切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 185 -193. doi: 10.3877/cma.j.issn.1674-134X.2026.02.007

临床论著

老年髋部骨折术后老老照护者社会支持与照顾负担分析
陈韵澄1, 张仄骞1, 江梓雯1, 陈玉梅1,2,(), 余淑萍1,3, 梁晓瑜1,3   
  1. 1 528000 广东佛山,广州中医药大学第八临床医学院
    2 528000 广东佛山,佛山市中医院服务拓展部
    3 528000 广东佛山,佛山市中医院关节科
  • 收稿日期:2026-01-30 出版日期:2026-04-01
  • 通信作者: 陈玉梅
  • 基金资助:
    国家卫生健康委科学技术研究所项目(HT[2021]00498)

Analysis of social support and caregiver burden among older caregivers of elderly patients after hip fracture surgery

Yuncheng Chen1, Zeqian Zhang1, Ziwen Jiang1, Yumei Chen1,2,(), Shuping Yu1,3, Xiaoyu Liang1,3   

  1. 1 The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan 528000, China
    2 Department of Service Development, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, China
    3 Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, China
  • Received:2026-01-30 Published:2026-04-01
  • Corresponding author: Yumei Chen
引用本文:

陈韵澄, 张仄骞, 江梓雯, 陈玉梅, 余淑萍, 梁晓瑜. 老年髋部骨折术后老老照护者社会支持与照顾负担分析[J/OL]. 中华关节外科杂志(电子版), 2026, 20(02): 185-193.

Yuncheng Chen, Zeqian Zhang, Ziwen Jiang, Yumei Chen, Shuping Yu, Xiaoyu Liang. Analysis of social support and caregiver burden among older caregivers of elderly patients after hip fracture surgery[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 185-193.

目的

探讨老年髋部骨折术后老老照护者社会支持、积极应对、心理韧性与照顾负担间的关系,并分析其照顾负担的潜在剖面。

方法

选取2025年2月至10月于佛山市中医院骨伤中心住院的老年髋部骨折术后患者的老老照护者234例。纳入标准:年龄≥60岁且为患者住院期间照顾时间最长、承担最主要照顾任务的家庭照顾者(照顾时长≥4 h/d);沟通无障碍,能理解问卷内容。排除标准:存在严重疾病或意识障碍;半年内遭遇重大应激事件;与患者存在雇佣关系或领取报酬;正在参与其他研究。采用一般资料调查表、老年人社会支持评价量表简化版、简易应对方式问卷、心理韧性量表简化版、Zarit护理者负担量表进行调查。采用Pearson相关性分析验证相关性;通过中介效应模型,探讨积极应对和心理韧性在老年髋部骨折术后老老照护者社会支持与照顾负担间的中介效应;采用潜在剖面分析,探究照顾负担的异质性。

结果

老年髋部骨折术后老老照护者积极应对(β=-0.115,P<0.001)和心理韧性(β=-0.058,P<0.001)在社会支持与照顾负担间的单独中介效应显著,积极应对和心理韧性在社会支持与照顾负担间的链式中介效应显著(β=-0.074,P<0.001);其照顾负担的潜在剖面分析可分为4组,分别为重度照顾负担组(11.1%),中度照顾负担组(33.3%),中度个人负担-轻度责任负担组(30.3%),轻度照顾负担组(25.2%)。

结论

老年髋部骨折术后老老照护者积极应对和心理韧性在社会支持与照顾负担间起链式中介作用,且其照顾负担存在异质性。医护人员可根据照顾负担潜在剖面及各变量间的关系制订针对性的适老化照护培训方案,以缓解老老照护困境。

Objective

To investigate the current status of social support, positive coping, psychological resilience and caregiver burden among older caregivers of elderly patients after hip fracture surgery and to analysis latent profiles of caregiver burden.

Methods

A convenience sampling method was used to select 234 older caregivers of elderly patients who underwent hip fracture surgery and admitted to the Orthopedics Center of Foshan Hospital of Traditional Chinese Medicine from February to October 2025. Inclusion criteria: age≥60 years old, family caregivers of elderly patients who spent the longest time providing care and undertook the primary caregiving responsibilities during hospitalization (care duration≥four hours per day), able to communicate effectively and understand the questionnaire. Exclusion criteria: presence of severe illness or impaired consciousness, having experienced a major stressful event within the past six months, having an employment relationship with the patient or receiving remuneration, currently participating in other studies. The investigation was conducted using a general information questionnaire, the social support appraisals scale, the simplified coping style questionnaire, the Conner-davidson resilience scale and the Zarit caregiver burden scale. Pearson correlation analysis were used to verify the correlations; a mediation model was used to examine the mediating effects of positive coping and psychological resilience on the relationship between social support and caregiver burden among older caregivers of elderly patients after hip fracture surgery. Latent profile analysis was used to investigate the heterogeneity in caregiver burden.

