Selected determinants of health behaviour of people aged over 65

Transkrypt

● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.3/2016 ●
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 3/2016 (20-26)
Selected determinants of health behaviour of
people aged over 65
(Wybrane czynniki determinujące poziom zachowań zdrowotnych osób
powyżej 65 roku życia)
G J Nowicki1,D, M Młynarska2,A, B Ślusarska1,E,F, P Rzońca2,D,B , M Kotus3,C, A Zagaja4,D
Abstract – Introduction. Factors influencing successful ageing,
i.e. ageing free from diseases common in the old age, include
selected life style determinants. One of the categories of human
behaviours, which constitutes the style of life and determines its
quality, is health behaviours.
The aim of the study. The assessment of the level of health behaviours of people aged over 65, depending on selected factors
such as: the feeling of pain, the limitation of functional capacity,
comorbidity and the self-evaluation of one’s health state.
Materials and Methods. The study was conducted from July to
September 2013, on 505 people aged 65 and older in 5 randomly
selected Primary Health Care (POZ) facilities located in the
Lubelskie voivodeship. In order to assess the level of health behaviours and the four categories thereof, Juczyński’s Health Behaviours Inventory (Inwentarz Zachowań Zdrowotnych, IZZ) was
used.
Results. The evaluation of the level of health behaviours for the
studied group of people aged over 65 showed the average IZZ of
76.49 points (SD = 15.94). 43.17% (n = 218) of the respondents
had a low level of health behaviours (1-4 sten), 36.43% (n = 184)
an average level (5-6 sten), and only 20.40% (n = 103), a high
level (7-10 sten). Statistical analysis has revealed that the level of
the declared health behaviours of people above 65 years of age
depended on the perception of pain (p <0.001), reduced mobility
(p <0.001), comorbidities (p <0.001) and the self-assessment of
one’s health (p <0.001).
Conclusions. Among people over 65 years of age, a lower level
of health behaviours was affected by the declared level of pain,
the reduction of mobility, comorbidities, and low and very low
self-perceived health. Seniors from the studied group, in more
than 43%, received low scores of health behaviours, which indicates that the analyzed factors are important in the development
thereof.
Key words – health behaviours, the elderly, comorbidity, pain,
reduced mobility.
Streszczenie – Wstęp. Czynnikami wpływającymi na pomyślne
starzenie się, rozumiane jako starzenie wolne od chorób, które
najczęściej występują w wieku podeszłym, są niektóre elementy
stylu życia. Jedną z kategorii zachowań człowieka, która składa
się na styl życia i decyduje o jego jakości, są zachowania zdrowotne.
Cel pracy. Ocena poziomu zachowań zdrowotnych osób powyżej
65 roku życia w zależności od wybranych czynników takich jak:
odczuwanego bólu, ograniczenia sprawności funkcjonalnej, wielochorobowości oraz samooceny stanu zdrowia.
Materiał i metoda.Badania przeprowadzono od lipca do września
2013 r. wśród 505 osób w wieku powyżej 65 roku życia w losowo wybranych 5 jednostkach Podstawowej Opieki Zdrowotnej
(POZ) na terenie województwa lubelskiego. W celu oceny poziomu zachowań zdrowotnych i ich czterech kategorii posłużono
się Inwentarzem Zachowań Zdrowotnych (IZZ) wg, Juczyńskiego.
Wyniki.W ocenie poziomu zachowań zdrowotnych dla badanej
grupy osób powyżej 65 roku życia średnia IZZ wyniosła 76,49
pkt. (SD=15,94). 43,17% (n=218) badanych miało niski poziom
zachowań zdrowotnych (1-4 sten), 36,43% (n=184) respondentów miało przeciętny poziom zachowań zdrowotnych (5-6 sten),
natomiast tylko 20,40% (n=103) wysoki (7-10 sten). Analiza
statystyczna pozwala stwierdzić, że poziom deklarowanych zachowań zdrowotnych osób powyżej 65 roku życia zależy od odczuwania bólu (p<0,001), występowania ograniczeń sprawności
(p<0,001), liczby schorzeń (p<0,001) oraz samooceny stanu
zdrowia (p<0,001).
