Quality of life and related factors: a questionnaire survey of older people living alone in Mainland China

Purpose

There is a growing population of older people living alone within the context of dramatic population ageing and changing living arrangements. However, little is known about the quality of life (QoL) of older people living alone in Mainland China. This study aimed to investigate QoL and its related factors among Chinese older people who live alone.

Methods

A stratified random cluster sample of 521 community-dwelling older people living alone in Shanghai completed a structured questionnaire through face-to-face interviews. QoL was measured using the Older People’s Quality of Life Questionnaire. Other data collected included self-rated health, physical health, cognitive function, depression, functional ability, loneliness, social support, physical activity, health services satisfaction, satisfaction with overall dwelling conditions and socio-demographic variables.

Results

Older people living alone in Mainland China rated social relationships and financial circumstances as sources of low satisfaction within their QoL. Multiway analysis of variance showed that satisfaction with overall dwelling conditions, self-rated health, functional ability, depression, economic level, social support, loneliness, previous occupation and health services satisfaction were independently related to QoL, accounting for 68.8 % of the variance. Depression and previous occupation had an interaction effect upon QoL.

Conclusions

This study identified nine factors influencing the QoL of older people living alone in Mainland China. Interventions to increase satisfaction with dwelling conditions, improve economic level, social support and functional ability, decrease loneliness and depression and improve health services satisfaction appear to be important for enhancing their QoL.     

Loneliness and social support of older people living alone in a county of Shanghai,China

China has an ageing population with the number of older people living alone increasing. Living alone may increase the risk of loneliness of older people, especially for those in China where collectivism and filial piety are emphasised. Social support may fill the need for social contacts, thereby alleviating loneliness. However, little is known about loneliness and social support of older people living alone in China. This study investigated loneliness and social support of older people living alone, by conducting a cross‐sectional questionnaire survey with a stratified random cluster sample of 521 community‐dwelling older people living alone in a county of Shanghai. Data were collected from November 2011 to March 2012. The instruments used included the UCLA Loneliness Scale version 3 and the Social Support Rate Scale. The participants reported a moderate level of loneliness. Their overall social support level was low compared with the Chinese norm. Children were the major source of objective and subjective support. Of the participants, 53.9% (n = 281) and 47.6% (n = 248) asked for help and confided when they were in trouble, but 84.1% (n = 438) never or rarely attended social activities. The level of loneliness and social support differed among the participants with different sociodemographic characteristics. There were negative correlations between loneliness and overall social support and its three dimensions. The findings suggest that there is a need to provide more social support to older people living alone to decrease their feelings of loneliness. Potential interventions include encouraging more frequent contacts from children, the development of one‐to‐one ‘befriending’ and group activity programmes together with identification of vulnerable subgroups.     

Loneliness as a gender-specific predictor of physical and mental health-related quality of life in older adults

Quality of Life Research - Health-related quality of life (HRQOL) in older persons is influenced by physical and mental health, as well as by their social contacts and social support. Older women...     

上海地区艾滋病患者的生存质量及其影响因素

目的调查中国文化背景下,在上海地区检测求治的艾滋病患者的生存质量现状及其影响因素。方法以世界卫生组织生存质量测定简表(WHOQOL-BREF)和访谈法分别对78名及118名患者进行定量和定性研究。结果患者生存质量在心理健康、生理健康、人际关系和社会环境4个方面都较差,突出表现为持续而严重的自卑感,身体免疫力低,日常生活严重受损;获得的社会支持较少,社会歧视严重;患者及其家庭经济负担沉重。主要影响因素有2大类:动力性因素包括应对风格、自我认知;资源性因素包括社会支持、生理健康和经济状况;这5个方面存在相互作用。结论在上海地区就诊的艾滋病患者生存质量总体较差,其影响因素间存在相互作用。     

Promoting social capital to alleviate loneliness and improve health among older people in Spain