Results

Among older caregivers of elderly patients after hip fracture surgery, positive coping (β=-0.115, P<0.001) and psychological resilience (β=-0.058, P<0.001) of older caregivers demonstrated significant individual mediating effects between social support and caregiver burden; positive coping and psychological resilience also showed a significant chain mediating effect between social support and caregiver burden (β=-0.074, P<0.001). The latent profile analysis of the caregiver burden could be divided into four groups: severe caregiver burden group (11.1%), moderate caregiver burden group (33.3%), moderate personal burden-mild responsibility burden group (30.3%), and mild caregiver burden group (25.2%).

Conclusion

The positive coping and psychological resilience among older caregivers of elderly patients after hip fracture surgery act as a chain-mediating factor between social support and caregiver burden, and their caregiver burden is heterogeneous. Medical staff can develop tailored training programs on age-friendly care based on the latent profile analysis of the caregiver burden and the relationships between various variables, in order to alleviate the challenges of aged care.

表1 老年髋部骨折术后老老照护者各维度的相关性分析
Table 1 Corelational analysis of multi-dimensions among older caregivers of elderly patients after hip fracture surgery
表2 老年髋部骨折术后老老照护者社会支持对照顾负担影响的标准化中介效应检验
Table 2 Standardized mediation analysis of the social support impact on caregiver burden among older caregivers of elderly patients after hip fracture surgery
图1 链式中介效应模型图 注:*-P<0.05,**-P<0.01,***-P<0.001
Figure 1 Diagram of chain mediation effect model Note: *-P<0.05, **-P<0.01, ***-P<0.001
表3 潜在剖面拟合指标
Table 3 Model fit indices for the latent profile
图2 老年髋部骨折术后老老照护者照顾负担的潜在剖面分布特征
Figure 2 Latent profile characteristics of caregiver burden among older caregivers of elderly patients after hip fracture surgery
表4 照顾负担不同类别的有效性检验(
±s
Table 4 Validation of caregiver burden across different classes
表5 照顾负担不同类别在一般资料的差异性分析[n(%)]
Table 5 Analysis of differences in general characteristics across different classes of caregiver burden
表6 照顾负担不同类别在社会支持、积极应对和心理韧性得分上的差异性分析(
±s
Table 6 Analysis of differences in social support, positive coping and psychological resilience across different classes of caregiver burden
[1]
Liu ZM, Li SY, Huang Q, et al. Greater habitual resveratrol intakes were associated with lower risk of hip fracture-a 1: 1 matched case-control study in Chinese elderly[J]. PhytotherRes, 2023, 37(2): 672-678.
[2]
Smith TO, Langford S, Ward K, et al. Unpaid caregiving for people following hip fracture: longitudinal analysis from the English Longitudinal Study of Ageing[J]. Eur Geriatr Med, 2023, 14(6): 1249-1260.
[3]
北京护理学会骨科专业委员会, 中华医学会骨科学分会护理学组, 中华医学会创伤学分会护理学组. 中国老年髋部骨折围手术期护理专家共识(2023)[J]. 中华创伤骨科杂志, 2023, 25(5): 369-379.
[4]
Xiao P, Zhou Y. Factors associated with the burden of family caregivers of elderly patients with femoral neck fracture: a cross-sectional study[J/OL]. J Orthop Surg Res, 2020, 15(1): 234. DOI: 10.1186/s13018-020-01749-9.
