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背景随着预期寿命的延长,罹患多种疾病的人数也在上升。然而在患有多种疾病的人群中,了解生活质量健康影响因素者寥寥无几。本试验旨在确定老年患者因患多种疾病接受基层医疗服务时,与其自感健康状况(SRH)相关的影响因素。方法从德国境内的8个研究中心158个全科医疗点中,选出因患多种疾病接受基层医疗服务、年龄65~85岁的3 189例老年患者进行横断面研究。通过面对面的访谈,收集有关患病情况、危险因素、智力水平、机体功能状态以及社会经济状况的资料。通过多元线性回归分析确定与SRH相关的因素。结果抑郁、精神症状躯体化、疼痛、工具性日常生活活动受限(iADL受限)、年龄、遭受打击以及体质指数(BMI)与SRH呈负相关。较高的躯体活动水平、收入以及自我效能预期与SRH呈正相关。最终模型中剩下的慢性疾病只有帕金森病和神经系统病变。最终模型占SRH差异的35%。分男、女进行的独立分析显示出一定的相似性,然而若干因素中均存在性别特异性变量。结论存在多种疾病的患者中,疾病的症状表现(如疼痛、活动受限以及抑郁)与SRH的关联性可能较其与疾病本身的关联性要强得多。较高的收入水平和自我效能预期与较好的SRH独立相关,高BMI和高龄与SRH低下独立相关。
Background With the extension of life expectancy, the number of people suffering from various diseases is on the rise. However, in people with multiple illnesses, few are aware of the health effects of quality of life. The purpose of this study was to determine the factors associated with self-perceived health status (SRH) in elderly patients receiving primary care for a variety of diseases. METHODS: A total of 3 189 elderly patients aged 65-85 years old who had received primary care services due to various diseases were selected from 158 general medical centers in 8 research centers in Germany. Through face-to-face interviews, information is collected on the prevalence, risk factors, intelligence level, functional status of the body, and socioeconomic status. Factors associated with SRH were determined by multivariate linear regression analysis. Results Depression, psychotic somatization, pain, limited instrumental activities of daily living (iADL restricted), age, hit and body mass index (BMI) were negatively correlated with SRH. High physical activity level, income, and self-efficacy expectations were positively correlated with SRH. The only remaining chronic disease in the final model is Parkinson’s disease and neurological disease. The final model accounted for 35% of SRH differences. Independent analysis of sub-male and female showed similarities, however, gender-specific variables existed in several factors. Conclusions In patients with multiple diseases, the association of symptoms of the disease (such as pain, limited mobility, and depression) with SRH may be significantly more relevant to the disease itself. Higher income levels and self-efficacy expectations are independently associated with better SRH, while high BMI and seniority are independently associated with lower SRH.