Health-Related Quality Of Life And Associated Factors For Rural Elderly People:Evidence From Shaanxi Province

Objective In order to implement the strategy of healthy China and vigorously construct an active aging society,comprehensive and systematic surveys were conducted to analyze the health-related quality of life and chronic diseasesof the elderly group in rural China,the main group of the elderly population in the country.Firstly,our study may avail tomaster the health status of the elderly in rural areas,and reveal its social,economic and environmental risk factors.Secondly,our study may provide statistical evidences for relevant functional departments at all levels to further improve the policies of rural elderly health,giving all-round full-cycle health services to the elderly in rural areas,establishing a basic medical and health system for the elderly with Chinese characteristics,formulating rural pension strategies,improving the environment for the elderly,and establishingthe mechanism of prevention and treatment to diseases.Lastly,our research can provide theoretical support for establishing a sound health assessment system for the elderly,exploring scientific and effective health promotion and health intervention strategies,and effectively improving the health and quality of life of the rural elderly population.Methods We conducted a cross-sectional,elderly population-based study in the Shaanxi Province,China.In brief,a four-stage,stratified,random sampling scheme was used to ensure that samples are representative of the population over 60 years old in Shaanxi Province.The final sample consisted 3307 rural seniors from 24 administrative villages in Shaanxi Province by stratified random clustering.The general status questionnaire,European Five-dimensional Health Scale(EQ-5D),chronic disease questionnaire,the Activity Capacity Scale(ADL)and the Pittsburgh Sleep Quality Scale(PSQI)were used to comprehensively assess the health-related quality of life of the rural elderly in Shaanxi Province.The database was established using Epidata 3.0 software,and SPSS 19.0 software was used for statistical analysis.The data was analyzed by t-test,one-way analysis of variance,Pearson correlation analysis,multiple stepwise regression analysis,and Tobit regression.Take the test level as 0.05 on both sides,ie P<0.05 indicates statistical significance.Results 1.The status of health-related quality of life of rural elderly in Shaanxi ProvinceThe EQ-5D index of the elderly in rural areas in Shaanxi Province was 0.90±0.15,and the self-evaluated health EQVAS score was 74.08±15.30.In the health description system,the constituent ratios of the dimensions of the seniors’ problem dimensions were: pain/discomfort dimension(27.1%),mobility ability dimension(15.9%),anxiety/depression dimension(13.4%),daily activity dimension(13.1%)and self-care dimensions(10.6%).Among the EQVAS scores,the elderly with 71-80 accounted for 31.3%,and the elderly with ≤60 points accounted for 25.3%.Only 6.9% of older people scored their health over 90 points.The prevalence of chronic diseases in the rural elderly in Shaanxi Province was 68.7%.The top five common chronic diseases were hypertension(27.7%),joint disease(22.6%),coronary heart disease(15.7%),gastrointestinal disease(10.0%),and deafness(7.8%).The score of the daily living activities of the elderly in rural areas in Shaanxi Province was 16.20±4.79.The percentage of completely normal daily activities were 65.8%,those with minor disabilities accounted for 21.2%,and those with daily living activities accounted for 13.0%.The score of sleep quality in the rural elderly in Shaanxi Province was 6.37±4.16,and the incidence of sleep disorders was 32.9%.2.Influencing factors of health-related quality of life of rural elderly in Shaanxi Province.The EQ-5D index of the elderly population were affected by the region(Shaanbei Β=0.034,Shannnan Β=0.027,P<0.001),regular exercise(Β=0.021,P<0.001),and children’s filial piety(Β=0.015,P=0.003),difficulty in getting help with mental illness(Β=-0.02,P=0.009),normal weight(Β=0.005,P=0.015),stress or acute illness(Β=-0.040,P<0.001),normal appetite(Β=0.020,P<0.001),drinking(Β=0.018,P=0.019),falling(Β=-0.021,P<0.001),chronic disease(Β=0.008,P<0.001),daily living activity ability(Β=-0.118,P<0.001),Sleep disturbance(Β=-0.032,P<0.001).Self-evaluation of health were affected by the region(ShaanbeiΒ= 3.639,Shannan Β =-6.942,P <0.001),age(Β =-0.123,P = 0.003),living pattern(shared with childrenΒ= 1.969,P = 0.010),economic burden(general economic burdenΒ=-2.019,P = 0.045),regular exercise(Β = 1.668,P = 0.001),filial piety(Β=4.813,P=0.007),drinking tea(Β=1.409,P=0.022),falling(Β=-1.855,P=0.036),chronic disease((one =-2.499,P<0.001;twoΒ =-4.756,P<0.001;three or more Β=-6.794,P<0.001),activities of daily living(mild disability of daily activityΒ=-3.713,P<0.001;severe disability of daily activityΒ=-13.009,P<0.001)and sleep obstructive(Β =-4.418,P <0.001).Living with children,no financial burden,children filial piety,regular exercise,tea drinking,proper drinking,etc.were positive factors,while Southern Shaanxi,falls,chronic diseases,daily impaired living activities,sleep disorders,stress,etc.were risk factors that related to health-related quality of life of the elderly in rural areas in Shaanxi.Conclusion1.The health-related quality of life of rural elderly in Shaanxi Province is not optimistic,and the problems in women are more severe than men.Physiologically,pain and discomfort is its primary health problem,followed poor physical function,high incidence of chronic diseases,high reliance on the ability of activities of daily living,and high rates of sleep disorders.In terms of psychological aspects,the rural elderly populations are suffering negative emotions such as anxiety/depression.As for social support,the rural elderly’s social performance is low and social scope is narrow.2.The health-related quality of life of the elderly in rural areas in Shaanxi Province was affected by demographic characteristics,socioeconomic status,health-related behaviors,illness and accidents,activities of daily living,and sleep quality.Avoiding or reducing the risk of controllable risk factors and expanding the influence of protective factors are of great significance to improving the health-related quality of life of the elderly in rural areas as a whole.3.We propose to improve cognitive health protection and improve the health and value of the elderly by enhancing the cognitive and practice of the elderly’s culture and health literacy and improving their health value and behavior.We must actively explore the “health care and support” rural endowment model and build a preventive and health care system.And thus the integrated health service system for the elderly in rural areas can effectively improve the health-related quality of life of the elderly population in the western rural areas and promote the healthy realization of the healthy China strategy.