农村地区老年人照料者的社会支持、卫生服务使用与精神卫生状况

目的 探讨我国农村地医老年人照料者的社会支持、卫生服务使用及精神卫生状况及其相互关系。方法 采用社会支持量表、社会网络量表、卫生服务使用问卷、流行病学调查用抑郁自评量表对199位60岁以是老人的长期照料者进行评估。结果 大多数照料者为老人的配偶儿子和儿媳。照料者最常使用的卫生服务方式为看医生。回归分析表明，抑郁量表评分与照料者年龄和收入、受照料老人性别和年龄、照料时间及社会网络量表总分有密切关系。结论 我国农村地区家庭在老人照料中承担着主要角色，大多数照料者选择使用医疗服务资源。照料过程中出现的抑郁体验与照料者及受照料老人的背景有关，社会支持力量可能起一定中介作用。     

Prevalence of dyslipidemia in the elderly in rural areas of Thailand

Dyslipidemia is highly prevalent in the urban areas of Thailand but information in the rural area, particularly in the elderly, is limited. The objective of this study was to determine the prevalence of dyslipidemia in the elderly who live in the rural areas of Thailand. Random sampling of the volunteers aged > or = 60 years in 3 districts of Samut Songkhram and Ratchaburi provinces was done. After 12-hour fast, the blood sampling was drawn for the analysis of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol. Eighty men and 123 women, aged 60-87 years old, were included in the study. Mean serum lipid levels of cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were 261.74+/-47.58, 180.35+/-45.06, 43.72+/-12.06, and 188.38+/-103.84 mg/dl respectively. Women had significantly higher body mass index, cholesterol and LDL cholesterol levels than men. Seventy percent of them had cholesterol > or = 240 mg/dl and LDL cholesterol > or = 160 mg/dl. Twenty-five percent had HDL cholesterol < or = 35 mg/dl. However, LDL/HDL cholesterol ratio > 5 which indicated high risk for coronary heart disease were found in only 34%. In conclusion, prevalence of dyslipidemia was very high in Thai rural elderly. Further surveillance in this population is essential in verifying the impact of dyslipidemia as a risk of cardiovascular disease in Thai elderly people.     

Strain, social support, and mental health in rural elderly individuals

This study examined the relationships among social support, life strain, and mental health in a sample of 210 rural elderly individuals. Life strain was operationalized as economic deprivation, illness disability, and ADL impairment. Demographic characteristics had little effect on mental health. Physical health status was highly predictive of life satisfaction and psychological distress among rural elderly individuals. Disability associated with chronic illness and ADL impairment was related to increased reports of symptoms of emotional and psychosomatic distress. Measures of social contacts and instrumental support exerted small to moderate effects on life satisfaction, psychosomatic distress, and emotional distress. Affective support moderated the effects of health-related strain on mental health.     

农村老年人生活质量构成指标关系的探讨

利用因子分析，线性回归模型的统计方法对生活质量构成指标间的关系进行分析，结果表明：构成生活质量的诸因素可概括为五个基本因子，残疾因子、社会支持因子、满意度因子、躯体健康因子和视听因子；各因素间存在着复杂的因果关系，指标间既存在直接间接作用，影响工的因素集资为经济状况，躯体健康，功能健康，而心理健康状况受躯体健康，经济状况，功能水平的作用，分析结果还证实，线性结构模型是分析多个复杂变量间相互关系的非     

Changes over 4 years in health, quality of life, mental health, and valuation of life

OBJECTIVE: This longitudinal study explores how the relationship between changes in physical health and changes in valuation of life (VOL) may be affected by changes in quality of life and in mental health. METHOD: 335 community residents older than age 70 were interviewed over a 4-year period. Analysis used correlation and regression models. RESULTS: The association between changes in health and changes in VOL was of little significance when quality of life and mental health mediators came into the picture. DISCUSSION: It is important for practitioners and clinicians to recognize that the way many old persons view their time use and their psychological well-being may be more salient than their physical health as old persons consider the value of their lives. As Lawton and colleagues suggested,"health is not the only determinant of VOL and decrement not the only direction of change."     

