浙江省老年人群生命质量及个性化健康干预模式的评价
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摘要
研究背景及目的
人口老龄化是当今全球人口发展的趋势。中国是世界上老年人绝对数最多的国家,2000年中国60岁以上老年人口就达到了12998万人,占总人口的10.46%。而且,中国老年人口正以每年596万的速度增长,专家估计2051年中国老年人口将达4.37亿。随着中国人口老龄化进程明显加快,老年人群的生命质量问题已成为目前许多学者关注的焦点。
老年人的生命质量要全面结合机体健康、心理健康及社会健康状态进行评估,SF-36量表因具有良好的综合测评特性、简明而较高的信度与效度被广泛用于老年人群生命质量评价。国外有一些研究文献涉及到评价城乡之间老年人群生命质量的差异及其可能的影响因素,由于社会经济状况的原因,农村老年人群在行为生活方式和生命质量上都较城市老年人群差；其影响因素主要包括社会人口学、行为生活方式及慢性病患病情况。针对这些因素的健康干预可能有助于提高老年人的生命质量。近几年来,浙江省老年人群虽然通过社区卫生服务中心获得了越来越多的医疗卫生服务,但是老年人群很少有机会获得针对其行为生活方式改变的健康干预。因此,针对老年人群这一弱势群体,开发和评估有效的、可行的健康干预行动方案将是今后老年健康干预研究的重要发展方向。
本研究以杭州市拱墅区和武义县为城乡研究现场,通过定量和定性相结合的研究方法分析了城乡干预组和对照组老年人群的基本社会入口学状况及其慢性病患病情况。同时,研究工作紧紧围绕老年人群的生命质量,以SF-36量表为评价工具,对城乡老年人群的生命质量及其影响因素进行对比分析,探索影响城乡老年人群生命质量的共同因素和特殊因素。在对城乡社区主要健康问题及其影响因素作出诊断后,课题组提出了以TTM理论为指导的个性化健康干预方案,并在城乡社区开展了9个月的干预试验,最终从行为生活方式改变及SF-36评分改变等方面对个性化健康干预效果进行了评价。研究为探索老年人群生命质量及其影响因素提供了科学依据,并为今后健康老龄化工作积累了宝贵的经验。
材料和方法
研究采用两阶段分层抽样的方法,在城乡分别选取干预和对照社区。在2007年10月到11月期间,通过面对面问卷调查的方式开展城乡社区老年人健康状况的横断面调查,并采用相关分析、信度分析、因子分析、t检验和方差分析等统计方法评价了SF-36量表的信度和效度。研究结合健康相关生命质量评分结果,运用多元线性回归等统计学方法,找出了城乡影响老年人群生命质量的主要因素。
2007年12月1日至2008年8月31日,在城乡干预社区开展了以TTM理论为指导的个性化健康干预,2008年9月开展干预结局调查。等级Logistic模型以行为改变为应变量,干预及其他混杂因素为自变量,来估计控制混杂因素后干预组与对照组在行为改变上的相对危险度(RR)；多元线性回归模型以干预前后配对评分的改变(结局减去基线)为应变量,干预及其他混杂因素为自变量,来分析在控制了各种混杂因素后干预措施对SF-36各维度评分的影响。
结果
基线调查在城乡两地区共完成有效问卷4230份,其中城市社区2157人,农村社区2073人。城乡干预组与对照组在社会人口学、行为生活方式及慢性病患病等方面存在统计学差异,这些差异在城乡之间尤其突出。城市未婚老人少于农村(1.5%vs.6.8%P<0.001)；城市文化程度高于农村(17.1%vs.70.0%P<0.001)；城市独居老人比例低于农村(10.7%vs.25.1%P<0.001)；城市的年收入显著高于农村(P<0.001)；吃腌制食品方面农村高于城市(57.4%vs.37.6%,P<0.001)；城市现在吸烟比例要低于农村(12.1%vs.35.1%,P<0.001)；城市现在饮酒比例也要低于农村(19.1%vs.32.7%,P<0.001)；城市喝茶比例要高于农村(56.2%vs.23.4%,P<0.001)；城市锻炼的比例远高于农村(66.6%vs.2.2%,P<0.001)；城市糖尿病患病率高于农村,而农村关节炎相对高发。
