孤独类型与老年男女功能残疾风险的关联：前瞻性分析。
Association Between Types of Loneliness and Risks of Functional Disability in Older Men and Women: A Prospective Analysis.
机构信息
Rory Meyers College of Nursing, New York University, New York, NY.
Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY.
出版信息
Am J Geriatr Psychiatry. 2023 Aug;31(8):621-632. doi: 10.1016/j.jagp.2023.02.046. Epub 2023 Feb 25.
OBJECTIVE
To examine the association between types of loneliness (transient, incident, and chronic) and the risk of functional disability.
METHODS
Data were from the Health and Retirement Study 2006/2008-2016/2018. A total of 7,148 adults aged ≥50 was included. Functional status was measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). Loneliness was assessed using the 3-item UCLA Loneliness Scale. We defined loneliness as no/transient/incident/chronic loneliness based on the pattern and duration of loneliness across 2006/2008 and 2010/2012. We applied multivariate Cox proportional hazard models with the new-onset ADL/IADL disability as outcome.
RESULTS
Overall, 69.3% respondents showed no loneliness; while 10.3%, 8.9%, and 11.5% showed transient, incident, and chronic loneliness, respectively. A total of 1,298 (18.16%) and 1,260 (17.63%) functionally normal respondents developed ADL and IADL disability during 36,294 person-years of follow-up, respectively. After adjusting for socio-demographic, behavioral, and health factors, chronic loneliness was associated with higher risks of ADL (hazard ratio [HR] = 1.37, 95% confidence interval [CI] = 1.16-1.63, p <0.001, χ = 3.60, degree of freedom [df] = 1) and IADL disability (HR = 1.25, 95% CI = 1.09-1.44, p = 0.002, χ = 3.17, df = 1) compared to no loneliness. By contrast, no significant associations between transient loneliness and ADL (HR = 1.17, 95% CI = 0.88-1.57, p = 0.273, χ = 1.10, df = 1) or IADL disability (HR = 1.16, 95% CI = 0.97-1.39, p = 0.112, χ = 1.59, df = 1) were found. Chronic loneliness was not associated with the risk of IADL disability in men (HR = 1.13, 95% CI = 0.91-1.40, p = 0.263, χ = 1.12, df = 1).
CONCLUSION
Chronic loneliness, rather than transient loneliness, is an independent risk factor for functional disability in middle-aged and older adults, especially for women.
目的
探讨不同类型的孤独感（短暂性、偶发性和慢性）与功能障碍风险之间的关系。
方法
数据来自 2006/2008 年至 2016/2018 年的健康与退休研究。共纳入 7148 名年龄≥50 岁的成年人。通过日常生活活动（ADL）和工具性日常生活活动（IADL）来衡量功能状态。孤独感采用 UCLA 孤独量表的 3 项进行评估。我们根据 2006/2008 年和 2010/2012 年的孤独模式和持续时间，将孤独感定义为无/短暂/偶发性/慢性孤独感。我们应用多变量 Cox 比例风险模型，以新发 ADL/IADL 残疾为结局。
结果
总体而言，69.3%的受访者没有孤独感；10.3%、8.9%和 11.5%的受访者分别表现出短暂性、偶发性和慢性孤独感。在 36294 人年的随访中，共有 1298（18.16%）和 1260（17.63%）名功能正常的受访者出现 ADL 和 IADL 残疾。在调整了社会人口统计学、行为和健康因素后，与无孤独感相比，慢性孤独感与 ADL（风险比 [HR] = 1.37，95%置信区间 [CI] = 1.16-1.63，p <0.001，χ = 3.60，自由度 [df] = 1）和 IADL 残疾（HR = 1.25，95%CI = 1.09-1.44，p = 0.002，χ = 3.17，df = 1）的风险更高相关。相比之下，短暂性孤独感与 ADL（HR = 1.17，95%CI = 0.88-1.57，p = 0.273，χ = 1.10，df = 1）或 IADL 残疾（HR = 1.16，95%CI = 0.97-1.39，p = 0.112，χ = 1.59，df = 1）之间无显著关联。慢性孤独感与男性 IADL 残疾的风险无关（HR = 1.13，95%CI = 0.91-1.40，p = 0.263，χ = 1.12，df = 1）。
结论
与短暂性孤独感相比，慢性孤独感是中年及以上成年人功能障碍的独立危险因素，尤其是对女性而言。
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