Abstract:

Objective To investigate the current states of cognitive impairment and to identify the influencing factors associated with cognitive impairment in community-dwelling older adults with chronic diseases. Methods A total of 734 patients aged 60 years or older with chronic diseases were recruited from a community health service center in Shanghai by convenient sampling method. Data on demographics,clinical information and lifestyle were collected. Montreal cognitive assessment basic scale（MoCA-B） was used to measure cognitive function. Results In the sample of 734 elderly patients with chronic diseases,373（50.8%） had cognitive impairment,including 326（44.4%） with mild cognitive impairment and 47（6.4%） with Alzheimer disease. The results of multivariate Logistic regression analysis showed that age,light physical household chores,physical exercise,frequency of playing wechat or computer,hobbies,hearing loss,and history of diabetes are all common influencing factors for mild cognitive impairment patients and Alzheimer disease patients. Low education and family history of dementia（P<0.05） are factors specially associated with mild cognitive impairment. The Kruskal-Wallis analysis showed that the types of chronic diseases had statistically significant differences in the average score of MoCA-B rank（P<0.05）. Conclusion Elderly adults with 4 chronic diseases in the community have a higher prevalence of cognitive impairment than those with single one chronic disease. Health clinicians should screen cognitive function for older adults to identify these vulnerable population as early as possible.

Key words: Community Nursing Care, Aged, Chronic Disease, Cognitive Function, Root Cause Analysis

摘要：

目的 调查社区老年慢性病患者认知功能现状并分析其影响因素。 方法 2019年9月—12月在上海市某社区卫生服务中心采用方便抽样方法选取60岁及以上患有慢性病的老年人734例,采用一般资料调查表、蒙特利尔认知评估基础量表（Montreal Cognitive Assessment-Basic,MoCA-B）进行调查。 结果 734例社区老年慢性病患者中,认知功能障碍患者373例（50.8%）,其中轻度认知功能障碍患者326例（44.4%）、阿尔茨海默病患者47例（6.4%）。Kruskal-Wallis分析结果显示,患慢性病种数不同的社区老年人的MOCA-B秩平均得分差异有统计学意义（P<0.05）。多元Logistic回归分析结果显示:年龄≥80岁、轻体力家务、锻炼身体、使用微信或电脑频率、兴趣爱好狭窄、听力下降、患糖尿病是轻度认知功能障碍患者和阿尔茨海默病患者共同的影响因素,而轻度认知功能障碍患者特异的危险因素是文化程度低和有痴呆家族史（P<0.05）。结论 患有4种慢性病的社区老年人比患有1种慢性病的社区老年人认知功能障碍患病率更高,医护人员应该及早筛查,并针对影响因素进行防控。

关键词: 社区护理, 老年人, 慢性病, 认知功能, 影响因素分析