除GH维度外,SF-36量表的其他维度评分均城市高于农村(P<0.001),特别是在RP和RE维度。城乡老年人群的年龄与PF、RP、VT及SF维度的评分呈负相关(P<0.05),性别(男性)与PF和BP维度呈正相关(P<0.05),年收入则与PF、BP及RE维度呈正相关(P<0.05),饮茶与除RP和BP以外的其他所有维度呈正相关(P<0.05),饮酒则与PF、GH及SF维度的评分呈正相关(P<0.05),慢病数量在城乡两个人群均与各维度的生命质量呈负相关(P<0.001)。农村曾饮酒与GH、VT、SF及MH维度呈负相关(P<0.05),曾吸烟与PF、GH及VT维度呈负相关(P<0.05),而现在吸烟却与GH维度呈正相关(P<0.05)。城市独居与PF、GH、VT及MH维度呈负相关(P<0.05),教育水平与PF、VT、RE及MH维度呈正相关(P<0.05)。体育锻炼作为行为生活方式因素与城市老年人群所有维度的评分呈正相关(P<0.01)
城市干预后的结果与预期相反。控制混杂因素后,对照组的新鲜蔬菜、水果摄入增加,吸烟、盐摄入、腌制蔬菜摄入对照组明显减少(P<0.05)；控制混杂因素后,SF-36各维度评分除MH维度没有改变外,其余维度均干预组低于对照组(P<0.05)。
农村干预后的结果与预期相同。控制混杂因素后,干预组的新鲜蔬菜、水果摄入增加,吸烟、盐摄入、腌制蔬菜摄入干预组明显减少(P<0.05)；控制混杂因素后,SF-36各维度评分除BP维度干预组略低于对照组外,RP、RE、MH及MCS维度均干预组高于对照组(P<0.05)。
结论
城乡干预组与对照组间,老年人群在社会人口学状况、经济状况、行为生活方式、心理状况、医疗服务、慢性病患病状况等方面存在差异,这种差异在城乡之间尤其明显。中文版SF-36量表具有良好的信度与效度,适用于中国老年人群健康生命质量评价。然而,MH维度的信度与效度较低,同时MH维度中的9-2、9-8以及PF维度中的3-1条目不适合于中国老年人群。
浙江省农村老年人群的生命质量评分要低于城市老年人群,尤其是在RP和RE这两个维度。在城乡老年人群中均与生命质量呈正相关的因素有：性别(男性)、饮茶、年收入和现饮酒；在城乡老年人群中均与生命质量呈负相关的有：年龄和慢病数量。曾吸烟和曾饮酒是与农村老年人群生命质量呈负相关的特殊因素,而教育水平和体育锻炼是与城市老年人群生命质量呈正相关的特殊因素。
在城市社区开展的个性化健康干预未达到预期效果,干预行动失败；然而,本次在农村地区开展的个性化健康干预被证实是切实可行。干预对农村老年人群行为生活方式的改变有明显的作用,特别是在戒烟和减少食盐的摄入上。此外,干预还能明显提高农村老年人群的生命质量,特别是心理健康。研究认为,通过强化培训,农村社区医生能够有效地执行针对老年人群的个性化健康干预工作。
Backgrouds and Objectives
Today, the global population is facing a tendency of aging and China is becoming the country with the largest older population in the world. In 2000, the older population aged 60 and more reached 129.98 million in China, it was near 10.46% of the whole population. Moreover, the older population in China is increasing in a rate of 5.96 million per year, and it is estimated that the number of older population will reach 437 million by the year 2051. With the development of aging in China, the quality of life (QoL) is becoming the focus in the fields of aging study.
