發(fā)布時間：2018-04-21 03:10

  本文選題：自我忽視 + 農村老年人��； 參考：《安徽醫(yī)科大學》2017年博士論文

【摘要】：目的 本研究旨在通過德爾菲專家咨詢法制定適合中國國情的農村老年自我忽視(elder self-neglect,ESN)評估量表,并評價農村老年自我忽視評估量表的信度和效度;在農村老年人中調查自我忽視的流行狀況,對自我忽視的影響因素及其與農村老年人生活質量的相關性進行初步探討;同時根據相關理論推測社會支持作為抑郁和老年自我忽視之間的中介變量,社會人口統計學變量作為調節(jié)變量,并檢驗其中介效應和調節(jié)效應。方法1.農村老年自我忽視評估量表的研制與評價應用德爾菲專家咨詢法構建量表,選擇公共衛(wèi)生、老年醫(yī)學、心理學、社會學等相關領域的30名專家參加咨詢,以電子郵件的方式開展2輪專家咨詢,要求專家對各備選條目進行評價篩選。采用方便抽樣法,選取220名安徽省馬鞍山市當涂縣某鄉(xiāng)鎮(zhèn)的≥60歲的農村老年人,進行量表的項目分析和信效度評估,分管其中201名老年人的村醫(yī)完成進行標準校標效度的老年自我忽視嚴重程度評估表(Assessment of Self-Neglect Severity,ASS),181名老年人的照顧者與其相應的老年人進行評估一致性測量。使用多種方法聯合篩選進行項目分析,使用量表接受率、完成率、完成時間評估農村老年自我忽視評估量表的可接受性,使用內部一致性信度、重測信度進行量表信度評價,使用內容效度、結構效度、標準關聯效度進行量表的效度評價。2.老年自我忽視影響因素研究采用整群抽樣的方法,以鄉(xiāng)鎮(zhèn)為單位抽取當涂縣某鄉(xiāng)鎮(zhèn)的農村≥60歲的老年人3182人。采取入戶面對面訪談的方式進行問卷調查,內容包括社會人口統計學特征、健康狀況、自我忽視、社會支持、日常生活能力、抑郁、焦慮、人格、認知功能。采用頻率和頻率分布描述計數資料的分布特征。量表得分如服從正態(tài)分布,選用均數和標準差描述分布的集中趨勢和離散趨勢;如不服從正態(tài)分布,選用中位數和第1、第3四分位數分布的集中趨勢和離散趨勢。采用卡方檢驗(或Fisher's確切概率法)對組間分布情況進行統計推斷。對不符合參數檢驗條件的不同組間計量指標的比較采用K個獨立樣本kruskal-Wallis H非參數檢驗。老年自我忽視多因素分析采用二分類logistic回歸分析。中介效應的檢驗中,因變量老年自我忽視、自變量抑郁、中介變量社會支持按照評分標準設置為類別變量,中介效應的統計分析使用Logistic回歸分析。調節(jié)效應的檢驗中,因變量、自變量和調節(jié)變量均為類別變量,調節(jié)效應的統計分析采取二分類Logistic回歸分析檢驗自變量和調節(jié)變量之間交互作用的偏回歸系數是否具有統計學意義。3.老年自我忽視與農村老年人生活質量相關性的研究基于老年自我忽視影響因素的研究人群,選用均數和標準差描述分布的集中趨勢和離散程度,采用t檢驗或單因素方差分析對生活質量總分及各領域得分進行組間比較,采用Person相關分析計算生活質量的4個領域得分與連續(xù)性變量的相關系數,采用Spearman相關分析計算生活質量的4個領域得分與自我忽視總分及5個維度得分的相關系數。采用分層線性回歸模型,在控制了社會人口統計學變量、社會心理變量、軀體健康變量后,分別對老年自我忽視對生活質量各領域的影響進行多因素分析。采用Epi Data3.1軟件建立數據庫,應用SPSS 16.0軟件對數據進行統計分析,檢驗水準a=0.05。結果1.農村老年自我忽視評估量表的研制與評價參加2輪專家咨詢的專家23人,來自9所城市,有較高的學科代表性和地區(qū)代表性。82.6%的專家在相關領域均工作超過10年,經驗豐富,熟悉研究內容,且參與積極性高,2輪專家咨詢的積極系數分別為76.7%、100%。2輪專家咨詢的總體專家權威系數(Cr)分別為0.70、0.79,專家評定可靠性較好。協調系數(W)分別為0.292、0.303,χ2檢驗P0.001,協調系數比較具有統計學意義。經過2論專家咨詢共篩選出6個因子和26個條目。經過項目分析最終應用量表由醫(yī)療保健、衛(wèi)生、情感、安全、社會交往5個維度,共14個條目組成。量表的接受率、完成率均為100%,量表平均完成時間為8分鐘。量表總分及各維度的Cronboch'sα、重測信度r值分別為0.623～0.779(P0.001)、0.691～0.819(P0.001)。因子分析共提取5個公因子,累積貢獻率為68.23%。該量表與ASS相關系數為0.370(P0.001);老年人與其照顧者得分的相關系數為0.587～0.747(P0.001)。