A Study On The Correlation Between The Daily Living Ability Of Elderly Patients With Diabetic Retinopathy,their Primary Caregivers’ Care Burden And Quality Of Life

Objectives:To investigate the care burden and quality of life of primary caregivers of elderly patients with diabetic retinopathy in China and the influencing factors behind;to analyze the correlation between primary caregivers’ care burden,quality of life,and patients’ activities of daily living;to analyze the influencing factors of primary caregivers’ quality of life by multiple linear regression analysis;To build a path analysis model with the care burden and the primary caregiver’s quality of life as the outcome variable;and to explore the mechanism of action between the primary caregiver’s quality of life,care burden and other influencing factors,thus providing a theoretical basis and guidance for reducing the care burden of primary caregivers and improving their quality of life.Methods:This study was a cross-sectional study.By convenience sampling,it has collected a total of 368 samples,i.e.368 pairs of elderly diabetic retinopathy inpatients and primary caregivers,at a grade 3 level A hospital in Liaocheng of Shandong Province from October 2020 to October 2021.Research tools used were a general information questionnaire,a scale evaluating patient’s activities of daily living(Barthel Index),a care burden scale(ZBI),and a health survey(SF-36).Besides,excel software was used for data entry,and SPSS 22.0 statistical software and Amos24.0 software were used to analyze the data.Statistical methods employed were descriptive analysis,independent sample t-test,analysis of variance(ANOVA),Pearson correlation analysis,multiple linear regression analysis,structural equation modeling,and mediating effect test.Results:1.The mean care burden score of primary caregivers of 368 elderly patients with diabetic retinopathy was(51.21±15.44),with 96 cases(26.1%)with mild burden,128 cases(34.8%)with moderate burden,and 144 cases(39.1%)with severe burden.The mean score of these caregivers’ quality of life was(101.15±9.20).The mean score of patients’ daily living ability was(81.52±13.80),with 120 cases(32,6%)with intact daily living ability and 248 cases(67.3%)with impaired daily living ability,including 232 cases(63.0%)with mild impairment and 16 cases with moderate impairment(4.3%).2.The results of the univariate analysis showed that the care burden scores of the primary caregivers were statistically significant in terms of the differences in caregivers’gender(t=-9.061,p<0.05),relationship with the patient(F=21.819,p<0.05),education level(F=11.047,p<0.05),marital status(t=13.57,p<0.05),work status(F=12.329,p<0.05)and monthly household income(F=6.95,p<0.05),whether they have chronic diseases(t=10.588,p<0.05),whether there are other caregivers(t=19.231,p<0.05)and whether they are caring for others(t=11.011,p<0.05),length of care(F=34.538,p<0.05).In addition,primary caregivers’ care burden scores were statistically significant regarding differences in patients’age(F=4.496,p<0.05),work status(F=8.049,p<0.05),hospitalization frequency(F=77.632,p<0.05),and health care payment method(F=27.105,p<0.05),and retinopathy stage(t=44.308,p<0.05).Additionally,in the univariate analysis of the quality of life of primary caregivers,their quality of life scores were statistically significant on the general characteristics of the primary caregiver in terms of gender(t=2.846,p<0.05),age(F=13.773,p<0.05),relationship with the patient(F=4.359,p<0.05),education level(F=5.442,p<0.05),work status(F=3.804,p<0.05),monthly household income(F=3.645,p<0.05),place of residence(F=3.804,p<0.05),presence or absence of chronic diseases(t=10.326,p<0.05),presence or absence of other caregivers(t=10.728,p<0.05),whether they are caring for others(t=4.555,p<0.05),and the length of caregiving per day(F=11.225,p<0.05).Among the general patient characteristic variables,there were also statistically significant differences in primary caregivers’ quality of life scores corresponding to patients’ hospitalization frequency(F=17.618,p<0.05),health care payment methods(F=5.644,p<0.05),and diabetic retinopathy stage(t=6.982,p<0.05).3.The results of the correlation analysis showed that the total score of primary caregivers’ quality of life and both dimensions(physical quality of life and psychological quality of life)had a significant negative correlation with the total score of primary caregivers’ care burden and both dimensions(responsibility burden and personal burden)(p<0.01);the total primary caregiver quality of life score and both dimensions(physical quality of life and psychological quality of life)had a significant positive correlation with patient’s ability to perform daily living activities(p<0.01);patients’ ability to perform daily living activities had a significant negative correlation with primary caregivers’ total care burden score and two dimensions(responsibility burden and personal burden)(p<0.01).The correlation coefficients between the total score of primary caregivers’ care burden and the two dimensions(responsibility burden and personal burden)were 0.856-0.985,indicating a high positive correlation between them.In addition,the correlation coefficients between the total score of primary caregivers’ quality of life and the two dimensions of physical quality of life and psychological quality of life were 0.804-0.878,indicating a high positive correlation between the three dimensions.4.The results of the multifactorial analysis(multiple linear regression analysis)of primary caregivers’ quality of life showed that there were five influencing factors:age of the primary caregiver,presence or absence of chronic diseases,monthly household income,caregiver’s care burden,and the patient’s ability to perform daily living activities(p<0.05).5.Structural equation modeling analysis was conducted first by constructing a total score model for patients’ ability to perform daily living activities,primary