Physical health, mental health, and social status should be combined together to assess the QoL among the older population, and the MOS 36-item short-form heath survey (SF-36) was widely used to assess the QoL because of its comprehensiveness, brevity and high standard of reliability and validity. A few literatures around the world explored the differences of the QoL and its possible influence factors between the older populations in urban and rural areas. Compared with the older population in urban area, the older population in rural area usually had poorer lifestyle and QoL due to their poorer social and economic status. The key factors of the QoL included social-demographic factor, lifestyle, and the chronic diseases, and health interventions aimed to these factors may help to improve the QoL of the older population. In recent years, although the older population in Zhejiang province can get more and more medical services through the health service center in the community, they rarely can get the health interventions which were aimed to their behavioral changes. Thus, developing and assessing an effective and feasible health intervention project for older population will be a very important direction of health intervention study in future
This study was conducted in the study fields of Gongshu district in urban area and Wuyi County in rural area, methods combined with quantitative analysis and qualitative analysis were used to explore the basic social-demographic status and chronic diseases in the intervention and control groups between the urban and rural areas. Meanwhile, focusing on the QoL, we used the SF-36 questionnaire to analyze the QoL and its influence factors in the older urban and rural populations, to explore the common and special factors which influence the QoL of the older urban and rural populations. After diagnosing the main health problems and its influence factors in both areas, we put forward the individualized health intervention project which was guided by the TTM theory, and conducted a 9-month intervention trial. Finally, we assessed the individualized health intervention through the behavioral changes and the changes of SF-36 scale scores. Study shows that individualized health interventions are a feasible method of changing the health behaviors and improving the QoL in the older rural population of China. Study provides scientific evidences for the QoL of the older people, and also provides useful experiences for the health aging study in future.
Materials and Methods
This study was based on a multistage cluster sampling at two stages, the intervention and control groups were selected in both urban and rural areas. Questionnaire was administered by face-to-face interviews to survey the health of the older people in a cross-sectional study from October to November 2007. The correlation analysis, reliability analysis, factor analysis, t-test and one-way ANOVA were used to evaluate the reliability and validity of the SF-36. With scale scores of the SF-36 were fitted as the dependent variable, statistic methods such as multiple linear regression models were used to discover the main influential factors of the QoL in urban and rural areas.
From December 1st 2007 to August 31st 2008, individualized health interventions guided by the TTM theory were conducted in both urban and rural areas, and the outcome survey of the intervention was conducted in September 2008. Ordinal logistic regression models were fitted with behavior change as the dependent variable and intervention type and confounding factors as the independent variable to calculate the odds ratio of the intervention group versus the control group. Multiple linear regression models were fitted with paired changes (outcome minus baseline) of each scale score as the dependent variable. Intervention type and other confounding factors were set as independent variables to investigate the effect of intervention on SF-36 scale scores after controlling the influences of other factors.
Results
After the baseline survey,4230 finished the questionnaire in both urban and rural areas,2157 in urban area while 2073 in rural area. Significant differences were existed in social-demographic factors, lifestyle, and the chronic diseases between intervention and control groups in both urban and rural areas, and these differences were more outstanding between urban and rural areas. The unmarried older people were less in urban than rural area (1.5% vs.6.8% P<0.001), illiterate people were more in rural area (17.1% vs.70.0% P<0.001), living alone people were more in rural area (10.7% vs.25.1% P<0.001), older people earned more in urban area (P<0.001), older people ate more brined vegetables in rural area (57.4% vs.37.6%, P<0.001), more current smoking older people in rural area (12.1% vs.35.1%, P<0.001), more current drinking older people in rural area (19.1% vs.32.7%, P<0.001), more tea consumption older people in urban area (56.2% vs.23.4%, P<0.001), more physical exercise older people in urban area (66.6% vs.2.2% P<0.001), meanwhile more diabetes in urban area, and more arthritis in rural area.
Study revealed that all scale scores of SF-36 in rural areas were significantly lower than that in urban areas except general health (GH) (P< 0.001), especially in RE and RP scales. In both rural and urban populations, age was negatively related with PF, RP, VT, and SF scale scores (P<0.05). Gender (male) was positively related with PF and BP scale scores (P< 0.05), and income was positively related with PF, BP, and RE scale scores (P<0.05). Tea consumption was positively associated with all scale scores, except for RP and BP (P<0.05), and alcohol consumption was positively associated with PF, GH, and SF scale scores in rural and urban populations (P<0.05). The number of diseases was a factor negatively related to all scale scores in both populations (P<0.001). In the rural population, ex-drinking was negatively associated with GH, VT, SF, and MH scale scores (P<0.05); ex-smoking was negatively associated with PF, GH, and VT scale scores (P<0.05); and current smoking was positively associated with GH scale score (P<0.05). In the urban population, living alone was negatively associated with PF, GH, VT, and MH scale scores (P<0.05), and educational level was positively associated with PF, VT, RE, and MH scale scores (P<0.05). Regular exercise was a health-related behavior factor positively associated with all scale scores (P<0.01).
