衰弱在社区慢病老年人共病与自我管理行为之间的中介效应研究

Study on the Mediating Effect of Frailty between Comorbidity and Self-Management Behavior of the Elderly with Chronic Diseases in the Community

摘要: 目的：探讨衰弱在社区慢病老人共病与自我管理行为之间的中介效应。方法：2020年10月至2021年4月，采取便利抽样法选取杭州市某社区下14个街道内符合纳入标准的慢病老年人作为研究对象，应用一般资料表、改良老年疾病计数累积评分表、中文版衰弱综合评估表、中文版自我管理行为量表对其进行调查。结果：社区慢病老年人共病、衰弱与自我管理行为之间两两相关(P < 0.001)；共病对自我管理行为的直接效应显著(P < 0.01)，其效应大小为0.218；共病通过衰弱对自我管理行为的间接效应大小为0.511；衰弱起部分中介作用，中介效应占总效应的70.10%。结论：社区管理层应该采取多种干预措施预防并改善社区慢病老人的共病与衰弱程度，从而提高社区慢病老人的自我管理能力，减轻老人的家庭负担和社区的医疗负担。

Abstract: Objective: To explore the mediating effect of frailty between comorbidity and self-management behavior of the elderly with chronic diseases in the community. Methods: From October 2020 to April 2021, elderly people who met the inclusion criteria were selected using a convenience sampling method from 14 subdistricts in a certain community in Hangzhou. They were investigated using a General Information Questionnaire, a Modified Cumulative Illness Rating Scale for Geriatrics, a Chinese version of the Comprehensive Frailty Assessment Tool, and a Chinese version of the Self-Management Behavior Scale. Results: Comorbidity, frailty and self-management behavior in the elderly with chronic diseases in the community are correlated in pairs (P < 0.001); the direct effect of comorbidity on self-management behavior is significant (P < 0.01), with an effect size of 0.218; the indirect effect of comorbidity on self-management behavior via frailty is 0.511; frailty plays a part of the mediating role, and the mediating effect accounts for 70.10% of the total effect. Conclusions: The community management should take a variety of interventions to prevent and reduce the comorbidity and frailty of the elderly with chronic diseases in the community, so as to improve the self-management ability of the elderly with chronic diseases in the community and reduce the family burden of the elderly and the medical burden of the community.