人不同活动频率对其生活自理能力的影响,为制定适合中国老年人活动习惯的积极老龄化策略提供参考依据。

方法

收集2021年中国老年健康影响因素跟踪调查(CLHLS)中27个省(自治区、直辖市)14 022名≥65岁老年人相关数据。采用多元有序logistic回归模型分析老年人不同活动频率对其日常生活活动能力(ADL)和工具性日常生活活动能力(IADL)的影响。

结果

中国14 022名老年人中,ADL完全可以自理9 474人(67.6%),部分需要帮助1 037人(7.4%),完全不能自理3 511人(25.0%);IADL完全可以自理3 803人(27.1%),部分需要帮助2 104人(15.0%),完全不能自理8 115人(57.9%);活动频率为低频率2 830人(20.2%),中等频率143人(1.0%),高频率11 049人(78.8%)。在调整了性别、年龄、子女经济支持、婚姻状况、居住地、收入是否够用和有无养老保险等混杂因素后,多元有序logistic回归分析结果显示,中等活动频率的中国老年人ADL和IADL失能风险分别是低活动频率中国老年人的0.309倍(OR=0.309,95%CI=0.218~0.437)和0.175倍(OR=0.175,95%CI=0.110~0.280);高活动频率中国老年人ADL和IADL失能风险分别是低活动频率中国老年人的0.142倍(OR=0.142,95%CI=0.129~0.156)和0.082倍(OR=0.082,95%CI=0.067~0.100)。

结论

高频率活动可改善中国老年人ADL和IADL的失能风险,增强其自理能力。

活动频率  /  生活自理能力  /  影响  /  老年人  /  中国
Objective

To investigate the impact of activity frequency on the self-care ability of older adults in China, providing a reference for developing active aging strategies aligned with their activity patterns.

Methods

Data were drawn from the 2021 Chinese Longitudinal Healthy Longevity Survey (CLHLS) covering 14 022 older adults aged ≥ 65 years in 27 provinces (autonomous regions and municipalities). Multivariate ordinal logistic regression models were employed to analyze the associations between activity frequency and two functional outcomes: activities of daily living (ADL) and instrumental activities of daily living (IADL).

Results

Among the 14 022 participants, 9 474 (67.6%), 1 037 (7.4%), and 3 511 (25.0%) showed the ADL status of full independence, requiring partial assistance, and full dependence, respectively; 3 803 (27.1%), 2 104 (15.0%), and 8 115 (57.9%) exhibited the IADL status of full independence, requiring partial assistance, and full dependence, respectively. The activity frequency was low, moderate, and high in 2 830 (20.2%), 143 (1.0%), and 11 049 (78.8%) participants, respectively. After adjustment for sex, age, children′s financial support, marital status, residence, income adequacy, and pension insurance, multivariate ordinal logistic regression analysis revealed that compared with the low-frequency group, the moderate-frequency group had reduced risks of ADL impairment (OR = 0.309, 95%CI: 0.218–0.437) and IADL impairment (OR = 0.175, 95%CI: 0.110–0.280). Furthermore, compared with the low-frequency group, the high-frequency group had decreased risks of ADL impairment (OR = 0.142, 95%CI: 0.129–0.156) and IADL impairment (OR = 0.082, 95%CI: 0.067–0.100).

Conclusions

Increased activity frequency is associated with a reduced risk of ADL and IADL impairment among older adults in China, promoting greater independence.

