There are a large number of middle-aged and elderly patients with chronic diseases. However, there is currently limited research on the depression status and influencing factors of middle-aged and elderly patients with chronic diseases nationwide.
By exploring the depression status and influencing factors of middle-aged and elderly patients with chronic diseases in China, to provide a reference for improving their mental health status.
According to the fifth round of national survey data conducted by the China Health and Retirement Longitudinal Study (CHARLS) in 2020, a total of 12 551 middle-aged and elderly patients with chronic diseases were selected as the study objects. The depression status of the study objects was measured using the Center for Epidemiologic Studies Depression Scale (CES-D), and the main factors affecting the depression status of middle-aged and elderly patients with chronic diseases were analyzed using the chi-square test and multivariate Logistic regression.
Among middle-aged and elderly patients with chronic diseases, the proportion of those with depressive symptoms was 40.7% (5 111/12 551). The results of multivariate Logistic regression analysis showed that: gender (male: OR=0.613, 95%CI=0.553-0.680), age (65-<75 years old: OR=0.862, 95%CI=0.769-0.965; ≥75 years old: OR=0.604, 95%CI=0.510-0.716), presence of spouse/partner living together or not (have OR=0.730, 95%CI=0.648-0.822), places of residence (rural: OR=1.515, 95%CI=1.387-1.654), educational levels (junior high school: OR=0.727, 95%CI=0.657-0.805; senior high school and above: OR=0.561, 95%CI=0.488-0.646), social status (1 item: OR=0.870, 95%CI=0.793-0.956; ≥ 2 items: OR=0.866, 95%CI=0.779-0.963), satisfaction with child relationships (satisfaction: OR=0.266, 95%CI=0.218-0.324), smoking (OR=1.131, 95%CI=1.014-1.263), alcohol consumption (OR=0.873, 95%CI=0.795-0.959), nighttime sleep duration (6-<8 h: OR=0.539, 95%CI=0.493-0.590; ≥8 h: OR=0.443, 95%CI=0.396-0.495), BADL (damaged: OR=1.875, 95%CI=1.692-2.077), IADL (damaged: OR=2.251, 95%CI=2.030-2.496), number of chronic diseases (2 types: OR=1.202, 95%CI=1.076-1.342; 3 types: OR=1.452, 95%CI=1.289-1.636; ≥ 4 types: OR=1.954, 95%CI=1.749-2.183) were the influencing factors of depression symptoms in middle-aged and elderly patients with chronic diseases (P<0.05) .
The incidence of depressive symptoms in middle-aged and elderly patients with chronic diseases is 40.7%, and the situation is not optimistic. Their depression is influenced by various factors. Healthcare institutions and policymakers should pay attention to their mental health and take targeted measures from personal, family, community, and other aspects to improve.
With the accelerated population aging, the number of elderly patients with chronic diseases is growingly elevated. Adherence to medication regimens is pivotal for the health outcomes of chronic diseases. Existing research mainly analyzed influencing factors for medication adherence and the outcome of medication adherence by interventions. A single analysis of medication adherence from the aspect of medication experience is one-sided.
To understand the current situations of medication experience and medication adherence in elderly patients with chronic diseases, and to explore the influence of medication experience at multiple dimensions on medication adherence, thus proposing countermeasures to improve medication adherence in elderly patients with chronic diseases.
From September 2023 to December 2023, a total of 2 432 residents of three cities in Shandong Province were selected by stratified random sampling according to the economic level and social development. Elderly patients (>60 years of age) with chronic diseases and long-term medications were screened according to the inclusion and exclusion criteria. A self-designed Medication Experience Scale, consisting of 7 dimensions and 28 items was used to investigate the medication experience. A Chinese version of 4-item Medication Adherence Scale was used to investigate the medication adherence. Current status of patients' medication experience and medication adherence were described. Multiple linear regression was performed to analyze the dimensions of medication experience that greatly influenced medication adherence.
