發(fā)布時間：2018-05-04 12:21

  本文選題：健康管理 + 空巢老人��； 參考：《山西醫(yī)科大學(xué)》2017年博士論文

【摘要】：目的:本研究將社區(qū)組織理論與健康管理科學(xué)融合,構(gòu)建適宜空巢老人的“SMG”健康管理模式,以山西省空巢老人為例進行實證研究,以期了解空巢老人健康管理特征及影響因素,評價健康管理模式應(yīng)用效果,從而為應(yīng)對社會“老齡化”、“空巢化”問題提供新思路,也為提高空巢老人生活質(zhì)量,更新基層衛(wèi)生服務(wù)模式提供可資借鑒之依據(jù)。方法:采用多階段隨機整群抽樣的方法,選取山西省11個地市的4901名空巢老人作為研究對象,利用健康促進生活方式量表(HPLP-C)、健康狀況調(diào)查簡表(SF-36)及社會支持評定量表(SSRS)等為研究工具,采用描述性分析進行空巢老人一般人口學(xué)特征分析,兩獨立樣本t檢驗和方差分析比較不同的一般人口學(xué)特征下空巢老人在各量表得分上的差異,多元逐步回歸對影響因素進行探索。采用分層隨機整群抽樣的方法,選取太原市三個社區(qū)的396名空巢老人作為干預(yù)研究對象,分別設(shè)置干預(yù)組與對照組,在實施為期7個月的“SMG”健康管理后,對模式應(yīng)用效果進行評價,采用卡方檢驗比較干預(yù)組與對照組的人口學(xué)特征差異,兩獨立樣本t檢驗比較干預(yù)組與對照組之間的得分差異,配對樣本t檢驗比較干預(yù)前后的得分差異�？粘怖先酥悄芙】敌畔⒉杉�系統(tǒng)則基于Windows 2008 Server平臺,以B/S為結(jié)構(gòu),運用PHP語言,采用My SQL數(shù)據(jù)庫完成相關(guān)功能及模塊的設(shè)計與實現(xiàn)。結(jié)果:特征及影響因素研究結(jié)果顯示,本次調(diào)查對象年齡分布以60~70歲為主,男性(2546人)與女性(2355人)人數(shù)基本相當(dāng),生活區(qū)域為農(nóng)村多于城市,居住形式為與配偶同住者最多,75.54%的被調(diào)查者屬于相對空巢狀態(tài)。健康促進生活方式方面,本次調(diào)查對象的健康促進生活方式總分為105.29±19.68,處于中等水平。在各維度單項均分中,營養(yǎng)得分(2.84)最高,健康責(zé)任得分(2.21)最低。除性別(P=0.955)、空巢情況(P=0.539)、現(xiàn)在是否工作(P=0.483)及飲酒頻率(P=0.107)四個維度外,其他不同人口學(xué)特征的空巢老人健康促進生活方式得分差異均具有統(tǒng)計學(xué)意義(P0.001)。經(jīng)多元回歸分析發(fā)現(xiàn),社會活動參與度、社區(qū)滿意度、文化程度等12個因素為空巢老人健康促進生活方式的主要影響因素。生命質(zhì)量方面,本次調(diào)查對象的SF-36各維度得分與全國65歲及以上人群常模相比,除軀體疼痛(BP)以外(P=0.311),其他各維度的差異均有統(tǒng)計學(xué)意義(P0.001)。對不同人口學(xué)特征的空巢老人的生命質(zhì)量進行比較,除空巢情況(PCS P=0.238,MCS P=0.089)與吸煙狀況(PCS P=0.091,MCS P=0.241)兩個維度差別無統(tǒng)計學(xué)意義外,其他不同人口學(xué)特征的空巢老人生活質(zhì)量得分差異均具有統(tǒng)計學(xué)意義(P0.001)。經(jīng)多元回歸分析發(fā)現(xiàn),生活自理情況、慢性病患病情況、年齡等16個因素為空巢老人生命質(zhì)量生理健康狀況(PCS)的主要影響因素;而生活自理情況、月收入、三餐規(guī)律程度等14個因素為空巢老人生命質(zhì)量心理健康狀況(MCS)的主要影響因素。社會支持方面,本次調(diào)查對象的社會支持評定量表得分與全國普通人群常模相比,量表各個維度的差異均具有統(tǒng)計學(xué)意義,除客觀支持維度低于全國常模外,主觀支持、支持利用度以及總得分均高于常模水平。對不同人口學(xué)特征的空巢老人的社會支持情況進行比較,除性別(P=0.703)與現(xiàn)在是否工作(P=0.429)外,其他不同人口學(xué)特征的空巢老人SSRS得分差異均具有統(tǒng)計學(xué)意義(P0.05)。經(jīng)多元回歸分析發(fā)現(xiàn),喪偶、夫妻關(guān)系、與子女關(guān)系等11個因素為空巢老人社會支持的主要影響因素。模式評價研究結(jié)果顯示,迎澤區(qū)、尖草坪區(qū)及晉源區(qū)的干預(yù)組與對照組研究對象在性別、年齡、文化程度、婚姻狀況、居住形式、空巢情況、月收入、社會活動參與度、生活自理能力以及慢性病患病情況方面均無統(tǒng)計學(xué)差異(P0.05),研究對象具有同質(zhì)性。健康促進生活方式方面,實施健康管理后,迎澤區(qū)、尖草坪區(qū)及晉源區(qū)的空巢老人健康促進生活方式均有所提高,總分、健康責(zé)任及人際支持維度上的變化最為明顯,營養(yǎng)與運動維度有一定提升但部分結(jié)果無統(tǒng)計學(xué)意義,自我實現(xiàn)與壓力管理維度上的變化有限。生命質(zhì)量方面,實施健康管理后,迎澤區(qū)、尖草坪區(qū)及晉源區(qū)的空巢老人生命質(zhì)量均有所提高,在SF-36量表的各維度中,心理健康總分(MCS)、情感職能(RE)、社會功能(SF)的變化最為明顯,活力(VT)、總體健康(GH)、軀體疼痛(BP)及精神健康(MH)有一定改變但部分結(jié)果無統(tǒng)計學(xué)意義,生理功能(PF)、生理職能(RP)與生理健康總分(PCS)的變化均無統(tǒng)計學(xué)意義。社會支持方面,實施健康管理后,迎澤區(qū)、尖草坪區(qū)及晉源區(qū)的空巢老人社會支持均有所提高,在社會支持評定量表的各維度中,總分、客觀支持及對支持的利用度的變化最為明顯,主觀支持有所改變但部分結(jié)果無統(tǒng)計學(xué)意義。結(jié)論:本項目以空巢老人為研究對象,通過特征與影響因素分析,挖掘了空巢老人的健康特征及危險因素,篩選出健康管理實施過程中的關(guān)鍵環(huán)節(jié)。在此基礎(chǔ)上,將社區(qū)組織理論引入健康管理,構(gòu)建集自我管理、互助管理、團體管理為一體的“SMG”健康管理模式。通過干預(yù)研究,證明了社區(qū)組織理論在健康管理中的適用性及模式干預(yù)方案的有效性。配合自主研發(fā)的空巢老人智能健康信息采集系統(tǒng),“SMG”健康管理模式可有效提升空巢老人的健康狀況。研究成果為應(yīng)對我國“老齡化”、“空巢化”問題提供了有效途徑,具有一定的科學(xué)價值與現(xiàn)實意義。
[Abstract]:Objective: to integrate community organization theory with health management science, construct a "SMG" health management model suitable for empty nest elderly, take the example of empty nest elderly in Shanxi as an example, in order to understand the health management characteristics and influencing factors of empty nest elderly, and evaluate the application effect of health management model, so as to cope with the social "aging". "Empty nest" problem provides new ideas, and also provides reference for improving the life quality of empty nest elderly and renewing the basic health service model. Method: using multi stage random cluster sampling method, 4901 empty nest elderly in 11 cities of Shanxi province are selected as the research objects, and the Health Promotion