Herbal medicine use and quality of life among people living with HIV/AIDS in northeastern Thailand

Many people living with HIV/AIDS (PHA) use herbal medicine as one of alternative therapies, where curative options are limited. This study aimed to examine the association between the herbal medicine use and quality of life (QOL) among PHA in northeastern Thailand. Participants were 132 HIV-positive Thai adults who attended the PHA's self-help group meetings from June to July 2002. Health-related QOL scores were measured by self-administered questionnaire from the Medical Outcomes Study-HIV Health Survey. Dimensions of physical function (PF) and mental health (MH) in QOL were assessed. Additional data were collected on herbal medicine use, socio-demographic, psychosocial and HIV-related characteristics. The herbal medicine users had significantly better MH scores than the non-users, while the herbal medicine use was not statistically associated with PF scores. When stratified, herbal medicine users with the following characteristics had significantly better MH scores than the non-users: female, widowed, having no income, reporting any HIV-related symptom, having no instrumental support or receiving subsidies. In conclusion, herbal medicine use was associated with better MH especially among socially vulnerable PHA. This study suggests that herbal medicine has a potential to improve the MH aspect of QOL among socially vulnerable PHA who cannot easily receive antiretroviral therapy in Thailand.     

Perceived social environment and quality of life among people living with HIV/AIDS in northern Thailand

Efforts have been made to improve the social environment of people living with HIV/AIDS (PLWHA) in Thailand but have not been assessed in terms of their quality of life (QOL). In this study, we preliminarily examined the relationship between PLWHA's perception of social environment and QOL. The participants of this study were 200 PLWHA who belonged to the self-help groups in Chiang Mai province, northern Thailand. We collected data in face-to-face interviews using a structured questionnaire. The QOL was measured using a Thai version of the Medical Outcomes Study HIV Health Survey. Those who perceived themselves as well accepted by the community, perceived health services accessible or someone's help available, tended to have better QOL in terms of mental health. Community acceptance was most significantly related to QOL. Stratified analyses revealed similar relationships between perceived social environment and QOL among symptomatic and non-symptomatic participants but the relationships appeared weaker among men than women. In sum, our preliminary findings suggest that supportive social environment, especially community acceptance, is important for mental aspects of PLWHA's QOL irrespective of the disease stages and for women who usually take on multiple roles in the Thai traditional family.     

Disability and quality of life in elderly people with diabetes

To implement preventive policies of disability in older diabetic people, the role of diabetes in the disablement process should be investigated. Diabetes mellitus is consistently associated with a higher prevalence of disability at all states, as well as with a progression in disability states and may be considered as a brake on recovery. This association is partially explained by existing complications, associated conditions (obesity, depression, arterial hypertension) treatment burden, and other social characteristics (lower income, lower educational level). Finally, in the disablement process, the role of altered muscle metabolism due to diabetes, aging, nutrition and sedentary lifestyle may represent a major target for interventions to improve functions and potentially activities in elderly people.     

Self-perception of health status,mental health and quality of life among adults with diabetes residing in a metropolitan area

AimThe study aimed to compare the self-perception of health, physiological distress and health-related quality of life (HRQL) in subjects with and without diabetes residing in a large metropolitan area (the city of Madrid), and to identify the variables associated with the poorest HRQL among diabetes patients.MethodsIn this case-control epidemiological study, we selected 358 patients with diabetes from the Madrid City Health Survey. For every patient, two controls without diabetes were randomly selected from the same database and matched for age, gender and health district. The resultant study population comprised 1074 subjects, who were analyzed according to their self-rated health status, with mental health assessed by the 12-item General Health Questionnaire (GHQ-12) and HRQL by the COOP/WONCA questionnaire. Independent variables included sociodemographic characteristics, lifestyle variables, associated chronic diseases and consumption of medications. Multivariate analyses were conducted using ANCOVA tests.ResultsThe prevalence of health perceived as fair or poor was 64.12% in those with diabetes vs 38.57% in those without diabetes (P < 0.05). The GHQ-12 results showed that mental health was also significantly worse among diabetes sufferers, and the COOP/WONCA questionnaire results indicated significantly poorer HRQL in those with diabetes. The variables that determined a poorer perception of HRQL among diabetes sufferers were female gender, older age, obesity, lack of physical exercise, coexistence of depression, use of sleeping pills, and Alzheimer's and cerebrovascular diseases.ConclusionSelf-rated health and psychological well-being, and HRQL, are all considerably poorer among patients with diabetes vs those without diabetes. The poorest quality of life among those with diabetes associated with female gender, depression, lack of exercise and obesity.     

