The Social-Psychological Integration Model Of Activities Of Daily Living In Rural Elderly With High-Risk Of Disability Caused By Hypertension And Depression

The population aging in the world and China has brought about an increasingly prominent challenge to the society due to the huge increase in the elderly disabled population.In rural China,due to the migration of young people to cities,the degree of aging is deeper and the proportion of elderly people with disabilities is higher;at the same time,due to relatively backward economic conditions,scarce medical resources,and weak health awareness,elderly disability problem is more prominent in rural areas.Currently,China lacks a complete disability care system,and the prevention of elderly people at risk of disability is insufficient.Chronic physical diseases,mental disorders,and social support can all affect activities of daily living in the elderly.There is a high comorbidity rate between chronic physical diseases and mental disorders,and comorbidities can further increase the risk of disability in the elderly.Current research activities of daily living intervention still focuses on physical exercise and cognitive training,with a lack of attention to psychological and social factors.Therefore,this research selects elderly people with hypertension and depression as the research subjects to analyze their activities of daily living impairment risk and explore the relationship between blood pressure,social support,depression and activities of daily living.This research also explores possible ways to effectively prevent and treat the elderly decline in activities of daily living.Based on the relevant theories of collaborative care model,a social-psychological intervention model for activities of daily living is designed for elderly people with hypertension and depression,which will be tested in rural communities to verify the intervention effect and explore possible mechanisms.The research includes three studies:(1)Study 1 aims to analyze and compare the differences in activities of daily living between rural elderly people with hypertension and depression and elderly people with hypertension but without depression,while exploring the impact of other demographic factors on activities of daily living of rural elderly hypertension patients.The study surveyed 1,930 elderly people with hypertension and without depression and 2,363 elderly people with hypertension and depression.Measurements included basic demographic information such as age and gender,the Activity of Daily Living Scale(ADLS)and 9-question Patient Health Questionnaire(PHQ-9).The results showed that the risk of activities of daily living impairment in the elderly with hypertension and depression was 5.89 times that of elderly people with hypertension and without depression(95% CI: 4.86-7.14).The results of this study provide evidence for interventions on impaired activities of daily living in elderly people with hypertension and without depression.Conventional hypertension management is based on the chronic disease management model.If psychological symptoms such as depression are ignored,it will be difficult to effect on interventions for activities of daily living.(2)Study 2 aims to explore the effects of blood pressure,depression and social support on activities of daily living,and analyze whether social support and depression play a mediating role between blood pressure and activities of daily living.The study included 2,365 elderly people with hypertension and depression symptoms,Measurements included demographic information,blood pressure values,the Activities of Daily Living Scale(ADLS),the 9-question Patient Health Questionnaire(PHQ-9),the Medical Outcomes Study Social Support Survey(MOS-SSS),and the 17-item Hamilton Depression Rating Scale(HDRS-17).The establishment of this multiple mediation model provides evidence-based support for the protective and damaging factors of activities of daily living impairment in patients with hypertension,and also provides a theoretical basis for further socialpsychological integration management models.(3)Study 3 aims to develop a social and psychological intervention model for managing activities of daily living of elderly rural residents with hypertension and depression symptoms,based on the mediation effect model of Study 2.Based on the relevant theories of collaborative care model,the intervention involved training village doctors and aging workers to manage the health status of elderly people with hypertension and depression symptoms under the guidance of psychiatrists.The study included 1,232 participants in the intervention group and 1,133 participants in the control group,who received a 12-month intervention or usual care and were evaluated at baseline,and at the first,third,sixth,ninth,and twelfth months.The evaluation included demographics information,blood pressure,ADLS,MOSSSS and HDRS-17.Linear mixed effects model showed that the interaction effects between time and group on blood pressure,social support,depression and activities of daily living were significant,and the intervention significantly improved blood pressure,social support,depression and activities of daily living in the elderly.The longitudinal data analysis results also showed that social support and depression partially mediate the association between blood pressure and activities of daily living in elderly people with hypertension and depression symptoms.The results of this study further validated the multiple mediation model established in Study 2,and also provided an evidence-supported intervention model for the prevention and treatment of the elderly at risk of disability caused by hypertension and depression.In conclusion,the risk of activities of daily living impairment in elderly rural residents with hypertension and depression symptoms is much higher than in elderly people with hypertension but without depression symptoms.The association between blood pressure and activities of daily living was partially mediated by social support and depression in the elderly with hypertension and depression symptoms.A social and psychological intervention model designed based on the collaborative care model can help elderly people with hypertension and depression symptoms effectively manage hypertension,increase social support,alleviate depression symptoms,and improve their activities of daily living.The study provides a possible theoretical model for the elderly with high risk of disability caused by common chronic diseases(such as hypertension)and emotional symptoms(such as depression),and constructs the model of the impairment mediating effect of depression and the protective mediating effect of social support,and verified the effect of the socialpsychological integration management model based on the multiple mediation model,which is conducive to the adaptive transformation and promotion in the rural areas of mainland China in the future.