Wnioski. Wśród osób powyżej 65 roku życia niższy poziom zachowań zdrowotnych determinowany jest deklarowanym stanem odczuwanego bólu, ograniczeniami sprawności funkcjonalnej, wyższym stopniem wielochorobowości oraz złą i bardzo złą
samooceną stanu zdrowia. Seniorzy w badanej grupie w ponad
43% uzyskali niskie wartości zachowań zdrowotnych, co wskazuje, że analizowane czynniki mają istotne znaczenie w kształtowaniu ich poziomu.
Słowa kluczowe – zachowania zdrowotne, ludzie starsi, wielochorobowość, ból, ograniczenie sprawności.
Author Affiliations:
20
1. Community Nursing Unit, Chair of Oncology and Environmental Health, Medical University of Lublin
2. Department of Expert Medical Assistance with Emergency Medicine Unit, Medical University of Lublin
3. Department of Anaesthesiological and Intensive Care
Nursing, Medical University of Lublin
4. Department of Ethics and Human Philosophy, Medical
University of Lublin
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Grzegorz Józef Nowicki, DHSc, Department of Family Medicine
and Community Nursing, Chair of Oncology and Environmental
Health, Faculty of Health Sciences, Medical University of Lublin,
Staszica 6 Str., PL-20-081 Lublin, Poland, e-mail: [email protected]
Accepted for publication: July 2, 2016.
I.
INTRODUCTION
emographic ageing of the world’s population is a
global process. Currently, the world’s average life
expectancy is over 60 years, with the Japanese and the
Australians living the longest (82.2 and 80.6 years respectively) [1]. In Europe, the longest life expectancies are attributed to the French and the Swedes, being 80.6 years on
average in both cases, followed by the Italians – 79.9, the
Greeks – 79.3, the Dutch – 79.1 and the Germans – 78.9
[2]. It is predicted that from 2005 to 2050, Europe will
experience an increase in the number of people aged over
eighty by 43 million, and at the same time, there will be a
significant decrease in the number of young people [3].
This problem also applies to the situation in Poland, although, according to the Eurostat data from 2010, Poland it
is one of the "youngest" countries and occupies the 8th
place in the ranking by the level of demographic old age
[4]. The process of ageing is influenced by various determinants including social, demographic, cultural, economic,
genetic, and health factors. The most important determinant of health is lifestyle and associated health behaviours
[5].
D
A healthy lifestyle is essential in any age group, and for
the elderly who have led an unhealthy lifestyle so far, it is
of particular significance. The very concept of "lifestyle" is
one of the basic social categories, allowing to describe the
way people live, their behaviours, standards, customs and
culture. A healthy lifestyle, according to public health specialists, is a combination of all actions undertaken by individuals, aimed at maintaining and improving their health
and preventing diseases. Actions characteristic of this type
of lifestyle comprise four basic factors: proper nutrition,
avoiding alcohol and nicotine, regular physical activity,
and avoiding stress [6-12].
Old age in the context of the entire course of the human
life is its last stage and it should be considered from various perspectives, including the biological, psychological
and social one. In the biological context, this period can be
associated with the gradual decline in mobility, the deterioration of organs and of system functioning, and increased
pain. All of these lead to weakness and the impairment of
bodily functions, resulting in the inability to adjust to
changing external and internal environment [13]. What is
more, these natural processes can directly affect the health
behaviours undertaken by seniors.
The aim of the study was to assess the level of health
behaviours of people aged over 65, depending on selected
factors such as: pain, mobility constraints, comorbidities
and the evaluation of one’s own health.
II.