Loneliness is especially frequent among older people in Southern Europe. Furthermore, promoting social capital to tackle loneliness and its health effects is an understudied intervention strategy. Therefore, a complex intervention was piloted in Spain in a pre–post study with a 2‐year follow‐up. Its aims were to explore the feasibility of the intervention and its short‐ and long‐term effects. It was conducted in one mixed rural–urban and two urban areas of diverse socioeconomic levels from 2011 to 2012. The intervention framework was based on social capital theory applying a behaviour change model and care co‐ordination. The intervention comprised: (i) a co‐ordinated action aimed at building a network between primary healthcare centres and community assets in the neighbourhood and (ii) a group‐based programme, which promoted social capital among lonely older people, especially social support and participation. Older people active in senior centres volunteered as gatekeepers. The main outcome domain was loneliness. Secondary outcome domains were participation, social support, self‐perceived health, quality of life, depressive symptoms and use of health resources. Pre–post changes were assessed with t‐test, Wilcoxon signed‐rank test and McNemar's test. Differences between the three time points were assessed with a one‐way ANOVA with repeated measures. Social workers and nurses were successfully involved as group leaders, 10 volunteers took part and 38 participants were included. After the intervention, loneliness decreased while social participation and support significantly increased. Furthermore, the number of visits to nurses increased. Exactly 65.8% of the participants built social contacts within the group and 47.4% became engaged in new activities. Two years later, social effects were maintained and depressive symptoms had decreased. Exactly 44.7% of the participants continued to be in contact with at least one person from the group and 39.5% continued participating. The intervention contributes a novel and feasible social capital‐based approach for alleviating loneliness among older adults while prompting meaningful changes in their lives.     

老年人孤独及其相关因素研究

目的　了解合肥市离退休老年人群孤独现状 ,探讨孤独的相关因素。方法　采用分层随机抽样方法 ,对合肥市 63 3名 60岁以上离退休老年人的孤独及相关因素进行横断面研究。使用UCLA孤独评定量表、健康相关生活质量量表和社会人口特征调查问卷进行询问调查。结果　孤独评分平均为 3 7 85 (SD =9 99) ,女性、高年龄组、文化程度低、独居、单身或丧偶、家庭经济收入低、家庭功能和社会支持不好的老年人 ,孤独评分较高。逐步回归分析结果表明 ,家庭功能、社会支持、支持利用度等变量对预测孤独有显著性差异 (P <0 0 1) ,其中家庭功能的作用最强。结论　家庭功能和社会支持是影响老年人孤独的重要因素。针对家庭功能和社会支持而采取人群干预策略和措施是减轻孤独、提高老年人生活质量的一个重要途径     

Using WHOQOL-BREF to evaluate quality of life among Turkish elders in different residential environments

Objective  This study used the Brief Version of The World Health Organization’s Quality of Life Questionnaire (WHOQOL-BREF) to assess and compare the quality of life in older people who live at home and older people who live in public assisted-living facilities for the elderly. Design  Cross-sectional. Setting  Data were collected by a research nurse in each home and in the assisted living facility. Participants  Participants were 60 years old and older. The sample included 37 people who were living in a public assisted-living facility and 37 elderly people living in their own homes. Measurement  The WHOQOL-BREF was used to measure participants’ quality of life. Results  The groups were similar according to gender, literacy, existence of chronic diseases, and general perceived health. However, quality of life scores for social relationships and environment domains were lower in those living in an assisted living facility than those living in their own homes. The scores for elderly females staying in the assisted living facility were lower compared to the scores of males in the facility. Conclusion  The results suggest that social and environmental domains of life quality are low in elderly assisted living facilities. Social activities should be diversified for elderly people staying in assisted living facilities to improve social relationships. Physical and psychological health of females in assisted living facilities should be comprehensively supported by professionals. Alternatively, elderly people may be professionally supported to live in their own homes.     

