The Study Of The Effect About Health Management On Obese Elderly In Nanjing Community

Objective Based on the practice of health management for obese elderly aged 60 years and over,theeffectof health management were evaluated by comparing the health-related indicators,EQ-5D quality of life,physical examination indicators,and laboratory tests of obese elderly before and after health management.The study provide a policy proposal for obese elderly health management program and the improvement of the obese elderly health level,and provide scientific basis for the comprehensive prevention and treatment of obesity in the elderly.Methods Arandomized controlled trial was taken to investigate the 520 obese seniors in a community hospital in Nanjing from March 2013 to December 2014.They were randomly divided into a management group and a control group and each group contains 258 individuals.A health management team was set up to conduct a personalized,targeted obesity health management program for obese patients in the management group.Health management includes health education,health manuals and self-management cards,telephone follow-up,health records,and personalized health management.Before and after health management,health status questionnaires,physical measurements,and laboratory tests were performed for obese individual.The health status questionnaire included sociodemographic characteristics(age,gender,education level,living status,and marital status),chronic disease-related conditions,lifestyle(smoking,drinking,diet,exercise,sit-in),EQ-5D quality of life scale,physical examination including height,weight,waist circumference and blood pressure,laboratory tests including total cholesterol(TC),Triglycerides(TG),high-density lipoproteins(HDL-C),low-density lipoproteins(LDL-C),and fasting blood glucose.Data were entered via Epi Data3.1 and analyzed by SPSS19.0.Method of statistical analysis like descriptive analysis,t-test,Chi-square testwere applied in this study.Results(1)Analysis of the general situation of the management group and the control group:(1)In the baseline survey,260 participants in management group and 260 participants in control group completed baseline survey.After 24 months of health management,there were 258 participants in management group and and 258 participants in control group.The total loss of sample rate was0.8%.The study excluded out-going cases.(2)The average age of the management group was 66.74±5.31 years old,and the average age of the control group was 66.82±4.66 years.There was no statistically significant difference between the management group and the control group in terms of age,gender,education level,living status,and marital status(P>0.05).(2)Comparative analysis of baseline conditions between management and control groups:(1)143(55.4%)smokers and 154(59.7%)drinkers in the management group,158(53.5%)smokers 153(59.3%)drinkers in the control group,there was no significant difference between the management group and the control group in terms of smoking,drinking,exercise,sit-in time and diet(P>0.05);(2)The average EQ-VAS score of the management group was 74.86±9.402,and the health utility value is 0.57±0.38.The average EQ-VAS score in the control group was 75.17±7.131,and the health utility value was 0.55±0.38.There was no statistically significant difference between the management group and the control group in activity index,self-care index,daily life index,pain/discomfort index,anxiety/depression,EQ-VAS score,and EQ-5D health utility value(P>0.05).(3)The average BMI in the management group was 30.05 ± 2.175,and the average BMI in the control group was 30.18±2.083.There were no significant difference between management group and the control in terms of BMI,waist circumference,hip circumference,systolic blood pressure,diastolic blood pressure,fasting blood glucose,TC,TG,HDL-C,LDL-C(P>0.05).4 The factors affecting analysis showed that gender,smoking status and sit-in time are the influencing factors of obesity in the elderly(P<0.05).(3)Comparative analysis of the final phase of the management and control groups:(1)The management group was superior to the control group in terms of smoking,drinking,exercise,sit-in time,and diet score(P<0.05);The management group was superior to the control group in performance indicators,self-care indicators,daily living indicators,pain/discomfort indicators,anxiety/frustration indicators,EQ-VAS score,and EQ-5D health utility value index(P<0.05).The management group had better indicators of BMI,waist circumference,hip circumference,systolic blood pressure,and low-density lipoprotein than the control group(P<0.05).(2)After 24 months of management,the management group increased dietary scores,increased number of high-intensity exercise days,increased number of days of walking compliance,and decreased amount of sit-in time than the control group.The reductions in BMI,waist circumference,and hip circumference in the management group were all higher than those in the control group.(3)Comparison of baseline and terminal indicators between management group and control group,and the difference of diet score,exercise index,sit-in time,EQ-VAS score,EQ-5D health utility value,BMI,hip circumference and LDL-Cwas statistically significant(P<0.05).(4)Using multivariate linear regression model to analyze the influencing factors of health management results,the results showed that women had better dietary effect than men.Obesity elderly couples who lived together or lived alone had better EQ-5D health utility value than old people who lived with their children.Obese elderly people with chronic diseases have better health management effects than those without chronic diseases.Conclusion This study shows that management group's lifestyle indicators,EQ-5D quality of life indicators,and physical biochemical indicators are better than the control group,fully demonstrating the effectiveness of community-based,multi-participated obesity health management.Established a health management team which includes health managers,doctors,nurses,health educators,and community managers,use health records,health education,dietary interventions,and exercise interventions to provide professional guidance to obese seniors.The personalized and targeted obesity health management model deserves further promotion.