Analysis of the empowerment of Disabled elderly people in rural areas in Henan province: a survey

doi:10.21203/rs.3.rs-4315353/v1

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Analysis of the empowerment of Disabled elderly people in rural areas in Henan province: a survey

https://doi.org/10.21203/rs.3.rs-4315353/v1

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Objective: To understand the health empowerment status of the rural disabled elderly, and analyze the influencing factors, to provide a reference for targeted intervention measures.

Methods: The Group sampling method investigated 208 disabled elderly people in a rural community in Henan Province.

Results: The total level of the rural disability score (55.43 ± 12.04), and the average score (2.42± 0.53), at the middle level, where the average score of each dimension is:.1Self-identification (113 ± 3.12), individual control (10.79 ± 3.46), decision participation (9.82 ± 2.79), knowledge and understanding (10.28 ± 3.26), empowerment (10.33 ± 3.03), The multiple regression results showed that the number of children, the type of chronic diseases with education level and the degree of disability were the influencing factors affecting the empowerment level of the disabled rural elderly (P <0.05).

Conclusion: The current situation of empowerment of the disabled elderly in rural areas is at the middle level, especially in terms of self-decision, health records, and smart pension, which can be implemented or improved for the current empowerment intervention program, and accurate empowerment can be achieved by stimulating the internal potential of the disabled elderly and improving their self-health management awareness.

rural areas

disabled elderly

active health

enabling

With the deepening of aging, the number of disabled elderly people in China has surged synchronously, and the problem of elderly disability is becoming increasingly serious. It is predicted that the number of disabled elderly people in China is expected to increase from 136.24 million to 136.74 million by 2030^[1]. Compared with the disabled elderly in urban areas, the rural disabled elderly have a large proportion and a low health level^[2]. China Geriatric Health Research Report (2020–2021)^[3] Points out, that empowerment is considered to be the key to improving the internal ability of the elderly and promoting the function to play, advocating for the elderly to explore their resources, encourage self-care, and promote health empowerment. Empowered by WHO is defined as a positive cooperative relationship to improve health status and quality of life, which is a prerequisite for health and is conducive to improving health outcomes and quality of life^{[4, 5]}. In healthcare, empowerment is considered a determinant of improved health status, with a positive effect on health outcomes^{[5, 6]}. Some foreign scholars have found that the empowerment level has a great impact on the self-management of chronic diseases, is an important factor affecting patients' participation in health self-management, and has a positive role in promoting health self-management^[7]. However, China's traditional care methods mainly focus on daily living and medical care, but they ignore the willingness and ability of the disabled elderly to actively pursue health, leading to the continuous decline of internal ability and the inability to maintain their function^[8]. Therefore, it is necessary to first investigate and analyze the current situation of the disabled elderly people in rural areas and analyze the influencing factors, to develop a regional-specific population health empowerment intervention program suitable for agriculture. Based on the above thinking, the researchers adjusted the empowerment level of the disabled elderly in a township and rural areas in Henan Province, to provide a valuable reference for promoting and improving the health empowerment intervention program of this group.

1.1 Selection of survey respondents

The disabled elderly people in the natural administrative villages of Henan Province were selected as the respondents. The inclusion/exclusion criteria were as follows: rural disabled elderly persons: ① 60 years or older; ② BI rated at least "slightly dependent" or above; ③ its caregivers were non-medical professionals; ④ voluntarily participated in the study.

Exclusion criteria: ① Patients with severe mental disorders; ② participating in other clinical trials; ③ without caregivers; ④ with chronic infectious diseases such as AIDS, hepatitis and tuberculosis.

1.2 Sample size calculation

The sample size was estimated using 5–10 times of the maximum number of items in the questionnaire^[9]. There were 23 items in the Energy Table for Chronic Disease Patients used in this study, and the calculated sample size was 115–230. Considering 20% of invalid questionnaires, at least 138 questionnaires were needed. In this study, 214 questionnaires were issued and 208 questionnaires were recovered, with an effective recovery rate of 97.1%.

1.3 Study tools

The questionnaire includes general data on the elderly, chronic disease energy scale, and the ability of daily living (ADL) -Barthel index rating scale (BI).

(1) General data questionnaire

The general data questionnaire for the disabled elderly in rural areas includes age, gender, education level, marital status, monthly medical expenses, income, number of children, main sources of income, types of chronic diseases disability degree, etc.

