| BackgroundThe problem of population aging in our country is serious.The advent of the"accelerated aging era" accompanied the aggravation of chronic non-communicable diseases.In addition,due to the complexity of chronic diseases and chronic illnesses,patients often fall into a state of coexistence of multiple diseases,especially elderly patients are extremely prone to the phenomenon of "accumulation" of multiple chronic diseases.The population with multiple chronic diseases has become the focus of chronic disease management.Health-related quality of life(HRQOL)is a health measurement technology proposed under the background of the new health era that can fully reflect the health status of an individual and fully reflects a positive outlook on health.The quality of life of the elderly that is evaluated as an important subject in the age of modernization,it is an important manifestation of healthy aging,we can improve the quality of life of elderly patients through health-related quality of life evaluation.This research focuses on Shandong Province,the phenomenon of "one body with multiple diseases" for the elderly has become a social problem that cannot be ignored in our province,and has brought a series of challenges to the development of our province’s public health and the improvement of the medical and health system.Exploring the quality of life of elderly patients with multiple chronic diseases in Shandong Province and improving the quality of life of elderly patients are important issues in the context of healthy aging in our province.ObjectivesThe elderly patients with multiple chronic diseases in Shandong Province was the research object,our objectives was to understand the basic characteristics of elderly patients with multiple chronic diseases and their health-related quality of life,and further explore from the general sociodemographic characteristics,disease characteristics,behavior and lifestyle characteristics of multiple perspectives influencing factors of health-related quality of life of patients with multimorbidity.Finally,provide policy recommendations for improving the quality of life of elderly patients with multimorbidity in Shandong Province.MethodsBased on the Sixth Health Service Survey in Shandong Province,this study screened patients with multiple chronic diseases over 60 years of age,and divided the population into young-old and old-old people based on age,and divided the population into two,three and three types based on the number of illnesses.The patients was based on the EQ-5D to describe the health-related quality of life of patients.Descriptive statistical analysis is used to describe the general sociodemographic characteristics and life behavior characteristics of the research objects.T test and analysis of variance were used for univariate analysis of variables.The analysis of the influencing factors was finished by Logistics regression and the Tobit regression model,with a test level of 0.05.The data selection,cleaning and statistical analysis of this research are all completed in the software Stata 14.0.ResultsA total of 1818 elderly patients with multimorbidity were included in this study,and the number of chronic diseases was 4 at most.(1)In 2018,the average EQ-5D utility index of elderly patients with multiple chronic diseases in Shandong Province was 0.80±0.24,and the self-rated health score was 62.877±19.07 points.With the increasing the number of chronic diseases and the increasing in age,the utility value of EQ-5D and health status scores showed a gradually downward trend.The proportions of elderly patients with multiple chronic diseases who did not have any problems in the five dimensions were 62.54%,80.86%,71.84%,49.06%,and 80.58%,respectively.People with pain/discomfort at the level of some problems and extreme problems accounted for the highest proportion,reaching 50.94%.(2)The independent variables that have protective effects on the five dimensions of the EQ-5D scale included:2 or more physical exercises a week,taking the initiative to receive health check-ups,and brushing teeth at least once a day,while the poor households and chronic diseases would exacerbate the problem of ability in five dimensions.Body obesity was a risk factor affecting the personal mobility(OR=1.868)and daily activity ability(OR=1.649)of patients.Low-weight patients were more likely to have a lack of self-care ability(OR=2.004).Rural patients were more prone to have physical pain or discomfort than urban patients(OR=0.764).Increasing income level had an enhanced effect on improving patients’ anxiety/depression.The risk of anxiety/depression problems for elderly patients whose family medical expenditure was between 2001-4000 yuan was 1.584 times that of families with 0-2000 yuan,and the risk of anxiety/depression problems for elderly patients with family medical expenditure of 1,4001-22000 was 0-2,000 yuan 2.468 times that of elderly patients,and poor households(OR=1.879)were also risk factors for patients with anxiety/depression.The variable that age had a significant impact on patients’ mobility,ability of daily living,and self-care dimensions,but there was no statistically significant difference in the two dimensions of patients’ subjective expression of pain/discomfort or anxiety/depression.(3)Employment/retirement,the number of chronic diseases,alcohol consumption within 30 days,physical exercise,tooth brushing,and health check-ups have the same effect on the health utility value of young-old and old-old patients,and family income has the same effect on the quality of life of young-old and old-old patients.Obesity had a greater negative impact on the quality of life of elderly patients.Among people suffering from different numbers of chronic diseases,only physical exercise could improve the health utility value of all patients.The quality life of elderly with two chronic diseases was more susceptible to many factors than those with three or four chronic diseases.Conclusion and policy recommendationThis study found that the elderly in Shandong Province had a severe prevalence of multiple chronic diseases,2018.Hypertension and diabetes were the most common combination of dual diseases,and patients had different degrees of socioeconomic disadvantages and poor healthy behaviors and lifestyles.In addition,we found that the quality of life of old-old patients in Shandong Province was worse,with a health utility value of 0.80 and a self-rated health score of only 62.87.The quality of life of young-old patients was significantly inferior to that old-old patients.More than half of elderly patients have pain/discomfort problems.Old age,unemployment,low education level,poor households,high medical expenses,and low-income households all caused low abilities in five aspects:mobility,self-care,daily activities,pain/discomfort,and anxiety/depression and worse self-assessment of health status value.High-frequency effective physical exercises,regular physical examinations,and good tooth brushing habits can effectively improve the quality of life of patients with multiple chronic diseases.In short,the quality of life of elderly patients with multimorbidity in Shandong Province cannot be ignored,especially for the old-old patients with chronic diseases.The prevention and treatment of chronic diseases is the top priority.Focusing on the vulnerable elderly,improving the family economic environment,increasing the accessibility of patients to medical care,and cultivating healthy living habits can not only enhance physical fitness and prevent the occurrence of chronic diseases,but also reduce the physical,psychological and social damage caused by various diseases to patients. |
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