activity frequency  /  self-care ability  /  impact  /  older adults  /  China
望甜, 杨婉婷, 王涛, 曹宏彬, 刘洋. 中国老年人不同活动频率对其生活自理能力影响:基于2021年CLHLS数据库. 中国公共卫生, 2026 , 42 (2) : 212 -216 . DOI: 10.11847/zgggws1148133
Tian WANG, Wanting YANG, Tao WANG, Hongbin CAO, Yang LIU. Impact of activity frequency on self-care ability of Chinese older adults: an analysis based on 2021 CLHLS data[J]. Chinese Journal of Public Health, 2026 , 42 (2) : 212 -216 . DOI: 10.11847/zgggws1148133
随着全球老龄化进程的加速,预测21世纪中叶≥60岁人口将达21亿[1]。中国作为老年人口最多的国家,老年人规模已突破3.1亿[2],预计在2030年前将迈入深度老龄化社会阶段,这一人口转变将带来巨大挑战。国家统计局数据显示,2023年中国基本养老保险基金支出已占国内生产总值(Gross Domestic Product, GDP)的5.4%[3]。提升老年人自理能力对于积极老龄化和缓解社会赡养压力至关重要。多项研究表明,运动锻炼对老年人健康具有多重益处,可降低慢性病患病风险[4–5]、降低心血管疾病发病率[6]、延缓阿尔茨海默病发生[7]、改善身心健康状况[8]以及提高健康水平和生活质量[9]等。为探讨中国老年人不同活动频率对其生活自理能力的影响,为制定适合中国老年人活动习惯的积极老龄化策略提供参考依据,本研究收集2021年中国老年健康影响因素跟踪调查(Chinese Longitudinal Healthy Longevity Survey, CLHLS)中27个省(自治区、直辖市)14022名≥65岁老年人相关数据,采用多元有序logistic回归模型分析不同活动频率对其日常生活活动能力(Activities of Daily Living, ADL)和工具性日常生活活动能力(Instrumental Activities of Daily Living, IADL)的影响。结果报告如下。
资料来源于CLHLS,该调查由北京大学健康老龄与发展研究中心/国家发展研究院组织,基线调查始于1998年,1998—2018年共开展8轮跟踪及补充调查,覆盖23个省(自治区、直辖市),2021年的第9次调查进一步扩展至27个省(自治区、直辖市),数据面向学术界开放共享。本研究提取其中2021年的追踪队列数据,经过样本清洗并剔除关键变量缺失值后,最终纳入14 022名≥65岁老年人的相关数据进行分析。研究变量包括性别、年龄、子女经济支持、婚姻状况、居住地、收入是否够用、有无养老保险、活动频率、ADL和IADL等。其中,活动频率由室内活动(包括做家务、种花养宠物、阅读书报、饲养家禽家畜、打牌打麻将、看电视听广播和上网等)、户外活动(包括打太极拳、广场舞和串门与朋友交往等)和社会活动(参加有组织的活动)3种活动类型具体项目中出现的频率确定频率等级[10]。老年人在上述活动中,存在≥1个项目为“几乎每天”或“不是每天,而是每周一次”视为高频率,无高频率项目且存在≥1个项目为“不是每周一次,但至少每月一次”视为中等频率,所有项目均为“不是每月一次,但有时”或“不参加”视为低频率。ADL包括洗澡、穿衣、如厕、室内活动、大小便控制和进餐共6项活动[11]。IADL包括邻居家串门、外出买东西、做饭、洗衣服、行走一段路、提起5 kg重物、搭乘交通工具出行和连续蹲站3次共8项活动[12]。每项活动按完成情况分为“不需要任何帮助可以完成”“需要部分帮助完成”和“完全需要帮助完成”。本研究将ADL或IADL中所有项目均选择“不需要任何帮助可以完成”定义为完全可以自理;ADL或IADL中所有活动中有≥1项选择“需要部分帮助完成”且其他项均未选择“完全需要帮助完成”定义为部分需要帮助;ADL或IADL中所有活动中有≥1项选择“完全需要帮助完成”定义为完全不能自理。
