Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2021 Dec;69(12):3507-3518. doi: 10.1111/jgs.17417. Epub 2021 Aug 21.
Physical frailty is defined as a syndrome of decreased physiologic reserve conferring vulnerability to functional decline, mortality, and other adverse outcomes upon experiencing stressors. Self-efficacy, which is confidence in one's ability to perform well in a domain of life, is modifiable. Self-efficacy is associated with improved health behavior and decreased chronic disease burden. Its relationship to frailty is unknown. The purpose of this study was to evaluate whether a general self-efficacy proxy predicts incident frailty.
A nationally representative sample of 4825 U.S. older adults aged 65 and older living in the community or non-nursing home care setting enrolled in the National Health and Aging Trends Study from 2011 to 2018 was used. Self-efficacy was dichotomized into low and high groups using the one-item self-efficacy proxy measure. The Physical Frailty Phenotype was used to categorize participants as frail and non-frail. A discrete time hazard model using data from eight rounds was used to obtain incident hazard ratios of frailty in two models. Model 1 was adjusted for age, race, sex, education, and income. Model 2 contained Model 1 covariates and added disability and comorbidities.
Among people without frailty at baseline, risk of developing frailty over 7 years was increased by 41% among those with low versus high self-efficacy after adjustment for sociodemographics (P = 0.002), and by 27% after further adjustment for disability and comorbidities (P = 0.032).
This study generates a rationale to further explore self-efficacy in frailty research. Self-efficacy may be a key modifiable element to incorporate into multimodal physical frailty interventions.
身体虚弱被定义为一种生理储备减少的综合征，使个体在面临压力时易发生功能下降、死亡和其他不良后果。自我效能感是指对自己在生活某个领域表现出色的能力的信心，是可以改变的。自我效能感与改善健康行为和减少慢性疾病负担有关。它与虚弱的关系尚不清楚。本研究旨在评估一般自我效能感代理指标是否可以预测虚弱的发生。
本研究使用了 2011 年至 2018 年期间参加国家健康老龄化趋势研究的 4825 名年龄在 65 岁及以上、居住在社区或非养老院护理环境中的美国老年人的全国代表性样本。使用一项自我效能感代理测量的单项自我效能感指标将自我效能感分为低和高两组。使用身体虚弱表型将参与者分为虚弱和非虚弱两类。使用来自 8 轮的数据的离散时间风险模型，在两个模型中获得虚弱的发病风险比。模型 1 调整了年龄、种族、性别、教育程度和收入。模型 2包含模型 1 的协变量，并增加了残疾和合并症。
在基线时没有虚弱的人群中，在调整社会人口统计学因素后（P=0.002），低自我效能感组发生虚弱的风险比高自我效能感组增加了 41%，在进一步调整残疾和合并症后（P=0.032），该风险比增加了 27%。
本研究为进一步探索虚弱研究中的自我效能感提供了依据。自我效能感可能是纳入多模式身体虚弱干预措施的关键可改变因素。
