| BackgroundIn the context of accelerating population aging,the number of empty-nest older adults is increasing,which has accounted for half of China’s older population in recent years.Nearly half of them live in rural areas.The empty-nesters in rural areas generally have low economic income,relatively lack of social pension security,health service resources,and care in daily life.They are facing increasingly prominent health problems,which have become social problems that cannot be ignored.Health-related quality of life can fully reflect individual health status,which has become an important indicator to evaluate the health status of the older adults in the context of healthy aging.The health ecology model combines ecological theory with health behavior and emphasizes that individual or group health is the result of individual and environmental factors.At present,there are relatively few studies on the quality of life of rural empty nesters.Therefore,it is of great significance to understand the status quo of health-related quality of life of empty nesters in rural areas and explore related factors of all dimensions from the perspective of health ecology,which is conducive to promoting the construction of healthy China and promoting the harmonious development of society.ObjectivesFirst,we access the status of health-related quality of life of empty nest older adults in rural Shandong province.Second,we explore the related factors of quality of life and the five health dimensions(mobility,self-care,usual activities,pain/discomfort,anxiety/depression)based on health ecology model and the differences of related factors in different age groups.The study will provide the theory basis for developing intervention measures and improving the life quality of old people,so as to promote healthy aging.MethodsThe data came from the "Health cohort survey of the elderly in rural Shandong Province"in 2020.The study adopted a multi-stage stratified sampling method to follow up 2785 older adults in 60 sample villages and 15 towns in Shandong Province,and 2277 empty-nest older adults were included in this study.Self-designed questionnaires were used to complete the survey through face-to-face interviews.Epidata3.1 and Stata14.0(Stata Corp,College Station,TX,USA)were used for data entry and statistical analysis.Based on the health ecology model,descriptive analysis of health-related quality of life of rural empty nesters was conducted for study variables,Wilcoxon rank-sum test,Kruskal-Wallis H test and Chi-square test were used to conduct univariate analysis of health utility value and health five dimensions.Tobit regression and Logistic regression were used for multivariate analysis to explore the related factors.ResultsIn the study,the health utility value of the rural empty-nesters in Shandong province was 0.91±0.16.Among the five dimensions of health,the proportion of action problems and physical discomfort/pain were the highest,followed by daily activities and psychological conditions,but most of them were able to complete self-care.Among the personal characteristics,gender,age,chronic disease and BMI were correlated with the health of rural empty-nesters.Men were more likely to have problems in daily activities(P=0.017,OR=0.679),and women were more likely to experience physical discomfort(P=0.013,OR=1.330).Older adults were more likely to have action problems(70-:P=0.033,OR=1.292;80-:P=0.032,OR=1.515),daily activity problems(P=0.024,OR=1.665),and physical discomfort or pain(70-:P=0.019,OR=1.269;80-:P=0.018,OR=1.511).The health utility values(β=-0.171,P<0.001)and health dimensions(P<0.001,OR=2.498;P<0.001,OR=2.885;P<0.001,OR=3.884;P<0.001,OR=3.021;P<0.001,OR=3.162)of the older adults without chronic diseases were significantly better than those of the old people with chronic diseases,and the health utility values of the older adults with BMI normal and obesity were higher than those of the underweight 18.5-:β=0.096,P=0.002;24-:β=0.093,P=0.002;28-:β=0.068,P=0.031).The elderly with high BMI were less likely to have daily activities(P=0.022,OR=0.500),anxiety and depression(18.5-:P=0.004,OR=0.447;24-:P=0.003,OR=0.432;28-:P;=0.020,OR=0.510)than those with underweight.Among the behavioral characteristics,tea drinking and physical exercise were related with health.The quality of life(β=0.047,P<0.001),self-care(P=0.043,OR=0.703),daily activities(P=0.011,OR=0.689),physical status(P=0.037,OR=0.816)and psychological status(P<0.001,OR=0.587)of tea drinkers were significantly higher than those of the elderly without this habit.The health utility value(β=0.099,P<0.001)and five health dimensions(P<0.001,OR=0.391;P<0.001,OR=0.410;P<0.001,OR=0.376;P<0.001,OR=0.724;P<0.001,OR=0.538)of the elderly with physical exercise habit were better.In the interpersonal network,marital status and social support were significantly correlated with health.The elderly without spouse had higher health utility scores(β=-0.034,P=0.034)and were less likely to have problems in daily activities(P=0.029,OR=1.455).Older adults with high social support had higher health utility scores(β=0.038,P=0.004)and were better able to complete self-care(P<0.001,OR=0.529)and daily activities(P<0.001,OR=0.591).In terms of living and working conditions,occupation,annual family income,education level and health were significantly correlated.The health utility value of the farmer elderly was significantly higher than that of the unemployed elderly(β=0.069,P<0.001),and they were less likely to have problems in mobility(P<0.001,OR=0.502),self-care(P<0.001,OR=0.371),daily activities(P<0.001,OR=0.481),and the non-farmer had better psychological status than the unemployed elderly(P=0.005,OR=0.338).The higher the income,the better the health utility value(β=0.045,P=0.013),daily activities(P=0.029,OR=0.639)and psychological status(P=0.002,OR=0.551).The higher the education level,the higher the health utility value(primary school:β=0.033,P=0.013;junior high school and above:β=0.056,P=0.001),and the lower likelihood of problems in mobility(P=0.013,OR=0.667),self-care(primary school:P=0.035,OR=0.691;junior high school and above:P=0.046,OR=0.606),daily activities(primary school:P=0.006,OR=0.666;junior high school and above:P=0.016,OR=0.610),anxiety or depression(P=0.005,OR=0.684).Stratified by age,among personal characteristics,chronic diseases were significantly correlated with the health utility of the elderly(60-69:β=-0.199,P<0.001;70-79:β=-0.161,P<0.001;≥80:β=-0.107,P=0.015),BMI was significantly associated with the health utility in adults aged 60 to 79(60-69:β=0.131,P=0.013,β=0.126,P=0.015;70-79:β=0.108,P=0.017,β=0.096,P=0.033).Among behavioral characteristics,there was a significant correlation between tea drinking habit and health utility of the aged ≥70 years(70-79:β=0.065,P<0.001;≥80:β=0.084,P=0.039),physical exercise was positively correlated with the health of the aged at all ages(60-69:β=0.091,P<0.001;70-79:β=0.109,P<0.001;≥80:β=0.101,P=0.007).In the interpersonal network,marriage was associated with health utility among 70-79 years(β=-0.048,P=0.029),and social support was associated with health utility among 60-69 years(β=0.064,P=0.002).Among living and working conditions,occupational and health utility values were significantly correlated in older adults aged 60-79(60-69:β=0.052,P=0.015,β=0.090,P=0.021;70-79:β=0.083,P<0.001),and the correlation between education level and education level was statistically significant in adults above 70 years(70-79:β=0.063,P=0.018;≥80:β=0.165,P=0.026).Conclusions and suggestionsConclusionsThe health-related quality of life of the rural empty-nesters in Shandong province was good,the five dimensions of health had the highest proportion of mobility problems and physical discomfort.Individual trait(Gender,age,chronic disease,BMI),characteristic of behavior(tea consumption,physical exercise),social network(marriage,social support),living and working conditions(occupation,annual family income,education level)were significantly correlated with health-related quality of life.SuggestionsFirst,we should strengthen community-level health services and make them more accessible.Second,paying attention to elderly patients with chronic diseases and improve the quality of life.In addition,we should strengthen health education propaganda,cultivate good behavior habits of the older adults.Lastly,paying more attention to the mental health of the empty-nest older adults and improving their happiness of life. |
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