Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Gerontology. 2021;67(5):591-598. doi: 10.1159/000514170. Epub 2021 Feb 17.
There is a lack of studies examining the link between perceived autonomy and frailty among the oldest old. Therefore, our objective was to fill this gap.
Data were used from the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe; follow-up [FU] wave 9; n = 510 observations in the analytical sample). The average age was 90.3 years (SD: 2.7 years). The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to assess frailty. Socioeconomic and health-related covariates were included in our regression model. The autonomy scale developed by Schwarzer was used to assess perceived autonomy in old age.
Adjusting for various confounders, multiple linear regressions showed that lower perceived autonomy was associated with increased levels of frailty (total sample: β = -0.13, p < 0.001; women: β = -0.14, p < 0.001; and men: β = -0.12, p < 0.001). Furthermore, lower perceived autonomy was associated with more depressive symptoms, higher cognitive impairment, and being institutionalized (except for men) in the total sample and in both sexes, but it was not significantly associated with age, sex, marital status, educational level, and social support.
Findings indicate that frailty is associated with lower autonomy among the oldest old. More generally, while health-related factors were consistently associated with autonomy, sociodemographic factors (except for being institutionalized) were not associated with autonomy among the oldest old. We should be aware of the strong association between autonomy and physical as well as mental health in very old age.
目前缺乏研究关注老年人感知自主性与虚弱之间的关系。因此，我们的目的是填补这一空白。
本研究使用了多中心前瞻性队列研究“大量老年初级保健患者（85 岁以上）的需求、卫生服务利用、成本和与健康相关的生活质量（AgeQualiDe；随访 [FU] 第 9 波；分析样本中有 510 个观测值）”的数据。平均年龄为 90.3 岁（SD：2.7 岁）。采用加拿大健康老龄化研究（CSHA）临床虚弱量表（CFS）评估虚弱程度。我们的回归模型纳入了社会经济和与健康相关的协变量。采用 Schwarzer 开发的自主性量表评估老年人的感知自主性。
在调整了各种混杂因素后，多元线性回归显示，感知自主性较低与虚弱程度增加相关（总样本：β=-0.13，p<0.001；女性：β=-0.14，p<0.001；男性：β=-0.12，p<0.001）。此外，在总样本和两性中，感知自主性较低与更多的抑郁症状、更高的认知障碍以及机构化（除男性外）相关，但与年龄、性别、婚姻状况、教育程度和社会支持无关。
研究结果表明，虚弱与老年人感知自主性较低有关。更普遍的是，虽然与健康相关的因素与自主性始终相关，但社会人口学因素（除机构化外）与老年人的自主性无关。我们应该意识到在非常高龄时，自主性与身体和心理健康之间存在很强的关联。
