老年人内在能力潜在类别分析及与跌倒的相关性研究

doi:10.3761/j.issn.0254-1769.2024.23.011

摘要/Abstract

摘要：

目的探讨老年人内在能力的潜在类别，并分析不同潜在类别对老年人跌倒发生的影响作用，为有效地预防老年人跌倒提供参考。方法采用便利抽样法，选取2020年11月—12月北京市某社区老年人为调查对象。采用一般资料调查问卷、WHO内在能力评估工具收集资料，并于2023年6月—7月对调查对象进行随访。应用Mplus 8.0软件对收集的数据进行潜在类别分析，采用Logistic回归分析老年人内在能力潜在类别对跌倒的影响。结果共调查了284名老年人，243名完成随访，有效随访率为85.6%。随访老年人内在能力得分与基线比较有所下降（Z=4.667，P<0.001），有30名（12.3%）老年人在近1年内发生过跌倒。老年人内在能力可聚类为3个潜在类别：低水平感知觉组（69.7%），低水平认知与感知觉组（23.2%），中等水平认知与低水平活力、心理及感知觉组（7.0%）。Logistic回归分析结果显示，中水平认知与低水平活力、心理及感知觉组跌倒发生风险是低水平感知觉组的5.777倍（95%CI：1.824~18.298），中水平认知与低水平活力、心理及感知觉组跌倒发生风险是低水平认知与感知觉组的7.534倍（95%CI：1.822~31.150）。结论老年人跌倒发生率高，且其内在能力具有异质性，内在能力的潜在类别对跌倒的预测风险程度不同。建议在临床工作中关注老年人内在能力的异质性，采取针对性措施以防范跌倒事件的发生。

关键词: 老年人, 内在能力, 跌倒, 潜在类别分析, 队列研究, 问卷调查, 护理

Abstract:

Objective To explore latent classes of intrinsic capacity in older adults and analyze the role of different latent classes in influencing the occurrence of falls in older adults. Methods A convenience sampling method was utilized to select the older adults in a community in Beijing in November-December 2020 as the survey respondents. General Information Questionnaire and WHO Intrinsic Capacity Assessment Tool were used to collect information，and the study participants were followed up in June-July，2023. Potential classes were analyzed using Mplus 8.0 software，and logistic regression was used to analyze the effect of potential classes of intrinsic capacity on falls. Results Follow-up was completed by 243（85.6%） survey respondents，with a decrease in the follow-up intrinsic capacity score from baseline（Z=4.667，P<0.001），and 30（12.3%） older adults had experienced falls in the last 1 year. The intrinsic capacity of the older people can be clustered into 3 potential classes，namely，the low level of perception group（69.7%），the low level of cognition and perception group（23.2%），and the medium level of cognition and low level of vitality，psychological and perception group（7.1%）. Logistic regression results showed that the risk of falling in the group with the medium cognition and low vitality，psychological and perception is 5.777 times（95%CI：1.824-18.298） higher than that in the group with low perception，and the risk of falling in the group with medium cognition and low vitality，psychological and perception is 7.534 times（95%CI：1.822-31.150） higher than that in the group with low cognition and perception. Conclusion The prevalence of falls in the older adults is high；the intrinsic capacity is heterogeneous；potential classes of intrinsic capacity play different roles in the degree to which they predict the risk of falls. It is recommended to pay attention to the heterogeneity of intrinsic capacity of older adults in clinical work and to take targeted measures to prevent falls.

Key words: Aged, Intrinsic Capacity, Falls, Latent Class Analysis, Cohort Study, Questionnaire, Nursing Care

齐亚君, 张洁, 张丹丹, 吴娟, 王海妍. 老年人内在能力潜在类别分析及与跌倒的相关性研究[J]. 中华护理杂志, 2024, 59(23): 2887-2892.

QI Yajun, ZHANG Jie, ZHANG Dandan, WU Juan, WANG Haiyan. A correlation research of intrinsic capacity and fall risk in older adults based on latent class analysis[J]. Chinese Journal of Nursing, 2024, 59(23): 2887-2892.

图/表 5

表1 老年人内在能力潜在类别模型的拟合指标（n=284）

Table 1 Model fit results of LCA for intrinsic capacity of older adults（n=284）

图1 老年人内在能力的潜在类别特征分布

Figure 1 Distribution of latent class characteristics of intrinsic capacity of older adults

表2 老年人内在能力的潜在类别转变概率矩阵（n=243）

Table 2 Latent class shift probability matrix for intrinsic capacity of older adults（n=243）

表3 不同特征老年人跌倒的发生情况比较（n=243）

Table 3 Unifactorial analysis of the occurrence of falls in older adults（n=243）

表4 老年人内在能力潜在类别对跌倒发生影响作用的Logistic回归分析（n=243）

Table 4 Logistic regression analysis of the role of latent classes of intrinsic capacity on the impact of falls in older adults（n=243）

