This study aims to construct a prediction model for the demand for medical and daily care services of the elderly and to explore the factors that affect the demand for medical and daily care services of the elderly. In this study, a questionnaire survey on the demand for medical and daily care services of 1291 elderly was conducted using multi-stage stratified whole cluster random sampling. SPSS21.0 statistical analysis software was used to describe the basic data of the elderly statistically, and univariate analysis was used to screen variables for model construction and binary logistic regression analysis. The acquired dataset has class imbalance, and to handle this issue, Synthetic Minority Over Sampling Technique with TomekLink (SMOTE-TomekLink) was adopted to resample the dataset for class-balancing. To improve computational efficiency, we used three algorithms to develop prediction models, including Random Forest (RF), Gradient Boosting Decision Tree (GBDT), and Light Gradient Boosting Machine (LightGBM) algorithms. The performance of each model was measured, and the performance of the prediction model was obtained using the following performance metrics: accuracy (ACC), recall (R), precision (P), F1-score, and area under the receiver operating characteristic (AUC). The prediction models for the medical and daily care services demand of the elderly were developed and validated using 12 and 13 key features, respectively. The LightGBM algorithm emerged as the superior prediction model for estimating the service needs of the elderly. For the medical service demand prediction model, LightGBM achieved an AUC of 0.910 and F1-score of 0.841. In the daily care services demand prediction model, LightGBM demonstrated an AUC of 0.906 and an F1-score of 0.819. In the LightGBM model, the analysis of feature importance indicates that the number of chronic diseases, education level, and financial sources emerge as the most significant predictors for the demand of healthcare services, encompassing both medical and daily care services. Based on questionnaire information combined with feature selection, unbalanced data processing and machine learning methods, this study constructed a machine learning model for predicting the demand for medical and daily care services for the elderly, and analyzed the influencing factors of the demand for medical and daily care services for the elderly, providing a reference for the construction and verification of future prediction models for the demand for medical and daily care services for the elderly.

As the ageing process in China further accelerates and the average life expectancy increases, chronic disease prevalence and multimorbidity rates are constantly rising, especially among elderly individuals. However, few previous studies have explored the impacts of chronic diseases and multimorbidity on health-related quality of life (HRQoL). This study aimed to investigate this association among community-dwelling elderly individuals in China. A cross-sectional study was conducted in communities in three cities (Suzhou, Qingdao, and Guangzhou). The basic characteristics, chronic diseases and HRQoL of participants were collected, and HRQoL was measured by the EuroQol 5-Dimensions 3-Level version (EQ-5D-3L). Logistic regression, Tobit regression and generalized linear models were used to assess the impacts of chronic diseases and multimorbidity on HRQoL. Approximately 83.2 percent of the 1,218 respondents had chronic conditions, with 30 percent having multimorbidity. After controlling for sociodemographic and health behaviour factors, patients with stroke were more likely to report problems in all five dimensions of the EQ-5D and had a lower EQ-5D utility index (UI) (b = -0.342) than patients with other chronic conditions. Patients with chronic pulmonary obstruction had a lower EuroQol Visual Analog Scale (EQ-VAS) (b = -11.169) than patients with other chronic conditions. Furthermore, patients with multimorbidity had worse HRQoL (P < 0.001). Both chronic condition probability and multimorbidity rates were high among Chinese community-dwelling elderly individuals. Different disease types had varying degrees of impact on HRQoL, and patients with multimorbidity had worse HRQoL. This study proposes that the government enhance the quality of life of community-dwelling elderly individuals with multimorbidity by establishing long-term care insurance and expanding comprehensive community-based home health care services.

ObjectiveThis study explores the health-related quality of life (HRQoL) scores of Chinese older adults with Cardiovascular Disease(CVD) using the EQ-5D-3L, the aim of this study is to investigate the association between health and HRQoL in older adults with CVD.MethodsThe data for this study were obtained from a cross-sectional study involving older adults residing in Chinese communities The EQ-5D-3L is used to measure the HRQoL scores in the older adults with CVD. One-way analyses were conducted using the Wilcoxon rank sum test and the Kruskal–Wallis H test to assess differences between groups. A binary logistic regression model was employed to analyze the influence each variable has on the presence of “any problem” on each dimension of EQ-5D-3L in older adults with CVD. An ordinal least squares (OLS) model is used to assess the relationship between older adults with CVD and HRQoL.ResultsThe mean EQ-5D-3L score for older adults with CVD is 0.774. 40.0% of older adults with CVD reported problems with pain/discomfort, followed by Mobility (35.9%), Self-care (31.5%), and Anxiety/depression (17.0%). Binary logistic regression models show that financial resources were the main factor influencing the five dimensions of EQ-5D-3L. The OLS model further indicates that younger age, financial resources, and a lower number of chronic conditions among older adults with CVD are associated with higher HRQoL scores.ConclusionChinese older adults with CVD have low HRQoL scores. Variousfactors influence both overall HRQoL scores and scores on each EQ-5D-3L dimension. This study is helpful in enhancing society’s attention to the HRQoL of older adults with CVD and taking targeted measures to improve them.