[5]
Zomar BO, Bryant DM, Marsh JD, et al. Assessment of informal caregiver assistance and strain with total hip and knee arthroplasty[J]. J Arthroplasty, 2021, 36(7): 2424-2430.e1.
[6]
颜国祥, 颜瑾, 袁文星. 人口老龄化背景下老老照护面临的挑战与对策[J]. 护理学杂志, 2023, 38(10): 117-120.
[7]
辛惠明, 叶毅敏, 陈芬菲, 等. 高龄老人家庭虐待倾向与照顾负担、照顾者心境的相关性[J]. 中国老年学杂志, 2020, 40(5): 1063-1066.
[8]
胡霞, 时翠勤, 姬东云. 维持性血液透析患者主要照顾者的照顾负担及其与心理弹性、社会支持的相关性分析[J]. 中华现代护理杂志, 2023, 29(7): 955-959.
[9]
Fowler J, Gullo MJ, Elphinston RA. Impulsivity traits and Facebook addiction in young people and the potential mediating role of coping styles[J/OL]. Pers Individ Differ, 2020, 161: 109965. DOI: 10.1016/j.paid.2020.109965.
[10]
Kubitza J, Große G, Schütte-Nütgen K, et al. Influence of spirituality on moral distress and resilience in critical care staff: a scoping review[J/OL]. Intensive Crit Care Nurs, 2023, 76: 103377. DOI: 10.1016/j.iccn.2022.103377.
[11]
袁冶, 范雪娇, 吴涛. 社会支持对早期乳腺癌患者手术方式决策冲突的影响: 自我效能和积极应对的中介作用分析[J]. 现代医学, 2025, 53(5): 760-766.
[12]
徐夏燕, 陆艳. 老年肠造口患者主要照顾者社会支持、心理韧性与照顾负担的相关性[J]. 中国老年学杂志, 2022, 42(2): 471-474.
[13]
Kline RB. Principles and Practice of Structural Equation Modeling[M]. New York: Guilford Press, 1998.
[14]
杨建, 王婷仙, 林艳伟. 老年人社会支持评价量表简化版的研制[J]. 中国卫生统计, 2024, 41(6): 823-829.
[15]
Folkman S, Lazarus RS, Gruen RJ, et al. Appraisal, coping, health status, and psychological symptoms[J]. J Pers Soc Psychol, 1986, 50(3): 571-579.
[16]
解亚宁. 简易应付方式量表信度和效度的初步研究[J]. 中国临床心理学杂志, 1998(2): 114-115.
[17]
Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the connor-Davidson resilience scale(CD-RISC): Validation of a 10-item measure of resilience[J]. J Trauma Stress, 2007, 20(6): 1019-1028.
[18]
叶增杰, 阮小丽, 曾珍, 等. 中文版10条目心理韧性量表在护生群体中的信效度分析[J]. 护理学报, 2016, 23(21): 9-13.
[19]
Zarit SH, Todd PA, Zarit JM. Subjective burden of husbands and wives as caregivers: a longitudinal study[J]. Gerontologist, 1986, 26(3): 260-266.
[20]
王烈, 杨小湜, 侯哲, 等. 护理者负担量表中文版的应用与评价[J]. 中国公共卫生, 2006, 22(8): 970-972.
[21]
温忠麟, 谢晋艳, 王惠惠. 潜在类别模型的原理、步骤及程序[J]. 华东师范大学学报(教育科学版), 2023, 41(1): 1-15.
[22]
汤丹丹, 温忠麟. 共同方法偏差检验: 问题与建议[J]. 心理科学, 2020, 43(1): 215-223.
[23]
孙倩, 翟睿, 陈玉梅, 等. 自我效能在老年髋关节置换术后患者主要照顾者应对方式与照顾负担的中介效应[J]. 现代临床护理, 2024, 23(12): 16-22.
[24]
路星星, 杨荆艳, 徐丽芬, 等. 泌尿造口老老照护家庭照顾负担与照顾准备度的相关性研究[J]. 护理学杂志, 2025, 40(7): 86-89.
[25]
张杰, 陈慧敏, 付勤. 创伤性脑损伤住院患儿主要照顾者负担及其影响因素[J]. 解放军护理杂志, 2022, 39(6): 48-51.
[26]
Kukihara H, Ando M, Koga K, et al. The mediating roles of psychological resilience and psychological well-being of caregivers for the older adults[J]. J Rural Med, 2024, 19(4): 241-249.
[27]
郑迎迎, 张艳霞, 时杰, 等. 心理弹性在口服敌草快中毒患者主要照顾者的社会支持与照顾负担之间的中介作用[J]. 华西医学, 2023, 38(11): 1666-1672.
[28]
Bass GA, Duffy CC, Kaplan LJ, et al. The revised cardiac risk index is associated with morbidity and mortality independent of injury severity in elderly patients with rib fractures[J]. Injury, 2023, 54(1): 56-62.
[29]
Rodakowski J, Skidmore ER, Rogers JC, et al. Role of social support in predicting caregiver burden[J]. Arch Phys Med Rehabil, 2012, 93(12): 2229-2236.