caregivers’ care burden,and their quality of life.The results showed that patients’ ability to perform daily living activities had a direct negative effect on primary caregivers’ care burden with a standardized model coefficient of-0.247(p<0.05);primary caregivers’ care burden had a negative effect on primary caregivers’ quality of life with a standardized model coefficient of-0.266(p<0.05);there was significant direct effect of patient’s ability to perform daily living activities on primary caregiver’s quality of life 0.156(p<0.05).The results of the mediated effect test showed that the mediated effect of primary caregivers’ care burden on patients’ ability to perform daily living activities and primary caregivers’ quality of life was 0.066.The test was performed using the Bootstrapping method,and the 95%Bootstraping confidence interval for the mediated effect was(0.023,0.120),without containing zero,indicating that the mediating effect is significant.A structural equation model with four subdivisions was constructed.From the analysis results,it can be seen that the subdivision 1 was constructed as patients’ daily living abilityprimary caregivers’ responsibility burden-primary caregivers’ physical quality of life,and patients’ daily living ability could indirectly affect primary caregivers’ physical quality of life through primary caregivers’ responsibility burden,but patients’ daily living ability had no direct effect on primary caregivers’ physical quality of life.The patient’s ability to perform daily living had no direct impact on the primary caregiver’s physical quality of life.Subdivision 2 involved patients’ ability to perform daily living-primary caregives’s burden of responsibility-primary caregivers’ psychological quality of life,in which the patients’ability to perform daily living activities could indirectly affect the primary caregivers’psychological quality of life through primary caregivers’ burden of responsibility,or directly affect primary caregivers’ psychological quality of life.Subdivision 3 was constructed as patients’ ability to perform daily living-primary caregiver’s personal burden-primary caregiver’s physiological quality of life,and the analysis results showed that patients’ ability to perform daily living activities only had a significant negative effect on primary caregivers’personal burden,but not ontheir physiological quality of life.Subdivision 4 was constructed as patients’ daily living ability-primary caregivers’ burden of responsibility-primary caregivers’ psychological quality of life,and the results showed that patients’ daily living ability could both indirectly affect primary caregivers’ psychological quality of life through primary caregivers’ personal burden and directly affect their psychological quality of life.In summary,patients’ ADLs had a significant negative effect on primary caregivers’ personal burden and responsibility burden,but they had a weak or indirect effect on primary caregivers’quality of life,mainly on their psychological and physical quality of life.To improve the quality of life of primary caregivers,the focus should be on their psychological quality of lifeConclusions:1.Primary caregivers of elderly patients with diabetic retinopathy generally had a heavy care burden.Therefore,the author suggests that medical workers focus on the care burden of less-educated,long-term and female caregivers,caregivers who are the spouse or child of the patients,and caregivers of patients who are hospitalized more than three times,have no other caregivers and are in the proliferation stage of retinopathy.2.The quality of life of these caregivers were poor.Their quality of life was affected by various factors,and medical professionals should take appropriate interventions to enhance the quality of life of primary caregivers.3.Currently,elderly patients with diabetic retinopathy generally show a decline in their ability to perform activities of daily living,and measures should be taken to improve it.4.There was a negative correlation between primary caregivers’ care burden and their quality of life,i.e.,the heavier the burden is,the lower their quality of life will be.In addition,there was a negative correlation between patients’ ability to perform daily living activities and primary caregivers’ care burden,i.e.,the stronger the patient’s ability is,the lower the primary caregiver’s care burden will be;there was a positive correlation between patients’ ability to perform daily living activities and primary caregivers’ quality of life,i.e.,the stronger the patients’ ability is,the higher the primary caregiver’s quality of life of will be.5.The path model analysis with primary caregivers’ quality of life as the outcome variable showed that after controlling the general characteristics of patients and primary caregivers(statistically significant variables in the univariate and multivariate analyses),patients’ ability to perform daily living activities and primary caregivers’ care burden had a significant effect on the quality of life of primary caregivers.Among these variables,patients’ability to perform activities of daily living had a positive effect on the quality of life of primary caregivers;patients’ ability to perform activities of daily living also had a negative effect on the care burden of primary caregivers;and the care burden of primary caregivers had a negative effect on the quality of life of primary caregivers.6.Based on the influencing relationship among primary caregivers’ quality of life,their care burden,and patient’s daily living ability,a path analysis model was constructed and fitted.The results of the analysis clearly showed that primary caregivers’ care burden played a significant mediating role between their quality of life and patients’ daily living ability.That is,patients’ ability to perform daily living can both directly affect primary caregivers’ quality of life and indirectly affect their quality of life by influencing their care burden.