参考文献 26

[1]	Montero-Odasso M, van der Velde N, Martin FC, et al. World gui-delines for falls prevention and management for older adults:a global initiative[J]. Age Ageing, 2022, 51(9):afac205.
[2]	吴婷婷, 魏晓琴, 董建惠, 等. 老年人内在能力的概念分析[J]. 中华护理杂志, 2024, 59(16):2037-2043. DOI URL
	Wu TT, Wei XQ, Dong JH, et al. Concept analysis of the intrinsic capacity of the elderly[J]. Chin J Nurs, 2024, 59(16):2037-2043. DOI URL
[3]	张丹丹, 奚桓, 齐海梅, 等. 老年人内在能力下降与跌倒的相关性研究[J]. 中华老年医学杂志, 2020, 39(10):1182-1185.
	Zhang DD, Xu H, Qi HH, et al. Relationship between decline of intrinsic capacity and activity of daily living of elderly patients[J]. Chin J Mod Nurs, 2020, 29(10):1182-1185.
[4]	Muneera K, Muhammad T, Pai M, et al. Associations between intrinsic capacity,functional difficulty,and fall outcomes among older adults in India[J]. Sci Rep, 2023, 13(1):9829. DOI PMID
[5]	杨影红, 沈珊珊, 曾幸坤, 等. 内在能力下降对老年患者跌倒和再入院的影响[J]. 中华老年医学杂志, 2023, 42(2):165-168.
	Yang YH, Shen SS, Zeng XK, et al. Impact of intrinsic capacity on predicting future falls and readmission in older patients[J]. Chin J Geriatr, 2023, 42(2):165-168.
[6]	Shi KW, He LX, Chen XD, et al. Prospective association of intrinsic capacity with falls and multiple falls in older adults (nhats)[J]. Innov Aging, 2023, 7(Suppl 1):1102.
[7]	Liu S, Kang L, Liu XH, et al. Trajectory and correlation of intrinsic capacity and frailty in a Beijing elderly community[J]. Front Med, 2021,8:751586.
[8]	曾宪华, 肖琳, 张岩波. 潜在类别分析原理及实例分析[J]. 中国卫生统计, 2013, 30(6):815-817.
	Zeng XH, Xiao L, Zhang YB. Principle of latent class analysis and case analysis[J]. Chin J Health Stat, 2013, 30(6):815-817.
[9]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[10]	World Health Organization. Integrated care for older people(ICOPE):guidance for person-centred assessment and pathways in primary care[DB/OL].(2020-02-12)[2021-03-24]. https://www.who.int/publications/i/item/WHO-FWC-ALC-19.1.
[11]	Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function:association with self-reported disability and prediction of mortality and nursing home admission[J]. J Gerontol, 1994, 49(2):M85-M94.
[12]	Montejano Lozoya R, Martínez-Alzamora N, Clemente Marín G, et al. Predictive ability of the Mini Nutritional Assessment Short Form(MNA-SF) in a free-living elderly population:a cross-sectional study[J]. PeerJ, 2017,5:e3345.
[13]	Scanlan J, Borson S. The Mini-Cog:receiver operating characteristics with expert and naïve raters[J]. Int J Geriatr Psychiatry, 2001, 16(2):216-222.
[14]	Kroenke K, Spitzer RL, Williams JB. The PHQ-9:validity of a brief depression severity measure[J]. J Gen Intern Med, 2001, 16(9):606-613. DOI PMID
[15]	Ryoo JH, Wang C, Swearer SM, et al. Longitudinal model building using latent transition analysis:an example using school bullying data[J]. Front Psychol, 2018,9:675.
[16]	World Health Organization. Integrated care for older people(ICOPE) implementation pilot programme:findings from the ‘ready’ phase[EB/OL]. (2022-04-25)[2023-05-17]. https://www.who.int/publications/i/item/9789240048355.
[17]	Wu WB, Sun L, Li H, et al. Approaching person-centered clinical practice:a cluster analysis of older inpatients utilizing the measurements of intrinsic capacity[J]. Front Public Health, 2022,10:1045421.
[18]	Yu JQ, Si HX, Jin YR, et al. Patterns of intrinsic capacity among community-dwelling older adults:identification by latent class analysis and association with one-year adverse outcomes[J]. Geriatr Nurs, 2022,45:223-229.
[19]	Meng LC, Chuang HM, Lu WH, et al. Multi-trajectories of intrinsic capacity decline and their impact on age-related outcomes:a 20-year national longitudinal cohort study[J]. Aging Dis, 2023.
[20]	Chern A, Golub JS. Age-related hearing loss and dementia[J]. Alzheimer Dis Assoc Disord, 2019, 33(3):285-290.
[21]	Ge SQ, McConnell ES, Wu B, et al. Longitudinal association between hearing loss,vision loss,dual sensory loss,and cognitive decline[J]. J Am Geriatr Soc, 2021, 69(3):644-650.
[22]	Yamada Y, Denkinger MD, Onder G, et al. Dual sensory impairment and cognitive decline:the results from the shelter study[J]. J Gerontol A Biol Sci Med Sci, 2016, 71(1):117-123.
[23]	Harithasan D, Mukari SZS, Ishak WS, et al. The impact of sensory impairment on cognitive performance,quality of life,depression,and loneliness in older adults[J]. Int J Geriatr Psychiatry, 2020, 35(4):358-364.
[24]	Islam MZ, Disu TR, Farjana S, et al. Malnutrition and other risk factors of geriatric depression:a community-based comparative cross-sectional study in older adults in rural Bangladesh[J]. BMC Geriatr, 2021, 21(1):572.
[25]	Wehner-Hewson N, Watts P, Buscombe R, et al. Racial and ethnic differences in falls among older adults:a systematic review and meta-analysis[J]. J Racial Ethn Health Disparities, 2022, 9(6):2427-2440.
[26]	胡慧秀, 孙超, 赵雅洁, 等. 我国9个省份老年人身体及认知功能状况的调查研究[J]. 中华护理杂志, 2023, 58(1):68-73. DOI URL
	Hu HX, Sun C, Zhao YJ, et al. Investigestion and character analysis of function of 12 141 older people in 9 provinces[J]. Chin J Nurs, 2023, 58(1):68-73. DOI URL