【作者】 刘娜；

【导师】 刘春兰；

【作者基本信息】 山东大学 ， 护理（专业学位）， 2021， 硕士

【摘要】 目的调查老年共病患者抑郁症状、营养不良与认知衰弱的关系;探究营养不良在老年共病患者抑郁症状和认知衰弱间的中介作用;分析抑郁症状和营养不良的相加交互作用对老年共病患者认知衰弱的影响。方法2020年7月至2020年11月,采用方便抽样的方法,选取在山东省两所三级甲等医院老年科就诊的381名60岁以上的共病患者作为研究对象。研究工具包括一般资料调查问卷、蒙特利尔认知评估量表、衰弱表型、5条目老年抑郁量表、临床痴呆评定量表、简易营养评价量表。采用Excel 2013、SPSS 24.0和MPLUS 8.0软件进行数据分析。统计方法包括描述性分析、独立样本t检验或卡方检验、Logistic回归分析等;营养不良在抑郁症状和认知衰弱间的中介效应采用z检验进行验证;抑郁症状和营养不良对老年共病患者的相加交互作用采用相对超额危险度(RERI)、归因比(AP)、交互作用指数(S)进行评估。结果1.本研究中,存在抑郁症状的老年共病患者107名,占总人数的28.1%;营养不良者187名,占49.1%;认知衰弱者90名,占23.6%。2.单因素分析结果显示:患有认知衰弱的老年共病患者,并发抑郁症状和营养不良者所占比重更大。存在认知衰弱的老年共病患者年龄大、文化程度低、离异或丧偶、多为独居状态、无智力活动、缺乏规律锻炼、睡眠质量较差、有多重用药(P<0.05)。认知衰弱与非认知衰弱的老年共病患者在性别、医疗付费方式上不存在统计学差异(P>0.05)。3.Logistic回归分析结果显示:抑郁症状(OR=3.39,P<0.001)和营养不良(OR=2.26,P<0.05)均增加了老年共病患者认知衰弱的发生风险,且抑郁症状与营养不良显著相关(OR=1.71,P<0.05)。文化程度、婚姻状况、规律锻炼、智力活动及睡眠质量也是老年共病患者认知衰弱的主要影响因素。4.中介效应分析结果显示:抑郁症状得分与认知衰弱密切相关(cstd=0.63,P<0.001);在抑郁症状与认知衰弱关系中并入营养不良后,抑郁症状对认知衰弱的标准化回归系数有所减小,但两者间关系仍然显著(cstd=0.33,P<0.001),且抑郁症状与营养不良关系显著(astd=-0.54,P<0.001),营养不良与认知衰弱之间的关系显著(bstd=-0.53,P<0.001)。检验结果证实,营养不良在老年共病患者抑郁症状和认知衰弱间中介作用显著(Z=7.65,P<0.001)。5.相加交互作用分析结果显示:患有认知衰弱的老年共病患者中,仅存在抑郁症状的OR=5.04(P<0.001),仅存在营养不良的OR=2.16(P<0.05),同时有抑郁症状和营养不良的OR=16.27(P<0.001)。经计算,相加交互作用评价指标RERI=10.07(0.06,20.08),AP=0.62(0.33,0.91),S=2.94(1.23,7.00),说明抑郁症状和营养不良对认知衰弱相加交互作用成立。结论1.老年共病患者认知衰弱现状不容忽视,文化程度、婚姻情况、规律锻炼、智力活动及睡眠质量是老年共病患者认知衰弱的影响因素。2.老年共病患者抑郁症状与认知衰弱相关性显著,抑郁症状加大了老年共病患者认知衰弱的发生风险。3.营养不良在老年共病患者抑郁症状和认知衰弱之间中介效应显著。4.在老年共病患者中,抑郁症状和营养不良对认知衰弱具备相加交互作用。更多还原