上海市某养老院老年人生活质量的影响因素分析

目的了解上海市某养老院老年人的生活质量及其影响因素,为行业管理部门制定养老服务的相关政策提供依据。方法2011年12月应用简明健康状况调查表（SF-36）、社会支持评定量表、老年抑郁量表（GDS）和孤独量表（UCLA—LS）对养老院内160名老年人进行调查,分析影响养老院老年人生活质量的因素以及生活质量与社会支持、抑郁、孤独的相关性。结果总调查人数160名,占该养老院老人总数的76．2％,年龄分布范围为60—98岁,平均年龄（82．0±8．8）岁。逐步多元线性回归分析显示,养老院老人生活质量中与生理功能明显相关的影响因素有3个,分别是有无子女、参加体育活动频率、自我健康状况评价;与生理职能、社会功能、活力及情感职能明显相关的影响因素有3个,分别是有年龄、参加体育活动频率、自我健康状况评价;与躯体疼痛明显相关的影响因素有2个,分别是性别、自我健康状况评价;与总体健康明显相关的影响因素有4个,分别是年龄、参加体育活动频率、慢性病数目、自我健康状况评价;与精神健康明显相关的影响因素有4个,分别是年龄、居住状况、参加体育活动频率、自我健康状况评价。Spearman秩相关分析显示,养老院老人客观支持与生活质量量表中情感职能、精神健康呈正相关,其主观支持、对社会支持利用度、社会支持总分与生活质量量表各维度均呈正相关;养老院老人其抑郁分值、孤独分值与生活质量量表各维度均呈负相关。结论影响养老院内老年人生活质量的因素众多,社会及家庭应予以关注。     

社区卫生服务中心在提升社区老人生活质量中的作用及对策

目的 :通过对上海曹杨社区500位老年人生活质量的调查分析,结合社区卫生服务中心在社区老年人居家养老中的功能定位,探索适宜社区老年人居家养老模式,进一步提升社区老年人的生活幸福指数。方法 :采用纽芬兰纪念大学幸福度量表和老年人生活质量评定量表,对500例上海市某社区的老年居民进行问卷调查,研究老年人生活质量的现状及影响因素。结果 :对老年人生活质量影响较大的是心理及社会因素,如情绪、家庭关系、人际关系、社会活动等。社区卫生服务中心可在现有资源下积极参与。结论 :政府及护理机构应深化社区护理模式的研究,社区卫生服务中心提供"以人为本"的社区护理服务,开展个性化的护理照顾,把关注老年人心理活动和提供更丰富的社会支持作为社区护理发展的重要内容。     

“They’re always in a hurry” – Older people´s perceptions of access and recognition in health and social care services

The article examines older people's perceptions of quality of life from the perspective of access and use of health and social care services. The data include focus group discussions with older people living alone. The data were analysed using thematic analysis focusing on the older people's collective views on health and social care services as supportive or restrictive factors for their quality of life. Two central themes were present in all the focus group discussions: the importance of accessing services and information regarding the services, and need for recognition within the services/by the professionals. Both themes were connected to the older people's desire to maintain autonomy in their everyday life despite increasing functional disabilities, which was seen as an important factor of quality of life. The older people felt that accessing and finding information about the services was difficult, and dependent on the professional's good will and the older person's own financial resources. Within the services, older people experienced a lack of recognition of their own personhood and individual needs. The participants felt that they were easily bypassed and left out of negotiations regarding their own care. The article highlights the importance of developing health and social care services and practices towards a more holistic approach recognising older people's individual needs.     

留守老年人孤独状况及影响因素分析

目的 了解留守老年人孤独现状及影响因素.方法 采用整群抽样法在安徽省全椒县抽取一个街道和一个行政村实足年龄60岁～留守老年人412人.采用自编调查问卷进行人户调查.结果 留守老年人孤独评分平均为(42.84±8.76)分;单因素分析留守老年人孤独感与睡眠状况、家庭功能、社会支持、自评健康等呈相关关系.多元逐步回归分析结果表明,主观支持、起居困难程度、家庭功能、睡眠情况等变量对孤独感呈显著性相关(P<0.05).结论 心理社会因素和生理状况影响留守老年人的孤独感.     

