| Background China is experiencing the world's largest and fastest ageing process,and a massive group of disease-afflicted,disable or half-disable older adults are in great need of persistent,comprehensive,and professional medical and nursing care,besides daily care.The number of nursing homes and nursing service beds is increasing with a series of relevant policies.We should pay more attention on the nursing home residents.Pain,a common complaint in older adults,is associated with the development of depression.The prevalence rates of depression among nursing home residents is also high.Risk factors associated with depression among the elderly are numerous,which are easy to be neglected.Moreover,late life depression has a number of adverse consequences and tends to be under-recognized and under-treated.It is vital to understand the relationship between pain and depression in the elderly,which can help us provide timely intervention,and effectively reduce the risk of depression in the elderly with pain.The factors and underlying mechanisms linking pain with depression are multifaceted,including biological,psychological,social,and cognitive factors.The current studies are limited,and the large national studies among the nursing home residents is scanty.Objective To measure the care quality of Chinese nursing homes by the Observable Indicators of Nursing Home Care Quality Instrument-Chinese version(OIQ-C).To explore how perceived social support and self-rated health in series mediate the relationship between pain and depression.To explore the gender and care quality differences in the association of pain and depression with perceived social support and self-rated health.To explore how nursing assistants in the nursing home perceive and experience late-life depression.To propose multidimensional intervention strategies.Method The cross-sectional study was conducted in 38 nursing homes of 13 cities in China.The care quality of nursing homes was evaluated by the Observable Indicators of Nursing Home Care Quality Instrument-Chinese version.The data of the elderly were collected by a questionnaire consisting of socio-economic and demographic characteristics,the Short Portable Mental Status Questionnaire,the Geriatric Depression Scale-15(GDS-15),the Multidimensional Scale of Perceived Social Support(MSPSS),the Self-rated Health Scale,and the Numerical Rating Scale of pain.The old people responded to the questionnaire through personal interviews.Epidata 3.1 was used to input data.IBM SPSS Statistics Version 21.0 and Mplus Version 7.4 software were applied for data analysis.Convenience sampling was employed and semi-structure interviews were used to collect the nursing assistants'experience of late-life depression.A content analysis of qualitative nature was performed to analyze the data.Results The item content validity index(CVI)of the OIQ-C was between 0.75 and 1.The average CVI was 0.90.In the pilot experiment,the Cronbach's?of the OIQ-C was 0.949,Guttman half coefficient was 0.799,Kendall coefficient was 0.612.The this study,16 nursing homes might have quality problems.The mean score of OIQ was 107.51(SD=15.09).The score of the care delivery dimension was the lowest.A convenience sample of 2154(effective response rate was 99.2%)older adults responded.The majority were female(64.2%),with an average age of 82.0(SD=7.0)years.46.0%of the elderly reported mild to severe pain.About one fifth of the elderly(20.5%)had depression.The co-occurred rate of pain and depression was 12.2%.The mean score of MSPSS was 60.1(SD=15.2).There were four types of social support networks:the private restricted social support network,the resources integrated social support network,the wider community focused social support network and the family depended social support network.16.1%nursing home residents reported excellent health or very good health,35.7%nursing home residents reported good health,36.9%nursing home residents reported fair health,and 11.3%nursing home residents reported poor health.20.5%of the participants reported depression.The influencing factors of late life depression included sleep status,skin condition,exercise,pain,self-care abilities,loneliness,self-rated health,perceived social support,need fulfillment,perceived economic stress,care quality of nursing homes,and education level.Pain,self-rated health,perceived social support and depression were all significantly correlated.Social support had the buffering effect in attenuating the postulated association between the pain and depressive symptoms.Perceived social support and self-rated health had partial mediation effect on the relationship between pain and depression(p<0.01).Overall,the amount of variance explained by the model for depressive symptoms using the model R~2 was 0.282,indicating that the model could explain 28.2%of the variance in depression.The mediation effect accounted for 47.6%of the total effect.Between the low-and high-quality groups,the difference in the specific indirect effect of pain on depression was significant,whether mediated by self-rated health or perceived social support.However,the difference in the specific indirect effect of pain on depression mediated by perceived social support and self-rated health in series was not significant.Between the different gender,the difference was not significant.A convenience sample of 175(effective response rate was 98.9%)nursing assistants participated.Of the remaining 175 nursing assistants,the majority were female(93.7%),with an average age of 47.95(SD=10.32)years.Three themes were emerged as the nursing assistants experiences of late life depression,(i)Late life depression is a part of aging:lack of systematic knowledge of late life depression,(ii)I can do nothing:insufficient confident about screening and managing depressed old adults,(iii)I want to do more:advanced training opportunities required.There were five ways to reduce the risk of depression,including relieving pain,enhancing social support,promoting positive health evaluation,increasing nursing manpower,and improving care quality of nursing homes.Conclusion The reliability and validity of OIQ-C is acceptable,however,more studies are needed to refine it.The care quality of majority Chinese nursing homes are basically qualified.Relatively speaking,the prevalence rates of pain and depression are high among the nursing home residents,the perceived social support is sufficient,and the self-rated health is good.Poor self-care abilities,economic stress,sleep disorder,skin problem,pain,insufficient social support,insufficient exercise,poor self-rated health,loneliness,and low degree of need fulfillment may lead to the development of depression.The stress-buffering hypothesis of social support was supported by data from this study among nursing home residents.Depression,the negative consequence of pain,can be buffered by social support.Higher levels of social support can attenuate the association between pain and depression.The finding of the serial mediation model indicated that self-rated health and perceived social support partially mediated the association between pain and depressive symptoms.The greater the pain was,the more it would contribute to a bad assessment of health and social support,sequentially leading to worse depression.In different genders,the pathways are different.The care quality of nursing homes has a moderation effect on the mediation model.The nursing assistants'understanding of late-life depression should be improved and advanced training is required.The findings in this study have important application value in terms of protecting nursing home residents with pain from depression.For nursing home residents,self-rated health and perceived social support as an internal resource can affect the ability to overcome the suffering of pain,without developing depression.Pain management can reduce depression.Effective interventions to improve perceived social support of the elderly can reduce depression.Efforts to increase good perceptions and avoid poor perceptions of health should be encouraged in gerontological practice in order to reduce depression.On the other hand,strengthening the rationality of nursing home staffing and improving the care quality of nursing homes can also protect pain from developing to depression in the elderly. |
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