Predictors of rehospitalization for community-dwelling older adults with chronic heart failure: A structural equation model.

Abstract:

AIMS:To examine the effects of health literacy, activities of daily living, frailty and self-care on rehospitalization for older adults with chronic heart failure using a structural equation model. DESIGN:This was a cross-sectional study. METHODS:Two hundred and seventy-one older patients with chronic heart failure were recruited using a convenience sampling method from three community healthcare centres in Guangzhou, Southern China. The data were collected using a questionnaire survey between April 2018 and October 2018 by three research assistants. FINDINGS:The proposed model revealed a good fit to the data (χ2 /d.f. = 2.39, root mean square error of approximation = 0.06, goodness of fit index = 0.93, comparative fit index = 0.91, normed fit index = 0.91). Health literacy (β = 0.21), activities of daily living (β = 0.43), frailty (β = 0.29) and self-care (β = 0.40) directly affected the rehospitalization of older patients with chronic heart failure. Health literacy (β = 0.19), activities of daily living (β = 0.36) and frailty (β = 0.33) indirectly affected rehospitalization through self-care. Frailty (β = 0.16) indirectly affected rehospitalization by activities of daily living. Activities of daily living had the highest direct and total effects on rehospitalization; the effect values were 0.43 and 0.57, respectively. CONCLUSION:Community-dwelling older adults with chronic heart failure who had limited health literacy, frailty, declined activities of daily living and lower self-care were eligible for rehospitalization. Self-care and activities of daily living were considered mediators between rehospitalization and its predictors. A future longitudinal study is required to validate the results. IMPACT:Tailored and targeted measures aiming to enhance self-care and activities of daily living have been developed for older patients with chronic heart failure because they are not only predictors but also mediators. Assessment of health literacy level of this population is the first step before developing health education. Frailty of patients with chronic heart failure should be reduced to a minimum level. :目的: 利用结构方程模型来探讨健康素养、日常生活活动、虚弱程度和自我护理对患有慢性心力衰竭的老年人再住院的影响。 设计: 本项研究为横向研究。 方法: 采用便利抽样法从中国南方城市广州三家社区卫生服务中心招募271名慢性心力衰竭老年患者进行调查。数据收集由三名研究助理于2018年4月至2018年10月期间通过问卷调查方式进行。 发现结果: 所建模型与数据拟合良好(χ2/d.f.=2.39,近似均方根误差=0.06,拟合优度指数=0.93,比较拟合指数=0.91,标准拟合指数=0.91)。健康素养(β=0.21)、日常生活活动(β=0.43)、虚弱程度(β=0.29)和自我护理(β=0.40)均对慢性心力衰竭老年患者的再住院有直接影响。健康素养(β=0.19)、日常生活活动(β=0.36)以及虚弱程度(β=0.33)通过自我护理对再住院有间接影响。虚弱程度(β=0.16)通过日常生活活动间接影响再住院。日常生活活动对再住院的直接影响和总影响最大,影响值分别为0.43和0.57。 结论: 那些健康素养低、身体虚弱、日常生活活动较少且自我护理能力低下的居住在社区的慢性心力衰竭老年患者适宜再进医院进行治疗。自我护理和日常生活活动被认为是再住院与其预测因素之间的中介因素。未来还需开展纵向研究来验证结果。 影响: 针对慢性心力衰竭老年患者制定了旨在加强自我护理能力和增加日常生活活动的量身定制的措施,因为这些措施不仅是预测因素,而且也是中介因素。在开展健康教育之前,首先应对这一人群的健康素养水平进行评估。慢性心力衰竭患者的虚弱程度应降至最低水平。.

journal_name

J Adv Nurs

authors

Ma C,Zhou W

doi

10.1111/jan.14327

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

1334-1344

issue

6

eissn

0309-2402

issn

1365-2648

journal_volume

76

pub_type

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