Application Effect Of Self-management Intervention Based On Protection Motivation Theory In Elderly COPD Patients With Disability

Objective:1.To understand the status of disability in elderly patients with COPD,and analyze the influencing factors of disability.2.To explore the effects of self-management intervention under the guidance of protection motivation theory on self-management ability,exercise endurance,disability degree and quality of life of elderly COPD patients with disability.Methods:1.From December 2018 to April 2019,213 elderly patients with COPD in the respiratory department of two three level of first class hospitals in Taiyuan city who met the inclusion and exclusion criteria were conveniently selected as the respondents.General information questionnaire,Elderly Disability Assessment Scale(EDAS),modified Medical Research Council scale(mMRC)and Hospital Anxiety and Depression Scale(HADS)were used to investigate the influencing factors of disability.2.From May 2019 to September 2019,96 elderly COPD patients with disability who met the inclusion and exclusion criteria in the respiratory department of a three level of first class hospital in Taiyuan city were selected as the research objects.Patients admitted in May and June were in the control group(48 cases),while those admitted in August and September were in the intervention group(48 cases).The control group received routine health education,and the intervention group carried out self-management intervention under the guidance of protection motivation theory.The intervention cycle of both groups was 3 months.COPD self-management scale,6-Minute Walk Test(6MWT),Elderly Disability Assessment Scale(EDAS)and COPD Assessment Test(CAT)were measured before and after intervention,respectively,to evaluate and analyze the effects of self-management intervention guided by protection motivation theory on self-management ability,exercise endurance,disability degree and quality of life of elderly COPD patientswith disability.Results:1.The disability score of elderly patients with COPD ranged from 79 to 196 points(154.28±26.62,M=159.00),and the disability degree was at the moderate level,among which the lowest score was 5.05±1.00 of the economic and social life dimension.The results of univariate analysis showed that there were statistically significant differences in disability scores among patients with different ages,degree of education,occupational status,degree of dyspnea,course of disease,number of complications,anxiety and depression,understanding of disease and exercise training(P<0.05).The results of multiple linear stepwise regression analysis showed that age,degree of education,exercise training,degree of dyspnea,number of complications,and anxiety and depression were the main influencing factors of disability in elderly patients with COPD(P<0.05).2.Before the intervention,there was no significant difference in the scores of self-management ability,exercise endurance,disability degree and quality of life between the two groups(P>0.05).After the intervention,the self-management ability,exercise endurance and quality of life of the patients in both groups were better than those before the intervention(P<0.05),and the self-management ability,exercise endurance and quality of life of the patients in the intervention group were better than those in the control group(P<0.05).Compared with the control group,patients in the intervention group showed greater improvement in each indicator(P<0.05).After the intervention,the score of disability in both groups was higher than that before the intervention(P<0.05),and the score of disability in the intervention group(except organ function dimension)was higher than that in the control group(P<0.05).The degree of improvement of disability(except organ function dimension)in the intervention group was higher than that in the control group(P<0.05).Conclusion:1.Elderly patients with COPD generally experience moderate disability,the degree of disability is related with the patients' age,degree of education,exercise training,degree of dyspnea,number of complications,and anxiety and depression.Patients should be comprehensively evaluated,factors affecting disability should be considered comprehensively,and nursing intervention measures should be constructed from the perspective of improving patients' disease prevention and management ability.2.Self-management intervention guided by protection motivation theory can enhance the self-management ability and exercise endurance of elderly COPD patients with disability,thus improving the disability degree and quality of life of patients.This study has certain reference significance for the nursing intervention of elderly COPD patients with disability.