目的 探讨中国老年人脊柱后凸畸形与认知功能的关联,并分析老年人日常生活活动能力和抑郁在其中的中介作用。方法 选取2018年中国老年健康影响因素跟踪调查（Chinese longitudinal healthy longevity survey,CLHLS）中的9 798名65岁及以上老年人的数据,收集老年人脊柱后凸及认知功能评分等一般资料,对老年人脊柱后凸畸形进行单因素及多因素分析,并采用多重中介模型检验日常生活活动能力和抑郁的中介效应。结果 中国老年人脊柱后凸畸形检出率为27.93%。高龄、女性、农村居住地、高血压、风湿或类风湿、存在基本日常生活活动能力（basic activities of daily living,BADL）及工具性日常生活活动能力（instrumental activities of daily living,IADL）受限、抑郁及较低的认知功能是影响脊柱后凸的危险因素。中介效应分析结果显示,脊柱后凸畸形对认知功能直接效应显著;IADL和抑郁对认知功能的中介效应显著;IADL和抑郁的链式中介效应显著。结论 脊柱后凸畸形与中国老年人认知功能下降显著相关,IADL受限与抑郁在其中起重要链式中介作用。应重视脊柱后凸老年人群的功能训练与心理干预,以多维策略延缓认知衰退。
Abstract
Objective To investigate the association between spinal kyphosis and cognitive function in Chinese older adults, and to analyze the mediating roles of ADL and depression in this relationship. Methods Data from 9, 798 adults aged 65 and older were selected from Chinese longitudinal healthy longevity survey (CLHLS) in 2018. General information, including spinal kyphosis status and cognitive function scores, was collected. Univariate and multivariate analyses were conducted to examine spinal kyphosis in older adults, and a multiple mediation model was used to test the mediating effects of ADL and depression. Results The detection rate of spinal kyphosis among Chinese older adults was 27.93%. Advanced age, female sex, rural residence, hypertension, rheumatoid or rheumatic diseases, presence of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) limitations, depression, and lower cognitive function were identified as risk factors for spinal kyphosis. The mediation effect analysis revealed a significant direct effect of spinal kyphosis on cognitive function. The mediating effects of IADL and depression on cognitive function were significant. The chain mediating effect of IADL and depression was also significant. Conclusion Spinal kyphosis is significantly associated with cognitive decline in Chinese older adults, with limitations in IADL and depression playing important chain-mediating roles in this relationship. Greater attention should be given to functional training and psychological interventions for older adults with spinal kyphosis, adopting multidimensional strategies to delay cognitive decline.
关键词
脊柱后凸 /
CLHLS数据库 /
认知功能 /
日常生活活动能力 /
抑郁
Key words
kyphosis /
CLHLS /
cognitive function /
activities of daily living /
depression
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基金
湖南省自然科学基金面上项目 “内在能力减退老年冠心病患者心脏康复依从性预测模型的构建及干预策略研究”（2023JJ30426）
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