| Objective: Accompanied by the increasing of ageing,considerable social burdens and family care burdens were carried.This phenomenon results in a growing number of older people who had to choose to live in nursing homes for assisted living and health care,especially widowed older people.The study aimed to explore the current status of a quality of life among widowed older people in nursing homes,and to further explore its influencing factors,which provide theoretical basis for optimal allocation and individualized and targeted services of nursing homes,and for reasonably allocating health resources of relevant departments.This study may be benefit to maximize costeffectiveness and promote quality of life for widowed older people,as well as promote the health of widowed older people.Methods: A national cross-sectional study was conducted among widowed older people aged 60 and above in nursing homes by multistage sampling method.In our study,a total of 296 nursing homes were investigated,of which 110 were located in urban areas,112 in suburban areas,70 in rural areas,and 4 were missing.A total of 10,113 widowed older people,including 5,077 males,4,825 females and 211 were missing,were surveyed in this study,with an average age of 75.32 ± 7.25 years.The effective response rate was 91.34%.Self-made questionnaire was used in this survey,and it mainly includes five aspects: basic characteristics,health status,children's status,nursing homes status and quality of life.The health status of widowed older people included three aspects: activities of daily living,life orientation,and cumulative illness rating of widowed older people,which were measured using Activities of Daily Living Scale,Life Orientation Scale and Modified Cumulative Illness Rating Scale-Geriatric,respectively.Quality of life was measured using SF-12v2 scale.Epi Data 3.1 software was used to input data,and SAS 9.4 software was used to analyze data.The basic characteristics,health status,children's status,nursing homes status were analyzed by descriptive statistics and numeric variables were described by x ± SD,and character variables were described by frequency and percentage.The status of quality of life among the participants was described by x ± SD.Variance analysis,t test and multilevel model were used to explore explanatory factors associated with quality of life among widowed older people.The influencing factors of quality of life include basic characteristics,health status,children's status,nursing homes status.A multi-level model analysis of the quality of life of the widowed older people in the nursing homes was made with variables about nursing homes as group level variables(level 2)and variables about widowed older people as the individual level variables(level 1).Results:(1)The mean scores of physical health and mental health among widowed older people in nursing homes were 45.02 ± 6.52 and 42.41 ± 8.63,respectively.(2)A univariate analysis showed that age(F=48.00,P<0.01),education level(F=52.11,P<0.01),pension(F=10.57,P<0.01),frequency of participatory social activities(F=68.06,P<0.01),activities of daily living(F=595.96,P<0.01),life orientation(t=259.18,P<0.01),and cumulative illness rating(F=102.66,P<0.01),number of children(F=7.97,P<0.01),the status of children' job(F=5.85,P<0.01),the frequency of family visits(F=17.36,P<0.01),nursing home expenses(F=10.34,P<0.01),the type of living room(F=7.14,P<0.01)and the evaluation of the nursing homes(F=32.40,P<0.01)influence the physical health among widowed older people in nursing home.And after controlling for the variables(the scale of nursing homes)of the nursing home level,multivariate analysis shows that age(Reference: "60~";"90~" :b=-1.01,P=0.03),frequency of participatory social activities(Reference: "Never";"Sometimes" :b=0.77,P=0.01),activities of daily living(Reference: "Normal";"Functional decline" :b=-2.29,P<0.01;"ADL disability" :b=-4.66,P<0.01),life orientation(Reference: "Positive life orientation";"Negative life orientation" :b=-1.65,P<0.01),and cumulative illness rating(Reference: "Mild damage";"Moderate damage" :b=-1.42,P<0.01;"Severe damage" :b=-2.16,P<0.01)influence the physical health among widowed older people in nursing homes.(3)A univariate analysis showed that gender(t=2.9,P<0.01),education level(F=3.84,P=0.02),pension(F=6.43,P<0.01),frequency of participatory social activities(F=434.65,P<0.01),activities of daily living(F=166.02,P<0.01),life orientation(t=143.08,P<0.01),and cumulative illness rating(F=169.67,P<0.01),number of children(F=27.02,P<0.01),the status of children' job(F=12.49,P<0.01),the frequency of family visits(F=28.32,P<0.01),nursing home expenses(F=27.29,P<0.01),the type of living room(F=5.55,P<0.01)and the evaluation of the nursing homes(F=266.62,P<0.01)influence the mental health among widowed older people in nursing home.And after controlling for the variables of the nursing home level,multivariate analysis shows gender(Reference: "Male";"Female" :b=-0.43,P=0.03), frequency of participatory social activities(Reference: "Never";"Sometimes" :b=3.83,P<0.01),activities of daily living(Reference: "Normal";"Functional decline" :b=-1.18,P<0.01;"ADL disability" :b=-2.31,P<0.01),life orientation(Reference: "Positive life orientation";"Negative life orientation" :b=-1.83,P<0.01),cumulative illness rating(Reference: "Mild damage";"Moderate damage" :b=-2.45,P<0.01;"Severe damage" :b=-3.39,P<0.01),the frequency of family visits(Reference: "No less than one time/month ";"One time/1-6 months " :b=-0.6,P=0.02;"One time/more than 6 months " :b=-0.82,P<0.01),nursing home expenses(Reference: "0~";"2000~" :b=-0.94,P=0.03)and the evaluation of the nursing homes(Reference: "Very good ";" General" :b=-1.26,P<0.01;"Not good " :b=-2.65,P<0.01)influence the mental health among widowed older people in nursing home.Conclusion:(1)The quality of life among widowed older people in nursing homes is low.(2)Age,frequency of participatory social activities,activities of daily living,life orientation,cumulative illness rating affect the physical health of widowed older people in nursing homes.(3)Gender,frequency of participatory social activities,activities of daily living,life orientation,cumulative illness rating,the frequency of family visits,nursing home expenses,and evaluation of the nursing homes affect the mental health of widowed older people in the nursing homes. |
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