Fauth Elizabeth Braungart, Zarit Steven H, Malmberg Bo
Department of Family, Consumer, and Human Development, Utah State University, Logan, UT USA.
2905 Old Main Hill, Logan, UT 84322-2905 USA.
Eur J Ageing. 2008 Sep 2;5(3):161. doi: 10.1007/s10433-008-0092-6. eCollection 2008 Sep.
The Disablement Process model proposes a pathway for how chronic diseases in late life can lead to disability, with the variables in the main pathway designated as pathology, impairment, functional limitations, and disability. The model also suggests that psychosocial and contextual variables in the periphery of the model affect disability outcomes. The current study included 149 Swedish adults aged 86, 90, or 94 living in the community or in institutions who answered questions and performed tasks of physical and cognitive ability. A series of regressions were used to test the mediating role of variables within the main pathway of the model, as well as the ability of psychosocial variables to mediate main pathway relationships. Results indicated that physical limitations accounted for between 31 and 52% of the direct effects between impairments and disability, but delayed recall did not mediate these relationships. For the tests of psychosocial variables, mastery was a consistent mediator between impairments and functional limitations, and also mediated several relationships between functional limitations and disability variables. Depression and loneliness also mediated some of the relationships within the main pathway, but explained a smaller percentage of the total effects than mastery. The study concludes that the Disablement Process model is an effective biopsychosocial approach in describing and predicting disability in the oldest-old. In addition, the course of disability seems to be buffered by certain psychosocial variables, particularly feelings of mastery.
致残过程模型提出了一个关于晚年慢性疾病如何导致残疾的路径，主要路径中的变量被指定为病理、损伤、功能受限和残疾。该模型还表明，模型外围的心理社会和环境变量会影响残疾结果。当前研究纳入了149名居住在社区或机构中的86岁、90岁或94岁瑞典成年人，他们回答了问题并完成了身体和认知能力任务。一系列回归分析用于检验模型主要路径中变量的中介作用，以及心理社会变量对主要路径关系的中介能力。结果表明，身体受限在损伤与残疾之间的直接效应中占31%至52%，但延迟回忆并未介导这些关系。对于心理社会变量的检验，掌控感是损伤与功能受限之间始终如一的中介变量，并且还介导了功能受限与残疾变量之间的几种关系。抑郁和孤独也介导了主要路径中的一些关系，但在总效应中所占比例小于掌控感。该研究得出结论，致残过程模型是描述和预测高龄老人残疾的一种有效的生物心理社会方法。此外，残疾进程似乎受到某些心理社会变量的缓冲，尤其是掌控感。