Barthel Index Evaluation Scale (BI)

This scale is the most widely used and studied scale for daily self-care ability (Activities of Daily Living, ADL), and was developed by Lawton and Brody in the United States in 1969^[10]The scale contains 10 items: eating, bathing, dressing, dressing, stool control, urination control, toilet use, bed and wheelchair transfer, flat ground walking, and going up and down stairs. According to the degree of help that the patient needs to complete each item (independent, need partial help, need great help, complete dependence), the full score is 100 points.

According to the final score, the patient's self-care ability was divided into the following levels: Grade A (61–99 points): mild dependence, basic self-care, mild impairment, and ability to complete daily activities independently. Grade B (41–60 points): moderate dependence, self-care, moderate dysfunction, life needs help; Grade C (040 points): severe dependence, most daily activities, completely unable to self-care, severe dysfunction, or complete disability. Barthel Index rating scale has been widely used at home and abroad. This scale is simple to use, and its reliability and validity have been widely confirmed. Its weight reliability reaches 0.89, inter-rating reliability is greater than 0.95, and high sensitivity^[11]。

(2) Energy assignment table for patients with chronic diseases

The scale was compiled by Nicola Small, University of Manchester, UK, and by Sun Yiqin^[12]Chinese, used to assess the level of elderly chronic patients, including self-identification (five items), individual control (four items), participation in decision-making (five items), knowledge and understanding (four items), can assign others (five items) five dimensions, a total of 23 items, using Likert 5 level scoring method, from "very disagree" to "very agree", 1–5 points, the total score of 23–115 points, the higher the score, said that the higher the level of assign. The scale total Cronbach's coefficient was 0.923.

1.4 Data collection method

Before the start of the survey, the two participants were uniformly trained, including filling standards, survey skills, data entry specifications, etc. The purpose, significance, and confidentiality of the study were explained to the subjects before the study, and the questionnaire was issued after obtaining the informed consent of the subjects. The questionnaire was used to issue on the spot and check and recover after completion.

1.5 Statistical methods

The results were entered and analyzed using SPSS 25.0, and two results were recorded to ensure the accuracy of the data. The general data of the research subjects were statistically described by means, standard deviation, frequency, and composition ratio, t-test, one-way variance to analyze the empowerment score of the rural disabled elderly, and multiple linear regression to analyze the main influencing factors. The test level was a = 0.05.

2.1 Basic information of the survey subjects

Current score of disabled elderly: 208 disabled elderly in rural areas (55.43 ± 12.04). See Table 1. Item scores are shown in Table 2 and Table 3.

Table 1

Enability scores of 208 rural disabled elderly people (score, x ± s)‾
project	score	Project average score
Total table score	55.43 ± 12.04	2.42 ± 0.53
self-recognition	.1113 ± 3.12	2.53 ± 0.78
Individual control	10.79 ± 3.46	2.42 ± 0.59
Decision participation	9.82 ± 2.79	2.16 ± 0.70
Knowledge and understanding	10.28 ± 3.26	2.45 ± 0.69
Empower others	10.33 ± 3.03	2.26 ± 0.65

Table 2

Minimum score of disabled elderly items (score, x ± s)‾
clauses and subclauses	score	sort
I can actively manage my health status.	2.45 ± 1.12	23
I felt that I could reject the treatment decisions that the doctors had made for me.	2.15 ± 0.78	22
I felt that I could reject the treatment decisions that the doctors had made for me.	2.03 ± 0.88	21
I know how to deal with my health problems.	2.01 ± 0.92	20

Table 3

Top score of disabled elderly entry (score, x ± s)‾
clauses and subclauses	score	sort
Despite my poor health, I feel useful in my daily life	2.92 ± 0.83	1
Despite my health problems, I feel that I am actively involved in life.	2.61 ± 1.06	3
Despite my health problems, I can live a normal life.	2.59 ± 0.98	5
Despite my health problems, I still plan to do something enjoyable.	2.69 ± 1.03	2
Despite my health problems, I feel that my life is both purposeful and meaningful.	2.60 ± 0.98	4

2.2 Analysis of the factors influencing the enabling level of the disabled elderly

The results show that the level of empowerment, age, educational level, monthly income, monthly medical expenses, number of children, main sources of income, number of chronic diseases, and degree of disability, The difference was statistically significant (all p < 0.05), as shown in Table 4.

