Status And Influencing Factors Of Social Participation In Elderly Patients With Chronic Obstructive Pulmonary Disease

Objective:To investigate the status of social participation in elderly patients with COPD,and to explore the influencing factors of social participation in elderly patients with COPD from the perspectives of social demography,health status(physical,psychological)and social environment.Respiratory symptoms were analyzed on the basis of the impact of social participation,and further analyzed depressive symptom,fatigue,and the role of social support in the two relationships.In order to reveal the relevant mechanisms of social participation in elderly patients with COPD,and lay a foundation for the development of intervention strategies to promote social participation in elderly patients with COPD.Methods:A cross-sectional study design was used to recruit 267 stable stage COPD patients≥60 years old from April 2021 to August 2021 in 13 communities in Jinan city,Shandong Province.Pulmonary function tests was adopted to determine severity of airflow restriction in COPD patients;General data questionnaire,Functional Comorbidities Index(FCI),The modified Medical Research Council Respiratory Questionnaire(mMRC),COPD Assessment Test(CAT),Functional Assessment-Fatigue(FACIT-Fatigue)Scale,Patient Health Questionnaire(PHQ-2),Social Support Rating Scale(SSRS),Impact on Participation and Autonomy Questionnaire(IPA)were used to measure factors influencing social participation in elderly patients with COPD.SPSS23.0 was used to analyze the data.Test level α=0.05,P<0.05 was considered statistically significant.Statistical methods include descriptive analysis,Mann-Whitney U test,Kruskal-Wallis H test,Spearman correlation analysis,stratified regression analysis,mediation and moderating effect analysis.Results:1.The total score of social participation in elderly patients with COPD in this study was 35.00(18.00);Among the four dimensions,the score of autonomy indoors was the lowest(items were 0.43(1.00)),followed by that was family role(items were 1.43(1.14)).The scores of social life and relationship were higher(items were 1.83(0.67)),while autonomy outdoors was the highest(items were 2.40(1.00)).2.Stratified regression model showed that the social participation level of elderly patients with COPD was affected by age,severity of airflow restriction,respiratory symptoms,fatigue,depressive symptom and social support.(all P<0.05).3.Fatigue played a partially mediating role in the relationship between respiratory symptoms and social participation in elderly patients with COPD,with an indirect effect value of 0.09,Bootstrap 95%CI[0.03,0.15],accounting for 33.3%of the total effect.Depressive symptom had no significant mediating effect between respiratory symptoms and social participation,with Bootstrap 95%CI[-0.01,0.05].4.Social support moderated the relationship between respiratory symptoms and social participation in elderly patients with COPD.β=-0.15,Bootstrap 95%CI[-0.27,-0.03].Conclusion:1.The overall social participation of stable elderly patients with COPD was fair;In the four dimensions,elderly patients with COPD had the highest level of autonomy indoors,followed by family role,low level of social life and relationship,and the lowest level of autonomy outdoors.Age,severity of airflow restriction,respiratory symptoms,fatigue,depressive symptom and social support significantly affected the level of social participation in elderly patients with COPD.2.Respiratory symptoms in elderly patients with COPD affected social participation by acting on fatigue.Social support moderated the effect of respiratory symptoms on social participation.Intervention of fatigue and social support could improve the level of social participation in elderly patients with COPD.