Study On The Correlation Between Self-regulatory Fatigue And Coping Style And Self-management In Elderly Patients With Maintenance Hemodialysis

Objective:1.To understand the status of self-regulatory Fatigue(SRF),coping style and selfmanagement in elderly patients with Maintenance Hemodialysis(MHD).2.To explore the influencing factors of self-management in elderly patients with MHD,and analyze the role of general information,SRF and coping style in self-management.3.To explore the mediating effect of coping style between SRF and self-management among elderly patients with MHD by analyzing the correlation between SRF,coping style and self-management,and put forward the suggestions for improving self-management level of elderly patients with MHD.Methods:A cross sectional study was used.From January to June,2022,the general information questionnaire,Self-regulatory Fatigue Scale(SRF-S),Medical Coping Modes Questionnaire(MCMQ),Hemodialysis patient Self-management Scale,Mini-Mental State Examinatio(MMSE),5-Item Geriatric Depression Scale(GDS-5),Family APGAR index(APGAR)and General Self-Efficacy Scale(GSES)were utilized.A total of 316 elderly patients(≥60years old)who received MHD treatment in blood purification centers of three Grade A hospitals in Jinan were investigated.310 valid questionnaires were collected,and the effective recovery rate was 98.10%.The database was established and SPSS21.0 was used for descriptive analysis,independent sample t test,analysis of variance,Pearson correlation analysis and multiple linear step-up regression analysis was performed.AMOS24.0 was used to construct the structural equation model.Results:1.The total SRF score of MHD elderly patients was(42.26±7.86),and average score of items was(2.64±0.49).The average scores of the three dimensions from high to low were cognitive dimension(2.87±0.64),emotional dimension(2.54±0.60)and behavioral dimension(2.47±0.62).The total SRF score and the average score of three dimensions was higher than that of the domestic norm(P<0.01).The MCMQ mean scores of the three dimensions from high to low were confronting coping(2.49±0.45),avoidancecoping(2.32±0.41),yielding coping(2.34±0.76)among MHD elderly patients.There was no statistical significance in the coping score of MHD elderly patients compared with the domestic norm(P>0.05),but the coping score of avoidance and yielding was higher than that of the domestic norm(P<0.01).The mean scores of the three dimensions from high to low were as follows:confronting coping(2.49±0.45),avoidance coping(2.32±0.41),yielding coping(2.34± 0.76).The total score of self-management was(51.70±7.67)points,and the average score of items was(2.59±0.38).Theaverage score of the four dimensions from high to low was: partnership(2.68±0.49),problem solving(2.61±0.49),self-care activities(2.59±0.52),emotional processing(2.40±0.54).2.Pearson correlation analysis showed that SRF,coping style and self-management were correlated in pairs.SRF total score and its dimensions were negatively correlated with self-management total score and its dimensions(P<0.05).The total score and dimensions of SRF were negatively correlated with confronting coping(P<0.01),but positively correlated with avoidance and yield coping(P<0.01).Confronting coping was positively correlated with the total score of self-management and all dimensions(P<0.01),while avoidance and yielding coping were negatively correlated with the total score of selfmanagement and all dimensions(P<0.01).The total scores of family function and selfefficacy were positively correlated with total scores of self-management(P<0.01).3.The results of univariate analysis showed that occupation before retirement,marital status,education level,family economic status,medical payment method,number of comorbiditions,depression and cognitive function were the factors affecting self-management of elderly patients with MHD(P<0.01).The results of multiple linear stepstep regression analysis showed that family economic situation,depression,self-efficacy,SRF,coping style of facing,avoidance and yield dimensions were significant predictors of self-management of elderly patients with MHD which accounted for 72.90% of the variance(P<0.05).4.Structural equation model was used to analyze the mediating effect of coping styles.The fitting indexes of structural equation model in this study were as follows:CMIN/DF=2.571(<3),GFI=0.953(>0.9),AGFI=0.914(>0.9),NFI=0.934(>0.9),IFI=0.959(>0.9),CFI=0.958(>0.9),RMSEA=0.071(<0.08).The direct effect value of SRF on self-management was-0.207 and the total effect value was-0.693.SRF indirectly predicted self-management with face coping,avoidance coping and yield coping as the mediating variables,and the standardized path coefficients of face coping,avoidance coping and yielding coping were-0.213,-0.142 and-0.131,accounting for30.73%,20.49% and 18.90% of the total effect,respectively.Conclusion:1.The SRF of elderly patients with MHD was above medium level,indicating a high degree of SRF.The elderly patients with MHD were more likely to adopt avoidance and submission coping styles,and less likely to adopt confronting coping styles.The selfmanagement of elderly patients with MHD was below medium level,and needed to be improved.2.SRF,avoidance and submission coping styles could negatively predict the selfmanagement level of elderly patients with MHD,while confronting coping styles could positively predict the self-management level of elderly patients with MHD.3.Family economic situation,depression,self-efficacy,SRF,coping style of confronting,avoidance and surrender dimension were the main influencing factors of self-management among old patients with MHD.4.Coping style of old patients with MHD partially mediated the relationship between SRF and self-management.