Social dimensions of mental illness among rural elderly populations

Despite growing concern with rural elderly populations, little attention has focused on their mental health, ways it may correlate with physical health, or how rural mental health patterns compare to urban. Popular wisdom contends that elderly people in general, and rural elderly persons in particular, are at increased risk for mental illness. This article examines these questions. A review of available literature suggests that elderly people may be at only slightly greater risk of mental illness than the population at large, though there are some indications that rates of depression may be somewhat higher among the elderly population. Much of this same literature implies that objective environmental conditions play a significant role in the incidence of depression. Analysis of data gathered in a statewide random poll (N = 743) indicates that while physical health tends to be poorer among rural populations, when health is held constant there is actually an inverse relationship between age and depression. Therefore, rural elderly persons are no more likely to be depressed than their urban counterparts despite harsher living conditions. Both conceptual and policy implications are discussed.     

天津蓟县农村老年人尿失禁的现况调查

目的 了解天津蓟县农村老年人尿失禁的患病情况及流行病学特征,为制定农村老年人尿失禁的防治策略提供科学依据.方法 采用整群抽样的方法 抽取天津市蓟县所辖的2个乡(镇)卫生院60岁及以上老年人,按统一设计的调查问卷内容以面对面询问的方式进行入户调查,以X2检验对患病率情况进行统计学分析. 结果 共调查746人,获有效问卷743份,老年人尿失禁患病率为33.4%(248/743),其中男性为22.8%(81/356),女性为43.2%(157/387),女性患病率高于男性(X2=34.70,P<0.0001).60～、65～、70～、75～、80～、85～95岁年龄组尿失禁患病率分别为28.6%、32.1%、34.1%、35.5%、47.8%、30.0%,随增龄尿失禁患病率呈升高趋势(X2趋势=4.79,P=0.029).本组老年人以混合性尿失禁(MUI)最多见,压力性尿失禁(SUI)、急迫性尿失禁(UUI)、混合性尿失禁(MUI)和其他类型尿失禁患病率构成比分别为27.4%、1.2%、60.9%和10.5%.在各年龄组老年人中,也均以MUI患病率最高.所有年龄组中,SUI、UUI在60～岁年龄组患病率高于其他年龄组,MUI在80～95岁年龄组患病率高于其他年龄组结论 天津市蓟县农村老年人尿失禁患病率较高. 、34.1%、35.5%、47.8%、30.0%,随增龄尿失禁患病率呈升高趋势(X2趋势=4.79,P=0.029).本组老年人以混合性尿失禁(MUI)最多见,压力性尿失禁(SUI)、急迫性尿失禁(UUI)、混合性尿失禁(MUI)和其他类型尿失禁患病率构成比分别为27.4%、1.2%、60.9%和10.5%.在各年龄组老年人中,也均以MUI患病率最高.所有年龄组中,SUI、UUI在60～岁年龄组患病率高于其他年 组,MUI在80～95岁年龄组患病率高于其他年龄组结论 天津市蓟县农村老年人尿失禁患病率较高. 、34.1%、35.5%、47.8%、30.0%,随增龄尿失禁患病率呈升高趋势(X2趋势=4.79,P=0.029).本组老年人以混合性尿失禁(MUI)最多见,压力性尿失     

Employment status is associated with both physical and mental health quality of life in people living with HIV

To evaluate the relationship between employment status and health-related quality of life (HRQOL) in HIV/AIDS. A total of 361 participants provided baseline data in the context of an ongoing cohort study examining the natural history of neurobehavioral functioning and its effects on HRQOL. We administered tests and collected laboratory data to determine demographic status, HIV disease markers, psychosocial symptom burden, neurocognitive function and HRQOL (MOS-HIV). We performed regression analyses to evaluate the contribution of employment status to the physical and mental health components of quality of life (QOL). Multivariate analyses showed that employment status was strongly related to better physical and mental health QOL after controlling for potential confounders. We found, however, that employment status had a greater impact on physical health than mental health QOL [physical health (β = 6.8, 95% CI 4.6 to 9.1) and mental health QOL (β = 3.3, 95% CI 0.93 to 5.7)]. The effect of employment for physical health QOL was stronger than that observed for ethnicity, social support, or having an AIDS diagnosis and was comparable to that observed with having many HIV-related symptoms. This cross-sectional study suggests that there may be physical and mental health benefits associated with obtaining or keeping employment, or more likely that both selection and causation mechanisms comprise an interactional and reinforcing process.     