MATERIAL AND METHODS
A survey was conducted from July to September 2013
on 505 people over 65 years of age who were patients of 5
Primary Health Care Outpatient Clinics (POZ) located in
the Lubelskie voivodeship (Poland); 3 of the clinics were
located in the Lublin district (the Non-Public Health Care
Institution ANI-MED, tbe Non-Public Health Care Institution UNI-MED and the Specialist Outpatient Department
for Rural Occupational Diseases located in the Institute of
Rural Health) and two institutions were outside of Lublin
(the Non-Public Outpatient Centre in Turobin and the NonPublic Outpatient Centre Goraj in Goraj).
The patients were recruited on a random basis from persons over 65 years of age who reported to the clinics. Only
those respondents were chosen for the study who – having
been provided with full information about the purpose of
the study and the study methods – consented to participate.
The research was carried out using the method of diagnostic survey, with the application of Z. Juczyński’s Health
Behaviour Inventory (IZZ) [14].
21
The tool consists of 24 items defining various types of
health-related behaviours and the item 25 defined as "other", where a respondent can provide their own assertions
that have been not mentioned in the items before. For each
statement, respondents assign a specific number depending
on how the information applies to them: 1 – almost never;
2 – rarely 3 – from time to time; 4 – frequently; 5 – almost
always. By analysing the frequency of various behaviours
indicated by the respondents, it is possible to determine the
intensity of behaviours conducive to health and the importance of the four health categories i.e. correct eating
habits, prophylactic measures, health practices, and a positive mental attitude [14]. Among healthy eating habits, the
research tool recognizes the type of food eaten by respondents e.g. the frequency of consuming whole-grain breads,
fruit and vegetables, salt or the avoidance of e.g. food with
preservatives, etc. Prophylactic measures include adhering
to doctors’ orders and obtaining information on health and
diseases. Health practices, in turn, include everyday behaviours such as sleep, physical activity and recreation. In
terms of a positive mental attitude, the following criteria
were considered: avoiding too strong emotions, stress,
strains, and depressing situations. Because of the fact that a
variety of health behaviours must have occurred in their
lifetime, the respondents were asked to take only the past
year into account.
The obtained results were counted in order to receive an
overall rate of health behaviours intensity. The values
ranged between 24 and 120 points and the higher the score,
the higher the level of the declared health behaviours. Afterwards, the results were translated into sten scores as
suggested by the authors of the tool.
The respondents were also asked about: the feeling of
pain (yes/no), reduced mobility (yes/no), the number of
chronic conditions, and additionally, they were asked to
assess the state of their heath on a 5-point scale: excellent,
good, decent, bad, and very bad.
The obtained results were statistically analysed. The
values of the analysed measurable parameters were expressed with mean values and standard deviations and the
non-measurable ones – with frequencies and percentages.
Prior to the study, the project had received a positive
opinion of the Bioethical Commission of the Medical University of Lublin, number: KE-0254/242/2012.
To test for differences in the measurable parameters between two groups, the Mann-Whitney U test was applied
and for more than two groups the Kruskal-Wallis test
along with the post hoc NIR test was used. The level of
significance was established at p <0.05 indicating the existence of statistically significant differences or dependen-
cies. The database and statistics were based on the Statistica 9.1 computer software (StatSoft, Poland).
III. RESULTS
Characteristics of the studied group
The study group consisted of 62.38% (n = 315) women
and 37.62% (n = 190) men, the majority of them were city
residents – 65,94% (n = 333). The age structure of the respondents was as follows: 65-75 years with 243 respondents (48.12%), 76-85 with 166 respondents (32.87%), and
in the oldest age group, i.e. those above 85 years of age,
there were 96 respondents (19.01%). The persons with
higher and secondary education accounted for 50.49% (n =
255) of the respondents, while those with vocational, primary and no education –for 49.51% (250 respondents).
