Gale C R, Cooper C, Deary I J, Aihie Sayer A
MRC Lifecourse Epidemiology Unit, University of Southampton, UK.
Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK.
Psychol Med. 2014 Mar;44(4):697-706. doi: 10.1017/S0033291713001384. Epub 2013 Jul 3.
Observations that older people who enjoy life more tend to live longer suggest that psychological well-being may be a potential resource for healthier ageing. We investigated whether psychological well-being was associated with incidence of physical frailty.
We used multinomial logistic regression to examine the prospective relationship between psychological well-being, assessed using the CASP-19, a questionnaire that assesses perceptions of control, autonomy, self-realization and pleasure, and incidence of physical frailty or pre-frailty, defined according to the Fried criteria (unintentional weight loss, weakness, self-reported exhaustion, slow walking speed and low physical activity), in 2557 men and women aged 60 to ≥ 90 years from the English Longitudinal Study of Ageing (ELSA).
Men and women with higher levels of psychological well-being were less likely to become frail over the 4-year follow-up period. For a standard deviation higher score in psychological well-being at baseline, the relative risk ratio (RR) for incident frailty, adjusted for age, sex and baseline frailty status, was 0.46 [95% confidence interval (CI) 0.40-0.54]. There was a significant association between psychological well-being and risk of pre-frailty (RR 0.69, 95% CI 0.63-0.77). Examination of scores for hedonic (pleasure) and eudaimonic (control, autonomy and self-realization) well-being showed that higher scores on both were associated with decreased risk. Associations were partially attenuated by further adjustment for other potential confounding factors but persisted. Incidence of pre-frailty or frailty was associated with a decline in well-being, suggesting that the relationship is bidirectional.
Maintaining a stronger sense of psychological well-being in later life may protect against the development of physical frailty. Future research needs to establish the mechanisms underlying these findings.
有观察表明，更享受生活的老年人往往寿命更长，这表明心理健康可能是健康老龄化的一种潜在资源。我们调查了心理健康是否与身体虚弱的发生率相关。
我们使用多项逻辑回归来研究心理健康与身体虚弱或虚弱前期发生率之间的前瞻性关系。心理健康通过CASP - 19进行评估，这是一份评估控制感、自主性、自我实现和愉悦感的问卷；身体虚弱或虚弱前期则根据弗里德标准（非故意体重减轻、虚弱、自我报告的疲惫、步行速度慢和身体活动水平低）来定义。研究对象为来自英国老龄化纵向研究（ELSA）的2557名年龄在60岁至90岁及以上的男性和女性。
在4年的随访期内，心理健康水平较高的男性和女性变得虚弱的可能性较小。在基线时心理健康得分每高出一个标准差，在调整了年龄、性别和基线虚弱状态后，发生虚弱的相对风险比（RR）为0.46 [95%置信区间（CI）0.40 - 0.54]。心理健康与虚弱前期风险之间存在显著关联（RR 0.69，95% CI 0.63 - 0.77）。对享乐（愉悦）和幸福（控制、自主性和自我实现）幸福感得分的检查表明，两者得分较高均与风险降低相关。通过进一步调整其他潜在混杂因素，这种关联有所减弱，但仍然存在。虚弱前期或虚弱的发生率与幸福感下降相关，这表明这种关系是双向的。
在晚年保持更强的心理健康意识可能有助于预防身体虚弱的发生。未来的研究需要确定这些发现背后的机制。
