目的 探讨社区老年人主观认知下降(subjective cognitive decline,SCD)的流行特征、影响因素及症状体验。方法 采用聚敛式平行混合方法设计,2024年6月至2025年6月,便利抽样选取苏州市60岁及以上社区老年人,采用一般资料调查表、社区综合护理系统痴呆症评估表和主观认知下降问卷对其进行调查;目的抽样法选取20名SCD老年人进行半结构式访谈,采用主题分析法分析资料;通过联合展示表呈现整合结果。结果 共纳入1458名社区老年人,710名(48.7%)存在SCD。多因素Logistic回归分析显示,年龄、文化程度、体质量指数、白内障/青光眼、骨质疏松、高脂血症、缺血性心脏病等是SCD的影响因素,差异均有统计学意义(均P<0.05)。质性分析提炼出症状感知、差异化归因、担忧与应对调适3个主题。整合分析显示,两类结果在社会人口学与慢病维度相互印证,质性资料揭示了量性关联背后的衰老与疾病归因过程,并补充了痴呆担忧、社交回避及主动/依赖应对等心理社会体验。结论 社区老年人SCD与多维因素相关,其症状体验、归因及应对方式存在个体差异,社区管理应在风险分层基础上兼顾症状多维评估、个体化归因沟通与心理社会支持。

Objective To explore the prevalence characteristics,influencing factors,and symptom experiences of subjective cognitive decline (SCD) among community-dwelling older adults.Methods A convergent parallel mixed methods was adopted. From June 2024 to June 2025,community-dwelling older adults aged 60 years and above in Suzhou were selected by convenience sampling and surveyed using a general information questionnaire,the dementia assessment sheet for community integrated care system,and the subjective cognitive decline questionnaire.20 older adults with SCD were purposefully selected for semi-structured interviews.Thematic analysis was used to analyze the qualitative data,and the integrated results were presented via table joins.Results A total of 1,458 community-dwelling older adults were included,of whom 710 (48.7%) presented with SCD.Multivariate logistic regression analysis showed that age,educational level,body mass index,cataract/glaucoma,osteoporosis,hyperlipidemia,and ischemic heart disease were influencing factors of SCD,with statistically significant differences (all P<0.05).Qualitative analysis extracted 3 themes:symptom perception,differentiated attribution,and worry with coping and adjustment.Integrated analysis revealed that the 2 types of results corroborated each other in sociodemographic and chronic disease dimensions.The qualitative data further revealed the processes of aging and disease attribution underlying the quantitative associations,and supplemented psychosocial experiences including dementia worry,social avoidance,and active/dependent coping strategies.Conclusions SCD in community-dwelling older adults is associated with multidimensional factors,and individuals exhibit variations in symptom experience,attribution,and coping styles.Community management should integrate multidimensional symptom assessment,individualized attribution communication,and psychosocial support based on risk stratification.

R473.74

老年长期照护教育部重点实验室(海军军医大学)；苏州市老年智慧护理与康养重点实验室资助项目(SZS2024009)；江苏省研究生科研与实践创新计划项目(KYCX24_3352)