In urban area, the intervention results were contrary with the assumption. Brined vegetable intake, salt intake, and smoking increased while fresh vegetable and fresh fruit intake decreased within the intervention group (P<0.05) after adjusting for confounding factors. Moreover, the scale scores in intervention group were significantly lower except MH (P<0.05) after adjusting for confounding factors. In rural area, the intervention results were consistent with the assumption. Brined vegetable intake, salt intake, and smoking decreased (P<0.001) while fresh vegetable and fresh fruit intake increased within the intervention group (P<0.01) after adjusting for confounding factors. The intervention group improved significantly in role-physical, role-emotional, mental health, and mental component summary scale scores (P<0.05) after adjusting for confounding factors.
Conclusions
Significant differences were existed in social-demographic factors, economic status, lifestyle, psychological status, medical services and the chronic diseases between intervention and control groups in both urban and rural areas, and these differences were more outstanding between urban and rural areas. The SF-36 Chinese version has good reliability and validity; it is acceptable for the evaluation of quality of life in the older population. However, the reliability and validity of MH is relative low and the items such as 9-2,9-8 in MH and 3-1 in PF are not suitable for Chinese older population.
The older rural population scored lower than the older urban population on QoL. Common factors that were positively associated with the QoL in both the older rural and urban populations were gender (male), tea consumption, income, and current alcohol consumption. Age and the number of chronic diseases an individual experienced were negatively associated with the QoL. Ex-smoking and ex-drinking were special factors negatively associated with the QoL of participants living in rural areas, whereas educational level and regular exercise were special factors positively associated with QoL of participants living in urban areas.
The individualized health intervention (IHI) has proved unsuccessful in urban area, however, IHI is feasible in rural areas of China and it has obvious effects on health behavior changes in the elderly population, especially on the cessation of smoking and the reduction of salt intake. Moreover, this intervention can improve the mental health scale scores of QoL among the elderly population. This suggests that, through intensive training, community doctors can effectively implement the intervention to the elderly in Chinese rural areas.
人口老龄化是当今全球人口发展的趋势。中国是世界上老年人绝对数最多的国家,2000年中国60岁以上老年人口就达到了12998万人,占总人口的10.46%。而且,中国老年人口正以每年596万的速度增长,专家估计2051年中国老年人口将达4.37亿。随着中国人口老龄化进程明显加快,老年人群的生命质量问题已成为目前许多学者关注的焦点。
老年人的生命质量要全面结合机体健康、心理健康及社会健康状态进行评估,SF-36量表因具有良好的综合测评特性、简明而较高的信度与效度被广泛用于老年人群生命质量评价。国外有一些研究文献涉及到评价城乡之间老年人群生命质量的差异及其可能的影响因素,由于社会经济状况的原因,农村老年人群在行为生活方式和生命质量上都较城市老年人群差；其影响因素主要包括社会人口学、行为生活方式及慢性病患病情况。针对这些因素的健康干预可能有助于提高老年人的生命质量。近几年来,浙江省老年人群虽然通过社区卫生服务中心获得了越来越多的医疗卫生服务,但是老年人群很少有机会获得针对其行为生活方式改变的健康干预。因此,针对老年人群这一弱势群体,开发和评估有效的、可行的健康干预行动方案将是今后老年健康干预研究的重要发展方向。
本研究以杭州市拱墅区和武义县为城乡研究现场,通过定量和定性相结合的研究方法分析了城乡干预组和对照组老年人群的基本社会入口学状况及其慢性病患病情况。同时,研究工作紧紧围绕老年人群的生命质量,以SF-36量表为评价工具,对城乡老年人群的生命质量及其影响因素进行对比分析,探索影响城乡老年人群生命质量的共同因素和特殊因素。在对城乡社区主要健康问题及其影响因素作出诊断后,课题组提出了以TTM理论为指导的个性化健康干预方案,并在城乡社区开展了9个月的干预试验,最终从行为生活方式改变及SF-36评分改变等方面对个性化健康干预效果进行了评价。研究为探索老年人群生命质量及其影响因素提供了科学依据,并为今后健康老龄化工作积累了宝贵的经验。