【Abstract】 ObjectiveTo investigate the relationship between depression,malnutrition and cognitive frailty in elderly patients with multimorbidity.To explore the mediating effect of malnutrition on depressive symptoms and cognitive frailty in elderly multimorbidity;To analyze the effect of additive interaction between depressive symptoms and malnutrition on cognitive frailty in elderly multimorbidity.MethodsFrom July 2020 to November 2020,a total of 381 multimorbidity over 60 years old were selected from the geriatrics department of two third-level,first-level hospitals in Shandong Province by the method of convenient sampling.The tools included the general data questionnaire,the Montreal cognitive assessment scale,the frailty phenotype,the 5-item geriatric depression scale,the clinical dementia rating scale,and the simple nutrition assessment scale.Excel 2013,SPSS 24.0 and Mplus 8.0 were used for data analysis.Statistical methods include descriptive analysis,independent sample t-test or chi-square test,Logistic regression analysis,etc.The mediating effect of malnutrition on depressive symptoms and cognitive frailty was verified by Z test.The additive interaction between depressive symptoms and malnutrition in elderly multimorbidity was evaluated using relative excess risk(RERI),attribution ratio(AP),and interaction index(S).Results1.In this study,107 elderly multimorbidity with depressive symptoms,accounting for 28.1%of the total number;187 were malnourished,accounting for 49.1%;90 patients with cognitive frailty,accounting for 23.6%.2.Univariate analysis results showed that the proportion of elderly multimorbidity with cognitive frailty was higher in patients with depressive symptoms and malnutrition.The elderly multimorbidity with cognitive frailty were older,less educated,divorced or widowed,mostly living alone,no intellectual activity,lack of regular exercise,poor sleep quality,and multiple drug use(P<0.05).There were no statistical differences in gender and medical payment methods among the elderly multimorbidity with different cognitive frailty states(P>0.05)3.Logistic regression analysis showed that depressive symptoms(OR=3.39,P<0.001)and malnutrition(OR=2.26,P<0.05)both increased the risk of cognitive frailty in elderly multimorbidity,and depressive symptoms were significantly correlated with malnutrition(OR=1.71,P<0.05).Education level,marital status,regular exercise,intellectual activity and sleep quality were also the main influencing factors of cognitive frailty in elderly multimorbidity.4.The results of mediating effect analysis showed that there was a significant relationship between depressive symptom scores and cognitive frailty(c=0.63,P<0.001).In depressive symptoms score and cognitive frailty relation model after scoring in malnutrition,depressive symptoms score on standardized regression coefficients of cognitive frailty is reduced,the relationship between the two remained significant(c’=0.33,P<0.001),and depressive symptoms score and score was significant malnutrition(a=0.54,P<0.001),malnutrition scores and the relationship between the cognitive frailty significantly(b=0.53,P<0.001).The results of Z test showed that malnutrition had a significant mediating effect on depressive symptoms and cognitive frailty in elderly patients with multimorbidity(Z=7.65,P<0.001).5.The results of additive interaction analysis showed that among the elderly patients with cognitive frailty multimorbidity,OR with depressive symptoms only was 5.04(P<0.001),OR with malnutrition only was 2.16(P<0.05),OR with depressive symptoms and malnutrition at the same time was 16.27(P<0.001).After calculation,the additive interaction evaluation indexes RERI=10.07(0.06,20.08),AP=0.62(0.33,0.91),S=2.94(1.23,7.00),indicating that depression symptoms and malnutrition have additive interaction on cognitive frailty.Conclusions1.The status of cognitive frailty in elderly multimorbidity should not be ignored.Educational level,marital status,regular exercise,intellectual activity and sleep quality are the influencing factors of cognitive decline in elderly multimorbidity.2.There is a significant correlation between depressive symptoms and cognitive frailty in elderly multimorbidity,and depressive symptoms increase the risk of cognitive frailty in elderly multimorbidity3.Malnutrition has a significant mediating effect between depressive symptoms and cognitive frailty in elderly patients with multimorbidity.4.In elderly multimorbidity,depressive symptoms and malnutrition have an additive interaction with cognitive frailty.更多还原