城市老年人孤独的相关因素与对策

目的　探讨城市老年人群孤独相关因素与对策。方法　采用分层随机抽样方法 ,对合肥市 6 33名6 0岁以上离退休老年人的孤独及相关因素进行横断面研究 ,使用UCLA孤独评定量表、健康相关生活质量量表和社会人口特征调查问卷进行调查。结果　孤独评分平均为 37.85 (SD =9.99) ,女性、高年龄组、文化程度低、独居、单身或丧偶、家庭经济收入低、家庭功能和社会支持不好的老年人 ,孤独评分较高。结论　家庭功能和社会支持是老年人孤独的重要因素。提出应采取针对家庭功能和社会支持多项干预策略和综合措施 ,以减轻城市老年人的孤独 ,提高老年人的生活质量。     

上海市青少年社会支持、亲子关系与情绪的关系

【目的】探讨青少年社会支持、亲子关系与青少年抑郁、焦虑、孤独的关系,为改善青少年心理健康问题提供参考。【方法】采用分层随机整群抽样法,调查上海市2个区的11 596名中学生。采用患者健康问卷2条目中文版、广泛性焦虑量表、加利福尼亚大学洛杉矶分校(UCLA)孤独感量表、领悟社会支持量表及亲子亲合问卷进行调查。使用t检验、方差分析、相关分析、logistic回归分析等进行统计推断。【结果】女性、非毕业班、成绩前25%、与父母同住及客观社会地位更高的青少年的社会支持、亲子亲合得分皆高于男性、毕业班、成绩中等或后25%、不与父母同住、客观社会地位较低的青少年(P<0.05)。青少年的亲子亲合、社会支持与各种情绪均呈负相关。亲子亲合是抑郁(OR=0.93,95%CI:0.91～0.94)、孤独(OR=0.94,95%CI:0.94～0.95)、焦虑(OR_轻度=0.98,95%CI:0.98～0.99;OR_中重度=0.96,95%CI:0.95～0.98)的相关因素,但不同维度的支持与情绪的关系差异有统计学意义(P<0.05)。【结论】社会支...     

Community-living older people’s interpretation of the Norwegian version of older people’s quality of life (OPQOL) questionnaire

The aim of this study is to investigate how community-living older people interpret the Norwegian version of Older People's Quality of Life (OPQOL) questionnaire. The original OPQOL questionnaire was translated based on guidelines for cross-cultural translation. The Three-Step Test-Interview instrument was adopted to investigate how community-living older people interpreted the questionnaire. Data were collected from 14 participants (72–89 years). The questionnaire was filled in under observation. Semi-structured interviews were then conducted to clarify the observational data and elicit the participants’ experiences and opinions. Lastly, data were analysed using a hermeneutic interpretation approach. Our findings indicate that most of the participants managed to complete the OPQOL questionnaire without problems. The data analysis resulted in four primary themes: relevance & applicability, formulation, consistency & accuracy and subjectivity. The questionnaire covered all aspects related to the participants’ quality of life. However, statements related to religion were found to be irrelevant to their quality of life. Most of the participants thought that religion, philosophy and culture should be separate rather than included in the same statement. The participants missed the option of ‘not applicable’ when the statements were irrelevant to them. The statements are formulated in both positive and negative ways, which was sometimes confusing to them. The participants perceived phases such as “around me” “local,” and “things” as ambiguous, and thus they raised concerns about whether the OPQOL questionnaire could capture consistent data regarding their quality of life. The results of this study pinpoint the issues that community-living older people faced when interpreting and answering the Norwegian version of OPQOL questionnaire. These issues were mostly caused by sociocultural differences. Our work provides an overview of the changes that must be made in the questionnaire in order to address these sociocultural differences while using the OPQOL questionnaire in the Norwegian context.     

Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE–A Randomized Controlled Trial

PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms.METHODS We undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months’ follow-up.RESULTS The mean age of the participants was 81 years, and 59% were women. All participants scored in the at–risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups.CONCLUSION The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control.     

