Psychological well-being in relation to frailty: a frailty identity crisis?
Psychological well-being in relation to frailty: a frailty identity crisis?
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DOI：
10.1017/s1041610212000269
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发表时间：
2012-08-01
影响因子：
7
通讯作者：
Rockwood, Kenneth
中科院分区：
文献类型：
--
作者：
Andrew, Melissa K.;Fisk, John D.;Rockwood, Kenneth
背景：虚弱可以定义为存在多种相互作用的医学和功能问题。虚弱与精神状况有关，但其与心理健康的关系尚不清楚。“脆弱身份危机”被认为是随着健康缺陷的积累而对自我意识的适应不良反应。我们评估了这个所谓的身份危机，通过调查之间的关联的福祉，脆弱性，和死亡率在社区居住的老年人candidals.Methods：在加拿大的健康和老龄化研究（N=5,703，年龄70+），脆弱性被定义为33个健康缺陷的指数的二次分析。心理健康是使用Ryff的18项量表测量的，有六个领域（自主性，个人成长，环境掌握，积极的关系，生活目的和自我接纳）。认知能力采用改良简易精神状态检查法进行测量。采用线性回归法测量幸福感、脆弱性和死亡率之间的关系，调整年龄、性别、教育、认知和心理健康。（0.29，95%CI：0.22-0.36，p < 0.001），与年龄、性别、教育、认知和心理健康无关。在幸福的六个领域中，只有“生活目的”和“自主性”与脆弱无关（所有其他，p < 0.001）。较差的心理健康与五年死亡率相关，与年龄、性别、教育、虚弱和心理健康无关;调整基线认知后，这种相关性在统计学上并不显著。由脆弱的身份危机受损的心理健康可能在定义老年人的主观健康方面发挥重要作用。
Background: Frailty can be defined as the presence of multiple, interacting medical and functional problems. Frailty is associated with psychiatric conditions but its relation to psychological well-being is unclear. A "frailty identity crisis" has been proposed as a maladaptive response to the sense of self as health deficits accumulate. We evaluated this so-called identity crisis by investigating associations between well-being, frailty, and mortality in community-dwelling older Canadians.Methods: In this secondary analysis of the Canadian Study of Health and Aging (N=5,703; age 70+), frailty was defined by an index of 33 health deficits. Psychological well-being was measured using Ryff's 18-item scale, with six domains (autonomy, personal growth, environmental mastery, positive relations, purpose in life, and self-acceptance). Cognition was measured using the Modified Mini-Mental State Examination. Associations between well-being, frailty, and mortality were measured using linear regression, adjusting for age, sex, education, cognition, and mental health.Results: For each additional frailty-defining deficit, the psychological well-being score worsened by 0.3 points (0.29, 95% CI: 0.22-0.36, p < 0.001), independent of age, sex, education, cognition, and mental health. Among the six domains of well-being, only "purpose in life" and "autonomy" were not associated with frailty (all others, p < 0.001). Worse psychological well-being was associated with five-year mortality independent of age, sex, education, frailty, and mental health; this association was not statistically significant when adjusting for baseline cognition.Conclusions: Frailty was associated with low levels of well-being. Psychological well-being impaired by a frailty identity crisis may play an important role in defining subjective health in older adults.