2.老年自我忽視影響因素研究根據評分標準,26.7%的老年人被認定為有自我忽視,11.1%的老年人沒有自我忽視,62.2%的老年人被懷疑可能存在自我忽視的情況,需要進一步的證實。有自我忽視中占前三位的依次為醫(yī)療保健自我忽視(31.0%)、情感自我忽視(19.0%)、衛(wèi)生自我忽視(16.8%)。二分類Logistic回歸分析表明:患有自我忽視的危險性,有宗教信仰是無宗教信仰的1.310倍(95%CI:1.074～1.597);主訴很大勞動強度是很少勞動強度的2.506倍(95%CI:1.226～5.121);獨居是非獨居的1.385倍(95%CI:1.009～1.901);抑郁組是非抑郁組的3.004倍(95%CI:2.320～3.890);焦慮組是非焦慮組的1.359倍(95%CI:1.043～1.770);生活自理能力障礙組是正常組的3.263倍(95%CI:2.446～4.354),生活自理能力下降組是正常組的1.552倍(95%CI:1.231～1.955);神經質中間組是情緒穩(wěn)定組的1.338倍(95%CI:1.098～1.630);喪偶組是已婚組的0.681倍(95%CI:0.499～0.930);文盲是小學及以上組的0.665倍(95%CI:0.490～0.901);自評身體狀況中等是自評身體狀況中等以上的0.490倍(95%CI:0.382～0.627),自評身體狀況中等以下是自評身體狀況中等以上的0.634倍(95%CI:0.478～0.840);社會支持的總分越高,其老年自我忽視發(fā)生的危險性越低。社會支持在抑郁對總體老年自我忽視及其醫(yī)療、衛(wèi)生、情感、安全維度起到部分中介效應,其中社會支持在抑郁與衛(wèi)生自我忽視中的中介效應比例最高,為35.92%,其次是在情感自我忽視與抑郁中的中介效應比例為25.19%。喪偶以及獨居在抑郁與老年自我忽視的調節(jié)效應顯著,其它社會人口統計學變量在抑郁與老年自我忽視中不存在調節(jié)效應。3.老年自我忽視對農村老年人生活質量相關性的研究自我忽視總分及其各個維度的分數均與生活質量的4個領域得分呈相關性(P0.001)。分層線性回歸分析的結果顯示,調整了其它變量后,報告較高自我忽視總分的老年人具有較低的生活質量的4個領域得分(P0.001)。教育水平、自評經濟狀況、自評健康狀況、生活自理能力、抑郁和認知功能在回歸模型中始終與生活質量4個領域得分呈相關性。結論本研究的發(fā)現對老年自我忽視有更深刻的認識,一方面充實和深化了理論,另一方面也為老年自我忽視的預防和干預提供理論支持。1.農村老年自我忽視評估量表的研制與評價應用專家咨詢法制定的農村老年自我忽視評估量表初始版,具有較好的可靠性、代表性和權威性。通過項目分析后篩選的農村老年自我忽視評估量表具有較好的可行性、信度和效度,可以應用于我國農村地區(qū)老年人自我忽視狀況的測量。2.老年自我忽視影響因素研究老年自我忽視在中國農村已經存在并且可能正在逐步增加。自我忽視與多種因素有關,日常生活能力受損是增加老年自我忽視風險的首要影響因素,其次是抑郁。對日常生活能力受損以及抑郁的干預應該會是干預老年自我忽視的有效的策略。應該重點關注喪偶和獨居的具有抑郁癥狀的農村老年人,并做好相應的支持措施。社會支持對于抑郁影響老年自我忽視有顯著的部分中介效應,表明抑郁會直接影響老年自我忽視,而且可能存在其他的中介變量在兩者關系中發(fā)揮中介作用,還需要進一步的檢驗。3.老年自我忽視對農村老年人生活質量相關性的研究自我忽視是農村老年人生活質量的獨立危險因素。自我忽視的農村老年人的生活質量水平不容樂觀,應考慮分配更多的資源去幫助和干預此部分人群。
[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.

【學位授予單位】：安徽醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R161.7

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5 張學強;;提高農村老年人自養(yǎng)能力的意義及對策[A];中國老年學學會2006年老年學學術高峰論壇論文集[C];2006年

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7 牛振耘;馮志強;;農村老年文化建設的現狀、問題及創(chuàng)新[A];陜西省老年文化與社會和諧研討會論文集[C];2009年

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