使用Stata 18.0统计软件进行一般描述性分析、χ2检验和多元有序logistic回归分析。首先统一ADL与IADL赋值方向(1=完全自理、2=部分需要帮助、3=完全不能自理);其次通过 χ2检验筛选与ADL/IADL相关的自变量;最后建立多元有序logistic回归模型,分析不同活动频率(低/中等/高)对其ADL和IADL的影响。多元有序logistic回归模型适用于因变量为有序分类的情况,可以更准确地体现ADL和IADL的顺序性,模型表达形式为:$ {\text{logit}}(P(Y \leqslant j'X)) ={\alpha _j} - ({\beta _1}{X_1} + {\beta _2}{X_2} + \ldots+ {\beta _k}{X_k}) $。其中,Y为因变量;j为有序类别(完全自理、部分需要帮助、完全不能自理);$ {\alpha _j} $为每个类别的阈值参数,表示达到该类别的条件;X为解释变量,包括活动频率和其他控制变量。检验水准为双侧检验α= 0.05。
中国14 022名老年人中,男性6 219人(44.4%),女性7 803人(55.6%);年龄65~74岁2 359人(16.8%),75~84岁3 631人(25.9%),≥85岁8 032人(57.3%);无子女经济支持6 570人(46.9%),有子女经济支持7 452人(53.1%);婚姻状况中非在婚8 660人(61.8%),在婚5 362人(38.2%);居住在城镇10 000人(71.3%),农村4 022人(28.7%);收入不够用1 838人(13.1%),够用12 184人(86.9%);无养老保险5 907人(42.1%),有养老保险8 115人(57.9%);活动频率为高频率11 049人(78.8%),中等频率143人(1.0%),低频率2 830人(20.2%)。
中国14 022名老年人中,ADL完全可以自理9 474人(67.6%),部分需要帮助1 037人(7.4%),完全不能自理3 511人(25.0%);IADL完全可以自理3 803人(27.1%),部分需要帮助2 104人(15.0%),完全不能自理8 115人(57.9%)。不同特征老年人比较,不同性别、年龄、子女经济支持、婚姻状况、收入是否够用、有无养老保险和不同活动频率老年人的ADL情况差异均有统计学意义(均P<0.05);不同性别、年龄、子女经济支持、婚姻状况、居住地、收入是否够用和不同活动频率老年人的IADL情况,差异均有统计学意义(均P<0.05)。
分别以中国老年人ADL(1=完全可以自理,2=部分需要帮助,3=完全不能自理)和IADL(1=完全可以自理,2=部分需要帮助,3=完全不能自理)为因变量,以性别、年龄、子女经济支持、婚姻状况、居住地、收入是否够用、有无养老保险和不同活动频率为自变量进行多因素有序logistic回归分析。结果显示,女性、年龄≥75岁和居住在城镇老年人的ADL失能风险较高;在婚、有子女经济支持、收入够用、中等和高活动频率中国老年人的ADL失能风险较低;女性和年龄≥75岁老年人的IADL失能风险较高;有子女经济支持、在婚、收入够用、中等和高活动频率中国老年人的IADL失能风险较低。
本研究基于2021年CLHLS数据探讨不同活动频率对中国老年人生活自理能力的影响。在调整性别、年龄、子女经济支持、婚姻状况、居住地、收入是否够用和有无养老保险等混杂因素后,多元有序logistic回归分析结果显示,中等活动频率的中国老年人ADL和IADL失能风险分别是低活动频率中国老年人的0.309倍(OR=0.309,95%CI=0.218~0.437)和0.175倍(OR=0.175,95%CI=0.110~0.280),高活动频率的中国老年人ADL和IADL失能风险分别是低活动频率中国老年人的0.142倍(OR=0.142,95%CI=0.129~0.156)和0.082倍(OR=0.082,95%CI=0.067~0.100)。提示中等和高频率的活动可降低中国老年人ADL和IADL的失能风险[13–14],且活动频率越高,保护效应越强。鼓励我国老年人增加活动,即便是日常生活中的活动,尽可能保持规律参与(即使达不到每天或每周的高频,达到≥1次/月的中等频率),对降低其失能风险至关重要。因此,建议根据老年人个体健康状况,循序渐进地增加活动量和频率,即使身体条件不允许不能进行体育运动,进行身体条件允许的日常活动也能有效降低失能风险。
