基于健康生态学模型的共病老年人多维衰弱影响因素研究

赵琳琳; 常冰洁; 胡清华; 杜娟; 邵爽

doi:10.16766/j.cnki.issn.1674-4152.004155

基于健康生态学模型的共病老年人多维衰弱影响因素研究

doi: 10.16766/j.cnki.issn.1674-4152.004155

首都医科大学全科医学与继续教育学院，北京 100069

基金项目:

北京市高层次公共卫生技术人才建设项目学科骨干-03-26

四大慢病国家科技重大专项 2023ZD0509600

详细信息

通讯作者:
邵爽，E-mail：shaoshuang@ccmu.edu.cn

中图分类号: R161.7 R592
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- 文章访问数: 10
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- 被引次数: 0
出版历程
- 收稿日期: 2024-10-08
- 网络出版日期: 2025-11-17

Research on the factors influencing multidimensional frailty among the comorbid elderly based on health ecology model

School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China

摘要

摘要: 目的从个体、家庭及社会等综合角度探究共病老年人多维衰弱影响因素，为制定干预策略提供证据基础。方法 2024年2—5月采取分层整群随机抽样选取北京城区4家社区卫生服务中心就诊的共病老年人为研究对象，基于健康生态学模型纳入指标进行问卷调查，以是否患多维衰弱、躯体、心理及社会衰弱分别作为因变量进行二分类logistic回归分析。结果 919例共病老年人中，患躯体、心理、社会及多维衰弱分别为309例(33.62%)、438例(47.66%)、151例(16.43%)、391例(42.55%)。多因素分析显示，增龄、共病数量、服药种类、久坐时间、健康赋能、家庭关怀度、社会参与等因素是共病老年人多维衰弱的影响因素。其中，共病数量≥4种是躯体衰弱的危险因素；而家庭关怀度功能良好是躯体、心理、社会的共同保护因素，健康赋能得分高是躯体及心理衰弱的保护因素，社会参与得分高是躯体衰弱的保护因素。结论个人行为特征、家庭功能、社会参与对共病老年人多维衰弱有不同程度影响，在共病管理中应重视衰弱综合评估，以此构建多元化管理格局。
- 多维衰弱 /
- 共病 /
- 影响因素
Abstract: Objective The study aimed to explore the factors influencing multidimensional frailty in the comorbid elderly from an integrated perspective. Methods The stratified cluster sampling method was used to recruit comorbid elderly patients from four community health centers in urban Beijing. Logistic regression analyses were performed based on the health ecology model, using the presence or absence of multidimensional, physical, psychological, and social frailty as the respective dependent variables. Results Of the 919 comorbid participants, the prevalence rates of physical, psychological, social, and multidimensional frailty were 33.62% (309 cases), 47.66% (438 cases), 16.43% (151 cases), and 42.55% (391 cases), respectively. The results of the multifactorial analysis showed that the advanced age, greater number of comorbidities, multiple medication types, sedentary time, health empowerment, family caring, and social participation are factors influencing multidimensional frailty in comorbid elderly. The number of comorbidities≥4 was a risk factor for physical frailty. Family caring was a co-protective factor for physical-psycho-social frailty. Health empowerment was a protective factor against both physical and psychological frailty, while social participation was a protective factor against physical frailty. Conclusion Individual behavioral characteristics, family caring, and social participation exert different degrees of influence on the multidimensional frailty in comorbid elderly.
- Multidimensional frailty /
- Comorbidity /
- Influencing factors

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表 1 不同特征的共病老年人多维衰弱患病情况比较

Table 1. Comparison of multidimensional frailty among elderly people with multimorbidity of different characteristics

