老年居家不出人群6年后转归及自我效能干预对心理的影响

The Natural Variances of Homebound Elderly after a Six- years Follow- up and Effect of Self-efficacy Intervention on Psychological State

目的探讨老年居家不出人群6年后自然转归及自我效能干预对老年居家不出者心理状况的影响。方法 2006年对唐山市5个社区275人的居家不出状态进行调查,2012年采用一般状况调查表、健康自评、孤独自评、老年抑郁评价量表简本(GDS-15)再次对发生居家不出的275人进行随访研究;对随访结果仍为居家不出的人群随机分为对照组和干预组,对照组给予常规健康教育,干预组在健康教育基础上给予自我效能理论指导下的综合心理干预,6个月后再次用健康自评、孤独自评、老年抑郁评价量表简本进行评价。结果随访时5人失去联系,81人已故,43人发生卧床,147人得到随访。随访时间间隔(72.3±0.6)个月,62名老年人仍然为居家不出状态。自我效能干预6个月后,干预组与对照组在健康自评(χ2=8.422,P<0.05),孤独感(χ2=7.643,P<0.05)、抑郁(t=11.182,P<0.05)等方面相比,差异有统计学意义。结论老年居家不出状态自然转归较差,但也有一定的可逆性。应用自我效能理论对居家不出者进行综合心理干预可明显改善其心理健康状况。

Objective To understand the natural outcome of the homebound elderly after 6 years natural history and the effect of selfefficacy intervention on the psychological state. Methods In 2006, a cross-sectional study on the homebound elderly was performed in 5 rural communities, and 1475 subjects were investigated and 275 subjects were homebound. The six-years follow-up study was performed in 2012, the general status questionnaire, health and lonely self-evaluation, GDS - 15 were used. The homebound elderly were randomly divided into control group and intervention group, the comprehensive psychological intervention was given and general status, health and lonely self-evaluation, depression were evaluated again after 6 months. Results During the follow - up,5 people lost contact, 81 people died ,43 people were lying in bed, 147 people received follow -up, follow -up time interval was （72.3 ± 0.6） months, 62 subjects （42. 2% ） were still homebound. After 6 months, the intervention group was significant differences to the control group in the self-rated health （χ^2 =8. 422,P 〈 0. 05 ） ,self-rating depression（ t=1 1. 182,P 〈 0. 05 ） andloneliness（χ^2=7.643,P〈0.05）.Conclusion The natural outcome of homebound elderly is not optimistic, but homebound status has a certain reversibility. Application of self-efficacy theory of comprehensive psychological intervention on homebound elderly can significantly improve their psychological health status.