A total of 2 432 questionnaires were distributed in this survey, and 2 415 were retrieved. After excluding samples with missing data on the main variables, a total of 1 544 samples were included in this study. The mean score of medication experience of elderly patients with chronic diseases was (4.31±0.39) point, with the highest score in the dimension of life influenced by medication (4.72±0.58) points, and lowest in the dimension of convenience (3.86±0.49) points. The mean score of medication adherence in elderly patients with chronic diseases was (3.48±0.62) points. A total of 698 (45.2%) patients were identified as a poor adherence. The most common cause for non-adherence was 'forgetting to take medication' (77.1%, 538/698). Medication adherence scores were significantly lower in female elderly, or elderly patients with two or more chronic diseases than those of counterparts (P<0.05). The results of multivariate linear regression showed that medication adherence was worse in female elderly patients (β=-0.056) and elderly patients with two or more chronic diseases (β=-0.053) (P<0.05). Among the dimensions of the Medication Experience Scale, the dimensions of effectiveness (β=0.083), and affordability (β=0.135) positively predicted patients' medication adherence (P<0.05) .
The proportion of elderly patients with poor medication adherence to chronic diseases in Shandong Province is 45.2%, among whom, female patients and elderly patients with two or more chronic diseases have a worse medication adherence. The effectiveness and affordability dimensions of the medication experience are positive predictors of medication adherence. Relevant departments should focus on continuously reducing the price of chronic disease medicines, and doctors should strengthen the pharmacy guidance service provided to female patients and elderly patients with two or more chronic diseases.
With the aging of the population, chronic diseases have become a significant public health challenge. Enhancing health literacy among individuals with chronic diseases can foster a proactive approach to health management, leading to improved health outcomes.
This study aims to examine the current status of health literacy and its influencing factors among patients with chronic diseases in Shanghai, with the goal of providing theoretical support for future health promotion strategies and chronic disease management programs.
From February to May 2023, a multi-stage stratified random sampling method was employed. Based on the resident population size and the number of community health service centers in each administrative district of Shanghai, 1 to 4 community health service centers were randomly selected from 16 districts, totaling 28 centers. A questionnaire survey was administered to chronic disease patients visiting these centers. A general information questionnaire was used to collect demographic and clinical data, and a health literacy scale was applied to assess the health literacy levels of the respondents.
Of the 768 chronic disease patients surveyed, 13 questionnaires with incomplete data were excluded, resulting in a final sample of 755 patients, with an effective response rate of 98.3%. Among the respondents, 435 (57.62%) exhibited good health literacy. In terms of specific dimensions, 664 patients (87.95%) demonstrated the ability to obtain information, 618 (81.85%) expressed willingness to provide economic support, 559 (74.04%) showed communication and interaction skills, and 646 (85.56%) were willing to improve their health. Binary logistic regression analysis revealed that female gender (OR=1.549, 95%CI=1.148-2.091) and family doctor contracting (OR=1.634, 95%CI=1.162-2.299) were significant influencing factors for health literacy among chronic disease patients (P<0.05). Furthermore, the proportion of patients with stable disease control in the past year was significantly higher among those with adequate health literacy compared to those without (P<0.05) .
The overall health literacy of chronic disease patients in Shanghai requires improvement. Gender and contracting with a family doctor are key factors influencing health literacy levels. Targeted interventions are recommended to expand the coverage and enhance the quality of family doctor services, thereby improving health literacy. These findings provide valuable insights for promoting proactive health management in chronic disease care.
The high incidence of chronic diseases is associated with the inadequate knowledge of health and disease risks. At the national level, traditional health education remains popular in community health services. The health education conducted by primary healthcare providers are often limited, and lacks specificity in the content. Additionally, community residents generally show a low enthusiasm for participating in health education. The quality and effectiveness of health education for chronic disease patients need an improvement.
To explore the effectiveness of individualized health education interventions generated through the application of an information-based knowledge base model on middle-aged and elderly patients with chronic diseases in the community. The findings are expected to provide insights to further enhance the management of community-based chronic diseases.
