Latent Class Analysis On The Self-care Ability Among The Elderly And Discussion On The Pattern Of Multimorbidity

Objective:This study was committed to identify the potential characteristics of the self-care ability of the elderly,interpret the differences between the potential categories and analyze the possible influencing factors of the heterogeneous subgroup of the elderly in order to provide a reference for reasonable prevention and control and relieve the self-care ability of the elderly;To explore the association and intensity of multimorbidity combinations in the elderly,and optimize the management of multimorbidity.Methods:In this study,3250 elderly people in Shanxi Province were selected by multi-stage cluster random sampling.The questionnaire included personal information,family relationship,community service,eating behavior,smoking status,type of past chronic diseases,Perceived Social Support Scale(PSSS)and Activity of Daily Living Scale(ADL).Descriptive analysis was used to analyze the general situation of self-care ability of the elderly.Mplus 8.3 was used to classify the self-care ability of the elderly by Latent Class Analysis(LCA),and SPSS 24.0 chi-square test and multi-category Logistic stepwise regression were used to explore the influencing factors of various categories.SPSS Modeler 18.0 software was used to establish data flow,web graph was used to observe the potential association between chronic diseases,and Apriori association rule algorithm was used to explore the association between multimorbidity.Results:(1)The disability rate of the elderly in Shanxi Province was about 19.6%.The analysis results of Latent Class Analysis showed that the self-care ability of the elderly can be divided into three classes: “Life Completely Dependent Group”,“Life Needs Help Group” and “Basic Self-care Group”.The Multiple Logistic regression results showed that,compared with the “Basic Self-care Group”,at the age of 80 or higher,70～79 years old,female,without formal education,poor relationship with their spouse,general relationship,community public infrastructure is not perfect,don’t know if there is a public infrastructure in the community,don’t know whether there is an activity center for the older adults,don’t pay attention to the daily healthy diet,don’t know what food collocation is reasonable,perceived social support at a moderate level were more likely to appear in the “Life Completely Dependent Group”;at the age of 80 or higher,70～79 years old,fat,lean,living in the city,not formal education,primary education,general relationship,don’t know if there is a public infrastructure in the community,don’t know whether there is an activity center for the older adults,don’t pay attention to the daily healthy diet,not sure whether dietary collocation is reasonable,perceived social support at the medium level,suffer from multimorbidity was more likely to appear in the“Life Needs Help Group”(P<0.05).(2)The prevalence of chronic disease and multimorbidity among the elderly in Shanxi Province was 58.5% and 30.3% respectively.Multimorbidity were mainly composed of two elements,three elements and four elements.Network graph analysis showed that high blood pressure + another chronic disease dominated the strong links,followed by hearing impairment + another chronic disease.The results of Apriori algorithm showed that atherosclerosis + coronary heart disease + hypertension,diabetes +coronary heart disease + hypertension were the most common disease combinations.Tetrad comorbidities of arrhythmia + osteoporosis + hypertension + sciatica,digestive system disease + osteoporosis + hearing impairment + eye disease were the most common tetrad comorbidities.All were strongly correlated.Conclusions:In Shanxi Province,bathing,bed and chair transfering,up and down the stairs involving coordinated movement of the whole body had obvious obstacles,suggesting that it should be monitored and identified.The categories of self-care ability of the three groups had group heterogeneity respectively,and Latent Class Analysis could identify key groups.Age,education level,spousal relationship,availability of public infrastructure in the community,availability of senior activity centers in the community,concern about daily healthy eating and perceived social support were the common influencing factors for the elderly self-care subgroup.It is suggested that relevant departments should take corresponding measures based on the risk factors of self-care ability of the elderly in different subgroups to reduce the dependence of the elderly on the outside world,improve the status of self-care ability,and promote the health and longevity of the elderly.The prevalence of chronic diseases and multimorbidity was higher in Shanxi Province.The majority of binary comorbidity combinations were hypertension + another chronic disease,the majority of triadic comorbidity combinations were coronary heart disease +hypertension + another chronic disease.Arrhythmia + osteoporosis + hypertension +sciatica,digestive system disease + osteoporosis + hearing impairment + eye disease were the most common chronic diseases.It is suggested that there is a correlation between multimorbidity.Medical institutions should do a good job in early screening and health education of multimorbidity,so as to improve the health status of the elderly and reduce the burden of family and society.