失能老年人及其配偶健康素养、赋能水平与生活质量的关系研究

doi:10.3761/j.issn.0254-1769.2022.08.014

摘要/Abstract

摘要：

目的基于二元应对理论探讨失能老年人及其配偶健康素养、赋能水平与生活质量的关系。方法 2020年12月—2021年6月,采用一般资料调查问卷、日常生活功能指数量表、慢性病病人健康素养量表、中文版简化老年人健康赋能量表及中文版生活质量量表对广东省广州市、珠海市、深圳市520对失能老年人及其配偶进行问卷调查,采用Spearman相关分析、结构方程模型对有效数据（498对失能老年人及其配偶）进行分析。结果回收有效问卷498对。失能老年人的健康素养、赋能水平与生活质量得分中位数分别为86.00、30.00、391.39分,配偶的健康素养、赋能水平与生活质量得分中位数分别为93.00、32.00、617.28分;相关分析结果显示,除配偶赋能水平与失能老年人生活质量相关性不显著（r=0.075,P=0.094>0.05）,其余变量（失能老年人与配偶的健康素养、赋能、生活质量）之间两两呈正相关（r=0.156~0.657,均P<0.05）。结构方程模型显示,失能老年人健康素养可直接或通过赋能水平间接作用于生活质量（路径系数分别为0.30、0.23,P<0.001）,模型拟合良好（拟合优度指数=0.811,调整的拟合优度指数=0.788,近似误差均方根=0.057）。失能老年人与配偶的健康素养互相促进（路径系数为0.47,P<0.001）,失能老年人生活质量对配偶生活质量有积极影响（路径系数为0.18,P=0.004）。结论失能老年人与配偶的健康素养、生活质量相互影响,提示在面对失能这一压力事件时,不能将失能老年人与配偶割裂为单独的个体,应基于二元应对理论将失能老年人及其配偶照护者视为一个整体,共同提高健康素养和赋能水平,以提高失能老年人及其配偶的生活质量。

关键词: 失能老年人, 配偶, 健康素养, 赋能, 生活质量, 二元应对, 社区保健护理

Abstract:

Objective To explore the relationship between health literacy （HL）,empowerment and quality of life （QOL） in disabled elderly and their spouses based on the theory of “dyadic coping”. Methods From December 2020 to June 2021,498 disabled elderly and their spouses in Guangzhou,Zhuhai and Shenzhen of Guangdong province were surveyed by sociological data questionnaire,Katz Index ADL Scale,Health literacy Scale for chronic disease patients,Chinese Elders Health Empowerment Scale and Chinese Short Form-36 Health Survey. Spearman correlation analysis and structural equation model were used to analyze the data. Results The median scores of HL,empowerment and QOL of the disabled elderly were 86.00,30.00 and 391.39,respectively. The median scores of HL,empowerment and QOL of the spouses were 93.00,32.00 and 617.28,respectively. Correlation analysis showed that there were positive correlations between all variables（r=0.156~0.657,P<0.05）,except correlation between spouses’ empowerment and QOL of the disabled elders（P=0.91）. The structural equation model showed that the HL of the disabled elderly could affect the QOL directly or indirectly through empowerment （path coefficients were 0.30 and 0.23,P<0.001）,and the model fitted well（GFI=0.811,AGFI=0.788,RMSEA=0.057）. The HL of the disabled elders and their spouses had a positive interaction（path coefficient was 0.47,P<0.001）. The QOL of the disabled elders was positively correlated with the QOL of their spouses（path coefficient was 0.18,P=0.004）. Conclusion The interaction of HL and QOL between the disabled elders and their spouses suggests that the disabled elders and their spouses should not be considered separately under the pressure of disability,which verifies the rationality of the application of “dyadic coping” theory. The disabled elders and their spouses should be educated and empowered together to improve their QOL.

Key words: Disabled Elder, Spouse, Health Literacy, Empowerment, Quality of Life, Dyadic Coping, Community Health Nursing

林晓露, 周春兰, 肖秀英, 陶艳玲, 孙梅花, 吴艳妮, 杨玲莉, 张咪, 王润, 杨丽潇, 叶孝灵, 赵慧慧. 失能老年人及其配偶健康素养、赋能水平与生活质量的关系研究[J]. 中华护理杂志, 2022, 57(8): 985-991.

LIN Xiaolu, ZHOU Chunlan, XIAO Xiuying, TAO Yanling, SUN Meihua, WU Yanni, YANG Lingli, ZHANG Mi, WANG Run, YANG Lixiao, YE Xiaoling, ZHAO Huihui. The relationship between health literacy,empowerment and quality of life in disabled elderly and their spouses based on the theory of “dyadic coping”[J]. Chinese Journal of Nursing, 2022, 57(8): 985-991.

图/表 5

表1 失能老年人及其配偶的一般资料[人数（百分比,%）]

Table 1 Sociological data of disabled elders and their spouses[case（percent,%）]

表2 失能老年人及其配偶慢性病病人健康素养量表、中文版简化老年人健康赋能量表、中文版生活质量量表及各维度得分

Table 2 Scores of health literacy, empowerment, quality of life with 8 dimensions of disabled elders and their spouses[score,M（P25,P75）]

表3 失能老年人及其配偶健康素养、赋能水平、生活质量的相关分析

Table 3 Correlation analysis of health literacy, empowerment and quality of life in disabled elders and their spouses

图1 失能老年人及其配偶健康素养、赋能水平与生活质量的结构方程模型图注：D1~8和SD1~8分别代表失能老年人及配偶的中文版简化老年人健康赋能量表的8个条目。

Figure 1 Structural equation model diagram of health literacy, empowerment and quality of life of disabled elders and their spouses

表4 失能老年人健康素养、赋能水平与生活质量之间的关系效应

Table 4 The relationship between health literacy, empowerment and quality of life of disabled elders

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