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目的以Wilson-Cleary模型为向导构建结构方程模型(SEM),了解老年糖尿病患者的健康相关生命质量(HRQOL)与临床表现之间的相互关系。方法自行设计调查问卷,选择来本院诊断治疗的450例老年糖尿病患者作为研究人群,运用SF-36生活质量调查表、老年人多功能评估问卷(OMFAQ)、医疗社会支持量表(MOS-SSS)、兰特心理健康量表(RMHI)和临床结果(与糖尿病有关的特征和生理数据)进行评估,构建机构方程模型。采用拟合优度的指标来评估路径模型的整体,配合卡方检验处理数据。结果心理困扰、收入和充足社会保障等四个因素,可通过一般健康感知对HRQOL产生直接影响(66%变异量);而症状、身体功能状态和心理状态等三个因素,则通过一般健康感知对HRQOL产生间接的影响(64%的变异量)。另外,症状、年龄、性别和体力活动等四个因素通过身体功能状态间接影响HRQOL(72%的变异量)。结论提高社会和财政支持或提供其他干预措施,可有效地提高老年糖尿病患者身体素质和心理抗压能力,并提高他们的HRQOL。
Objective To construct a structural equation model (SEM) using the Wilson-Cleary model as a guide to understand the relationship between health-related quality of life (HRQOL) and clinical manifestations in elderly diabetic patients. Methods A total of 450 elderly patients with diabetes mellitus who were diagnosed and treated in our hospital were selected as the study population by self-designed questionnaire. SF-36 quality of life questionnaire, multi-functional assessment questionnaire for the elderly (OMFAQ), MOS-SSS ), The Rand Mental Health Scale (RMHI), and clinical outcomes (characteristics and physiologic data related to diabetes) were used to construct an institutional equation model. Using the goodness of fit index to evaluate the whole of the path model, with the chi-square test processing data. Results Four factors, psychological distress, income and adequate social security, could directly affect HRQOL through general health perception (66% of variance). The three factors of symptoms, physical function and psychological status were determined by general health perception Indirect impact on HRQOL (64% variation). In addition, four factors, including symptoms, age, gender, and physical activity, indirectly affect HRQOL (72% variation) through functional status of the body. Conclusions Increasing social and financial support or providing other interventions can effectively improve the physical and psychological resilience of elderly patients with diabetes and improve their HRQOL.