A Study Of Activation For Self-health Management And Influencing Factors Among Rural Older Adults At High Risk Of CVD In Hot Summer

ObjectiveThis study aims to investigate the activation self-health management and influential factors of among older adults with degenerated function and a higher risk of CVD during high temperature weather.It will lay the foundation for the development and implementation of tailored intervention to prevent CVD in the future.MethodsA random sampling was used to select and recruit older adults with CVD and/or having at least two risk factors of CVD but without any severe disease or communication difficulties from those aged 65 years or older who had electronic health records in the community health center.From July 26 to August 18,2020,during which the hottest summer days were included,the questionnaire survey was conducted in the house of participants.Data were collected using 10-item Patient Activation Measure(PAM-10),13-item Vulnerable Elderly Survey scale(VES-13),15-item Geriatric Depression Scale(GDS-15),Short Form International Physical Activity Questionnaire(IPAQ-SF),15-item Older Adults’ Summer Heat Adaptability Scale(shortened as heatAdapt)in addition to basic information sheet.SPSS 26.0 was used to manage and analyze data.The counting data were expressed as count(number)and percentage;Measurement data was expressed as mean and standard deviation(x±SD).Mann-Whitney U test and Kruskal-Wallis H test were employed to compare mean scores between two groups and three or more groups.Spearman correlation analysis was conducted to examine the correlation between the scores and levels of PAM-10 and the other measurements.Stepwise linear regression analysis was performed to identify the factors that contributed to the variance of PAM-10 score for self-health management.ResultsA total of274 eligible older adults were selected to participate in the study,of whom 245 provided the written agreement and completed the questionnaire successfully.Valid response rate is 89.4%.On average participants aged 73.23 years old(SD=5.783),and 58%(n=142)were male.Older participants’ PAM-10 score ranged from 21.7 to 79.2(40.91±7.847).Most(75.1%,n=]84)were at the lowest/lower level of activation.Many factors influenced their activation for self-health management(all ps<0.05),including age,sex,education level,marital status,living status,monthly family income,medical insurance,number of diagnosed disease,family history of CVD,level of physical activity,vulnerability,and depression.Spearman correlation analysis showed that PAM-10 was positively correlated with heatAdapt(rs=0.478)and physical activity(rs=0.73),but negatively correlated with VES-13(rs=-0.260)and GDS-15(rs=-0.342).The level of activation for self-health management was positively correlated with the level of heatAdapt(rs=0.291)and the level of physical activity(rs=0.227),but negatively correlated with the level of GDS-15(rs=0.282).All correlation coefficients are of statistical significance(all ps<0.05).Stepwise regression analysis showed that depression(β=-0.230),frequent drinking(β=0.205),age(β=-0.120),hypertension(β=-0.097),level of education(β=0.424),marital status(β=0.096),heat adaptation(β=0.182).multi-morbidity(β=0.122),and family history of CVD(β=0.118)were factors/independent variables(all ps<0.05)that significantly influence the score of activation for self-health management.The summer model was of statistical significance(F=32.688,and P<0.01).All factors(i.e.,independent variables)could explain 55.6%of score variance on the activation for self-health management(i.e.,R2=0.556).ConclusionOlder adults with a high risk of CVD in rural areas in hot summer were at the lower level of activation for self-health management.The score of activation was positively correlated with that of heat adaptation,but negatively correlated with the score of vulnerability and depression respectively.Depression,frequent drinking,age,hypertension,level of education,marital status,heat adaptation,multi-morbidity,and family history of CVD were factors that may influence the activation for self-health management among older adults at high risk of CVD in rural areas during in hot summer.