Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis.
Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis.
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DOI：
10.1186/s12877-023-04554-1
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发表时间：
2023-12-12
期刊：
影响因子：
4.1
通讯作者：
Lapane, Kate L.
中科院分区：
文献类型：
--
作者：
Yuan, Yiyang;Peng, Changmin;Burr, Jeffrey A.;Lapane, Kate L.
关键词：
虚弱、认知障碍和抑郁症状是人口老龄化中密切相关的疾病。然而，有限的研究纵向分析了中国老年人这三种突出疾病的并发轨迹。本研究旨在探索衰弱、认知障碍和抑郁症状的八年轨迹，并确定与轨迹相关的个体水平和结构水平因素。来自中国健康与退休纵向研究（2011-2018）的四波数据被用来确定6106名符合条件的老年人。主要测量指标包括：用30个指标构建的虚弱指数来衡量虚弱，用即时和延迟单词回忆、图形绘制、连续减法和定向的综合得分来衡量认知障碍，用流行病学研究中心抑郁量表来衡量抑郁症状。随着时间的推移，多轨迹模型确定了脆弱、认知障碍和抑郁症状的轨迹。在对人口特征进行调整后，采用多项逻辑回归估计了个人层面的资本因素与一个结构因素（户口和地理居住）之间的关联。出现了4种轨迹：(1)虚弱加重、认知障碍加重、抑郁（14.0%）；(2)虚弱前期下降、认知能力下降、边缘性抑郁（20.0%）；(3)体弱多病，认知功能障碍加重，无抑郁（29.3%）；(4)身体健壮，认知能力下降，无抑郁（36.7%）。以“身体强壮、认知能力下降、无抑郁”为参照，不工作、不参加社会活动、童年家庭经济状况较差、成年健康状况较差与“身体虚弱、认知能力下降、抑郁”轨迹最密切相关；儿童期健康状况较差与“虚弱前期下降、认知能力下降、边缘性抑郁”轨迹的相关性最高；受教育程度较低、家庭消费较低和农村户口与“虚弱前、认知障碍恶化、无抑郁”轨迹增加的可能性最大。研究结果有助于了解中国老年人虚弱、认知障碍和抑郁症状之间的相互关系，并可能帮助从业者发现有不良轨迹风险的成年人，从而实施适当的护理策略。在线版本包含补充材料，可在10.1186/s12877-023-04554-1获得。
Frailty, cognitive impairment, and depressive symptoms are closely interrelated conditions in the aging population. However, limited research has longitudinally analyzed the concurrent trajectories of these three prominent conditions in older adults in China. This study aimed to explore the eight-year trajectories of frailty, cognitive impairment, and depressive symptoms, and to identify individual-level and structural-level factors associated with the trajectories. Four waves of data from the China Health and Retirement Longitudinal Study (2011–2018) were used to identify 6,106 eligible older adults. The main measures included frailty by the frailty index constructed using 30 indicators, cognitive impairment by the summary score of immediate and delayed word recall, figure drawing, serial subtraction, and orientation, and depressive symptoms by the Center for Epidemiologic Studies Depression Scale. Multi-trajectory models identified the trajectories of frailty, cognitive impairment, and depressive symptoms over time. Multinomial logistic regression was employed to estimate the associations between individual-level capital factors and one structural factor (hukou and geographic residency) with the identified trajectories, adjusting for demographic characteristics. Four trajectories emerged: (1) worsening frailty, worsening cognitive impairment, depression (14.0%); (2) declining pre-frailty, declining cognition, borderline depression (20.0%); (3) pre-frailty, worsening cognitive impairment, no depression (29.3%); and (4) physically robust, declining cognition, no depression (36.7%). Using the “physically robust, declining cognition, no depression” as the reference, not working, no social activity participant, worse childhood family financial situation, and poorer adult health were most strongly associated with the “worsening frailty, worsening cognitive impairment, depression” trajectory; worse health during childhood had the highest association with the “declining pre-frailty, declining cognition, borderline depression” trajectory; less education, lower household consumption, and rural hukou had the greatest association with the increased likelihood of the “pre-frailty, worsening cognitive impairment, no depression” trajectory. Findings could inform the understanding of the interrelationship of frailty, cognitive impairment, and depressive symptoms in older adults in China and may help practitioners detect adults at risk for adverse trajectories to implement strategies for proper care. The online version contains supplementary material available at 10.1186/s12877-023-04554-1.
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