Research On Risk Behavior And Health Management Path Of The Older Adults With Multimorbidity From The Perspective Of Health Ecology

Objectives:With the socio-economic development and advances in medical technology,the average life expectancy of human beings has increased further.Yet longevity does not mean health.The phenomenon of "living with disease" is very common among the older adults.The data shows that more than half of the 267 million elderly people in China are "far away" from their health and are entangled with various diseases,the most serious of which is the common problem of multiple chronic diseases.Against this background,this study takes the health ecology model as the starting point to understand the current situation of multimorbidity in the older adults,explore the common disease model,and formulate intervention measures to prevent and control the occurrence and development of diseases from multiple dimensions.Methods:The data of this study is from the China Community Health and Behavior of the Elderly Panel Study(CHBEPS).The baseline data of the first stage were used to analyze the epidemic status,disease patterns and related influencing factors of multimorbidity in the older adults.The special survey data of the second stage to explore the management experience and difficulties of chronic diseases and multimorbidity among the older adults.The statistical software used includes SPSS 22.0,SPSS Modeler 18.0,Mplus 8.3 and Nvivo 11.0.The corresponding statistical methods are as follows:general demographic characteristics are analyzed by descriptive statistics,description of continuous variables by mean standard deviation,and classification variables are described by count and percentage(%).Apriori association rules analysis and factor analysis were used to explore the combination mode of multimorbidity.Logistic regression analysis was used to analyze the influencing factors of multimorbidity.Latent class analysis was used to explore health-related behavior patterns.Thematic Framework Analysis was used to summarize and refine the experience and difficulties of multimorbidity management.Results:The study found that the prevalence of chronic diseases was 62.0%in older adults,of which 708(20.9%)suffered from one chronic disease,and 1395 suffered from two or more chronic diseases,that is,the prevalence of multimorbidity was 41.1%.Further analysis showed that the number of multimorbidity was mainly two and three,the common combination mode of binary diseases was {diabetes+hypertension},{hyperlipidemia+hypertension},{chronic bronchitis+asthma},and the common combination mode of ternary diseases was {hypertension+hyperlipidemia+diabetes}.According to the health ecology model,this study found that factors such as individual characteristics,behavior style,interpersonal network and living and working conditions will affect the occurrence of multimorbidity in the older adults.Age,occupation before retirement,drinking behavior,frequency of fresh fruit intake,sleep behavior,physical activity,living area and personal monthly income were found to be the influencing factors of multimorbidity(P<0.05).Combined with Latent class analysis,nine behaviors,including smoking,drinking,eating habits,sleeping behavior,physical activity and social participation,were selected for model fitting.The results showed that the older adults with multimorbidity showed four different health behavior patterns,characterized as healthy behavior(29.1%),variable behavior(17.9%),inclined to health(22.8%),and low social participation(30.2%).The mixed-method found that the effective management of multimorbidity requires the joint efforts of elderly patients,family members,grass-roots medical staff and other parties.First,improving the health awareness and self-health management ability of elderly patients is the key to achieve effective management.Secondly,the companionship and support of family members and friends around can help elderly patients better develop healthy behavior patterns.Third,the effective guidance of grassroots medical personnel,the scientific use of behavior change technology,and the necessary health education work have a great "external force" role in maintaining the healthy behavior model of elderly patients.Conclusions:The prevention and control of chronic diseases and multimorbidity is not only the responsibility of the health system,but also requires the cooperation of multiple departments,systems,levels and aspects.This study selected the older people in Guangdong Province as the research object,analyzed the epidemic status,disease pattern,related influencing factors,and high-risk and volatile behaviors of multimorbidity,and explored the current status of health management of chronic diseases and multimorbidity among grass-roots medical personnel.This study found that the pattern of the multimorbidity in the older people was complex,and a unified and effective health management model has not yet been formed.Based on the health ecology model,it is of great practical significance to build a multi-level and multifaceted health management integrating individuals,families,medical staff and communities to improve the quality of life and health level of the older adults with multimorbidity.