特征	例数	无多维衰弱(n=528)	有多维衰弱(n=391)	统计量	P值
个人特质层
性别[例(%)]
男性	329	214(65.0)	115(35.0)	12.083^a	0.001
女性	590	314(53.2)	276(46.8)
年龄[M(P₂₅, P₇₅)，岁]	919	72(65, 94)	75(65, 96)	-6.624^b	＜0.001
BMI[例(%)]
偏瘦	21	6(28.6)	15(71.4)	7.365^a	0.025
正常	335	196(58.5)	139(41.5)
超重或肥胖	563	326(57.9)	237(42.1)
共病数量[例(%)]
2种	383	289(75.5)	94(24.5)	112.775^a	＜0.001
3种	322	172(53.4)	150(46.6)
4种及以上	214	67(31.3)	147(68.7)
行为特征层
健康赋能[M(P₂₅, P₇₅)，分]	919	34(15, 40)	28(12, 40)	-12.933^b	＜0.001
服药种类[例(%)]
＜5种	422	293(69.4)	129(30.6)	45.796^a	＜0.001
≥5种	497	235(47.3)	262(52.7)
久坐时长[例(%)]
＜5 h	254	182(71.7)	72(28.3)	78.579^a	＜0.001
5~＜8 h	354	229(64.7)	125(35.3)
≥8 h	311	117(37.6)	194(62.4)
睡眠时长[例(%)]
＜6 h	272	105(38.6)	167(61.4)	59.508^a	＜0.001
6~＜8 h	464	293(63.1)	171(36.9)
≥8 h	183	130(71.0)	53(29.0)
步行时长[例(%)]
＜1 h	95	14(14.7)	81(85.3)	79.092^a	＜0.001
≥1 h	824	514(62.4)	310(37.6)
人际网络层
家庭关怀度[例(%)]
功能重度障碍	167	34(20.4)	133(79.6)	152.618^a	＜0.001
功能中度障碍	214	103(48.1)	111(51.9)
功能完好	538	391(72.7)	147(27.3)
婚姻状况[例(%)]
已婚	721	444(61.6)	277(38.4)	23.891^a	＜0.001
丧偶	191	82(42.9)	109(57.1)
其他	7	2(28.6)	5(71.4)
居住方式[例(%)]
独居	100	39(39.0)	61(61.0)	22.814^a	＜0.001
与配偶居住	498	310(62.2)	188(37.8)
多代合住	315	178(56.5)	137(43.5)
其他	6	1(1.67)	5(83.3)
生活条件层
社会参与[M(P₂₅, P₇₅)，分]	919	12(4, 20)	9(4, 17)	-9.641^b	＜0.001
文化程度[例(%)]
初中及以下	432	215(49.8)	217(50.2)	20.023^a	＜0.001
高中/中专	255	167(65.5)	88(34.5)
大专及以上	232	146(62.9)	86(37.1)
注：表中仅列出差异有统计学意义的指标。^a为χ²值，^b为Z值。

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表 2 不同特征的共病老年人躯体衰弱维度患病情况比较

Table 2. Comparison of physical frailty among elderly people with multimorbidity of different characteristics

特征	例数	无躯体衰弱(n=610)	有躯体衰弱(n=309)	统计量	P值
个人特质层
年龄[M(P₂₅, P₇₅)，岁]	919	72(65, 94)	75(65, 96)	-7.909^a	＜0.001
共病数量[例(%)]				169.086^b	＜0.001
2种	383	322(84.1)	61(15.9)
3种	322	220(68.3)	102(31.7)
4种及以上	214	68(31.8)	146(68.2)
行为特征层
健康赋能[M(P₂₅, P₇₅)，分]	919	33(12, 40)	28(13, 40)	-11.806^a	＜0.001
服药种类[例(%)]				72.794^b	＜0.001
＜5种	422	341(80.8)	81(19.2)
≥5种	497	269(54.1)	228(45.9)
久坐时长[例(%)]				64.669^b	＜0.001
＜5 h	254	200(78.7)	54(21.3)
5~＜8 h	354	257(72.6)	97(27.4)
≥8 h	311	153(49.2)	158(50.8)
睡眠时长[例(%)]				29.481^b	＜0.001
＜6 h	272	146(53.7)	126(46.3)
6~＜8 h	464	326(70.3)	138(29.7)
≥8 h	183	138(75.4)	45(24.6)
步行时长[例(%)]				84.407^b	＜0.001
＜1 h	95	23(24.2)	72(75.8)
≥1 h	824	587(71.2)	237(28.8)
人际网络层
家庭关怀度[例(%)]				88.553^b	＜0.001
功能重度障碍	167	67(40.1)	100(59.9)
功能中度障碍	214	125(58.4)	89(41.6)
功能完好	538	418(77.7)	120(22.3)
婚姻状况[例(%)]				6.870^b	0.032
已婚	721	494(68.5)	227(31.5)
丧偶	191	112(58.6)	79(41.4)
其他	7	4(57.1)	3(42.9)
生活条件层
社会参与[M(P₂₅, P₇₅)，分]	919	12(4, 20)	9(4, 18)	-9.307^a	＜0.001
文化程度[例(%)]				17.369^b	＜0.001
初中及以下	432	257(59.5)	175(40.5)
高中/中专	255	186(72.9)	69(27.1)
大专及以上	232	167(72.0)	65(28.0)
注：表中仅列出差异有统计学意义的指标。^a为Z值，^b为χ²值。

