农村老年人自我忽视的评定、影响因素及其对生活质量影响的研究

发布时间：2018-04-21 03:10

本文选题：自我忽视 + 农村老年人　；参考：《安徽医科大学》2017年博士论文

【摘要】：目的本研究旨在通过德尔菲专家咨询法制定适合中国国情的农村老年自我忽视(elder self-neglect,ESN)评估量表,并评价农村老年自我忽视评估量表的信度和效度;在农村老年人中调查自我忽视的流行状况,对自我忽视的影响因素及其与农村老年人生活质量的相关性进行初步探讨;同时根据相关理论推测社会支持作为抑郁和老年自我忽视之间的中介变量,社会人口统计学变量作为调节变量,并检验其中介效应和调节效应。方法1.农村老年自我忽视评估量表的研制与评价应用德尔菲专家咨询法构建量表,选择公共卫生、老年医学、心理学、社会学等相关领域的30名专家参加咨询,以电子邮件的方式开展2轮专家咨询,要求专家对各备选条目进行评价筛选。采用方便抽样法,选取220名安徽省马鞍山市当涂县某乡镇的≥60岁的农村老年人,进行量表的项目分析和信效度评估,分管其中201名老年人的村医完成进行标准校标效度的老年自我忽视严重程度评估表(Assessment of Self-Neglect Severity,ASS),181名老年人的照顾者与其相应的老年人进行评估一致性测量。使用多种方法联合筛选进行项目分析,使用量表接受率、完成率、完成时间评估农村老年自我忽视评估量表的可接受性,使用内部一致性信度、重测信度进行量表信度评价,使用内容效度、结构效度、标准关联效度进行量表的效度评价。2.老年自我忽视影响因素研究采用整群抽样的方法,以乡镇为单位抽取当涂县某乡镇的农村≥60岁的老年人3182人。采取入户面对面访谈的方式进行问卷调查,内容包括社会人口统计学特征、健康状况、自我忽视、社会支持、日常生活能力、抑郁、焦虑、人格、认知功能。采用频率和频率分布描述计数资料的分布特征。量表得分如服从正态分布,选用均数和标准差描述分布的集中趋势和离散趋势;如不服从正态分布,选用中位数和第1、第3四分位数分布的集中趋势和离散趋势。采用卡方检验(或Fisher's确切概率法)对组间分布情况进行统计推断。对不符合参数检验条件的不同组间计量指标的比较采用K个独立样本kruskal-Wallis H非参数检验。老年自我忽视多因素分析采用二分类logistic回归分析。中介效应的检验中,因变量老年自我忽视、自变量抑郁、中介变量社会支持按照评分标准设置为类别变量,中介效应的统计分析使用Logistic回归分析。调节效应的检验中,因变量、自变量和调节变量均为类别变量,调节效应的统计分析采取二分类Logistic回归分析检验自变量和调节变量之间交互作用的偏回归系数是否具有统计学意义。3.老年自我忽视与农村老年人生活质量相关性的研究基于老年自我忽视影响因素的研究人群,选用均数和标准差描述分布的集中趋势和离散程度,采用t检验或单因素方差分析对生活质量总分及各领域得分进行组间比较,采用Person相关分析计算生活质量的4个领域得分与连续性变量的相关系数,采用Spearman相关分析计算生活质量的4个领域得分与自我忽视总分及5个维度得分的相关系数。采用分层线性回归模型,在控制了社会人口统计学变量、社会心理变量、躯体健康变量后,分别对老年自我忽视对生活质量各领域的影响进行多因素分析。采用Epi Data3.1软件建立数据库,应用SPSS 16.0软件对数据进行统计分析,检验水准a=0.05。结果1.农村老年自我忽视评估量表的研制与评价参加2轮专家咨询的专家23人,来自9所城市,有较高的学科代表性和地区代表性。82.6%的专家在相关领域均工作超过10年,经验丰富,熟悉研究内容,且参与积极性高,2轮专家咨询的积极系数分别为76.7%、100%。2轮专家咨询的总体专家权威系数(Cr)分别为0.70、0.79,专家评定可靠性较好。协调系数(W)分别为0.292、0.303,χ2检验P0.001,协调系数比较具有统计学意义。经过2论专家咨询共筛选出6个因子和26个条目。经过项目分析最终应用量表由医疗保健、卫生、情感、安全、社会交往5个维度,共14个条目组成。量表的接受率、完成率均为100%,量表平均完成时间为8分钟。量表总分及各维度的Cronboch'sα、重测信度r值分别为0.623～0.779(P0.001)、0.691～0.819(P0.001)。因子分析共提取5个公因子,累积贡献率为68.23%。该量表与ASS相关系数为0.370(P0.001);老年人与其照顾者得分的相关系数为0.587～0.747(P0.001)。2.老年自我忽视影响因素研究根据评分标准,26.7%的老年人被认定为有自我忽视,11.1%的老年人没有自我忽视,62.2%的老年人被怀疑可能存在自我忽视的情况,需要进一步的证实。有自我忽视中占前三位的依次为医疗保健自我忽视(31.0%)、情感自我忽视(19.0%)、卫生自我忽视(16.8%)。二分类Logistic回归分析表明:患有自我忽视的危险性,有宗教信仰是无宗教信仰的1.310倍(95%CI:1.074～1.597);主诉很大劳动强度是很少劳动强度的2.506倍(95%CI:1.226～5.121);独居是非独居的1.385倍(95%CI:1.009～1.901);抑郁组是非抑郁组的3.004倍(95%CI:2.320～3.890);焦虑组是非焦虑组的1.359倍(95%CI:1.043～1.770);生活自理能力障碍组是正常组的3.263倍(95%CI:2.446～4.354),生活自理能力下降组是正常组的1.552倍(95%CI:1.231～1.955);神经质中间组是情绪稳定组的1.338倍(95%CI:1.098～1.630);丧偶组是已婚组的0.681倍(95%CI:0.499～0.930);文盲是小学及以上组的0.665倍(95%CI:0.490～0.901);自评身体状况中等是自评身体状况中等以上的0.490倍(95%CI:0.382～0.627),自评身体状况中等以下是自评身体状况中等以上的0.634倍(95%CI:0.478～0.840);社会支持的总分越高,其老年自我忽视发生的危险性越低。社会支持在抑郁对总体老年自我忽视及其医疗、卫生、情感、安全维度起到部分中介效应,其中社会支持在抑郁与卫生自我忽视中的中介效应比例最高,为35.92%,其次是在情感自我忽视与抑郁中的中介效应比例为25.19%。丧偶以及独居在抑郁与老年自我忽视的调节效应显著,其它社会人口统计学变量在抑郁与老年自我忽视中不存在调节效应。3.老年自我忽视对农村老年人生活质量相关性的研究自我忽视总分及其各个维度的分数均与生活质量的4个领域得分呈相关性(P0.001)。分层线性回归分析的结果显示,调整了其它变量后,报告较高自我忽视总分的老年人具有较低的生活质量的4个领域得分(P0.001)。教育水平、自评经济状况、自评健康状况、生活自理能力、抑郁和认知功能在回归模型中始终与生活质量4个领域得分呈相关性。结论本研究的发现对老年自我忽视有更深刻的认识,一方面充实和深化了理论,另一方面也为老年自我忽视的预防和干预提供理论支持。1.农村老年自我忽视评估量表的研制与评价应用专家咨询法制定的农村老年自我忽视评估量表初始版,具有较好的可靠性、代表性和权威性。通过项目分析后筛选的农村老年自我忽视评估量表具有较好的可行性、信度和效度,可以应用于我国农村地区老年人自我忽视状况的测量。2.老年自我忽视影响因素研究老年自我忽视在中国农村已经存在并且可能正在逐步增加。自我忽视与多种因素有关,日常生活能力受损是增加老年自我忽视风险的首要影响因素,其次是抑郁。对日常生活能力受损以及抑郁的干预应该会是干预老年自我忽视的有效的策略。应该重点关注丧偶和独居的具有抑郁症状的农村老年人,并做好相应的支持措施。社会支持对于抑郁影响老年自我忽视有显著的部分中介效应,表明抑郁会直接影响老年自我忽视,而且可能存在其他的中介变量在两者关系中发挥中介作用,还需要进一步的检验。3.老年自我忽视对农村老年人生活质量相关性的研究自我忽视是农村老年人生活质量的独立危险因素。自我忽视的农村老年人的生活质量水平不容乐观,应考虑分配更多的资源去帮助和干预此部分人群。
