| BackgroundWith the rapid development of economy and the rapid progress of aging process,the problem of aging in our society has become increasingly prominent,among which the elderly endowment and health problems of the elderly have attracted widespread attention.The essence of the endowment is whether the elderly's endowment needs can be met and how to meet them.Family support is the main way for China to retire now even for a long period of time.In the traditional family structure,the elderly live with adult children commonly.With the deepening of urbanization and the reduction of the number of children,more and more families are becoming smaller and older.In urban areas,the trend of the elderly not living with their children is more obvious,as the improvement of housing conditions and the increase of the two generations'independent living concept.In rural areas,as the increasing trend of population mobility and the increasing number of the left-behind elderly,the traditional concept and arrangement of living with their children have been sufferred.The function of family support has gradually been weakened,which greatly reduces the opportunities for the elderly to enjoy their children's daily care and spiritual comfort.In the context of population structure change and social transition,we need to retreat the consequences of changes in the living arrangements of elderly people,so as to formulate policy for the elderly and improve the quality of the elderly in urban and rural areas.Some studies have shown that the mental discomfort caused by the "empty nest" of the elderly,such as loneliness,depression and anxiety,has become a prominent problem.A number of studies abroad show that elderly people with different living arrangements need different physiological and psychological concerns.In China,research on the influence from the living arrangements towards the mental health of the elderly is still less,especially the research on the effects of mental health of rural elderly is rare.Because there is a big difference between the definition of living arrangement and regional culture,the results are not consistent.Therefore,it is of great practical significance to study the mental health status of elderly people living in urban and rural areas and its influencing factors in the case of great changes in residential patterns.This study analyzes the differences of the elderly psychological status of urban and rural living in different mode,on the one hand expect to cause social concern on the mental status of the elderly,on the other hand,to provide a scientific basis for urban and rural endowment mode transformation and development.Objectives1.To investigate living arrangements and mental status among the elderly people in urban and rural areas,and to explore the relationship between the living arrangements and mental status of the elderly in urban and rural areas;2.to compare the factors affecting the mental status of the elderly with different living arrangements in urban and rural areas.MethodsThe participants were recruited from five urban communities,two urban endowment apartments and two rural communities in this study.The participants must meet the following inclusion criteria:aged 60 years old or above;having lived in this community or endowment apartment for more than 6 months in the past 12 months;no mental diseases that might affect on completing the questionnare.Eligible subjects were 1824 cases,including 1594 cases from urban areas and 230 cases from rural areas.Self-rating Depression Scale(SDS)was used to measure participants' depression status and Self-rating Anxiety Scale(SAS)was used to measure participants' anxiety status.The item of Physical Functioning(PF)of the MOS item short from health survey(SF-36)was used to measure participants' self-care ability.SPSS 18.0 was used to describe the living arrangement,depression and anxiety status of elderly people in urban and rural areas,to analyze the difference of depression and anxiety status between elderly people in urban and rural areas and the difference of depression and anxiety status between urban and rural elderly in the same living arrangement.Multiple factors analysis was conducted using generalized linear models(GLM)to explore the influencing factors of depression and anxiety status of elderly people in urban and rural areas.Furthermore,generalized linear models were established to compare influencing factors of depression and anxiety status of urban and rural elderly people in different living arrangements by statisfying acccording to living arrangement.Results1 Living arrangements of elderly people in urban and rural areasA total of 1824 eligible subjects were enrolled in the survey,among which 1594 cases were from urban areas and 230 cases were from rural areas.In the urban area,there were 1047 cases(65.7%)living with their children which accupied the highest proportion,276 cases(17.3%)only living with spouse,212 cases(13.3%)living alone,only 21 cases(1.3%)living wih relatives or housekeepers and 38 cases(2.4%)living in endowment apartment.In the rural area,there were 112 cases(48.7%)only living with spouse,92 cases(40%)living with their children,26 cases(11.3%)living alone and there was no case living with relatives or housekeepers and no case living in endowment apartment.2 Depression status of urban and rural elderly with different living arrangementsThe depression scores of urban and rural elderly were 42.63 ±8.85 and 44.80 ±9.874 respectively.The depression scores of urban elderly