材料和方法
研究采用两阶段分层抽样的方法,在城乡分别选取干预和对照社区。在2007年10月到11月期间,通过面对面问卷调查的方式开展城乡社区老年人健康状况的横断面调查,并采用相关分析、信度分析、因子分析、t检验和方差分析等统计方法评价了SF-36量表的信度和效度。研究结合健康相关生命质量评分结果,运用多元线性回归等统计学方法,找出了城乡影响老年人群生命质量的主要因素。
2007年12月1日至2008年8月31日,在城乡干预社区开展了以TTM理论为指导的个性化健康干预,2008年9月开展干预结局调查。等级Logistic模型以行为改变为应变量,干预及其他混杂因素为自变量,来估计控制混杂因素后干预组与对照组在行为改变上的相对危险度(RR)；多元线性回归模型以干预前后配对评分的改变(结局减去基线)为应变量,干预及其他混杂因素为自变量,来分析在控制了各种混杂因素后干预措施对SF-36各维度评分的影响。
结果
基线调查在城乡两地区共完成有效问卷4230份,其中城市社区2157人,农村社区2073人。城乡干预组与对照组在社会人口学、行为生活方式及慢性病患病等方面存在统计学差异,这些差异在城乡之间尤其突出。城市未婚老人少于农村(1.5%vs.6.8%P<0.001)；城市文化程度高于农村(17.1%vs.70.0%P<0.001)；城市独居老人比例低于农村(10.7%vs.25.1%P<0.001)；城市的年收入显著高于农村(P<0.001)；吃腌制食品方面农村高于城市(57.4%vs.37.6%,P<0.001)；城市现在吸烟比例要低于农村(12.1%vs.35.1%,P<0.001)；城市现在饮酒比例也要低于农村(19.1%vs.32.7%,P<0.001)；城市喝茶比例要高于农村(56.2%vs.23.4%,P<0.001)；城市锻炼的比例远高于农村(66.6%vs.2.2%,P<0.001)；城市糖尿病患病率高于农村,而农村关节炎相对高发。
除GH维度外,SF-36量表的其他维度评分均城市高于农村(P<0.001),特别是在RP和RE维度。城乡老年人群的年龄与PF、RP、VT及SF维度的评分呈负相关(P<0.05),性别(男性)与PF和BP维度呈正相关(P<0.05),年收入则与PF、BP及RE维度呈正相关(P<0.05),饮茶与除RP和BP以外的其他所有维度呈正相关(P<0.05),饮酒则与PF、GH及SF维度的评分呈正相关(P<0.05),慢病数量在城乡两个人群均与各维度的生命质量呈负相关(P<0.001)。农村曾饮酒与GH、VT、SF及MH维度呈负相关(P<0.05),曾吸烟与PF、GH及VT维度呈负相关(P<0.05),而现在吸烟却与GH维度呈正相关(P<0.05)。城市独居与PF、GH、VT及MH维度呈负相关(P<0.05),教育水平与PF、VT、RE及MH维度呈正相关(P<0.05)。体育锻炼作为行为生活方式因素与城市老年人群所有维度的评分呈正相关(P<0.01)
城市干预后的结果与预期相反。控制混杂因素后,对照组的新鲜蔬菜、水果摄入增加,吸烟、盐摄入、腌制蔬菜摄入对照组明显减少(P<0.05)；控制混杂因素后,SF-36各维度评分除MH维度没有改变外,其余维度均干预组低于对照组(P<0.05)。
农村干预后的结果与预期相同。控制混杂因素后,干预组的新鲜蔬菜、水果摄入增加,吸烟、盐摄入、腌制蔬菜摄入干预组明显减少(P<0.05)；控制混杂因素后,SF-36各维度评分除BP维度干预组略低于对照组外,RP、RE、MH及MCS维度均干预组高于对照组(P<0.05)。
结论
城乡干预组与对照组间,老年人群在社会人口学状况、经济状况、行为生活方式、心理状况、医疗服务、慢性病患病状况等方面存在差异,这种差异在城乡之间尤其明显。中文版SF-36量表具有良好的信度与效度,适用于中国老年人群健康生命质量评价。然而,MH维度的信度与效度较低,同时MH维度中的9-2、9-8以及PF维度中的3-1条目不适合于中国老年人群。
浙江省农村老年人群的生命质量评分要低于城市老年人群,尤其是在RP和RE这两个维度。在城乡老年人群中均与生命质量呈正相关的因素有：性别(男性)、饮茶、年收入和现饮酒；在城乡老年人群中均与生命质量呈负相关的有：年龄和慢病数量。曾吸烟和曾饮酒是与农村老年人群生命质量呈负相关的特殊因素,而教育水平和体育锻炼是与城市老年人群生命质量呈正相关的特殊因素。
在城市社区开展的个性化健康干预未达到预期效果,干预行动失败；然而,本次在农村地区开展的个性化健康干预被证实是切实可行。干预对农村老年人群行为生活方式的改变有明显的作用,特别是在戒烟和减少食盐的摄入上。此外,干预还能明显提高农村老年人群的生命质量,特别是心理健康。研究认为,通过强化培训,农村社区医生能够有效地执行针对老年人群的个性化健康干预工作。
Backgrouds and Objectives
Today, the global population is facing a tendency of aging and China is becoming the country with the largest older population in the world. In 2000, the older population aged 60 and more reached 129.98 million in China, it was near 10.46% of the whole population. Moreover, the older population in China is increasing in a rate of 5.96 million per year, and it is estimated that the number of older population will reach 437 million by the year 2051. With the development of aging in China, the quality of life (QoL) is becoming the focus in the fields of aging study.
Physical health, mental health, and social status should be combined together to assess the QoL among the older population, and the MOS 36-item short-form heath survey (SF-36) was widely used to assess the QoL because of its comprehensiveness, brevity and high standard of reliability and validity. A few literatures around the world explored the differences of the QoL and its possible influence factors between the older populations in urban and rural areas. Compared with the older population in urban area, the older population in rural area usually had poorer lifestyle and QoL due to their poorer social and economic status. The key factors of