Study On Multimorbidity And Quality Of Life Among The Elderly In Community

Background and objectives:With the growth in the size of older persons,the human disease spectrum has undergone tremendous changes.The prevalence of chronic diseases is rising over the years,and multimorbidity has become an important public health problem.Multimorbidity not only impairs physiological function and mobility,increasing disease burden but also brings a significant economic burden to society.Our study investigated the status of multimorbidity among the elderly in the community to reveal the common patterns of multimorbidity.The quality of life(QoL)of elderly with multimorbidity was investigated,and factors in QoL and the relationship between them were explored.In order to improve the health management plan of elderly with multimorbidity,and promote the proposal of preventive and health care decisions for elderly with multimorbidity.Methods:1.Research on the status of multimorbidity: The elderly(≥60 years old)who received physical examination in a community healthcare center in Nanjing from December 2015 to December 2018 were selected as the research objects,and the electronic medical record system was used to collect information on chronic diseases of the elderly.SPSS 25.0 software was used in research.Statistical descriptions such as frequency distribution,chi-square test,logistic regression model,factor analysis and other statistical analyses were used to explore the status of multimorbidity and main multimorbidity patterns in the elderly.2.Research on quality of life and its influencing factors: According to cluster sampling,elderly with multimorbidity(≥60 years old)who received physical examinations in a community healthcare center in Nanjing were selected as the research objects.General information was collected through questionnaires,and quality of life was measured by QLCD-GM.SPSS 25.0 software was used for descriptive statistics such as (?) ± S and frequency distribution,t-test,F-test,multiple linear regression and other statistical analyses to evaluate QoL in elderly with multimorbidity and explore factors in QoL.Using AMOS 23.0 software,a structural equation model was established to analyze and verify the path and effect of each factor in quality of life,and test the mediation of the model by Bootstrap method.Results:1.Nine thousand six hundred and fourteen elderly people and 12 chronic diseases were involved in the study of multimorbidity.The prevalence of chronic diseases was 76.45%,and hypertension had the highest prevalence(49.69%).The prevalence of multimorbidity among the elderly was 49.62%,and was higher among women and the older age group than their respective counterparts.Nine chronic disease pairs had O/E greater than 1.Three chronic disease pairs with stronger associations were heart disease and arthritis(OR=2.62;95%CI:2.33-2.94),heart disease and cerebrovascular disease(OR=2.23;95%CI:1.94-2.56),diabetes mellitus and dyslipidemia(OR=2.14;95%CI: 1.90-2.40).Four multimorbidity patterns were obtained based on factor analysis,“chronic liver disease + chronic gastrointestinal disease +biliary tract disease”,“arthritis + chronic kidney disease + chronic lung disease + heart disease”,“cerebrovascular disease + hypertension” and “dyslipidemia + diabetes mellitus”.2.In the study of quality of life,781 elderly patients with multimorbidity were included.The average scores of QoL in physical function module,mental state module,social function module and general part were 54.23±21.21,59.89±21.94 51.71±18.92,54.09±18.44,respectively.The multiple linear regression model showed that: the positive factors in physical function module(P<0.05)were pain,impaired glucose tolerance,number of multimorbidity,family history of multimorbidity,health knowledge scores,and the negative factors(P<0.05)were smoking,drinking,weekly exercise frequency,self-assessed health scores;the positive factors in mental state module(P<0.05)were gender,BMI,number of multimorbidity,family history of multimorbidity,health knowledge scores,and the negative factors(P<0.05)were drinking and weekly exercise frequency;the factors positively related to social function module(P<0.05)were gender,education level,BMI,impaired glucose tolerance,number of multimorbidity,family history of multimorbidity,health knowledge scores,and negative factors(P<0.05)were marital status,smoking and drinking;the positive factors in overall QoL(P<0.05)were gender,BMI,pain,impaired glucose tolerance,number of multimorbidity,family history of multimorbidity,health knowledge scores,and negatively correlated factors(P<0.05)were age,smoking,drinking,diet,weekly exercise frequency.Structural equation model showed that the revised model fit well,and all path assumptions were supported by the results;health literacy had a negative impact on unhealthy lifestyle(β=-0.669,P<0.05),health literacy had a positive impact on general physical condition(β=0.130,P<0.05),health literacy had a positive effect on QoL(β=0.119,P<0.05),unhealthy lifestyle had a negative effect on general physical condition(β=-0.672,P<0.05),unhealthy lifestyle had a large negative impact on QoL(β=-0.719,P<0.05),and general physical condition had a strong positive impact on QoL(β=0.491,P<0.05).Serial mediation analysis showed that unhealthy lifestyle and general physical condition were the serial mediators on the association between health literacy and QoL,and the indirect effect was 0.766(accounting for 86.55% of the total effect).“Health literacy –Unhealthy lifestyle – QoL” pathway was 0.481(95%CI: 0.364-0.607),the effect ratio was54.35%.“Health literacy – Unhealthy lifestyle – General physical condition – QoL” pathway was 0.221(95%CI: 0.160-0.301),the effect ratio was 24.97%.“Health literacy – General physical condition – QoL” pathway was 0.064(95%CI: 0.009-0.128),the effect ratio was7.23%.Conclusions:1.Multimorbidity was common among the elderly in community,and there were specific associations between multiple chronic diseases.The most common multimorbidity patterns were “cerebrovascular disease + hypertension” and “dyslipidemia + diabetes mellitus”.2.The various dimensions and overall QoL of elderly patients with multimorbidity in the community were at a middle level,and needed to be further improved.Gender,age,education level,marital status,smoking,drinking,diet,weekly exercise frequency,BMI,self-assessment health scores,impaired glucose tolerance,pain,number of multimorbidity,family history of multimorbidity and health knowledge scores had varying degrees of influence on each dimension and overall QoL.Health literacy,unhealthy lifestyle,and general physical condition all had an impact on quality of life,and unhealthy lifestyle and general physical were serial mediation variables on the association between health literacy and QoL.