2 型糖尿病老年患者心理弹性分析——来自 LOOK AHEAD 试验
Psychological resilience in older adults with type 2 diabetes from the Look AHEAD Trial.
机构信息
Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA.
Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA.
出版信息
J Am Geriatr Soc. 2023 Jan;71(1):206-213. doi: 10.1111/jgs.17986. Epub 2022 Oct 5.
BACKGROUND
There is growing interest in identifying factors associated with healthy aging. This cross-sectional study evaluated associations of psychological resilience with factors associated with aging in older adults with type 2 diabetes mellitus (T2DM).
METHODS
Participants were 3199 adults (72.2 ± 6.2 years of age, 61% female, 61% White, body mass index [BMI] = 34.2 ± 8.2 kg/m ) with T2DM enrolled in Look AHEAD (a multi-site randomized clinical trial comparing an intensive lifestyle intervention for weight loss to diabetes education and support). Participants were followed observationally after the 10-year intervention was discontinued. The following items were assessed approximately 14.4 years post-randomization in a cross-sectional analysis: Brief Resilience Scale; overnight hospitalizations in past year; physical functioning measured objectively (gait speed, grip strength) and via self-report (Pepper Assessment Tool for Disability; physical quality of life [QOL; SF-36]); a measure of phenotypic frailty based on having ≥3 of unintentional weight loss, low energy, slow gait, reduced grip strength, and physical inactivity. Depressive symptoms (PHQ-9) and mental QOL (SF-36) were also measured. Logistic/linear/multinomial regression was used to evaluate the association of variables with resilience adjusted for age, race/ethnicity, and gender.
RESULTS
Greater psychological resilience was associated with lower BMI, fewer hospitalizations, better physical functioning (i.e., lower self-reported disability, better physical QOL, faster gait speed, greater grip strength, lower likelihood of frailty), fewer depressive symptoms, and greater mental QOL (all p < 0.05). Psychological resilience moderated the relationship of number of hospitalizations in the past year with self-reported disability and grip strength.
CONCLUSIONS
Psychological resilience is associated with better physical function and QOL among older adults. Results should be interpreted cautiously given cross-sectional nature of analyses. Exploring the clinical benefits of resilience is consistent with efforts to shift the narrative on aging beyond "loss and decline" to highlight opportunities to facilitate healthy aging.
背景
人们越来越关注与健康老龄化相关的因素。本横断面研究评估了心理弹性与 2 型糖尿病（T2DM）老年患者与衰老相关因素之间的关联。
方法
参与者为 3199 名成年人（72.2±6.2 岁，61%为女性，61%为白人，体重指数 [BMI] = 34.2±8.2 kg/m），患有 T2DM，参加了 LOOK AHEAD（一项比较减肥强化生活方式干预与糖尿病教育和支持的多站点随机临床试验）。在 10 年干预结束后，对参与者进行了观察性随访。大约在随机分组后 14.4 年进行了横断面分析，评估了以下项目：简要韧性量表；过去一年的住院情况；通过客观（步态速度、握力）和自我报告（胡椒评估工具残疾；身体质量生活[QOL；SF-36]）测量的身体功能；基于非故意体重减轻、低能量、缓慢步态、握力降低和身体活动减少的≥3 项指标的表型脆弱性的衡量标准。还测量了抑郁症状（PHQ-9）和精神 QOL（SF-36）。使用逻辑/线性/多项回归评估调整年龄、种族/民族和性别后变量与韧性的关联。
结果
更高的心理弹性与较低的 BMI、较少的住院、更好的身体功能（即较低的自我报告残疾、更好的身体 QOL、更快的步态速度、更大的握力、较低的脆弱性可能性）、较少的抑郁症状和更好的精神 QOL 相关（均 p<0.05）。心理弹性调节了过去一年住院次数与自我报告残疾和握力之间的关系。
结论
心理弹性与老年患者更好的身体功能和 QOL 相关。鉴于分析的横断面性质，应谨慎解释结果。探索韧性的临床益处符合将衰老叙事从“损失和衰退”转变为强调促进健康衰老的机会的努力。
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