In 2021, a total of 7 390 patients at the age of 50-70 years with the chronic diseases of hypertension, diabetes, coronary heart disease, and stroke in Beijing Dongcheng District Community Health Service Center were selected as study subjects. A one-year cluster randomized controlled trial was conducted. Patients in both groups received routine follow-up management strategies for chronic diseases, with the preservation of the existing basic public health services for chronic diseases. Those in the intervention group were additionally given individualized health education programs generated through an information-based knowledge base model, including health education prescriptions and individualized health management. Follow-up visits and interventions were conducted every three months, for a total of 12 months. An end-point survey was conducted one year after recruitment. The primary outcome measures were the differences between the baseline and end-point results of the knowledge awareness of chronic diseases, self-management attitudes, self-efficacy, medication adherence, and acceptance of health information technology.
A total of 7 390 patients with the four types of chronic diseases were included in the study, involving 3 673 patients in the intervention group and 3 717 in the control group. There were no significant differences in the age distribution, gender, education level, and employment status between groups (P>0.05). However, there was a significant difference in the type of medical insurance coverage between groups (P<0.05). After the intervention, patients in the intervention group demonstrated significantly higher correct awareness rates of overall disease knowledge, basic knowledge of chronic diseases, diabetes knowledge, coronary heart disease knowledge, and stroke knowledge compared to pre-intervention levels (P<0.05), while that of hypertension knowledge was not statistically significant (P>0.05). In the control group, there were no significant changes in the correct awareness rates of overall disease knowledge, basic knowledge of chronic diseases, hypertension knowledge, diabetes knowledge, or coronary heart disease knowledge before and after the intervention (P>0.05). However, the correct awareness rate of stroke knowledge in the control group was significantly lower after the intervention compared to pre-intervention levels (P<0.05). The scores of the self-management attitude questionnaire, self-efficacy questionnaire, medication adherence questionnaire, and health information acceptance questionnaire in the intervention group were significantly higher than those of the control group after the intervention (P<0.05). Additionally, in the intervention group, the scores on the self-management attitude questionnaire, self-efficacy questionnaire, medication adherence questionnaire, and health information acceptance questionnaire after the intervention were significantly higher compared to pre-intervention levels (P<0.05). In the control group, the scores of the self-efficacy questionnaire and medication adherence questionnaire improved significantly after the intervention compared to pre-intervention levels (P<0.05), while no significant changes in the scores of the self-management attitude questionnaire and health information acceptance questionnaire were detected (P>0.05) .
Knowledge awareness of chronic diseases, self-management attitude, and health information acceptance are more significantly improved in the intervention group than the control group. Both groups showed improvements in self-efficacy and medication adherence following the intervention, especially in the intervention group. Overall, an individualized health education based on an information-based knowledge base model is beneficial for enhancing the health literacy of patients with chronic diseases.
Multimorbidity accelerates cognitive decline and leads to an increased risk of cognitive impairment. However, existing studies have mainly explored the cognitive status of patients with a single or specific chronic disease, and the patient with multimorbidity remains to be urgently explored. The present study describes the epidemiological characteristics of cognitive impairment in multimorbidity, summarizes the influencing factors, organizes the association patterns between multimorbidity and cognitive impairment, elucidates the mechanisms underlying their occurrence, and finally proposes preventive and control strategies. The findings of this study are intended to serve as a valuable reference for future efforts in preventing and treating cognitive impairment in multimorbidity.
With the population aging, the number of patients with chronic diseases and disability is increasing, which brings a heavy burden on the medical system. While it is well established that comorbidity and disability are closely interconnected, there is a noticeable scarcity of studies addressing the relationship between different patterns of comorbidity and disability.
To explore the common comorbidity patterns and their associations with disability among the older adults in China taking Sichuan as an example.
