| ObjectiveThe aim of this study was to establish a pool of International Classification of Functioning,Disability and Health(ICF)categories of factors influencing quality of life in elderly patients with chronic diseases and to find correlations between the categories;to assess the weights of factors influencing quality of life in elderly patients with chronic diseases;and to establish a system dynamics model to analyze the effects of dynamic changes of each factor on quality of life in elderly patients with chronic diseases.MethodsThis study was a non-experimental study and was conducted in three parts.1.A semi-structured interview study on factors influencing the quality of life in elderly patients with chronic diseases: From October 2020 to December 2020,the purpose sampling method(maximum differential sampling method)was applied to select elderly patients with chronic diseases in a tertiary-level general hospital in Qingdao as the study population.The results of the interviews were analyzed based on the Colaizzi seven-step analysis method,and linked to the ICF categories according to the "ICF linking rules".Then to form a pool of ICF categories and find the correlation between the categories,which provides a basis for building a system dynamics model.2.Questionnaire survey study of factors affecting quality of life in elderly patients with chronic diseases: The International Classification of Functioning,Disability and Health Rehabilitation Set(ICF-RS)questionnaire,Jagger Hospital Environment Factor Scale,and Brief Health Status Scalewere were used to survey elderly patients with chronic diseases in a tertiary-level general hospital in Qingdao from October 2021 to January 2022.SPSS 25.0(IBM Crop.,Armon K,NY)and SPSSAU was used for statistical analysis and data processing,including descriptive analysis,independence weights method,multiple linear regression,to provide support for the quantitative system dynamics model.3.Simulation study of system dynamics model of quality of life for elderly patients with chronic diseases: a system dynamics model was built based on the results of semi-structured interviews,questionnaires and literature review.The Vensim PLE simulation platform was used to establish a system dynamics model to analyze the impact of dynamic changes of each influencing factor on quality of life,and to provide a reference basis for the subsequent development of interventions to improve the quality of life of elderly patients with chronic diseases.Results1.Results of the semi-structured interview study:(1)A total of 51 elderly patients with chronic diseases were interviewed in this study,including 25(51.0%)female patients and 26(49.0%)male patients with a mean age of(70.94±9.47)years;9(17.6%)each had diabetes,coronary heart disease and chronic lung disease,10(19.6%)had stroke and 14(27.5%)had cancer;32(62.6%)patients had more than one chronic disease in combination.(2)A total of 148 meaningful statements were extracted and linked to 73 ICF categories,including 27 items,25 items,and 21 items for physical function,activity and participation,body structure,and environmental factors,respectively.In addition,three other meaningful concepts "Coronal Virus Disease-2019,COVID-19,side effects,and fear of falling" could not be linked to the corresponding ICF categories,and the correlations between the categories were discussed in the discussion section.2.Results of the questionnaire method study:(1)A total of 360 elderly patients with chronic diseases were included in this study,including 188(52.5%)males and 172(47.8%)females,age range 60-92 years,mean age(70.28±7.07)years;61(16.9%)patients with diabetes mellitus,123(34.2%)patients with coronary heart disease,57(15.8%)patients with stroke,57(15.8%)patients with chronic lung disease in 64 patients(17.8%),and cancer in 55 patients(15.3%).(2)The highest quality of life score for elderly patients with chronic diseases was 137,the lowest score was 54,and the average score was(97.84±17.69).The component physical scale was(49.53±10.75)and the mental component scale was(63.32±20.91).(3)The results of the independence weighting method analysis showed that the weight values for pain,energy,emotional functioning,exercise tolerance functions,exercise assistance function,urinary function,and sleep function on the physical functioning subscale were 0.1482,0.2569,0.0971,0.1488,0.1118,0.0924,and 0.1448,respectively;the activity and participation subscale for carrying out daily routine,looking after one’s health,activities,social participation,family tasks,and interpersonal interactions/relationships weighting values of 0.1234,0.1260,0.1134,0.1292,0.1784,0.1267,and 0.2065,respectively;and attitudes,social support,services and assistance,policies,and physical environment weighting values of 0.1595,0.2787,0.1818,0.1569,0.2231,respectively,on the environmental factors scale.(4)Multiple linear regression analysis showed that physical function(β=-0.169,P <0.001),activity and participation(β=-0.567,P < 0.001),and environmental factors(β=-0.273,P < 0.001)were factors influencing quality of life in elderly patients with chronic diseases,and these factors together explained 57.8% of the total variance in quality of life in elderly patients with chronic diseases(F = 164.820,P < 0.001)..3.System dynamics model simulation study results:(1)Based on the content of the interview,the causal cycle diagrams of physical function,activity and participation,and environmental factors were established,and then the causal cycle diagrams were integrated and optimized to construct a causal cycle diagram of the system dynamics of quality of life and a stock flow diagram of elderly patients with chronic diseases.(2)Simulation results of the system dynamics model on quality of life in elderly patients with chronic diseases showed that the level of social support,self-care ability,exercise function,emotional function,and mobility increased and the level of pain decreased,and the level of quality of life in elderly patients with chronic diseases increased accordingly.At the simulation time of 40 days,the dynamics of exercise function and self-care ability slowly increased the quality of life of elderly patients with chronic diseases,but the dynamics of exercise function had a greater impact on the quality of life.When the simulation time was 45 days,the dynamic changes of emotional function and social support started to increase the quality of life,and social support had a greater impact on the quality of life.At the simulation time of 50 days,the dynamic changes of pain made the quality of life among elderly patients with chronic diseases start to rise.When the simulation time was60 days,the dynamic change of mobility made the quality of life of elderly patients with chronic diseases start to increase..Conclusion1.The quality of life status of elderly patients with chronic diseases is at an intermediate level and needs to be further improved.2.The quality of life in elderly patients with chronic diseases is influenced by factors such as physical function,activity and participation,and environmental factors.The poorer the physical function,the lower the level of activity participation,and the greater the degree of environmental impairment,resulting in a lower level of quality of life in older patients with chronic diseases.3.System dynamics model simulations showed that quality of life improves in elderly patients with chronic diseases as emotional functioning,mobility,self-care,social support levels,and exercise function improve and pain levels decrease.Medical professionals should consider the factors affecting the quality of life of elderly patients with chronic diseases in terms of physical function,activity and participation,and environmental factors,and develop targeted interventions for patients to improve the quality of life of elderly patients with chronic diseases. |
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