[Abstract]:Objective to determine the reliability and validity of the rural elderly self neglect (elder self-neglect, ESN) assessment scale suitable for China's national conditions through Delphy's expert consultation, and to evaluate the reliability and validity of the rural elderly self neglect assessment scale, and to investigate the prevalence of self neglect among the elderly in the rural areas and the influencing factors of self neglect and their relationship. The relationship between the quality of life of the elderly in rural areas is discussed preliminarily; at the same time, according to the relevant theories, it is deduced that social support is the intermediary variable between depression and the elderly self neglect, and the social demographics variables are used as regulating variables, and their mediating effect and adjustment effect are tested. Method 1. the development of the assessment scale for the self neglect of the elderly in rural areas 30 experts in public health, geriatrics, psychology, sociology and other related fields were selected for consultation by 30 experts in the field of public health, geriatrics, psychology, sociology and other related fields, and 2 rounds of expert consultation were carried out by e-mail, and experts were asked to evaluate and select the alternative items. A convenient sampling method was used to select 220 Ma'anshan city in Anhui province. The project analysis and reliability and validity assessment of the rural elderly people over 60 years old in a township of a county, which were divided into 201 elderly people's village doctors, completed the Assessment of Self-Neglect Severity, ASS, and 181 elderly caregivers were evaluated with their corresponding elderly people. Assessment of consistency. Multiple methods were used to analyze project analysis, use scale acceptance rate, completion rate, and completion time to assess the acceptability of rural elderly self neglect assessment scale, use internal consistency reliability, retest reliability to evaluate the scale reliability, use content validity, structure validity and standard associated validity to scale the scale. The study of the influence factors of.2. elderly self neglect. A cluster sampling method was used to extract 3182 people aged 60 years old in a township of Dang Tu County. A questionnaire survey was carried out in the way of face-to-face interviews. The contents included social demographic characteristics, health status, self neglect, social support, and social support. Normal life, depression, anxiety, personality, cognitive function. Use frequency and frequency distribution to describe the distribution characteristics of counting data. The scale scores, such as the normal distribution, the concentration trend and the discrete trend of the selection of mean and standard deviation distribution, such as disobeying the normal distribution, the concentration trend of the median and first, third four quantiles distribution The inter group distribution was statistically inferred by chi square test (or Fisher's exact probability method). K independent sample kruskal-Wallis H nonparametric tests were used for the comparison of different groups of measurement indexes that did not conform to the parameters test conditions. Two classification logistic regression analysis was used for the multiple factor analysis of the elderly self neglect. In the test of the effect, the dependent variable is self ignored, the independent variable is depressed, the social support of the intermediary variable is set as the class variable according to the scoring standard. The statistical analysis of the intermediary effect is analyzed by the Logistic regression analysis. In the test of the adjustment effect, the dependent variable, the independent variable and the adjusting variable are all category variables, and the statistical analysis of the adjustment effect takes two points. Logistic regression analysis test whether the partial regression coefficient of the interaction between the independent variable and the variable variable has statistical