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表 3 不同特征的共病老年人心理衰弱维度患病情况比较

Table 3. Comparison of psychological frailty among elderly people with multimorbidity of different characteristics

特征	例数	无心理衰弱(n=481)	有心理衰弱(n=438)	统计量	P值
个人特质层
性别[例(%)]
男性	329	206(62.6)	123(37.4)	21.687^a	＜0.001
女性	590	275(46.6)	315(53.4)
共病数量[例(%)]
2种	383	242(63.2)	141(36.8)	38.382^a	＜0.001
3种	322	159(49.4)	163(50.6)
4种及以上	214	80(37.4)	134(62.6)
行为特征层
健康赋能[M(P₂₅, P₇₅)，分]	919	33(15, 40)	30(12, 40)	-10.316^b	＜0.001
服药种类[例(%)]
＜5种	422	259(61.4)	163(38.6)	25.535^a	＜0.001
≥5种	497	222(44.7)	275(55.3)
久坐时长[例(%)]
＜5 h	254	155(61.0)	99(39.0)	25.099^a	＜0.001
5~＜8 h	354	198(55.9)	156(44.1)
≥8 h	311	128(41.2)	183(58.8)
睡眠时长[例(%)]
＜6 h	272	95(34.9)	177(65.1)	47.997^a	＜0.001
6~＜8 h	464	271(58.4)	193(41.6)
≥8 h	183	115(62.8)	68(37.2)
步行时长[例(%)]
＜1 h	95	25(26.3)	70(73.7)	28.765^a	＜0.001
≥1 h	824	456(55.3)	368(44.7)
人际网络层
家庭关怀度[例(%)]
功能重度障碍	167	41(24.6)	126(75.4)	78.528^a	＜0.001
功能中度障碍	214	101(47.2)	113(52.8)
功能完好	538	339(63.0)	199(37.0)
生活条件层
社会参与[M(P₂₅, P₇₅)，分]	919	12(4, 20)	10(4, 20)	-6.669^b	＜0.001
注：表中仅列出差异有统计学意义的指标。^a为χ²值，^b为Z值。

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表 4 不同特征的共病老年人社会衰弱维度的患病情况比较

Table 4. Comparison of social frailty among elderly people with multimorbidity of different characteristics

特征	例数	无社会衰弱(n=768)	有社会衰弱(n=151)	统计量	P值
个人特质层
性别[例(%)]
男性	329	294(89.4)	35(10.6)	12.523^a	＜0.001
女性	590	474(80.3)	116(19.7)
年龄[M(P₂₅, P₇₅)，岁]	919	73(65, 96)	76(65, 91)	-5.499^b	＜0.001
共病数量[例(%)]
2种	383	340(88.8)	43(11.2)	18.481^a	＜0.001
3种	322	267(82.9)	55(17.1)
4种及以上	214	161(75.2)	53(24.8)
行为特征层
健康赋能[M(P₂₅, P₇₅)，分]	919	32(12, 40)	29(14, 40)	-4.887^b	＜0.001
久坐时长[例(%)]
＜5 h	254	224(88.2)	30(11.8)	15.905^a	＜0.001
5~＜8 h	354	305(86.2)	49(13.8)
≥8 h	311	239(76.8)	72(23.2)
睡眠时长[例(%)]
＜6 h	272	201(73.9)	71(26.1)	26.343^a	＜0.001
6~＜8 h	464	406(87.5)	58(12.5)
≥8 h	183	161(88.0)	22(12.0)
人际网络层
家庭关怀度[例(%)]
功能重度障碍	167	104(62.3)	63(37.7)	75.378^a	＜0.001
功能中度障碍	214	176(82.2)	38(17.8)
功能完好	538	488(90.7)	50(9.3)
婚姻状况[例(%)]
已婚	721	661(91.7)	60(8.3)	160.922^a	＜0.001
丧偶	191	104(54.5)	87(45.5)
其他	7	3(42.9)	4(57.1)
居住方式[例(%)]
独居	100	21(21.0)	79(79.0)	323.988^a	＜0.001
与配偶居住	498	449(90.2)	49(9.8)
多代合住	315	294(93.3)	21(6.7)
其他	6	4(66.7)	2(33.3)
生活条件层
社会参与[M(P₂₅, P₇₅)，分]	919	11(4, 20)	9(4, 17)	-4.544^b	＜0.001
注：表中仅列出差异有统计学意义的指标。^a为χ²值，^b为Z值。

