| Part One:A Cross Sectional Study on the Self-neglect among the Elderly in Mmaanshan City of Anhui ProvinceObjective:Self-neglect is one of the important health problems in the fast aging society.The prevention and intervention of self-neglect requires a comprehensive understanding of the influencing factors for self-neglect.However,the research on elder self-neglect has just started at present.The research on the influencing factors of self-neglect is urgently needed.This study is intended to conduct a cross sectional study of self-neglect to explore the effects of demographic characteristics,economic and medical status,life style status,mental health and physical health on the self-neglect of the elderly,and to explore the mediating effect of psychological resilience and social support on the association between mental health and self-neglect.It would provide a scientific basis for the prevention and intervention of self-neglect of the elderly.Methods:Using the method of cluster random sampling,6,524 elderly persons aged 60 years and above were investigated in Maanshan of Anhui Province.In this survey,a questionnaire survey was carried out in the form of face-to-face interview with a combination of centralized investigation and household survey.The contents of the survey included general information,self-neglect,cognitive function,activities of daily living,sleep quality,anxiety,depression,social support,resilience and so on.SPSS 23.0 and Amos 21.0 statistical analysis software was carried out for statistical analysis.Univariate analysis of self-neglect was conducted by two-independent-samples tests,tests for several independent samples,and spearman correlation analysis.Binary logistic regression analysis was used in multivariate analysis.The mediating effect of resilience and social support on the association between mental health and self-neglect is based on the Amos mediating effect model.Results:A median(25 percent,75 percent)was used to describe the score of self-neglect,and the total score of the self-neglect in the elderly was 4(1,7).The total score in the rural elderly was 5(1,7),while it was 3(1,6)in the urban elderly.And the difference was statistically significant.Among the five dimensions of self-neglect,medical health and care self-neglect,environmental sanitation and personal hygiene self-neglect,affective self-neglect scored higher.Multivariate binary logistic analysis results showed that the people who was man,had religious beliefs,the self-assessment economy is poor,economic origin from their own or spouse,no often physical examination,higher labor intensity,no physical exercise,depression,disability,poorer activities of daily living,lower social support,and lower resilience had a greater risk for overall self-neglect of the elderly.The mediating effect model showed that the direct standardization effect of mental health on self-neglect was 0.139,and the indirect standardization effect was 0.232 by the mediation effect of resilience and social support.In the exploration of the influencing factors of the five dimensions of self-neglect,the people who had religious beliefs,the education level was lower,in marriage,living in the city,the self-assessment economy was poorer,economic origin from their own or spouse,personal monthly income was fewer,no often physical examination,anxiety,disability,pain,poorer activities of daily living,and lower social support had a greater risk for medical health and care self-neglect of the elderly;the male,the education level was lower,living in the city,the self-assessment economy was poorer,personal monthly income was fewer,no physical exercise,the self-assessment health condition was poorer,poorer activities of daily living,lower social support,and lower resilience had a greater risk for environmental sanitation and personal hygiene self-neglect of the elderly;the people who had not in marriage,living in rural area,personal monthly income was fewer,depression,chronic disease,pain,lower social support,and lower resilience had a greater risk for affective self-neglect of the elderly;the people who was younger,had religious beliefs,the education level was higher,in marriage,the self-assessment economy is poorer,no smoking,better sleep quality,no anxiety,no chronic disease,no pain,poorer activities of daily living,lower social support,and lower resilience had a greater risk for safety self-neglect of the elderly;the male,the people who was younger,the people who had higher level of education,in marriage,depression,disability,lower social support,and lower resilience had a greater risk for social communication self-neglect of the elderly.Conclusions:Medical health and care self-neglect,environmental sanitation and personal hygiene self-neglect,and affective self-neglect scored higher among the five dimensions of self-neglect.Elderly self-neglect was influenced by many factors such as demographic characteristics,economic health,lifestyle,mental health and physical health.Mental health influences self-neglect mainly by mediation effect of resilience and social support.This research suggests that we should combine multiple departments and various measures to strengthen the prevention and intervention of self-neglect in the elderly so as to achieve the goal of healthy aging.Part Two:Longitudinal Study on Self-neglect of Rural Elderly in Maanshan City of Anhui ProvinceObjective:Self-neglect is a widespread but underestimated problem in the elderly.At present,the research on self-neglect of the elderly in our country is relatively lacking.In particular,there is a lack of longidinal study to verify the influencing factors of elderly self-neglect.A longidinal study was constructed on the basis of repeated cross-sectional studies in this research,in order to verify the influencing factors of elderly self-neglect and to provide theoretical basis for prevention and control of elderly self-neglect.Methods:2 cross-sectional surveys were carried out in rural elderly in Maanshan City,Anhui province during October to Desember 2014 and August to October 2016.The elderly people who participated in two cross-sectional surveys formed a cohort.A total of 945 people were included in this cohort.The two surveys collected data on the general demographic characteristics,economic status,lifestyle,mental health,physical health and social support of the elderly.EPI Data3.1 was used to establish the database and SPSS23.0 statistic software was used to analyze the data.The GEE model(Generalized Estimated Equation)was used for univariate and multi-factor analysis of elderly self-neglect in the longitudinal data.Results:The baseline score and repeat survey score of total self-neglect among the elderly were 4(2,6)and 5(2,7)respectively.And the difference was statistically significant(P<0.05).In the dimension of self-neglect,the scores of environmental sanitation and personal hygiene self-neglect decreased,while the scores of affective self-neglect,and safety self-neglect increased.The results of multi-factor GEE model showed that higher education level,in marriage,self-assessment of the economic situation was poorer,depression,no chronic disease,poorer activities of daily living,poorer social support were the risk factors of overall self-neglect;higher education level,higher labor intensity,depression,poorer activities of daily living and poorer social support were the risk factors of medical health and care self-neglect;self-assessment of the economic situation,economy came from others(relative to the person or spouse),healthy situation was poorer,no chronic disease,disability,poorer activities of daily living and poorer social support were the risk factors of environmental sanitation and personal hygiene self-neglect;higher education level,self-assessment of the economic situation was poorer,economy came from others(relative to the person or spouse),depression,self-assessment of poorer health,and poor social support were the risk factors of affective self-neglect;self-assessment of poorer health,poorer activities of daily living and poorer social support were the causes of safety self-neglect;self-assessment of poorer economic situation,self-assessment of poorer health,and poorer social support were the risk factors of social communication self-neglect in the rural elderly.Conclusions:The self-neglect in rural elderly is related to economic level,depressive state,activities of daily living and social support.Improving their economic level,strengthening the care and support for the elderly in rural areas,and enhancing the activities of daily living are important ways to prevent and control the self-neglect of the rural elderly. |
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