significance. The study on the correlation between the elderly self neglect and the quality of life of the elderly in rural areas.3. research based on the influencing factors of the elderly self neglect, the concentration trend and dispersion of the distribution of the mean and standard deviation description distribution are selected. Degree, t test or single factor variance analysis were used to compare the total scores of quality of life and the scores in various fields. Person correlation analysis was used to calculate the correlation coefficient between 4 field scores and continuous variables of quality of life. The score of 4 fields of life quality and the total score of self neglect and 5 dimensions were obtained by using Spearman correlation analysis. The stratified linear regression model was used to analyze the influence of the social demography variables, social psychological variables and physical health variables, respectively, on the influence of the elderly self neglect on the quality of life in various fields. Epi Data3.1 software was used to establish the data base, and the data were statistically divided by the SPSS 16 software. Analysis, test level a=0.05. results 1. the development and evaluation of the rural elderly self neglect assessment scale, 23 experts participated in the 2 rounds of expert consultation, from 9 cities, high disciplinary and regional representative.82.6% experts worked for more than 10 years in related fields, experienced and familiar with the research content, and participated in the high enthusiasm, 2 round of experts. The positive coefficient of consultation is 76.7% respectively. The overall expert authority coefficient (Cr) of 100%.2 wheel expert consultation is 0.70,0.79 respectively. The expert evaluation is good. The coordination coefficient (W) is 0.292,0.303, the x 2 tests P0.001, and the coordination coefficient is statistically significant. After 2 experts consultation, 6 factors and 26 items are selected. The final application scale was composed of 5 dimensions: health care, health, emotion, safety and social communication. The acceptance rate of the scale was 14, the completion rate was 100%, the average completion time was 8 minutes. The total score of the scale and the Cronboch's alpha of each dimension were 0.623 to 0.779 (P0.001), 0.691 to 0.819 (P0.001). A total of 5 public factors were extracted, the cumulative contribution rate was 68.23%. and the correlation coefficient of ASS was 0.370 (P0.001); the correlation coefficient between the elderly and the caregivers was 0.587 ~ 0.747 (P0.001).2. elderly self neglect influence factors according to the scoring criteria, 26.7% of the elderly were identified as self neglect and 11.1% of the elderly had no self neglect. 62.2% of the elderly were suspected of self neglect and need further confirmation. The first three of the self neglect were health care self neglect (31%), emotional self neglect (19%), and health self neglect (16.8%). Two classified Logistic regression analysis showed that the risk of self neglect was a religious belief. It is 1.310 times as much as no religious belief (95%CI:1.074 ~ 1.597); the major labor intensity is 2.506 times (95%CI:1.226 ~ 5.121) of very little labor intensity, 1.385 times (95%CI:1.009 ~ 1.901) for solitude, 3.004 times (95%CI:2.320 to 3.890) in the depression group, and 1.359 times (95%CI:1.043 to 1.770) in the anxiety group (95%CI:1.043 to 1.770); The control group was 3.263 times as high as the normal group (95%CI:2.446 ~ 4.354), the decrease group of life self-care ability was 1.552 times (95%CI:1.231 ~ 1.955) in the normal group, and the middle group was 1.338 times (95%CI:1.098 ~ 1.630) of the emotional stability group (95%CI:1.098 to 1.630), and the widowhood group was 