Table 4

General data and univariate analysis results of empowerment level of rural disabled elderly people (points, x ± s)‾
project	Number of cases, [n (%)]	Score (score, x ± s)	t perhaps F	p
sex			−0.482	0.630
man	121(58.2)	55.57 ± 12.23
woman	87(41.8)	54.63 ± 12.22
age			−6.901	<0.001
60-	78(25.7)	73.15 ± 12.57
70-	90(29.7)	78.46 ± 15.96
80-	120(39.6)	79.92 ± 22.74
marital status			1.954	0.052
unmarried	6(2.9)	60.67 ± 11.67
married	156(75)	54.11 ± 10.28
other	46(22.1)	57.39 ± 17.14
degree of education			19.850	<0.001
Uneducated	36(17.3)	38.47 ± 5.63
primary school	76(36.5)	53.38 ± 6.02
junior middle school	76(36.5)	58.50 ± 8.31
High school and above	20(9.6)	77.85 ± 4.75
monthly income			8.262	<0.001
<200	123(40.6)	46.35 ± 15.81
200-	116(38.2)	52.39 ± 8.98
500-	60(19.8)	54.25 ± 8.13
1000-	4(1.4)	67.97 ± 8.80
Monthly medical expenses			−4.263	<0.001
<100	37(17.8)	48.12 ± 0.83
100-	44(21.2)	61.89 ± 16.32
500-	88(42.3)	57.08 ± 6.74
1000-	39(18.8)	49.89 ± 11.36
quantity of children			−8.203	<0.001
0	8(3.8)	59.25 ± 1.03
1	20(9.6)	77.85 ± 4.75
2	80(38.5)	54.81 ± 8.40
Three or more	100(48.1)	50.29 ± 11.02
Main economic sources			2.224	<0.05
sons and daughters	86(41.3)	50.44 ± 11.52
retirement pay	73(35.1)	61.05 ± 14.14
government subsidies	41(19.7)	54.05 ± 3.96
other	8(3.8)	54.25 ± 1.98
The number of chronic diseases			−7.274	<0.001
0	37(17.8)	68.57 ± 11.07
1	83(39.9)	53.24 ± 11.75
≥ 2	88(42.3)	51.01 ± 8.73
Disability degree			−7.623	<0.001
Mild dependence	75(36.1)	62.45 ± 12.18
Moderate dependence	99(47.6)	52.45 ± 8.37
Heavy dependence	34(16.3)	12.92 ± 2.21

2.3 Multiple linear regression analysis of the empowerment level of disabled elderly people

Enabling chronic diseases, the score of the scale as the dependent variable, age, educational level, monthly income, monthly medical expenses, number of children, major economic sources, number of chronic diseases, and Disability degree As an independent variable, a multiple linear regression was analyzed by the stepwise method (α in = 0.05, α out = 0.10). The independent variables were assigned in a way as follows, as shown in Table 5. The results showed that the educational level, number of children, number of chronic diseases, and the degree of disability were the influencing factors for the empowerment level of the rural disabled elderly (p < 0.05), as shown in Table 6.

Table 5

The assignments of the independent variables
variable	Assignment description
degree of education	The dummy variable was set with "uneducated" as the control group, 1 = uneducated (Z1 = 0, Z2 = 0, Z3 = 0), 2 = primary school (Z1 = 1, Z2 = 0, Z3 = 0), 3 = junior high school (Z1 = 0, Z2 = 1, Z3 = 0), 4 = high school and above (Z1 = 0, Z2 = 0, Z3 = 1)
quantity of children	The dummy variables were set with "0" as the control group, 1 = 0 (Z1 = 0, Z2 = 0, Z3 = 0), 2 = 1 (Z1 = 1, Z2 = 0, Z3 = 0), and 3 = 2 (Z1 = 0, Z2 = 1, Z3 = 0)
The number of chronic diseases	The dummy variables were set with "0" as the control group, 1 = 0 (Z1 = 0, Z2 = 0, Z3 = 0), 2 = 1 (Z1 = 1, Z2 = 0, Z3 = 0), and 3 = 2 (Z1 = 0, Z2 = 1, Z3 = 0)
Disability degree	The dummy variable was set with "mild dependence" as the control group, 1 = mild dependence (Z1 = 0, Z2 = 0, Z3 = 0), 2 = moderate dependence (Z1 = 1, Z2 = 0, Z3 = 0), and 3 = heavy dependence (Z1 = 0, Z2 = 1, Z3 = 0)