A total of 501 older adults, aged 60 and above, were selected using quota sampling in Sichuan from August to Novermber 2022. Detailed data on chronic diseases, disability, and general demographics were collected. Comorbidity patterns among the older adults were identified using a two-step clustering method that combined self-organizing maps and K-Means. The association between patterns of comorbidity and disability was explored using a logistic regression model, employing the National Disability Assessment Scale for the Long-term Care issued by the National Healthcare Security Administration of China in 2021.
In this survey, The prevalence of comorbidity 62.3% (312/501) and the prevalence of disability was 74.3% (372/501). We identified six comorbidity patterns: Arthritis/Rheumatism and Hypertension diseases, Cardiovascular and Metabolic diseases, Kidney and Arthritis/Rheumatism diseases, Cancer and Arthritis/Rheumatism diseases, Asthma, Hypertension, and Gastrointestinal diseases, Emotional/Mental and Memory-related diseases. The results of binomial logistic regression showed that the risk of disability was 6.3 times higher when people suffering from two or more chronic diseases at the same time (OR=6.3, 95%CI=3.9-10.3, P<0.05). The results of multinomial logistic regression showed that the risk of disability was increased in all six comorbidity patterns (P<0.05). Compared to the population without comorbidities, the comorbid group with the emotional/mental and memory-related diseases pattern has a 10.7 times risk with more severe disability (OR=10.7, 95%CI=1.7-63.6), which had the greatest impact on disability. Next is the Cancer and Arthritis/Rheumatism pattern (OR=7.8, 95%CI=2.4-24.8) .
The incidence of comorbidity among the older adults in Sichuan is high, and there is a significant association between several comorbidity patterns and disability, especially for the Emotional/Mental and Memory-related diseases pattern and Cancer and Arthritis/Rheumatism pattern. The health care system should focus on the older adults with comorbidity, formulate accurate and effective long-term care policies and strategies based on different comorbidity patterns to prevent and reduce the occurrence of disability, improve the well-being of the older adults, and save social medical resources.
As global population continues to age, disability has become one of the most prominent health problems in the aging population. Chinese older adults with chronic diseases often diagnosed with multi-morbidities resulting in increased risks for disability. However, previous evidence on disability rates in this population have been inconsistent.
To systematically evaluate the prevalence of disability in older adults with chronic diseases in China.
We searched databases including PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, Wanfang Data, VIP, CBM and China Medical Journal Full-text Database up until August 2023 for publications on disability prevalence in Chinese older adults with chronic diseases. Literature screening, quality appraisal and data extraction were performed independently by two researchers. Meta-analysis was conducted using Stata 16.0 software.
A total of 32 publications (34 studies) were included. Sample sizes ranged from 221 to 16 566 cases with a disability rate of 6.9%-82.8%. Meta-analysis showed that the prevalence of disability in Chinese older adults with chronic diseases was 43.2% (95%CI=32.9%-53.5%). Subgroup analyses showed: disability rate was higher in female (36.6%, 95%CI=27.0%-46.2%) than in male (33.9%, 95%CI=23.9%-43.9%) ; disability prevalence increased with age (60-69 years old: 24.2%, 95%CI=14.3%-34.0%; 70-79 years old: 34.9%, 95%CI=24.1%-45.7%; ≥80 years old: 47.7%, 95%CI=36.3%-59.1%) ; compared to other chronic diseases, individuals with dementia/Parkinson's disease (56.3%, 95%CI=40.9%-71.7%), mental illness (53.9%, 95%CI=46.0%-61.7%), and cerebrovascular disease (49.2%, 95%CI=33.5%-64.8%) had the highest prevalence of disability; and the prevalence of disability increased with the number of comorbidities (1 disease: 33.1%, 95%CI=20.8%-45.3%; 2 diseases: 36.3%, 95%CI=22.6%-50.0%; ≥3 diseases: 49.7%, 95%CI=31.3%-68.0%) .
The prevalence of disability among Chinese older adults with chronic diseases is high and can be impacted by both the type of chronic disease and the number of comorbidities. It is recommended to strengthen chronic disease monitoring and management efforts to prevent and eliminate disability and promote healthy aging in this population.