Lifestyle Scale (HPLP-C) is used. The health status survey (SF-36) and social support rating scale (SSRS) were used as research tools. Descriptive analysis was used to analyze the general demographic characteristics of empty nesters. Two independent sample t test and variance analysis were used to compare the differences in the scores of the empty nest elderly under the different general demographic characteristics, and the multiple stepwise regression analysis of the influence causes The method of stratified random cluster sampling was used to select 396 empty nest elderly in three communities in Taiyuan city as the intervention research subjects. The intervention group and the control group were set up respectively. After the implementation of the "SMG" health management for 7 months, the effect of the model was evaluated and the chi square test was used to compare the intervention group and the control group. Two independent sample t test compared the score difference between the intervention group and the control group. The paired sample t test compared the scores before and after the intervention. The intelligent health information collection system of the empty nest elderly was based on the Windows 2008 Server platform, B/S as the structure, the PHP language, and the My SQL database to complete the related functions and models. Design and implementation of block. Results: the results of characteristics and influencing factors showed that the age distribution of the subjects was 60~70 years old, the number of male (2546) and female (2355) was basically equal, the living area was more rural than the city, the form of living was the most with the spouse, and 75.54% of the respondents belonged to the relative empty nest state. In terms of lifestyle, the total health promotion lifestyle of the subjects was 105.29 + 19.68, at the middle level. In the single dimension, the nutrition score (2.84) was the highest and the health responsibility score (2.21) was the lowest. Except for sex (P=0.955), the empty nest (P= 0.539), the present work (P=0.483) and the drinking frequency (P=0.107) four dimensions In addition, there were statistically significant differences in the scores of health promotion lifestyles of empty nest elderly with different demographic characteristics (P0.001). Through multiple regression analysis, 12 factors, such as social activity participation, community satisfaction and cultural degree, were the main factors influencing the health promotion of empty nest elderly. The SF-36 dimensions of the subjects were compared with those of the population aged 65 and above, except for somatic pain (BP) (P=0.311), and the differences in other dimensions were statistically significant (P0.001). The quality of life of empty nest elderly with different demographic characteristics was compared, except for empty nest (PCS P=0.238, MCS P=0.089) and smoking status (PCS P=0.091, MCS). P=0.241) there was no statistically significant difference in the two dimensions, and the scores of the quality of life of the empty nest elderly with different demographic characteristics were all statistically significant (P0.001). Through multiple regression analysis, 16 factors, such as life self-care, chronic disease and age, were the main images of the quality of life (PCS) of the empty nesters. The 14 factors such as life self-care, monthly income, and the law degree of three meals were the main factors affecting the mental health status of the empty nest elderly (MCS). In terms of social support, the score of the social support rating scale was compared with the norm of the general population in the country, and the differences in the dimensions of the scale were statistically significant. Besides the objective support dimension