the QoL included social-demographic factor, lifestyle, and the chronic diseases, and health interventions aimed to these factors may help to improve the QoL of the older population. In recent years, although the older population in Zhejiang province can get more and more medical services through the health service center in the community, they rarely can get the health interventions which were aimed to their behavioral changes. Thus, developing and assessing an effective and feasible health intervention project for older population will be a very important direction of health intervention study in future
This study was conducted in the study fields of Gongshu district in urban area and Wuyi County in rural area, methods combined with quantitative analysis and qualitative analysis were used to explore the basic social-demographic status and chronic diseases in the intervention and control groups between the urban and rural areas. Meanwhile, focusing on the QoL, we used the SF-36 questionnaire to analyze the QoL and its influence factors in the older urban and rural populations, to explore the common and special factors which influence the QoL of the older urban and rural populations. After diagnosing the main health problems and its influence factors in both areas, we put forward the individualized health intervention project which was guided by the TTM theory, and conducted a 9-month intervention trial. Finally, we assessed the individualized health intervention through the behavioral changes and the changes of SF-36 scale scores. Study shows that individualized health interventions are a feasible method of changing the health behaviors and improving the QoL in the older rural population of China. Study provides scientific evidences for the QoL of the older people, and also provides useful experiences for the health aging study in future.
Materials and Methods
This study was based on a multistage cluster sampling at two stages, the intervention and control groups were selected in both urban and rural areas. Questionnaire was administered by face-to-face interviews to survey the health of the older people in a cross-sectional study from October to November 2007. The correlation analysis, reliability analysis, factor analysis, t-test and one-way ANOVA were used to evaluate the reliability and validity of the SF-36. With scale scores of the SF-36 were fitted as the dependent variable, statistic methods such as multiple linear regression models were used to discover the main influential factors of the QoL in urban and rural areas.
From December 1st 2007 to August 31st 2008, individualized health interventions guided by the TTM theory were conducted in both urban and rural areas, and the outcome survey of the intervention was conducted in September 2008. Ordinal logistic regression models were fitted with behavior change as the dependent variable and intervention type and confounding factors as the independent variable to calculate the odds ratio of the intervention group versus the control group. Multiple linear regression models were fitted with paired changes (outcome minus baseline) of each scale score as the dependent variable. Intervention type and other confounding factors were set as independent variables to investigate the effect of intervention on SF-36 scale scores after controlling the influences of other factors.