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表 5 共病老年人不同维度衰弱患病影响因素的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis of factors influencing different dimensions of frailty in comorbid elderly

自变量	多维衰弱					躯体衰弱
自变量	B	SE	Waldχ²	OR(95%CI)	P值	B	SE	Waldχ²	OR(95% CI)	P值
个人特质层
性别	0.488	0.186	6.860	1.629(1.131~2.347)	0.009
年龄	0.058	0.015	15.173	1.060(1.029~1.091)	＜0.001	0.078	0.015	27.088	1.081(1.050~1.113)	＜0.001
共病数量
3种	0.548	0.204	7.257	1.730(1.161~2.579)	0.007	0.371	0.214	3.001	1.449(0.952~2.205)	0.083
≥4种	1.001	0.250	16.072	2.721(1.668~4.438)	＜0.001	1.581	0.246	41.158	4.858(2.997~7.873)	＜0.001
行为特征层
健康赋能	-0.121	0.019	40.086	0.886(0.853~0.920)	＜0.001	-0.099	0.018	29.318	0.906(0.874~0.939)	＜0.001
服药种类	0.450	0.190	5.588	1.568(1.080~2.276)	0.018	0.705	0.195	13.081	2.024(1.381~2.965)	＜0.001
久坐行为
5~＜8 h	0.311	0.219	2.012	1.365(0.888~2.098)	0.156	-1.906	0.270	1.507	0.334(0.197~0.568)	＜0.001
≥8 h	0.814	0.230	12.522	2.257(1.428~3.542)	＜0.001	-0.832	0.367	5.852	0.435(0.212~0.893)	0.023
睡眠时长
6~＜8 h	-0.646	0.200	10.463	0.524(0.354~0.775)	0.001
≥8 h	-0.777	0.259	9.037	0.460(0.277~0.763)	0.003
步行时长	-1.278	0.361	12.529	0.279(0.137~0.565)	0.003	-0.909	0.308	8.700	0.403(0.220~0.737)	0.003
人际网络层
家庭关怀度
功能中度障碍	-0.961	0.287	11.237	0.338(0.218~0.671)	0.001	-0.237	0.264	0.808	0.789(0.470~1.323)	0.369
功能良好	-1.693	0.265	40.813	0.184(0.109~0.309)	＜0.001	-0.882	0.243	13.231	0.414(0.257~0.666)	＜0.001
生活条件层
社会参与	-0.097	0.033	8.585	0.908(0.851~0.968)	0.003	-0.100	0.034	8.709	0.905(0.847~0.967)	0.003

自变量	心理衰弱					社会衰弱
自变量	B	SE	Waldχ²	OR(95% CI)	P值	B	SE	Waldχ²	OR(95% CI)	P值
个人特质层
性别	0.605	0.156	15.103	1.832(1.350~2.486)	＜0.001
行为特征层
健康赋能	-0.100	0.016	38.868	0.904(0.876~0.933)	＜0.001
服药种类	0.498	0.149	11.133	1.646(1.228~2.206)	0.001
睡眠时长
6~＜8 h	-0.634	0.174	13.288	0.520(0.369~0.732)	＜0.001	-1.095	0.270	16.452	0.335(0.197~0.568)	＜0.001
≥8 h	-0.705	0.220	10.321	0.494(0.321~0.760)	0.001	-0.886	0.357	6.154	0.412(0.205~0.830)	0.013
人际网络层
家庭关怀度
功能中度障碍	-0.628	0.246	6.503	0.528(0.330~0.865)	0.011	-1.024	0.316	10.529	0.359(0.193~0.667)	0.001
功能良好	-0.953	0.225	18.013	0.386(0.248~0.599)	＜0.001	-1.621	0.283	32.822	0.198(0.114~0.344)	＜0.001
婚姻状况
丧偶							1.052	0.333	9.974	2.863(1.490~5.449)	0.002
其他							1.517	1.135	1.787	4.557(0.493~42.115)	0.181
居住方式
与配偶居住							-2.802	0.411	46.426	0.061(0.027~0.136)	＜0.001
多代合住							-3.734	0.401	86.817	0.024(0.011~0.052)	＜0.001
其他							-1.981	1.016	3.804	0.138(0.019~1.010)	0.052
生活条件层
社会参与	-0.062	0.028	4.968	0.940(0.889~0.993)	0.026
注：以男性共病数量2种、服药种类 < 5种、久坐行为 < 5 h、睡眠时长 < 6 h、步行时长 < 1 h、家庭关怀度为功能重度障碍、已婚、独居为参照。

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