| Objectives This study aimed to develop the scale for assessing the elder self-neglect(ESN)in the rural areas of China,and assess the reliability and validity of the Scale of the Elderly Self-Neglect(Rural)(SESNr);to examine the prevalence rate of self-neglect among the elderly in Chinese rural areas,and to explore the associations of the socio-demographic,health-related,psychosocial characteristics and quality of life(QoL)with ESN;in addition social support as mediator effect and social demographic variables as moderator effect between depression and ESN are also explored.Methods1.Development and assessment of Scale of the Elderly Self-Neglect(Rural)A survey was administered to an expert panel using Delphi technique.30 experts from the research fields of public health,geriatric medicine,psychology,sociology,etc were asked to screen out and ascertain the alternative items.The Delphi survey was administered from two to three rounds via email communications,and panelists could revise their subsequent responses based on review of the anonymous opinions of their peers in the first round.220 elders aged 60 years or older who resided in the rural area for at least 1 year were selected using a convenient sampling method.Elderly and their physicians or caregivers were invited to questionnaire survey.Firstly,all elders complete SESNr questionnaire.Then,10 village physicians responsible for 201 elderly completed Assessment of Self-Neglect Severity(ASS)for criterion-related validity test.The refusal rate of the physicians is 16.7%.Lastly,181 elderly have caregivers lived with them for at least 1 year and take the care duty for them.The 181 caregivers were recruited to complete SESNr for consistency test.All of the participants who had speech impediment,hearing impairment and other communication disorder were excluded.Item selection was performed by research team according to the results of eight statistical methods.Acceptability was estimated using reception rate,completion rate and completion time in the elderly.Cronbach's ? and test-retest reliability were used to assess reliability of SESNr.Factor analysis was used for construct validity.Spearman's correlation analysis was used for criterion validity and the consistency of the elderly and their caregivers.2.Influencing factors of the elder self-neglect This cross-sectional study was conducted among 3,182 elder adults aged 60 years or older by cluster-sampling technique in one township in Dangtu,a county in Anhui province.All participants completed their face to face questionnaires in their household.The contents of the questionnaires included social demography characteristics,elder self-neglect,social support,activities of daily living,depression,anxiety,personality,and cognitive function.The distribution of characteristics was described by frequency and frequency distribution.If the scores of scales followed normal distribution,mean and standard deviation were employed to describe data.If the scale scores followed nonnormal distribution,median and the first and third quantile were used to describe data.Either Chi-squared test(or Fisher' s exact test),or kruskal-Wallis H non-parametric test were used for single factor analysis of elder self-neglect in this study.Binary Logistic regression analysis was applied to explore multiple risk factors.Spearman's correlation coefficients between social support,depression and self-neglect were employed to examine whether the data is suitable for mediator effect analysis.Contingency coefficients between social demographic variables,depression and elder self-neglect were implemented to examine whether the data are suitable for moderator effect analysis.Partial regression coefficients of interaction were analyzed by using binary logistic regression analysis for moderator effect.3.Associations of elder self-neglect with quality of life The participants of this study were from the same sample of the study on influencing factors of elder self-neglect.QoL was assessed using a brief form of the World Health Organization's quality of life questionnaire(WHOQOL-BREF).The independent sample t-test or one-way analysis of variance(ANOVA)was performed to compare four QoL domains scores across categorical covariates.Person's correlation test was performed to estimate the correlation coefficients between the QoL scores and continuous variables,and Spearman's correlation coefficients were used to describe the associations of the QoL scores with the ESN scores.Hierarchical linear regression models were used to analyze the associations between the ESN scores and QoL scores after adjusting for sociodemographic,social support,and physical and psychological variables.EpiData 3.1 was used to set up the quantitative database after checking and coding collected questionnaires.The database was analyzed using SPSS 16.0.In all tests,the level of significance was set up at P<0.05.Results1.Development and assessment of the Scale of the Elderly Self-Neglect(Rural)In total there were 23 experts from 9 cities who completed two-rounds of Delphi expert consultations.82.6%of