among different living arrangements were not all the same,in which the elderly who lived alone had a higher depression scores(45.47 ± 8.804),and those living with children(41.47±8.588)is lower;there was no significance in depression scores of the rural elderly with different living arrangements.There was no significance in depression scores between urban and rural elderly in the same living arrangement.3 Influencing factors of depression scores of urban and rural elderly with different living arrangementsIn the urban area,elderly who was women,with self-financed medical treatment or NCMS and self-care ability decreasing in different degrees had a higher depression score,and those living with children had a lower depression score;in the rural area,elderly who aged 70-74 years old,with self-financed medical treatment,with two or more chronic diseases and self-care ability decreasing in different degrees had a higher depression score.The common influencing factors of depression scores of urban and rural elderly were the form of medical insurance and the self-care ability.For the elderly living alone in urban and rural areas,the common influencing factors of depression scores was poor self-care ability;the unique factors for the urban elderly were education,economic sources,medical insurance and the number of chronic diseases;the unique factors for the rural elderly was sex.For the elderly only living with spouses in urban and rural areas,the common influencing factors of depression scores was poor self-care ability;the unique factors for the rural elderly were age,medical insurance and the number of chronic diseases.For the elderly living with their children in urban and rural areas,the common influencing factors of depression scores was age and with two or more chronic diseases;the unique factors for the urban elderly were medical securance and self-care ability.4 Anxiety status of urban and rural elderly with different living arrangementsThe scores of anxiety of urban and rural elderly were 37.97± 6.165 and 37.67 ±8.194 respectively.The anxiety scores of urban elderly between different living arrangements were not all the same,in which the elderly who lived alone had a higher anxiety scores(40.38±6.159),and those only living with spouse(38.18±6.151)and those living with children(41.47±8.588)were lower;there was no significance in anxiety scores of the rural elderly between different living arrangements.There was no significance in anxiety scores between urban and rural elderly in the same living arrangement.5 Influencing factors of anxiety scores of urban and rural elderly with different living arrangementsIn the urban area,elderly who was women,with NCMS,with two or more chronic diseases and self-care ability decreasing in different degrees had a higher anxiety score,and those aged 80 years old or above,only living with spouse and living with children had a lower anxiety score;in the rural area,elderly who with two or more chronic diseases had a higher anxiety score.The common influencing factors of anxiety scores of urban and rural elderly were the number of chronic diseases.For the elderly living alone in urban and rural areas,the common influencing factors of anxiety scores was poor self-care ability;the unique factors for the urban elderly were education and economic sources;the unique factors for the rural elderly was married status.For the urban elderly only living with spouses,the influencing factors of anxiety scores was self-care ability;and for the rural elderly,the influencing factors of anxiety scores were age and the number of chronic diseases.For the elderly living with their children in urban and rural areas,the common influencing factors of anxiety scores were with two or more chonic diseases and poor self-care ability;the unique factors for the urban elderly were age,sex and medical securance.Conclusions1?In the urban area,the elderly who lived with their children had the lowest depression scores among elderly with different living arrangements,and those who lived alone,lived in the endowment apartment or with relatives/housekeepers had a higher depression and anxiety scores;the elderly who lived alone had a higher anxiety scores than those who only lived with spouse,lived with their children or with relatives/housekeepers.2.In the rural area,depression and anxiety scores of the elderly were both not significantly different with different living arrangements.Suggestions1.Society and family should pay attention to the physical and mental health of the elderly,and different mental health interventions should be given to the elderly with different living arrangements and characteristics in urban and rural areas.The elderly people who living alone should be strengthened the support of family and society;communities,village committees and other grassroots organizations should take positive and effective measures to develop flexible model of family endowment mode and enrich the elderly's life;we should improve the quality of endowment service,pay attention to meet the spiritual needs of the elderly,and do a good job on the elderly psychological counseling when developing the social endowment.2.The elderly should change the concept of retirement endowment,adapt to the new situation and try to accept the community endowment,institutional endowment and other new social endowment services.When meeting physical and mental problems,the elderly had better to seek medical assistance actively to improve the quality of life. |
PDF Full Text Request