Predictive Modeling Of TCM Constitution And Quality Of Life In Elderly Patients With Hypertension

Objective:To understand the status and predicting factors of quality of life and the distribution characteristics of traditional Chinese Medicine(TCM)constitution;among elderly patients with hypertension;explore the relationship among TCM constitution,perceived social support,resilience,sleep quality and quality of life among elderly patients with hypertension,which may provide a new theoretical foundation for improving the quality of life and developing a model of Chinese-Western intervention among elderly patients with hypertension.Methods:A questionnaire survey was investigated by convenient sampling on the Elderly patients with hypertension in three tertiary hospitals in Shandong Province during March 2018 and October 2018.A total of 460 questionnaires were distributed,430 questionnaires were returned,and 403 valid questionnaires were used.The contents of the instruments included general demographic data,Constitution in Chinese Medicine Questionnaire(CCMQ),Perceived Social Support Scale(PSSS),Connor-Davidson Resilience Scale(CD-RISC10),Pittsburgh Sleep Quality Index(PSQI)and the 12-items short-from health survey(SF-12),witch measured respectively the patient’s general demographic variables,TCM constitution,perceived social support,resilience,Sleep quality and quality of life.SPSS 21.0 and AMOS 22.0 software were usedfor statistical analysis including descriptive statistics,independent sample t-test,ANOVA,Pearson correlation analysis,and path analysis.Results:1.TCM constitution was mainly composed of complex physique in elderly patients with hypertension,and the proportion of people with eight constitutions was the highest(18.9%).2.The distribution of TCM constitution among elderly patients with hypertention: The main type was biased(also called pianpo)and the least type was normal(also called pinghe).87.8%(354)were Qi deficiency,68.7%(277)were yang deficiency,61.3%(247)were phlegm wetness,59.5%(240)were qi stagnation,50.1%(202)were yin deficiency,46.7%(188)were wetness heat,44.9%(181)were blood stasis,36.4%(147)were inherited special constitution,and 13.5%(55)were normal.3.The scores of quality of life among elderly patients with hypertension were as follows: Physical Component Summary(PCS)was 50.00±8.83,Mental Component Summary(MCS)was 50.00±8.51,Physical Functioning(PF)was 53.03±32.96,Role-Physical(RP)was 43.88±26.17,Bodily Pain(BP)was 51.24±25.58,General Health(GH)was 28.78±19.46,Vitality(VT)was 54.83±24.96,Social Functioning(SF)was 52.91±28.31,Role-Emotional(RE)was 45.65±25.92.4.The results of one-way analysis of variance of quality of life showed that the differences in PCS among age,duration of hypertension,marital status and physical exercise(number of exercise,length of exercise and exercise mode)were 0statistically significant(P<0.05,P<0.01);the differences in MCS among education level,pre-retirement occupation,medical insurance payment methods,dietary knowledge(degree of understanding of dietary guidelines for Chinese residents and understanding of the relationship between dietary habits and chronic diseases)and sports knowledge(mastering the length of exercise)were statistically significant(P<0.05,P<0.01).5.The pearson correlation analysis results showed that:(1)resilience was significantly positively correlated with the normal type(r =0.279,P<0.01),and negatively correlated with the other eight biased types(r=-0.101--0.257,P<0.05 或 P<0.01)(2)The PCS and MCS dimensions were significantly positively correlated with the normal type(r = 0.412,r =0.364,all P<0.01),and negatively correlated with the other eight biased types(r=-0.151--0.366,all P<0.01;the PF,RP,BP,GH,VT,SF,RE and MH were significantly positively correlated(r=0.311-0.400,all P<0.01),and the other eight biased types were significantly negatively correlated with PF,RP,BP,GH,VT,SF,and RE dimension scores(r=-0.113--0.357,P<0.05 or P<0.01),respectively;MH dimension score and eight biased types(except yang deficiency,blood stasis,and inherited special constitution)had a significant negative correlation(r=-0.138--0.294,both P<0.01);(3)The scores of PCS,MCS and eight dimensions were significantly positively correlated with the scores of resilience,respectively(r=0.136-0.335,all P<0.01);(4)The MCS dimension and the perceived social support score,family support and other support scores(except for friend support)were significantly positively correlated,respectively(r=0.143--0.210,both P<0.01);PCS dimension had no significant correlation with perceived social support total score and dimension;(5)The scores of PCS,MCS and eight dimensions were significantly negative correlation with sleep quality respectively(r=-0.189--0.358,all P<0.01).6.Path analysis showed that the total effect of the normal type on quality of life in the elderly patients with hypertension was 0.537,and the total effect of the phlegm wetness on quality of life was-0.468.The direct effect of normal type on sleep quality was-0.461,and the direct effect of the phlegm-dampness on sleep quality was-0.330.The normal type and qi stagnation can directly affect resilience and indirectly affect quality of life.Other TCM constitutions indirectly affect resilience by perceived social supportor sleep quality,thereby affecting the quality of life.Conelusions:1.TCM constitution was mainly composed of complex physique in elderly patients with hypertension,and the proportion of people with eight constitutions was the highest.2.The distribution of TCM constitution types in elderly patients with hypertension: The main type is biased(also called pianpo)and the least type is normal(also called pinghe).TCM constitution type is from most to less:Qi deficiency> yang deficiency> phlegm wetness> qi depression> yin deficiency> wetness heat> blood stasis> inherited special constitution>nomal.3.There were a correlation among TCM constitution,perceived social support,resilience,sleep quality and quality of life.4.TCM constitution had a direct impact on quality of life,and can also indirectly affect the quality of life by perceived social support,resilience and sleep quality.The normal type and qi stagnation can directly affect resilience and indirectly affect quality of life.Other TCM constitutions indirectly affect resilience by perceived social support or sleep quality,thereby affecting the quality of life.