51.29% (n = 259) of the respondents admitted experiencing pain, while 61.19% (n = 309) admitted feeling reduced physical mobility. Out of all the respondents, the
majority claimed to have from 1 to 3 diseases – 246 persons (48.71%), and the rest had 4 and more diseases – 229
persons (45.34%). 30 respondents declared that they were
healthy (5.94%). In the self-assessment of the health quality, the majority of seniors stated that it was either very bad
or bad – 214 (42.38%). Those who assessed their health as
decent represent the second most numerous group, with
167 respondents (33.07%). It should be noted, however,
that the term "decent" does not mean good. Only 124 respondents (24.56%) declared their health to be good or
very good. Detailed data have been presented in Table I.
Table I. The distribution of the analysed variables among
the respondents
Variable
Pain
Mobility limitations
The number of diseases
Self-evaluation of the
respondents’ state of
health
Yes
No
Yes
No
No diseases
1-3 diseases
4 and more diseases
Very good/good
Decent
Bad/very bad
N
259
246
309
196
30
246
229
124
164
214
%
51.29
48.71
61.19
38.81
5.94
48.71
45.34
24.55
33.07
42.38
The level of seniors’ health behaviours
22
The results have revealed that the assessment of health
behaviours for the studied group has the average IZZ of
76.49 points. (SD = 15.94). In terms of standardized units,
out of 505 respondents, 43.17% (n = 218) achieved a result
within 1-4 sten, which is considered a low score; 36.43%
(n = 184) received a score of 5-6 sten, which is an average
value; and only 20.40% (n = 103) of the respondents reported a high level of health behaviours (7-10 sten).
In the analysis of individual categories of health behaviours, it has been discovered that the highest rates were
attributed to prophylactics (average: 20.44 pts., SD = 5.23)
and health practices (average: 19.06 pts., SD = 4.09), and
the lowest rates were attributed to a positive mental attitude (average: 18.66 pts., SD = 4.84) and proper eating
habits (average: 18.33 pts., SD = 5.33).
Health behaviours of the respondents and selected variables
Statistical analysis has revealed a statistically significant
relationship between the stated perception of pain or lack
thereof and the level of health behaviours (p <0.001). The
respondents who declared no pain achieved a higher score
in the overall rate of health behaviours and in two categories: proper eating habits and positive mental attitude, as
compared with those who suffered from pain. Detailed data
have been presented in Table II.
Tabela II
The analysis of health behaviours depending on mobility
limitations or the lack thereof has led to the conclusion that
there are statistically significant differences in the overall
level of health behaviours and three categories (p <0.05).
Those who did not experience mobility limitations obtained higher scores in the general level of health behaviour (p <0.001) and in the following categories: correct
eating habits (p <0.001), prophylactics (p = 0.001), and a
positive mental attitude (p <0.001). The results have been
presented in Table II.
Similar observations were made when analysing the
number of declared maladies against the level of health
behaviours. With the increase of the declared number of
diseases, the assessment of the overall health behaviours
and their four categories decreased (p <0.001). Detailed
data have been presented in Table II.
Another analysed variable was the self-assessment of the
health quality. A statistically significant difference in the
overall level of health behaviours and their four categories
depending on the self-declared state of health has been
revealed (p <0.05). In general, one may state that the higher the self-evaluation of the health quality, the higher the
overall level of health behaviours and their four categories.
Detailed data have been presented in Table II.
IV.
DISCUSSION
Ageing is a complex and inevitable process that covers
many interrelated levels. To obtain an overall picture of
this process, in addition to experimental research in the
field of biological sciences aimed at explaining the mechanisms of ageing, equally important considerations need to
be undertaken with respect to social and psychological
aspects. In recent years, there has been a growing interest
in this stage of life, which, undoubtedly, is closely related
to the increase in the number of people over 65 years of
age. Therefore, a multilateral analysis of the process of
ageing, based on interdisciplinary research in the field of
biology, medicine, pedagogy, psychology or sociology,
seems fully justified [15,16]. The interest of gerontologists
focused on the process of ageing and the living conditions
of the elderly, together with the obtained knowledge enable
to create a better future for seniors. Because ageing may
occur in different ways, and the process depends on a large
number of factors, its explanation still remains a major
challenge for future researchers [17]. What influences successful ageing, understood as a life free from diseases, are
certain lifestyle factors. One of the categories of human
behaviours, which constitutes the style of life and determines its quality, is health behaviours [18]. The studied
problems related to seniors and concerning their health
behaviours are a part of a growing demand for studies devoted to the elderly. The paper has been focused on important issues associated with the process of ageing, including the impact of pain, the limitations of mobility, the
existence of multiple diseases and the influence of the state
of health on health behaviours of people over 65 years of
age.
