A Study On The Current Situation And Influencing Factors Of Self-Perceived Burden In Elderly Patients With Multiple Chronic Disease

ObjectiveTo investigate the current situation and influencing factors of self-perceived burden in elderly patients with multiple chronic conditions,and to describe the real experiences of elderly patients with multiple chronic conditions with moderate and severe levels of self-perceived burden,to supplement and deeply analyze the influencing factors related to self-perceived burden in elderly patients with multiple chronic conditions,and to provide reference for the development of effective interventions to reduce self-perceived burden in elderly patients with multiple chronic conditions.Methods1.Cross-sectional study: a convenience sampling method was used to select 320 elderly patients with multiple chronic conditions attending 2 tertiary care hospitals in Lanzhou City,Gansu Province from May 2022 to January 2023,and the study instruments for the cross-sectional survey included the General Information Questionnaire,the Self-perceived Burden Scale,the Hospital Anxiety and Depression Scale,the Medical Coping Modes Questionnaire,the Social Support Rating Scale,and the General Self-Efficacy Scale.Statistical analysis of the data was performed using SPSS 26.0 software,using x ± s,number of cases,and percentage to describe the current situation,t-test,ANOVA,and correlation analysis for one-way analysis of influencing factors,and multiple linear stepwise regression analysis for multi-factor analysis,respectively.α=0.05 was chosen as the test level.2.Qualitative study: a purposive sampling method was used to conduct semi-structured interviews with 13 elderly patients with multiple chronic conditions who participated in the first part of the cross-sectional study and scored ≥30 on the Self-perceived Burden Scale.The interview data were analyzed according to the seven-step analysis of phenomenological data.Results1.Cross-sectional study: current status and factors influencing self-perceived burden of multiple chronic conditions in the elderly(1)A total of 328 questionnaires were distributed,and 320 valid questionnaires were finally collected,with an effective recovery rate of 97.6%.(2)The mean score of self-perceived burden in 320 elderly patients with multiple chronic conditions was(27.19±8.88),with 72 patients(22.5%)with no significant self-perceived burden,83 patients(25.9%)with mild self-perceived burden,151patients(47.2%)with moderate self-perceived burden,and 14 patients with severe self-perceived burden(4.4%).(3)The results of univariate analysis showed that gender,education level,medical payment method,place of residence,residence status,primary caregiver,health status of self-conscious primary caregiver,and monthly per capita household income had an effect on the self-perceived burden score of elderly patients with multiple chronic conditions,with statistically significant differences(P<0.05).(4)Correlation analysis showed that the total score of self-perceived burden was positively correlated with anxiety(r=0.592),depression(r=0.553),and avoidance coping style(r=0.221)(P<0.01);the total score of self-perceived burden was negatively correlated with confrontation coping style(r=-0.222)and general self-efficacy(r=-0.221)(P<0.01).(5)The results of the multifactorial analysis showed that anxiety,depression,general self-efficacy,health status of the self-conscious primary caregiver,and health care payment method were the main influencing factors of self-perceived burden in elderly patients with multiple chronic conditions(P<0.05),which together explained46.1% of the total variance in self-perceived burden scores.2.Qualitative study: real experiences of elderly patients with multiple chronic conditions with moderate and severe levels of self-perceived burdenBy analyzing and refining the interview data of 13 elderly patients with multiple chronic conditions,five themes and 11 sub-themes were finally summarized.Theme 1:burden of disease management,including disturbed by disease symptoms,reduced self-care ability,and poor compliance;Theme 2: burden of family,including fear of affecting family members,lack of family roles,and insufficient family support;Theme 3: burden of psychology,including negative emotions,suppression of true feelings,and negative thoughts;Theme 4: burden of economy,including high treatment expenses and insufficient reimbursement ratio by medical insurance;Theme5: burden of medical services.Conclusions1.Elderly patients with multiple chronic conditions generally have mild or moderate levels of self-perceived burden,and some patients even have severe levels of self-perceived burden.2.The main factors influencing the self-perceived burden of multiple chronic conditions in the elderly include anxiety,depression,general self-efficacy,health status of the self-perceived primary caregiver,and health care cost payment method.3.Elderly patients with moderate and severe levels of self-perceived burden of multiple chronic conditions have multiple complex experiences that manifest as:burden of disease management,family burden,psychological burden,financial burden,and burden of medical services,complementing the factors influencing the self-perceived burden of chronic disease co-morbidities in the elderly.4.It is suggested that healthcare professionals should identify and assess the self-perceived burden of elderly patients with multiple chronic conditions and develop individualized nursing interventions based on influencing factors to reduce the self-perceived burden of elderly patients with multiple chronic conditions.