Results
After the baseline survey,4230 finished the questionnaire in both urban and rural areas,2157 in urban area while 2073 in rural area. Significant differences were existed in social-demographic factors, lifestyle, and the chronic diseases between intervention and control groups in both urban and rural areas, and these differences were more outstanding between urban and rural areas. The unmarried older people were less in urban than rural area (1.5% vs.6.8% P<0.001), illiterate people were more in rural area (17.1% vs.70.0% P<0.001), living alone people were more in rural area (10.7% vs.25.1% P<0.001), older people earned more in urban area (P<0.001), older people ate more brined vegetables in rural area (57.4% vs.37.6%, P<0.001), more current smoking older people in rural area (12.1% vs.35.1%, P<0.001), more current drinking older people in rural area (19.1% vs.32.7%, P<0.001), more tea consumption older people in urban area (56.2% vs.23.4%, P<0.001), more physical exercise older people in urban area (66.6% vs.2.2% P<0.001), meanwhile more diabetes in urban area, and more arthritis in rural area.
Study revealed that all scale scores of SF-36 in rural areas were significantly lower than that in urban areas except general health (GH) (P< 0.001), especially in RE and RP scales. In both rural and urban populations, age was negatively related with PF, RP, VT, and SF scale scores (P<0.05). Gender (male) was positively related with PF and BP scale scores (P< 0.05), and income was positively related with PF, BP, and RE scale scores (P<0.05). Tea consumption was positively associated with all scale scores, except for RP and BP (P<0.05), and alcohol consumption was positively associated with PF, GH, and SF scale scores in rural and urban populations (P<0.05). The number of diseases was a factor negatively related to all scale scores in both populations (P<0.001). In the rural population, ex-drinking was negatively associated with GH, VT, SF, and MH scale scores (P<0.05); ex-smoking was negatively associated with PF, GH, and VT scale scores (P<0.05); and current smoking was positively associated with GH scale score (P<0.05). In the urban population, living alone was negatively associated with PF, GH, VT, and MH scale scores (P<0.05), and educational level was positively associated with PF, VT, RE, and MH scale scores (P<0.05). Regular exercise was a health-related behavior factor positively associated with all scale scores (P<0.01).
In urban area, the intervention results were contrary with the assumption. Brined vegetable intake, salt intake, and smoking increased while fresh vegetable and fresh fruit intake decreased within the intervention group (P<0.05) after adjusting for confounding factors. Moreover, the scale scores in intervention group were significantly lower except MH (P<0.05) after adjusting for confounding factors. In rural area, the intervention results were consistent with the assumption. Brined vegetable intake, salt intake, and smoking decreased (P<0.001) while fresh vegetable and fresh fruit intake increased within the intervention group (P<0.01) after adjusting for confounding factors. The intervention group improved significantly in role-physical, role-emotional, mental health, and mental component summary scale scores (P<0.05) after adjusting for confounding factors.
Conclusions
Significant differences were existed in social-demographic factors, economic status, lifestyle, psychological status, medical services and the chronic diseases between intervention and control groups in both urban and rural areas, and these differences were more outstanding between urban and rural areas. The SF-36 Chinese version has good reliability and validity; it is acceptable for the evaluation of quality of life in the older population. However, the reliability and validity of MH is relative low and the items such as 9-2,9-8 in MH and 3-1 in PF are not suitable for Chinese older population.
The older rural population scored lower than the older urban population on QoL. Common factors that were positively associated with the QoL in both the older rural and urban populations were gender (male), tea consumption, income, and current alcohol consumption. Age and the number of chronic diseases an individual experienced were negatively associated with the QoL. Ex-smoking and ex-drinking were special factors negatively associated with the QoL of participants living in rural areas, whereas educational level and regular exercise were special factors positively associated with QoL of participants living in urban areas.
The individualized health intervention (IHI) has proved unsuccessful in urban area, however, IHI is feasible in rural areas of China and it has obvious effects on health behavior changes in the elderly population, especially on the cessation of smoking and the reduction of salt intake. Moreover, this intervention can improve the mental health scale scores of QoL among the elderly population. This suggests that, through intensive training, community doctors can effectively implement the intervention to the elderly in Chinese rural areas.
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