Pain is a natural, subjective, negative and a very complex reaction to sensory stimuli. It is associated with actual
or potential tissue damage. Experiencing chronic pain is
associated not only with the emotions and suffering of the
person directly concerned, but also of the closest environment. Chronic pain is more common in the elderly; however, it is not a symptom of the normal process of ageing.
Pain increasing with age should be attributed to the coexistence of multiple chronic diseases, which is typical of old
age [19]. In a study conducted by Kozak-Szkopek et al. on
two groups of respondents: 716 persons aged 55-59, and
4979 persons over 65, the prevalence of chronic pain was
greater
23
Table II. The influence of selected variables on the declared health behaviour of the respondents
The level
of health
behaviours
Variables
Pain
The feeling of
pain
Statistical
analysis
Proper
eating
habits
Statistical
analysis
17.32
Prophylactic behaviours
Statistical
analysis
20.01
Positive
mental
attitude
Statistical
analysis
17.78
Health
practices
18.73
M
73.85
SD
15.63
M
79.27
SD
15.82
5.61
5.13
4.51
4.11
M
73.21
17.17
19.74
17.59
18.72
SD
15.43
M
81.66
SD
15.38
5.59
5.03
4.36
4.11
M
89.87
21.60
23.23
22.40
22.63
SD
13.80
4.91
4.64
3.35
3.27
M
79.25
SD
15.78
M
71.78
17.07
19.36
16.93
18.41
SD
14.68
5.16
5.36
4.04
3.83
M
84.18
21.09
21.51
21.56
20.02
SD
13.54
5.06
4.63
3.53
4.05
M
78.26
SD
15.67
M
70.65
16.50
19.43
16.41
18.31
SD
15.26
5.02
5.63
4.30
4.01
ZA / tB=
-3.869;
p<0.001*
4.85
19.39
ZA / tB=
-4.306;
p<0.001*
5.30
20.89
ZA / tB=
-1.883;
p=0.060
4.97
19.58
Statistical analysis
ZA / tB=
-4.782;
p<0.001*
4.06
ZA / tB=
-1.850;
p=0.065
19.41
Self-evaluation of respondents’ state
of health
The number of diseases
mobility constrains
No pain
Mobility
limitations
No mobility limitations
No diseases (I)
1-3 diseases (II)
4 and
more
diseases
(III)
Very
good/
good (I)
Decent
(II)
Bad/ very
bad(III)
Z=-5.401;
p<0.001*
H=46.490;
p<0.001*
(RM: I-II.
I-III. IIIII)
H=54.971;
p<0.001*
(RM: I-II.
I-III. IIIII)
4.82
20.17
19.11
5.24
18.63
5.00
Z=-6.069;
p<0.001*
H=29.218;
p<0.001*
(RM: I-II.
I-III. IIIII)
H=54.209;
p<0.001*
(RM=I-II.
I-III. IIIII)
5.24
21.54
21.10
4.95
20.93
4.90
Z=-3.460;
p=0.001*
H=17.944;
p<0.001*;
(RM=IIII. II-III)
H=8.841;
p=0.012*
(RM: IIII)
4.82
20.35
19.82
5.07
19.40
4.96
Z=-6.415;
p<0.001*
H=63.220;
p<0.001*
(RM=I-II.
I-III. II-III)
H=100.066;
p<0.001*
(RM=I-II.
I-III. II-III)
4.06
Z=-1.469;
p=0.142
19.60
H=26.87;
p<0.001*
(RM=I-II.