[30]
丁茹蕾, 黄丽芳, 唐三辉, 等. 老年慢病长期居家患者主要照顾者社会支持及负担、应对方式的现状调查[J]. 中国医药导报, 2021, 18(29): 25-30.
[31]
Denckla CA, Cicchetti D, Kubzansky LD, et al. Psychological resilience: an update on definitions, a critical appraisal, and research recommendations[J/OL]. Eur J Psychotraumatology, 2020, 11(1): 1822064. DOI: 10.1080/20008198.2020.1822064.
[32]
Yu J, Song H. Prevalence and risk factors of loneliness among patients with hematological malignancies[J/OL]. Medicine, 2022, 101(48): e31900. DOI: 10.1097/md.0000000000031900.
[33]
Bongelli R, Busilacchi G, Pacifico A, et al. Caregiving burden, social support, and psychological well-being among family caregivers of older Italians: a cross-sectional study[J/OL]. Front Public Health, 2024, 12: 1474967. DOI: 10.3389/fpubh.2024.1474967.
[34]
宁学斯, 张成岗. 社区居家智慧养老服务评价体系构建、模式划分和综合评估[J/OL]. 电子政务. 1-14.
[35]
杨雪娟, 陈思颖, 王海彦, 等. 社会生态系统下老年脑卒中主要照顾者照护体验的质性研究[J]. 护理学报, 2026, 33(3): 1-6.
[36]
钟向娣, 任婷婷, 任丽, 等. 全髋关节置换护理的可视化分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(2): 256-263.
[37]
衡元元. 上有老、下有小: “夹心层”低龄老年人代际挤压困境的形成及治理[J]. 社会保障研究, 2025(6): 72-86.
[38]
邓新茹, 耿力, 陈婷, 等. 中青年妇科恶性肿瘤患者及配偶二元应对影响因素的质性研究[J]. 护理学杂志, 2025, 40(17): 31-35.
[1] 葛建岭, 杨勇, 王坤, 徐成, 李晓明, 王伟. 超声引导下星状神经节阻滞联合右美托咪定对老年腹腔镜胆囊切除术患者炎性因子及快速康复的影响[J/OL]. 中华普通外科学文献(电子版), 2025, 19(06): 390-395.
[2] 叶佳慧, 张建薇, 葛兆霞, 沈艳婷, 马慧珍, 房芳, 张寅. 完全植入式输液港在高龄非肿瘤患者中的长期安全性及风险因素分析[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(02): 191-194.
[3] 张迪, 王素美, 陈阳, 熊霞鹂, 梁兵, 白雁飞, 郑雪云, 李华. 老年女性盆腔器官脱垂手术患者合并症分布及多学科诊疗围手术期管理效果分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(02): 206-212.
[4] 许志翱, 顾丽萍, 曹敏, 宣梦馨, 李艳婷, 赵丽亭. 基于加速康复外科和预康复模式对老年肺癌围术期多维度管理干预及预后的影响[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 979-984.
[5] 公伟, 邓鑫, 徐帅, 王博文, 刘军. 老年患者腹腔镜胰十二指肠切除术后教科书结局及影响因素分析[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(06): 329-336.
[6] 弓欣艳, 于祥, 冀雨薇, 王宝龙, 张伟光, 冯哲. 老年下尿路症状的影响因素及其作用机理全景分析[J/OL]. 中华肾病研究电子杂志, 2025, 14(06): 331-338.
[7] 陈思潮, 姬涛, 吴屹冰, 郭明君, 甘永雄, 苏炜, 魏鹏, 宋庆华. 组配式半骨盆假体治疗老年髋臼周围转移性肿瘤患者的临床疗效评估[J/OL]. 中华老年骨科与康复电子杂志, 2026, 12(02): 79-84.
[8] 王晓伟, 杨红梅, 孙天胜, 刘智, 刘川, 高杰. 髓内钉治疗老年股骨转子间骨折术后内固定相关并发症预测模型建立与验证[J/OL]. 中华老年骨科与康复电子杂志, 2026, 12(01): 38-46.
[9] 曾凯, 樊仕才. 老年骨盆脆性骨折的治疗进展[J/OL]. 中华老年骨科与康复电子杂志, 2025, 11(06): 372-378.
[10] 肖骥峰, 廖兴志, 汤燕彬, 陈湉, 施冬冬, 乔燕. 环泊酚复合小剂量艾司氯胺酮在老年患者腹腔镜胆囊切除术中的麻醉效果及术后认知功能影响[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 179-184.
[11] 石伯生, 黄涌, 王展. 锁骨下静脉最大直径和塌陷指数与老年胃肠道手术患者麻醉诱导后低血压的关系[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(06): 649-654.
[12] 温欢, 苏博, 刘金波, 王宏宇. 社区中老年人群心踝血管指数纵向轨迹影响因素及与预后的相关性[J/OL]. 中华临床医师杂志(电子版), 2025, 19(09): 642-650.
[13] 温欢, 苏博, 刘金波, 王宏宇. 甘油三酯葡萄糖指数与老年社区人群内皮功能障碍的相关性研究[J/OL]. 中华临床医师杂志(电子版), 2025, 19(08): 559-566.
[14] 马蓓蓓, 高翔, 黄露, 汪阳, 柳莹, 卢光东, 王雪梅. 社会支持在介入治疗后脑卒中主要照顾者负性情绪和照顾准备度间的中介作用[J/OL]. 中华介入放射学电子杂志, 2026, 14(01): 46-54.
[15] 陈芸, 杨海燕, 陈薇, 董贯忠, 张伟媛, 许钰. 社会支持和心理弹性在急性期脑卒中患者感知压力与睡眠质量间的链式中介作用[J/OL]. 中华卫生应急电子杂志, 2025, 11(06): 329-335.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?