Factors associated with health discussion network size and composition among elderly recipients of long-term services and supports.
Factors associated with health discussion network size and composition among elderly recipients of long-term services and supports.
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DOI：
10.1080/10410236.2011.640975
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发表时间：
2012
影响因子：
3.9
通讯作者：
Hirschman KB
中科院分区：
文献类型：
--
作者：
Abbott KM;Bettger JP;Hanlon A;Hirschman KB
社交网络在帮助老年人监测症状和管理慢性病方面发挥着重要作用。人们通过口头讨论来理解症状、确定其严重性并决定是否寻求医疗护理。在这项研究中，随着时间的推移，对接受长期服务和支持 (LTSS) 的老年人中被称为健康讨论网络 (HDN) 的特定问题社交网络进行了检查。数据收集自最近搬入疗养院 (NH) 或辅助生活设施 (ALF) 或已开始接受家庭和社区服务 (H&CBS) 的老年人。 LTSS 接受者确定了与他们讨论症状或疾病信息的人，讨论了他们的医生所说的话，并考虑咨询其他医疗保健提供者。对 216 名简易精神状态检查 (MMSE) 基线分数为 20 或更高的成年人进行了数据分析，并在 12 个月的时间内对这些人进行了季度访谈。使用广义估计方程 (GEE) 对 HDN 大小和组成的重复测量进行建模，将其作为基线年龄、性别、种族、民族、婚姻状况、教育、生活质量、环境、成年子女数量和认知状态的函数。 GEE 模型表明，HDN 的规模随着时间的推移而减小 (p=.01)，并且提及正规护理提供者作为该网络一部分的概率随着时间的推移而增加 (p=.003)。 HDN 大小增加的多变量预测因素是生活质量评级较低 (p=.001)、成年子女较多 (p=.04) 以及控制协变量后较高的 MMSE 评分 (p<.0001)。新接受 LTSS 的老年人的 HDN 相对较小，是混合网络，包括家人、朋友和正规护理提供者。这表明有机会进行旨在维持和增强家庭成员以外的老年人 HDN 的干预措施。
Social networks play an important role in helping older adults monitor symptoms and manage chronic conditions. People use verbal discussions to make sense of symptoms, determine their seriousness, and decide whether to seek medical care. In this study, problem-specific social networks called health discussion networks (HDNs) are examined over time among older adults receiving long-term services and supports (LTSS). Data were gathered from older adults who had recently moved into a nursing home (NH) or assisted-living facility (ALF) or who had started to receive home and community-based services (H&CBS). LTSS recipients identified people with whom they discussed symptoms or disease information, talked over what their physician said, and considered consulting other health-care providers. Data were analyzed for 216 adults with Mini Mental State Examination (MMSE) baseline scores of 20 or higher, and these individuals were interviewed quarterly over a 12-month period. Generalized Estimated Equations (GEE) were used to model repeated measures of HDN size and composition as a function of baseline age, gender, race, ethnicity, marital status, education, quality of life, setting, number of adult children, and cognitive status. GEE modeling demonstrated that HDN size decreased over time (p=.01) and that the probability of mentioning formal care providers as part of that network increased over time (p=.003). Multivariate predictors of increased HDN size were lower ratings of quality of life (p=.001), having more adult children (p=.04), and higher MMSE scores (p<.0001) after controlling for covariates. Older adults new to receiving LTSS had relatively small HDNs that were mixed networks including family, friends, and formal care providers. This suggests an opportunity for interventions aimed at maintaining and enhancing the HDNs of older adults beyond family members.