公共场所从业人员生存质量及影响因素分析

目的探讨公共场所从业人员生存质量及其影响因素,为制定提高其生存质量的干预措施提供科学依据。方法采用整群抽样方法选取2012年某市开展监测的公共场所从业人员作为研究对象,用世界卫生组织编制的生存质量测定量表（WHOQOL-BREF）中文版进行问卷调查,测定并评价其生存质量现状。结果公共场所从业人员主观生存质量平均分为3.57分,主观总体健康状况平均分为3.67分,生理领域得分（14.65±2.27）,心理领域得分（13.62±2.67）,社会关系领域得分（14.42±2.39）,环境领域得分（12.64±2.60）。生理领域得分低于常模,社会和环境领域得分高于常模,差异有统计学意义（P﹤0.01）。单因素分析表明,影响从业人员生理领域得分的因素有学历、是否生病、单位类别、月均收入、人均住房面积。多元回归分析可知,影响公共场所从业人员生理领域得分的因素有家庭摩擦、食欲和学历。结论公共场所从业人员生存质量尚可,生理领域得分低于普通人群,应针对性地采取相应措施来提高其生存质量。     

老年高血压患者社会支持与生活质量的相关性研究

[目的]探讨老年高血压患者的生存质量与社会支持的相关性,为老年高血压的治疗提供依据。[方法]采用社会支持评定量表(SSRS)和生活质量综合评定量表(GQOLI-74)对52例老年高血压患者及47例健康老年体检者的生活质量及社会支持进行评定,并对两者的相关性进行分析。[结果]老年高血压患者的生活质量及社会支持评分均低于健康者,差异均有统计学意义(P﹤0.05)。社会支持与生活质量呈显著正相关(P﹤0.01)。[结论]社会支持可从心理层面影响老年高血压患者的生活质量,提高社区老年高血压人群的社会支持有助于促进其身心健康。     

独居老年人心理健康状况与社会支持关系

目的了解独居老年人心理健康与社会支持的关系,为改善独居老年人的生活质量提供依据。方法用健康自评量表(SRHMS)对云南省昆明市18个社区中≥65岁的63名独居老年人和112名对照进行测评和比较。结果独居老年人心理健康和正向情绪得分分别为(5.78±1.68)和(6.62±2.29)分,明显低于对照(6.59±1.46)和(7.49±1.76)分(P0.01);角色活动/社会适应(6.13±1.72)分,社会资源/社会接触(5.51±2.24)分、社会支持(5.52±1.91)分,明显低于对照的(7.14±1.76),(6.79±1.81),(6.37±1.61)分(P0.01)。结论独居老年人的心理健康较差,社会支持亟待加强。     

AIDS病人/HIV感染者孤独现状与相关因素分析

目的了解血源性艾滋病高发乡艾滋病病人（AIDS）／人类免疫缺陷病毒（HIV）感染者（PLWHAS）的孤独现状。探讨其孤独的相关因素。方法整群抽取某血源性AIDS高发乡10个行政村的219名艾滋病病人／HIV感染者。用自制的农村社区艾滋病病人／HIV感染者社会支持模式调查表（包括孤独评定量表（UCLA）、家庭功能量表（APGAR）、社会支持量表（SSS）、日常生活功能状态量表（ADL）等）对目标人群进行调查。结果孤独均分为（47．62±11．52）分。在所调查的项目中，职业为农民、子女不孝顺、无经济来源、与邻居关系差、家庭功能和社会支持差的PLWHAS。孤独评分较高。多元逐步回归分析结果表明。主观生活满意度、社会支持、家庭功能等变量对预测孤独差异有统计学意义（P〈0．05），其中主观生活满意度的作用最强。结论PLWHAS孤独是多因素综合作用的结果，针对家庭功能和社会支持而采取人群干预策略和措施是减轻孤独、提高PLWHAS生活质量从而提高主观生活满意度的一个重要途径。