2015—2018年湖北省抽样点老年人日常生活活动能力受损发生情况及其影响因素队列研究

目的 了解湖北省抽样点荆门市东宝区、黄冈市蕲春县老年人2015—2018年日常生活活动(activities of daily living,ADL)能力受损情况及其影响因素。 方法 依据多阶段分层整群抽样,2015年基线调查在湖北省抽取2个代表点共计4 041名研究对象,2018年随访,剔除2015年基线ADL已受损对象及3年间失访、死亡、数据不完整人群,最终纳入2 927名≥60岁老年人作为研究对象,对其进行问卷调查、身体测量、日常生活活动能力评估,采用单因素χ²检验及多因素logistic回归模型分析日常生活活动能力受损的影响因素。 结果 湖北省抽样点老年人3年ADL累计受损发生率为5.47%,3年基本生活能力(basic living ability scale,BADL)累计受损率为1.91%,3年仅工具性日常生活活动能力(instrumental activity of daily life scale,IADL)累计受损率为3.55%。多因素logistic分析结果表明:年龄增加(70～79岁OR=1.784,95%CI:1.208～2.634;≥80岁OR=3.124,95%CI:1.859～5.25)、自评生活状态不太好(OR=3.201,95%CI:1.805～5.678)、自觉家庭累赘感(OR=3.532,95%CI:2.01～6.205)、听力受损(OR=4.787,95%CI:1.978～11.588)、脑卒中(OR=3.571,95%CI:2.00～6.377)及一年内跌倒3次及以上(OR=6.226,95%CI:1.333～29.072)是老年人ADL受损发生的危险因素,城市居住(OR=0.418,95%CI:0.272～0.64)、非文盲(OR=0.546,95%CI:0.368～0.809)、喜欢参与社会活动(OR=0.417,95%CI:0.293～0.593)为老年人ADL受损发生的保护因素。14项功能受损率中,BADL功能受损排名第一的为如厕(2.25%),IADL功能受损排名第一的为打理钱财(3.59%)。除服药外,每一项IADL功能的受损率均高于BADL功能的受损率。 结论 改善老年人日常生活活动能力应重点关注农村居住、高龄、文盲、自评生活状态不佳、自觉家庭累赘感,不喜社交、患有听力受损、脑卒中及一年内多次跌倒的老年人群,建议尽早对其采取有针对性的防控措施,提高这一群体的生活质量。

Cohort study on incidence of activities of daily living disability and its influencing factors among the elderly from sampling sites in Hubei Province, 2015-2018

Objective To investigate the incidence and influencing factors of activities of daily living (ADL) disability among the elderly from sampling sites, including Dongbao District of Jingmen City and Qichun County of Huanggang City in Hubei Province from 2015 to 2018. Methods In 2015, a total of 4,041 study subjects were selected through a stratified multi-stage cluster sampling in 2 representative sites and joint baseline survey. The follow-up was conducted in 2018 to collect the related information using the same questionnaires and examinations. Finally, 2,927 senior citizens aged 60 years and above were included in this analysis after excluding those who were defined as ADL disability at the baseline survey, died, failed to follow up during the 3-year period or had incomplete data cases, and questionnaire surveys, physical measurements and daily life activities ability evaluation were conducted. Single factor χ² test and multiple factor logistic regression model were employed to analyze the factorsinfluencing ADL disability. Results During the 3-year follow up, the incidence rates of ADL, BADL and only IADL disability in the elderly from the sampling sites in Hubei Province were 5.47%, 1.91% and 3.55%, respectively. Multiple factor logistic regression analysis showed that the risk factors for ADL disability in the elderly included increased age (70-79 years old OR=1.784, 95%CI: 1.208-2.634; ≥ 80 years old OR=3.124, 95%CI: 1.859-5.25), poor self-rated health (OR=3.201, 95%CI: 1.805-5.678), sense of family encumbrance (OR=3.532, 95%CI: 2.01-6.205),impaired hearing (OR=4.787, 95%CI:1.978-11.588), stroke (OR=3.571, 95%CI: 2.00-6.377) and falls 3 times or more within a year (OR=6.226, 95%CI: 1.333-29.072). The protective factors for ADL disability included city dwellers (OR=0.418, 95%CI: 0.272-0.64), literates (OR=0.546, 95%CI: 0.368-0.809) and liking to participate in social activities (OR=0.417, 95%CI: 0.293-0.593). Among the rates of 14 functional impairments, going to the toilet (2.25%) ranked first for BADL functional impairment, and managing finance (3.59%) ranked first for IADL functional impairment. The damage rates of all IADL functions except taking medicine were higher than those of BADL function. Conclusion To improve the activities of daily living ability of the elderly, we should pay special attention to senior citizens who live in rural areas, are advanced in age, are illiterate, have poor self-rated health, are conscious of family encumbrance, dislike social interaction, suffer from hearing impairment and stroke and fall many times within a year. It is recommended to take targeted prevention and control measures as soon as possible so as to improve the quality of life of the elderly.