Page 108 - 2022-01-中国全科医学

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·101·

enhancing family functions，and gradually develop a family-centered home care system with community support. Objective To
explore the mechanism of mediating action of family function between disability severity and family resilience in home-living older
adults with disability in Xinjiang's minority areas，offering new ideas for relevant departments to improve family resilience of this
population. Methods From July to August 2020，a household survey was conducted with older adults with disability，and their
primary caregivers and core family members of 431 Uygur or Kazak households selected from Xinjiang's Bortala Mongol Autonomous
Prefecture by use of stratified multistage sampling. Questionnaires including demographic questionnaire developed by our research
team，Katz Index of Independence in Activities of Daily Living（Katz ADL），Mini-mental State Examination（MMSE），
Family Resilience Assessment Scale（FRAS），and the Family Concern Index Questionnaire（APGAR）were used in the survey
to collect information regarding degree of disability，family resilience，and family functions of the older adults with disability.
Spearman correlation analysis was used to explore the relationship of family resistance with disability severity，family function and
its five functional components（adaptability，partnership，growth，affection，and resolve）. Multiple linear regression analysis
and Bootstrap test were used to verify and examine the medicating effect of family function and its five components between disability
severity and family resilience. Results From the 431 households，older adults with disability，primary family caregivers，and
core family members were selected at a ratio of 1∶1∶1（each group contained 431 cases）. Among the older adults with disability，
the prevalence of mild，moderate and severe disability was 46.9%（202/431），40.1%（173/431），and 13.0%（56/431），
respectively. The prevalence of intact family function，moderate and severe family dysfunction in the households was 46.4%（200/431），
43.6%（188/431），and 10.0%（43/431），respectively. The prevalence of low and high family resilience in the households was
51.7%（223/431），and 48.3%（208/431），respectively. Spearman correlation analysis revealed that disability severity of the
older adults reduced with the increase of family function and its five components as well as family resilience（P<0.05）. And family
resilience grew with the increase of family function and its five components（P<0.05）. Mediation analysis found that family function
partially mediated between disability severity and family resilience，with an effect size accounting for 67.2% of the total effect. The
components of adaptability，partnership，growth，affection，and resolve also partially mediated between disability severity and
family resilience，with effect sizes accounting for 38.7%，47.1%，48.2%，24.2%，and 25.3% of the total effect respectively.
Conclusion Family function played a partial mediating role between the degree of disability and family resilience in home-living
older adults with disability in minority areas of Xinjiang. In view of this，for those with severe disability，besides offering more
medical assistance，relevant governments are suggested to pay attention to improving their family function by making use of family
internal resources，so as to improve family resilience to enhance the quality of care for this population.
【Key words】 Family function；Disability；Elderly；Family resilience；Mediating effect；Xinjiang；Uygur；Kazakh

新疆已步入老龄化社会，据统计，新疆少数民族老 庭外部资源来减轻家庭照护者的负担，进而提高家庭抗
年人口占全疆老年人口总数的 57.33% ［1］ 。维吾尔族与哈 逆力 ［10］ 。较少研究者从家庭内部资源，即家庭功能视角
萨克族作为新疆两大少数民族，人口老龄化问题日益严 出发探讨提升居家失能老年人家庭抗逆力的路径。关于
峻 ［2］ 。在长期的农耕和游牧生活中，维吾尔族和哈萨克 居家失能老年人失能程度、家庭功能与家庭抗逆力之间
族擅长将畜禽肉加工制成腌制肉等便于携带、易于储存 作用机制的研究更是少见。鉴于此，本研究以家庭抗逆
的肉制品，形成了以高盐、高脂为主要特点的饮食习惯。 力作为因变量提出假设：家庭功能在居家失能老年人失
独特的饮食习惯和生活方式使维吾尔族与哈萨克族老年 能程度与家庭抗逆力间可能存在中介作用。本研究以新
人高血压患病率高达 52.4% 和 79.0%，远高于全国平均 疆少数民族地区博尔塔拉蒙古自治州（简称博州）有维
水平 ［3-4］ 。高血压引发的脑卒中、冠心病等是造成维吾 吾尔族 / 哈萨克族居家失能老年人的家庭作为研究和调
尔族和哈萨克族老年人失能和死亡的主要原因 ［5］ 。受维 查单元，对上述假设进行验证，旨在为提高居家失能老
吾尔族、哈萨克族根深蒂固的孝道文化影响，居家照护 年人家庭抗逆力提供新视角、新思路。
是多数失能老年人首选的照护模式 ［6］ 。虽然居家照护满 1 对象与方法
足了失能老年人的意愿和情感需求，但居家照护也给长 1.1 研究对象 以新疆少数民族聚居地区博州的维吾尔
期照护者、家庭带来了沉重负担，甚至会激化家庭矛盾、 族 / 哈萨克族居家失能老年人、居家主要照护者、家庭
引发家庭危机 ［7］ 。研究表明，良好的家庭功能可减轻失 核心人物为研究对象。居家失能老年人纳入标准 :（1）
能老年人家庭因照护带来的负担，提高家庭抗击逆境的 年龄≥ 60 岁的维吾尔族 / 哈萨克族老年人；（2）经日
能力，从而帮助家庭顺利度过照护危机 ［8］ 。家庭成员面 常生活活动能力量表（KatzADL）筛查，存在不同程度的
对危机时的反弹或应对能力即家庭抗逆力 ［9］ 。目前，居 日常生活自理能力丧失；（3）为当地常住居民（在当地
家失能老年人照护家庭负担领域研究更多地关注调动家 居住≥ 1 年） ［11］ ；（4）对调查知情同意并愿意配合者。