Table 6

Multiple linear regression analysis of the factors influencing the empowerment level of rural disabled elderly people
variable	β	S.E.	β'	t	p
(constant)	39.969	8.861		4.511	<0.001
degree of education	8.935	0.773	0.646	11.553	<0.001
quantity of children	-4.042	0.716	-0.265	-5.642	<0.001
Disability degree	-3.82	0.754	-0.219	-5.068	<0.001
The number of chronic diseases	-1.541	0.735	-0.093	-2.097	<0.05

3.1 The empowerment level of the disabled rural elderly is at a medium level

This study found that the overall level of health empowerment among disabled rural elderly was moderately low. This may be related to the relatively backward economic level and poor health conditions in rural areas, although the current national emphasis on the need to empower rural public services to promote the extension of 'Internet + nursing services' to rural areas."^[13], However, under the influence of the urban-rural dual structure in China, there is a big gap between urban and rural health services in resource allocation and service quality^[14]Therefore, it is considered that domestic rural medical personnel have an insufficient understanding of empowerment and less implementation of empowerment skills in the supply of health services. The average score rates for each dimension were highest for self-identification, followed by individual control, knowledge and understanding, empowerment of others, and decision participation. The self-identification score is the highest, and the possible reason is that the disabled elderly have accepted their patient status, recognized their sick role, and started to find new meaning in life due to their long-term disease state. This may be related to the fact that the disabled old people included in this study have received some positive psychological education from relevant professionals^[12]To gradually accept their disabled status from the deep heart; second, because the family caregivers mainly provide positive support to the disabled elderly in daily life and emotional companionship^[15], Old people expect to be recognized by the society, which makes them find their own value and meaning of life. This hints in the future intervention should pay attention to this phenomenon, on the one hand, shows that disability the old man is willing to accept his identity, and accept change, these are the basis of fu intervention can implement and maintain, on the other hand, it is also digging the potential of positive behavior, should pay attention to maintain and strengthen, through active intervention means mining its active participation in their health management potential, play its subjective initiative. The decision participation dimension score is relatively low. Studies have shown that while the current disabled elderly people recognize the vulnerability and dependence of their physical function, they are also extremely eager to have the ability to make independent decisions^[16]. However, due to the weak health awareness of the disabled elderly in rural areas and the caregivers often take the disabled elderly passively as the leader, it is difficult to participate in their own medical decisions^[17]. Therefore, in the future empowerment intervention, we should consider strengthening this weak point, reducing paternalistic " excessive care, establishing an independent and independent life circle for the disabled elderly, and enhancing the health knowledge of the disabled elderly. It is suggested that medical staff promote patient participation in decision-making and better health outcomes through shared communication.

3.2 Education level

This study showed that the higher the educational level, the higher the empowerment level of the disabled elderly. The reasons may be that the elderly with higher education level have stronger learning ability and are more motivated to actively accept and learn health knowledge. Studies have proved that patients with a high level of health knowledge have better health conditions, because good knowledge can help patients to understand the disease correctly, and then implement health behaviors^[18]. At the same time, health knowledge is an important factor in balancing the doctor-patient relationship, enabling patients to judge when they can act autonomously and when without physician guidance^[19]. Therefore, a high level of empowerment requires corresponding health knowledge, literacy and skills. Medical staff should regard the provision and support of knowledge as the early guarantee of empowerment, not only a simple notification during treatment, but also a systematic dissemination of health knowledge in a prepared, planned and strategic way. In the empowerment intervention for the disabled rural elderly, individual differences among different participants should be considered to promote mutual communication and sharing among the elderly. Health service personnel can help the disabled rural elderly to establish common trait groups to achieve mutual empowerment.

