| ObjectiveTo investigate the current situation of frailty,self-management and quality of life of elderly diabetic patients in community,and to analyze the influencing factors and explore its correlation,path relationship and mediation effect.To inquiry the influence of nursing intervention based on the integration theory of health behavior change on the quality of life of elderly diabetic patients with frailty in the community,so as to provide practical experience for improving the attention of elderly diabetic patients with frailty in community and innovative the health education models.Methods(1)Totally 263 elderly diabetic patients in community were selected as the research object.The general information questionnaire,Frailty Phenotype,Chinese version scale of the Diabetes Self-care Activities,and Diabetes Specific Quality of Life scale were used to investigate the situation of frailty,self-management and quality of life and analyze the influencing factors.The structural equation model was established to analyze the path relationship and mediation effect among the situation of frailty,self-management and quality of life.(2)According to the results of the cross-sectional survey to develop nursing intervention based on integrated theory of health behavior change,and under the guidance of the programme,intervention was carried out for elderly diabetic patients with frailty in community.Elderly diabetic patients with frailty were divided into the intervention group(n=40)and the control group(n=40).Patients in the control group received routine community elderly diabetes health education,and patients in the intervention group underwent three months of nursing intervention on the basis of the routine community elderly diabetes health education.The general information questionnaire,Frailty Phenotype,Chinese version scale of the Diabetes Self-care Activities,and Diabetes Specific Quality of Life scale were used to evaluate frailty,self-management and quality of life in two groups before and after the intervention.Results(1)Among 263 elderly diabetic patients in the community,71 were in a debilitating state,accounting for 27.0%,143 patients(54.4%)were in the early stages of frailty,49 patients were not weak,of which accounted for18.6%.The main influence factors of frailty included quality of life,self management,frequency of hypoglycemia in the past half-year,gender,age and alcohol consumption.(2)The total score of self-management of patients was(35.33±13.54).The average score of each dimension from high to low is exercise dimension(9.13±3.03),ordinary diet(8.24±2.16),special diet(7.21±1.91),drug treatment(3.70±2.84),foot care(3.63±2.65)and blood glucose monitoring(3.41±3.27).Frailty,age,living style and quality of life were the main influencing factors.(3)The total score of quality of life of patients was(61.05±7.53).The average score of each dimension is mental/spiritual(19.40±2.29),physiological functional areas(28.20±2.69),social relations(7.84±2.01),therapeutic areas(5.60±1.70).Frailty,age,self-management,frequency of hypoglycemia in the past half-year,marital status and education were the main influencing factors.(4)The total score of quality of life was negatively correlated with the total score of self-management(r=-0.514,P<0.01),and positively correlated with frailty(r=0.677,P<0.01).The total score of selfmanagement was negatively correlated with the score of frailty(r=-0.622,P<0.01).The results of the structural equation model showed that the frailty of the patients was an intermediate variable between selfmanagement and quality of life.The quality of life was not only directly affected by self-management,but also indirectly affected by frailty.(5)After intervention,the total score of self-management and the scores of all dimension in the intervention group were significantly higher than before intervention,and the difference had statistically significant(P<0.05).The total score of self-management and scores of all dimension in the intervention group were higher than those in the control group,and the difference had statistically significant(P<0.05).(6)After intervention,the total score of quality of life and the scores of all dimensions in the intervention group were lower than those before intervention,and the differences were statistically significant(P<0.05).The total scores of quality of life and the scores of all dimension in the intervention group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).(7)After intervention,the decrease of grip strength and fasting blood glucose in the intervention group was significantly higher than before intervention(P<0.05),but there were no significant differences in the score of TUGT and BMI in the intervention group(P>0.05).There were no significant differences in the score of grip strength,TUGT fasting blood glucose and BMI in the control group after the intervention(P>0.05).And the decrease of grip strength and fasting blood glucose in the intervention group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).(8)After intervention,the score of frailty in the intervention group was lower than those in the control group,and the difference was statistically significant(P<0.05).The score of frailty in the intervention group was lower than before(P<0.05).And there was no significant difference in score of frailty in the control group before and after intervention(P>0.05).Conclusion(1)Elderly diabetic patients with frailty is higher.Frailty is mainly affected by quality of life,self-management,the frequency of hypoglycemia in the last half-year,gender,age and alcohol consumption;(2)There is a correlation among self-management,frailty and quality of life,and frailty plays a mediating role in their self management and quality of life.(3)The nursing intervention based on the integration theory of health behavior change could improve the level of self-management,grip strength,quality of life and frailty,and reduce the level of fasting blood glucose. |
