Mielenz Thelma J, Kannoth Sneha, Xue Qian-Li
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
Division of Geriatric Medicine and Gerontology, School of Medicine Department of Medicine and the Center on Aging and Health, The Johns Hopkins University, Baltimore, MD, United States.
Front Aging. 2021 Dec 24;2:770476. doi: 10.3389/fragi.2021.770476. eCollection 2021.
Few studies have addressed the combined effects of health-promoting and self-care behaviors among older adults. Thus, new research is needed to assess the potential for behavior change to prolong independence in later life. To determine the relationships between self-care behaviors and risks of mobility and activities of daily living (ADLs) over time. Longitudinal data was used from the National Health and Aging Trends Study (NHATS) cohort. Eight baseline self-care behaviors were summarized using latent class analysis. Separately, longitudinal latent classes of mobility and ADLs were created. Annual in-person interviews conducted for a nationally representative sample. The baseline study sample included 7,609 Medicare beneficiaries aged ≥65 from NHATS who were living in community or residential care settings, with a 71% response rate. The average age was 75, with 57% female, 81% white and 78% high school graduates or higher. Approximately, 80% (n = 6,064) completed 5 years of follow-up. Favorable vs. unfavorable self-care latent classes measured at baseline. Associations were measured between baseline classes and longitudinal classes of mobility and ADLs difficulty. Among decedents, 5-year associations were measured between baseline classes and years of overall, healthy, able, and healthy/able life. Two habitual baseline self-care behavioral patterns (46% favorable; 54% unfavorable) and three trajectories of change in mobility and ADLs disability (maintaining independence; shifting to accommodation/difficulty; shifting to assistance) emerged over time. Participants with a favorable baseline pattern had 92% (0.90-0.94) reduced risk in shifting to assistance class and 70% (0.64-0.76) reduced risk for shifting to accommodation/difficulty class for mobility disability. Participants with a favorable baseline pattern had 86% (0.83-0.89) reduced risk in shifting to assistance class and 24% (0.11-0.36) reduced risk in shifting to accommodation/difficulty class for ADLs disability. Those with an unfavorable pattern had 2.54 times greater risk of mortality by the end of the 5-year follow-up compared to those with a favorable pattern. Self-care behaviors in older age represent a habitual pattern. A favorable self-care behavioral pattern decreased the risk of moving towards a more disabled profile and added years of life. Interventions should encourage self-care behaviors constituting a favorable pattern.
很少有研究探讨促进健康行为和自我护理行为对老年人的综合影响。因此，需要开展新的研究来评估行为改变对延长晚年独立生活的潜力。以确定自我护理行为与随时间推移的行动能力风险及日常生活活动（ADL）之间的关系。使用了来自国家健康与老龄化趋势研究（NHATS）队列的纵向数据。通过潜在类别分析总结了八项基线自我护理行为。另外，创建了行动能力和ADL的纵向潜在类别。对具有全国代表性的样本进行年度面对面访谈。基线研究样本包括来自NHATS的7609名年龄≥65岁的医疗保险受益人，他们居住在社区或机构护理环境中，应答率为71%。平均年龄为75岁，女性占57%，白人占81%，高中及以上学历者占78%。大约80%（n = 6064）的人完成了5年的随访。在基线时测量有利与不利的自我护理潜在类别。测量基线类别与行动能力和ADL困难的纵向类别之间的关联。在已故者中，测量基线类别与总体、健康、有能力及健康/有能力生活年数之间的5年关联。随着时间的推移，出现了两种习惯性基线自我护理行为模式（46%有利；54%不利）以及三种行动能力和ADL残疾的变化轨迹（保持独立；转变为适应/困难；转变为需要帮助）。具有有利基线模式的参与者转变为需要帮助类别的风险降低了92%（0.90 - 0.94），行动能力残疾转变为适应/困难类别的风险降低了70%（0.64 - 0.76）。具有有利基线模式的参与者转变为需要帮助类别的ADL残疾风险降低了86%（0.83 - 0.89），转变为适应/困难类别的风险降低了24%（0.11 - 0.36）。与具有有利模式的人相比，具有不利模式的人在5年随访结束时死亡风险高出2.54倍。老年人的自我护理行为代表一种习惯模式。有利的自我护理行为模式降低了向残疾程度更高状态转变的风险，并增加了寿命年数。干预措施应鼓励构成有利模式的自我护理行为。