3.3 Number of children

This study shows that the more the number of children, the lower the empowerment level of the disabled elderly, compared with Pan Shuo^[20]The opposite findings of et al. The reasons may affect the lack of professional knowledge and technical ability of the rural disabled elderly caregivers^[21], Ignoring the attention to the disabled elderly'the initiative to maintain their own health from the subject, and thus affecting the quality of care. In addition, at present, the caregivers of the disabled elderly in rural areas are mainly children, and if the caregivers excessively intervene and arrange the life of the elderly through top-down care, and seriously neglect their dignity and autonomy, it will have a negative impact on the empowerment level of the elderly^[22]. Research shows that in the traditional "giving care" mode, there are excessive behavioral restriction and excessive emotional giving for the disabled elderly. However, too strict and compact arrangements and activities will weaken the initiative of the disabled elderly^[23]. Therefore, caregivers should provide care for disabled elderly people with sufficient private space, full understanding and respect, and the opportunity to make joint decisions. For disabled elderly people who are increasingly dependent on their role due to illness or physiological aging, caregivers should be encouraged to perform their own daily activities. In conclusion, when the disabled elderly can make decisions and actively participate, it is helpful to stimulate them to obtain key information to match their personal life wishes, to actively pay attention to and decide on their own health problems.

3.4 Number of chronic diseases

The results of this study showed that the disabled elderly with more types of chronic diseases. The reasons may be that the disabled elderly with more types of chronic diseases often face many health problems, such as rapid decline in physical function and quality of life, increased risk of frailty, and cross-occurrence of chronic disease symptoms^[24], Soares believes that health status is related to stress management capacity related to health empowerment, and that relatively good health status is a prerequisite for performing disease self-management^[25]Therefore, due to the influence of this factor, the disabled elderly may have negative emotions towards the people and things around them, and are prone to the problems of psychological maladjustment^[26], Thus, it is difficult to adopt effective health management behaviors. In conclusion, medical staff to understanding of that old man can also should see different health conditions, in building fu can intervention program, should put the part of the disability of the elderly as the focus on object, for different chronic diseases or chronic disease comorbidity characteristics personalized support plans, regularly in grassroots health institutions and disability family to carry out chronic disease prevention knowledge education and psychological counseling activities, and the disease progress and health factors should pay attention to the important role, directly or indirectly improve their health, and motivate disability the elderly actively take healthy behavior, actively deal with their own condition.

3.5 Degree of disability

The results of this study indicate that the higher the disability of the community elderly, the lower the empowerment level. The reasons may be that with the increase of disability, the worse the self-care ability, the more their families need to spend time to take care of them, and their psychological burden increases^[27]Therefore, the elderly are prone to negative emotions that hinder their active health management behaviors. When the elderly body function is damaged, the social collective activities, with colleagues, friends, neighbors, relatives interaction frequency decline, thus gradually fade out once social circle, subjective social support, the formation of social self closed and social support network, lead to lack of social, spiritual emptiness^[28]. When disabled elderly people experience significant changes in their social roles and interpersonal relationships, they may cause psychological problems such as anxiety and depression, and inhibit their active participation in health-promoting behaviors^[17]. This suggests that families and society should pay special attention to the elderly with high disability level, help them establish correct health awareness in the future empowerment intervention, guide the elderly to participate in daily social activities and self-care, constantly enhance confidence in rehabilitation and relieve negative emotions^[29], Changing from passive empowerment to self-empowerment.

To sum up, the empowerment status of disabled elderly people in rural China is in the middle, among which the self-recognition dimension scores the highest. The education level, the number of children, the number of chronic diseases and disability are independent factors, so encouraging the elderly to actively participate in their health management, for different disabilities can improve their health status will be an important measure, due to time constraints, the study only for Henan parts of the township village disability the old man, so the representative of the conclusion may be limited, follow-up will be multicenter, large samples, to be more in-depth and comprehensive understanding of the rural disability of the old man can assign level.

Acknowledgements

Not applicable.

Authors’ contributions

Li XZ is conceived of the study, Zhang HZ and Yan YW participated in its design, data analysis, and statistics, and Zhang Y helped draft the manuscript. All authors read and approved the final manuscript.

Funding

This study did not receive any funding in any form.

Data Availability

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of School of Nursing and Health Zhengzhou University. Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Analysis of the empowerment of Disabled elderly people in rural areas in Henan province: a survey

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Abstract

Introduction

Objects and Methods

1.1 Selection of survey respondents

1.2 Sample size calculation

1.3 Study tools

1.4 Data collection method

1.5 Statistical methods

Findings

2.1 Basic information of the survey subjects

2.2 Analysis of the factors influencing the enabling level of the disabled elderly

2.3 Multiple linear regression analysis of the empowerment level of disabled elderly people

Discussion

3.1 The empowerment level of the disabled rural elderly is at a medium level

3.2 Education level

3.3 Number of children

3.4 Number of chronic diseases

3.5 Degree of disability

Summary

Declarations

References

Additional Declarations

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