Health locus of control,depression and quality of life in people who are elderly

Objectives : This study examines the relationship between quality of life, depression and three aspects of health locus of control for people living in retirement villages. Method : A total of 101 people who are elderly living in a south Queensland city completed self‐report scales of life quality, depression, and health locus of control. Results and Conclusion : The results revealed that attributing control over one's health to powerful others can be linked with greater helplessness and depression which in turn is linked with lower perceptions of aspects of life quality. Depression was found to be a mediator between locus of health control and quality of life.     

The rural elderly support in China and Thailand

Aims:   This paper aims to investigate support mechanisms for the elderly in rural China and rural Thailand, and to take lessons from each other on its rural elderly support and the policy interventions.
Methods:   Using data from secondary sources, the situation of the rural elderly was investigated from different aspects. Policies and programs designed for the rural elderly were then summarized in the following section.
Results:   China and Thailand are both under tremendous social changes and economic development processes, with Thailand more economically developed. Family remains the main source of support for the rural elderly in both countries, however, it has been suffering increasing difficulties and problems such as industrialization, modernization, and rural-to-urban migration have been taking place. This calls for attention and the development of social security services to support the elderly in rural areas.
Both countries have set up a number of policies, plans, and programs toward supporting the elderly, the coverage, however, is relatively low.
Conclusions:   Governments should introduce policies for integrating the rural elderly into national development strategies. Family should be empowered to become strong sociocultural units, as well as an economic resource and a focal point for the preservation of social and moral values in providing support for the elderly. Health care should be given freely to the rural elderly. Programs providing support to the rural elderly should be gender-specific with more focus on female elderly.     

Gender differences in correlates of mental health among elderly Koreans

OBJECTIVE: . This study examined the differential impact of social roles and socioeconomic resources on the mental health of Korean men and women aged 65 years or older. METHODS: The study sample was a weighted population of 930 people (905 survey samples) aged 65 years or older who had responded to the health behavior survey of the 2001 Korean National Health and Nutrition Examination Survey. RESULTS: We observed striking gender differences in the correlates of poor mental health. Living alone was significantly associated with depressive symptoms and suicidal ideation in men but not in women. Living in a multigenerational family without a spouse and having a lower household income were significantly associated with poor mental health in both men and women. DISCUSSION: We discuss the intriguing evidence of gender differences in the correlates of mental health within the context of traditional Asian society and suggest further research on social components of gender differences in mental health across diverse cultures.     

Comparison of health status between Portuguese and Finnish elderly people

This study compares the living situation, morbidity and mortality and related factors between two different communities, one in eastern Finland (with high mortality in cardiovascular diseases) and another in Lisbon, Portugal (representing the Mediterranean area with low ischaemic heart disease but nigh cerebrovascular mortality). The representative samples of 65–74 year old population were examined using the same study protocol, and official mortality statistics were analyzed from these countries. The results show that elderly Finns have more facilities at home than elderly Portuguese. Self reported diabetes mellitus, stroke and chronic bronchitis as well as obstipation, urinary problems, leg pain and chest pain, and cough in the morning were more prevalent in Portugal but cardiac failure was more common in Finland. Reported hypertension and antihypertensive drug treatment were equally prevalent in both countries, but diastolic blood pressure level was clearly higher in Portugal. Total CVD mortality in this age group is higher in Finland among men but lower among women, stroke mortality is higher but ischaemic heart disease lower among both genders in Portugal.     

加强心理保健提高老年人的生活质量

随着医学科学的进步、社会文明程度和人们生活水平的提高,人的寿命普遍延长,老年人口数也逐年增加,目前我国已开始进入“老龄化的社会”。社会老龄化势必引起一系列的老年医学问题,其中“老年心理卫生”问题格外引起人们的关注。1999年中国／世界卫生组织精神卫生高层研讨会指出“精神卫生问题对人民健康的影响越来越突出”,