本研究发现,高龄和女性是失能的重要因素[15]。年龄≥85岁老年人ADL和IADL的失能风险分别为65~74岁老年人的7.772倍(OR=7.772,95%CI=6.447~9.370)和11.326倍(OR=11.326,95%CI=10.090~12.713)。随着年龄的增长,老年人的身体机能逐渐下降,自理能力也随之降低[16]。女性失能风险高于男性,可能与女性更容易出现抑郁、孤独和焦虑等负面情绪[17],及活动强度不足有关[18]。此外,老年女性预期寿命更长,高龄女性比例更高,暴露于失能风险的时间更久[19]。因此,需针对女性老年人开展力量训练、积极活动、心理健康干预以及社会支持服务。
本研究还揭示了社会经济因素对自理能力的重要影响。有子女经济支持的老年人ADL和IADL失能风险分别为无子女经济支持老年人的0.834倍(OR=0.834,95%CI=0.769~0.905)和0.829倍(OR=0.829,95%CI=0.767~0.895),这可能是因为来自子女的经济支持不仅可以改善老年人的生活条件,还能提供一定的情感支持和交流,这对老年人的自理能力具有一定的保护作用。同时,收入够用老年人的ADL和IADL失能风险分别为收入不够用老年人的0.567倍(OR=0.567,95%CI=0.504~0.638)和0.481倍(OR=0.481,95%CI=0.426~0.544)。经济支持提升老年人健康安全感,提示充足的物质保障可减少因医疗、生活开支产生的焦虑,间接维护身体功能[20]。此外,在婚状态亦明显降低老年人的ADL和IADL失能风险,这可能与有配偶的老年人能得到伴侣的日常照料、精神支持,促进了健康生活方式[21],从而缓冲年老带来的功能衰退。
本研究显示,老年人的自理能力存在独特的城乡差异特征。城镇居住老年人ADL的失能风险较高,但IADL失能风险与农村居住老年人无明显差异。这可能是因为城镇快节奏生活压缩了老年人的活动时间和活动范围,难以形成持续的健康刺激[22]。因此,城镇应加强慢性病管理与提供时间灵活的社区活动项目,农村则需改善适老化设施与资源的可达性。
综上所述,促进老年人多样化、规律性活动是一项低成本、低风险、高产出且易落实的公共卫生干预措施,应纳入到国家老龄事业规划和健康中国行动计划中。建议在社区建设适老化的活动场所,推广适合各层次老年人的活动项目和健康教育。对高龄和衰弱老年人,应重在提供安全、低强度且社交支持性的活动选项;对低收入、居住在城镇和女性老年人,则需配套相应的社会支持和经济保障政策,消除参与障碍。需要说明的是,本研究中≥85岁高龄老年人占57.3%,此现象主要源于CLHLS数据已持续跟踪27年,故样本中高龄老年人占比较高。这一结构虽能反映中国人口高龄化的发展趋势,使研究结论对中高龄老年群体具有更强的针对性,并对中高龄老年人防控失能风险具有一定启示作用,但也可能在一定程度上限制了结论对低龄老年群体的普适性。鉴于高龄与低龄老年人在生理机能、生活需求和干预响应上均存在明显差异,后续研究将进一步对不同年龄组样本开展分层分析,从而更全面地揭示各年龄段老年人活动频率与自理能力的关联特征。此外,由于本研究中活动频率基于老年人自我报告,可能存在一定回忆偏倚,且横断面设计难以确立因果关系,未来需通过队列研究进一步验证活动频率与失能的时序关联。

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doi: 10.11847/zgggws1148133
  • 接收时间:2025-06-05
  • 首发时间:2026-10-23
  • 出版时间:2026-02-10
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  • 收稿日期:2025-06-05
  • 修回日期:2025-08-03
  • 录用日期:2025-10-10
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    1湖北汽车工业学院汽车商学院,十堰 442002
    2湖北汽车工业学院数字经济学院,十堰 442002
    3吉林大学东北亚研究院,长春 130012
    4湖北汽车工业学院绿色低碳研究院,十堰 442002

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