| ObjectiveThis study was a practice aiming to improve the health management of the elderly in the community of Nanjing, and to evaluate the effect of health management by comparing the relevant index and life quality of old people from two groups before and after the management. Besides, the influence of management time on the management effect was also assessed by analyzing the medium-term and long-term effect of health management. Finally, this thesis tried to explore how to improve the living quality of elderly patients with chronic diseases, make more perfect health management measures, in order to better promote the situation of the elderly chronic illness.MethodsCommunity-based study of randomized controlled trial was selected, and the research object was the elderly over 60 years old having physical examinations in a community hospital in Nanjing. After the baseline survey, elderly participants were randomly divided into either management or control group. The management group received the intervention, while the control group received nothing. Participants were required to complete questionnaires in 18-months later. The questionnaires in baseline include the basic information of the elderly, health KAP, health services utilization, self-rated health status, quality of life, and so on. The questionnaires in deadline include health KAP, health services utilization, self-rated health status, quality of life, and so on. Data were entered via EpiData3.1 and analyzed by SPSS19.0, and MLwin was used to analyze the life quality. Method of statistical analysis like descriptive analysis, Chi-square test, t-test, and Multi-level model method were applied in this study.Results(1) In this study, the hypertension group was 210 participants in management group and 210 participants in control group completed baseline survey. The diabetes group was 90 participants in management group and 90 participants in control group.18-month later, the hypertension group has 199 participants in management group and 173 participants in control group completed. The diabetes group has 80 participants in management group and 73 participants in control group completed the questionnaires. The follow-up loss ratio in the management group and control group were 11.1% and 18.9%, respectively.(2) The heath-related indicators were compared in the two group using Chi-square test, t-test, and so on. Results showed that health knowledge, self-rated health score, health behaviours (diet, smoking, regular monitoring of blood pressure and blood glucose), Systolic Pressure, Diastolic Pressure, outpatient visits in 6-month, there was significant improvement in hypertension control group (all p<0.05). Health knowledge, self-rated health score, health behaviours (diet, smoking, drinking), Diastolic Pressure, outpatient visits in 6-month, there was significant improvement in diabetes control group (all p<0.05). Multivariable linear regression model was used to conduct influencing factors analysis of health-related measures. The results showed that:the older with higher education, living with their children, and married have a higher change score of health knowledge; the female and the older with higher education have a higher change score of diet score; the married have a higher change in regular monitoring of blood pressure and blood glucose; the female, living with their children, the older with higher education, and the married have a higher change score of systolic pressure; the female, and the elderly living with their children have a higher change of number of outpatient visits;(3) In management Group, Physical function scores had increased by 0.15 than the base period; psychological function increased by 0.19; social function increased by 0.15; diabetes-dimension modules increased by 0.20; hypertension-dimension modules increased by 0.13; there was significant improvement in the five dimensions score (all p<0.05). While in control group, the five dimension scores had decreased than baseline. The quality of life in management group had increased, while gender, age, education, residence, marital status on quality of life scores for each dimension of the effects was different. Male and the elderly with lower education had high score in physical function dimension; different education levels had different aspects of diabetes-dimension modules, college educated seniors scored highest, followed by illiteracy and undergraduate and above, the lowest score was the elderly in junior high school education.(4) Multilevel model analysis showed that:the elderly in management group has different general health score, along with the management time, the score of quality life has increased; different group had different scores. The interaction effect had living in group and time. Group had effected on social adaptation dimension, memory dimension, emotional personality dimension, self-care dimension.(5)Self-care dimension scores has lower than baseline, but score in physical function dimension, emotional personality dimensions, memory dimension, social adaptation dimension and the overall health dimension has rising. There was no significant improvement in self-assessment between two groups. Age, gender, education, living conditions had no effect in health management.Conclusion:To improve the life expectancy of chronic elderly, and reduce the physical and psychological harm caused by chronic disease is not only the purposes of health management, but also one of the social and economic development goals. This research leaded to the following conclusions:(1) the health intervention programs demonstrated significant effects in "Co-participatory" communities; (2) Putting chronic health management programs into medical coverage and establishment chronic medical insurance fund projects are effective means to reduce the burden on individual and the country. Formulate supporting laws and policies and endow the administrators and managers respective rights and obligations. A perfect management system on chronic can reduce the waste of health resources and control medical expenses. |
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