0.681 times of the married group (95%CI:0.499 to 0.930), and the illiteracy was 0.665 in the primary and above group. Times (95%CI:0.490 to 0.901); self evaluation of physical condition was 0.490 times as high as moderate or above (95%CI:0.382 ~ 0.627). Self evaluation under moderate physical condition was 0.634 times as high as moderate or above (95%CI:0.478 ~ 0.840); the higher the total score of social support, the lower the risk of self neglect. Depression has a partial mediating effect on the overall elderly self neglect and its medical, health, emotional and safety dimensions, of which social support has the highest proportion of mediating effects in depression and health self neglect, 35.92%, followed by the intermediary effect in emotional self neglect and depression is 25.19%. widowhood and solitude in depression and old age. The regulation effect of self neglect was significant, other social demography variables did not have regulation effect in depression and elderly self neglect.3. the relationship between the elderly self neglect and the quality of life of the elderly in rural areas, the scores of the total scores and the scores of each dimension were correlated with the scores of 4 areas of life quality (P0.001). The results of linear regression analysis showed that after the adjustment of other variables, the elderly who reported higher self neglect had 4 areas of low quality of life (P0.001). Education level, self evaluation, self-assessment, self-care, depression and recognition were always in the 4 areas of life quality in the regression model. Conclusion the findings of this study have a deeper understanding of the self neglect of the elderly, on the one hand, enrich and deepen the theory, on the other hand, provide theoretical support for the prevention and intervention of the elderly self neglect. The development and evaluation of the.1. rural elderly self neglect assessment scale should be used by the expert consultation legal system for the elderly self neglect. The initial version of the assessment scale has good reliability, representativeness and authority. The evaluation scale of rural elderly self neglect through the analysis of the project analysis has good feasibility, reliability and validity, and can be applied to the measurement of the self neglect of the elderly in the rural areas of China.2., the factors of the elderly self neglect and the study of the elderly self Neglect is existing in China's rural areas and may be increasing gradually. Self neglect is related to a variety of factors. Impairment of daily living ability is the primary factor in increasing the risk of self neglect, followed by depression. Intervention in daily life ability and depression should be an effective strategy to intervene in the elderly self neglect. The emphasis is on the depressive and solitary rural elderly people with depressive symptoms and the corresponding support measures. Social support has a significant partial mediator effect on depression affecting elderly self neglect, indicating that depression will directly affect the self neglect of the elderly, and that his intermediary variable may play an intermediary role in the relationship between them. It is also necessary to further examine the relationship between the.3. elderly self neglect and the relationship between the quality of life of the elderly in rural areas. Self neglect is an independent risk factor for the quality of life of the elderly in rural areas. The quality of life of the elderly people neglected in rural areas is not optimistic. More resources should be allocated to help and intervene in this part of the population.

【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R161.7

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