I-III)
19.23
4.19
H=9.984;
p=0.007*
(RM: IIII)
19.31
4.07
M – mean. SD – standard deviation. Z –Mann–Whitney U test results . H –Kruskal–Wallis test results. p- the level of statistical significance. RM – intergroup differences. AMann–Whitney U test analysis. B Student T test analysis
24
in the persons over 65 , as compared to the 55-59 age
group (41.6% and 35.1% respectively) [20].
Musculoskeletal pain syndromes are the most common
type of chronic pain [21] (also in the population of people
over 65); however, the signs and symptoms from the osteoarticular system do not appear suddenly or accidentally.
Many predisposing factors are associated with certain unhealthy behaviours, or the type of work performed. These
include the lack of physical activity, overweight, sedentary
lifestyle – combined together especially in sedentary, mental work, or too intense exercise and prolonged overload
for some occupations, e.g. farmers. The study has revealed
that the respondents who did not feel pain obtained significantly higher scores in the overall health behaviours level
and in the following categories: proper eating habits, and a
positive mental attitude.
The mobility of the elderly depends on the process of
ageing, the occurrence of various diseases, lifestyle, and
socio-environmental and psychological factors taking effect in their lifetime. The capability of self-care, which
decreases with age, increases the demand for different
types of care. That is why elderly and disabled persons
frequently need special nursing care.
The care for such people is aimed at assisting in maintaining the independence from others, general support, and
care in diseases [22]. The capability of self-care, or functional capacity, should be understood as the independence
from others in satisfying the basic necessities of life, which
include: movement, nutrition, the control of bodily functions, and maintaining personal hygiene [23]. In our study,
the persons aged over 65 reporting no mobility restrictions
achieved higher scores in the overall rate of health behaviours as well as the following categories: proper eating
habits, preventive behaviours and a positive mental attitude
than those who experienced reduced mobility.
The coexistence of various diseases is a common geriatric problem. It entails the need for concurrent use of multiple medications, and the use of multiple drugs may in turn
increase the risk of side effects. The phenomenon of using
too many drugs is intensified by the patients themselves,
who, out of the desire stay fit and healthy, expand the
standard treatment with drugs sold without prescription
believing that because they are sold without prescription,
they are safe and have no side effects, which is not true
[24]. Over 50% of elderly people suffer from three or more
chronic diseases, the accumulation of which creates an
individual image of the patient's health. The occurrence of
many diseases at the same time is associated with higher
rates of death, disabilities, adverse events; it is also associ-
ated with the necessity of increased medical care, the institutionalization of care and lower quality of life [25]. Our
study has revealed that along with the increase of the number of declared illnesses, the assessment of the overall level
of health behaviours and their four categories decreased.
Self-assessment of health as a subjective assessment of
an individual’s state of health affects the level of activity,
maintaining social contacts, the way of coping with stress
and self-acceptance. [26] The lower the subjective evaluation of one’s state of health, the lower the individual’s activity and the poorer social contacts. People with higher
health self-esteem are not only more active, but they also
have more plans for the future and are more satisfied with
life. The feeling of good health has a positive impact on
the overall assessment of seniors’ situation. It turns out that
activity of the elderly depends to a great extent on a subjective health perception, not a medical diagnosis [27].
What is more, the research conducted by Switała [28]
among respondents aged over 65 has revealed that selfevaluation of health also influences consumer behaviours.
The lower the respondents evaluated their health, the more
often they expressed a negative opinion about its impact on
their purchasing activity. In our study, with the increase in
the self-assessment of the health status, the overall level of
health behaviours and their four categories increased as
well.
V.CONCLUSIONS
Among persons aged over 65, a lower level of health
behaviours was determined by a declared feeling of pain,
functional capacity constraints, comorbidities, and poor
and very poor self-perceived health. Over 43% of the seniors in the studied group received low scores of health behaviours level, which indicates that the analysed factors are
important in shaping these behaviours.
VI.
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