them have more than ten years profeddional experience,indicating that they have an excellent expertise in their reaearch fileds.The positive coefficient of the two rounds consultations were 76.7%,100%respectively,suggesting experts in high enthusiasm.The authority coefficient were 0.70 and 0.79 respectively,suggesting reliable results.Kendall's coefficient of concordance were 0.292(P<0.001)?0.303(P<0.001)respectively.The scale with 6 domains including 26 items were developed after two rounds expert consultations.After item selection,a 14-item instrument that is a short and easy-to-administer tool was developed.The SESNr includes five domains.Both the reception rate and completion rate were 100%,and the mean completion time was 7.54 minutes.Cronboch's ?,r value of total score and five domain were 0.623-0.779(P<0.001)and 0.691-0.819(P<0.001)respectively.Five common factors which extracted from factor analysis almost consistent with theoretic structure,and the cumulative contributing rate was 68.29%.The correlation coefficient between this scale and ASS was 0.370(P<0.001).The correlation coefficients between the elderly and their caregivers were 0.587-0.747(P<0.001).2.Influencing factors of elder self-neglect 26.7%of the elderly were identified as self-neglect,11.1%as no self-neglect,and 62.2%were suspected to self-neglect which needed further verification.This study found the top three types of ESN among the rural elderly were:medical health(31.0%),emotion(19.0%),and environmental sanitation and personal hygiene(16.8%).The binary Logistic regression model showed that religious belief,living alone,labor intensity,anxiety,depression,activities of daily living,and a medium level of neurotic personality were risk factors of elder self-neglect,while widowed,illiterate,self-rated average and poor health status,and social support were protective factors.Social support played significant partial mediator roles between depression and self-neglect,which was manifested in the overall self-neglect(the total score of the scale)and the domains:medical health and care,environmental sanitation and personal hygiene,emotion,safe.The highest mediation effect was between depression and environmental sanitation and personal hygiene self-neglect,which accounted for 35.92%of the total effect,followed by emotion self-neglect which contributed for 25.19%of total effect.Both the widowed and living alone were the quasi moderator between depression and overall self-neglect,but the other social demographic variables did not show no moderation effect.3.Associations of elder self-neglect with quality of life The scores of overall ESN and five domains were significantly correlated with the scores of four QoL domains(P<0.001).After adjusting for sociodemographic characteristics,social support,and physical and psychological health characteristics,elders who reported higher overall self-neglect scores had significantly lower scores in the four QoL domains(P<0.001).Education,economic level,physical health,ADL,depression,and cognitive function are consistent predictors across all QoL domains.Conclusions The findings from this study have important practical implications for social work policy-makers,healthcare providers,and public health officials in guiding their strategies and programs in rural areas.In addition,the results also provided theoretical support for the prevention and intervention of elder self-neglect,especially among the elderly in rural regions.1.Development and assessment of the Scale of the Elderly Self-Neglect(Rural)The scale for assessing the elder self-neglect in the rural area has been developed using the Delphi method was credible,representative,and authoritative.And the Scale of the Elderly Self-Neglect(Rural)had very good validity and reliability,which can be applied for the evaluation of elder self-neglect,especially in rural areas in the developing countries.2.Influencing factors of elder self-neglect There is a high prevalence rate of self-neglect among the elderly in the Chinese rural areas.ESN is related to multiple factors,among which,impairment of activities of daily living was the primary influencing factor that may have increased the risk of elder self-neglect,followed by depression.The intervention for impairment of activities of daily living and depression should be an effective strategy for elder self-neglect intervention.Special attention should be focused on the windowed elder adults and the elderly living alone with depression in rural areas with relevant supporting measures.Social support played significant partly mediation effect between depression and self-neglect,suggesting that depression could directly affect elder self-neglect.There may be the other mediator between the both which needed further exploration.3.Associations of elder self-neglect with quality of life ESN is an independent risk factor for poor QoL in elderly people in rural China.Understanding the role of ESN and its influence on QoL is important for the management of and intervention in ESN. |
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