贵州农村老年人社会支持与认知功能的关系及焦虑睡眠的中介作用

目的 探讨贵州农村老年人社会支持与认知功能的联系，并分析焦虑和睡眠在其间的中介作用，为认知功能减退及痴呆的行为预防提供科学参考。方法 于2019年7—8月采用多阶段整群随机抽样方法选取贵州农村≥60岁者共1 615人作为调查对象，采用自编一般情况调查表、社会支持评定量表（SSRS）、简易智力状态检测量表（MMSE）、阿森斯失眠量表（AIS）、焦虑状态量表（GAD - 2）进行问卷调查。采用结构方程模型探讨老年人社会支持水平、焦虑、睡眠及认知功能四者间的联系。结果 1 615名老年人认知功能得分为（21.09±5.21）分，女性（t = 16.559,P＜0.001）、少数民族（t = 2.425,P = 0.015）、非在婚（t = 8.954,P＜0.001）、年龄越大（F = 42.638,P＜0.001）、文化程度越低（F = 174.167,P＜0.001）的老年人认知功能相对较差。MMSE得分与GAD - 2、AIS得分均呈负相关，与SSRS得分呈正相关（r = - 0.135、 - 0.135、0.271，P＜0.01）。结构方程模型结果显示，社会支持水平对认知功能的总效应值为0.374，其中社会支持对认知功能的直接效应值0.353（95%CI:0.294～0.411），睡眠的中介效应值0.010（95%CI:0.002～0.020）及焦虑和睡眠的链式中介效应值0.011（95%CI:0.003～0.020）。结论 老年人社会支持可能直接影响认知功能，也可能通过睡眠质量的中介作用及睡眠和焦虑的链式中介作用间接影响认知功能。

Relationship between social support and cognitive function and mediation of anxiety and sleep in rural aged people in Guizhou

Objective To explore the relationship between social support and cognitive function in rural elderly in Guizhou, and to analyze the mediating role of anxiety and sleep, so as to provide a scientific reference for behavioral prevention of cognitive decline and dementia. Methods A total of 1 615 rural residents ≥ 60 years old in Guizhou were selected as respondents using a multistage cluster random sampling method from July to August in 2019, and a questionnaire survey was conducted using a self-developed general condition questionnaire, social support rating scale (SSRS), Mini-Mental State Examination (MMSE), Athens Insomnia Scale (AIS), and Anxiety State Scale (GAD-2). Structural equation model was used to explore the relationship between social support level, anxiety, sleep, and cognitive function in the elderly. Results The cognitive function score of 1 615 elderly was (21.09±5.21) points, and the cognitive function of the elderly was relatively poor in females (t= 16.559, P<0.001), ethnic minorities (t=2.425, P=0.015), the non-married (t=8.954, P<0.001), the aged (F=42.638, P<0.001), and those with lower education level (F=174.167, P<0.001). MMSE scores were negatively correlated with both GAD-2 and AIS scores and positively correlated with SSRS scores (r=-0.135, -0.135, and 0.271, P<0.01). The results of structural equation model showed that the total effect of social support level on cognitive function was 0.374, in which the direct effect value of social support on cognitive function was 0.353 (95%CI: 0.294-0.411), the mediating effect value of sleep was 0.010 (95%CI: 0.002-0.020), and the chain mediating effect value of anxiety and sleep was 0.011 (95%CI: 0.003-0.020). Conclusion Social support in the elderly may directly affect cognitive function and may also indirectly affect cognitive function through the mediating effect of sleep quality and the chained mediating effect of sleep and anxiety.