is lower than the national norm, the subjective support, the support utilization and the total score are higher than the norm level. The social support of the empty nest elderly with different demographic characteristics is compared. Except for the sex (P=0.703) and the present work (P=0.429), the difference of the SSRS scores of the empty nest elderly with different demographic characteristics is all Statistical significance (P0.05). Through multiple regression analysis, it was found that 11 factors such as widowhood, husband and wife relationship and relationship with children were the main factors affecting the social support of the empty nesters. The results of the model evaluation showed that the subjects of the intervention group and the control group in the Yingze District, the tip lawn area and the Jinyuan area were in sex, age, educational level and marital status. There were no statistical differences in living forms, empty nest conditions, monthly income, social activity participation, life self-care ability and chronic diseases (P0.05). The research objects were homogeneity. After health promotion, the health promotion methods of empty nests in Yingze, the grass area and Jinyuan district were all healthy. The improvement, the total score, the health responsibility and the interpersonal support dimension were the most obvious changes, the nutrition and sports dimension had a certain promotion but the partial results were not statistically significant, the change of self realization and pressure management dimension was limited. The quality of life, the quality of life, after the implementation of health management, the quality of life of the empty nesters in the Yingze District, the tip lawn area and the Jinyuan District In all the dimensions of the SF-36, mental health total score (MCS), emotional function (RE), social function (SF) were most obvious, vitality (VT), overall health (GH), somatomatic pain (BP) and mental health (MH) had some changes but partial results were not statistically significant, physiological function (PF), physiological function (RP) and physiological health total score (PCS) There was no statistical significance in the changes. Social support, after the implementation of health management, the social support of empty nesters in the Yingze District, the tip lawn area and the Jinyuan district had been improved. In all the dimensions of the social support rating scale, the total score, the objective support and the utilization of support were most obvious, the subjective support was changed but some of the results were not unified. Conclusion: this project takes the empty nest elderly as the research object. Through the analysis of the characteristics and influencing factors, the health characteristics and risk factors of the empty nest elderly are excavated, and the key links in the implementation of health management are screened out. On this basis, the community organization theory is introduced into the health management to build a set of self-management, mutual management and group management. "SMG" health management model. Through intervention research, it is proved that the applicability of community organization theory in health management and the effectiveness of model intervention program. With the independent research and development of empty nest elderly intelligent health information collection system, "SMG" health management model can improve the health status of empty nest elderly. In order to deal with the problem of "aging" in China, it provides an effective way to solve the problem of "empty nest" and has certain scientific and practical significance.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R195.1

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