Objective To study the quality of life of the community-based homebound elderly based on EQ-5D scale, analyze the relationship between socioeconomic status and quality of life in the elderly, and provide help for health management on local elderly.Methods A multi-stage stratified cluster random sampling method was used to investigate the elderly at home in communities in Qingdao, Guangzhou and Suzhou.Wilcoxon rank sum test and Kruskal-Wallis H test were used to analyze the differences in health effect values of general conditions in the elderly, and Tobit regression model was used to analyze the relationship between socioeconomic status and quality of life.Results A total of 1,254 community-dwelling elderly people were included, whose health effect value was 0.887（0.696,0.961）.Age, education level, marital status, average monthly income, occupation, socioeconomic status and the health effect value of the elderly in the community were statistically significant（P＜0.05）.Tobit regression results showed that socioeconomic status of the community-based homebound elderly has an impact on quality of life（P＜0.05）.Conclusion The socioeconomic status of the elderly in the community had influence on the quality of life.It is suggested that the relevant responsible departments should take targeted measures according to the different social and economic status factors of the elderly to improve their health status and improve their quality of life.

Aims:To explore the structural relationship between perceived participation and autonomy among older adults with stroke and hypertension in home and community-based services (HCBSs) in the eastern coastal region of China.Design:An explorative cross-sectional study.Methods:From July to September 2021, a total of 714 respondents were reported to have stroke and hypertension, and their information was used in the analysis of this study. A multiple linear regression analysis was used to explore the factors influencing factors older adults' perceived participation and autonomy. Using the ISM model, we analyzed the factors affecting social participation in patients with stroke and hypertension and explained the logical relationships and hierarchy among the factors.Results:The mean score of perceived participation was 58.34 ± 27.57. Age, marital status, health insurance, living status, number of children, chronic diseases, sleep time, frequency of outings, and health utility value were significant factors affecting perceived participation and autonomy with stroke and hypertension patients. Among them, health insurance is the direct factor on the surface, age, number of children, chronic diseases, sleep time, frequency of outings, and health utility value are the intermediate indirect factors, and marital status and living status are the deep-rooted factors.Conclusion:By the study that the hierarchical structure provides a visualization of interrelationships and interdependences among the influencing factors of perceived participation and autonomy. It also may be a significant complement to traditional variable-entered approaches and construct an optimized multidimensional perspective of participation and autonomy. Future research should focus on optimizing the living environment of older adults with stroke and hypertension to explore the model of rehabilitative intervention and help patients successfully reintegrate into their families/societies.

目的 了解社区居家医养结合服务利用情况及影响因素,为做到精确服务,提升医养结合服务质量提供科学依据.方法 2021年9月至11月采用分层整群随机抽样方法,对苏州、广州和青岛8家社区居家医养结合机构的老年人进行问卷调查.采用x2检验进行单因素分析,采用Chi-squared automatic interaction detector(CHAID)模型分析服务利用的影响因素.结果 共回收有效问卷1310份,其中广州218人,苏州334人,青岛758人.医疗服务、健康管理服务、生活照料服务的模型预测正确率分别为82.4％、81.0％、81.7％.CHAID模型分析表明,室内自主参与、地区、主要经济来源、子女数量是医疗服务利用情况的影响因素(P＜0.05);地区、自主参与总分、主要经济来源、慢病数量是健康管理服务利用情况的影响因素(P＜0.01);自主参与总分、年龄是生活照料服务利用情况的影响因素(P＜0.001).结论 社区居家医养结合服务中的医疗服务、健康管理服务、生活照料服务的利用情况仍需要改进,应该为不同特征的老年人提供差异化服务,切实提升医养结合服务质量,满足养老需求.

目的:构建社区居家智慧化医养结合服务模式评价指标体系,为社区居家智慧化养老服务模式的评价和改进提供参考.方法:采用文献分析法、专题小组讨论、Delphi法等,基于"结构-过程-结果"理论初步构建社区居家智慧化医养结合模式服务评价指标体系,通过层次分析法确定指标权重.结果:两轮专家咨询的问卷有效回收率分别是100％和97.2％.专家权威系数分别是0.871和0.877.第一轮专家咨询中一、二、三级指标的专家协调系数分别为0.138、0.122、0.132,第二轮专家咨询中一、二、三级指标的专家协调系数分别为0.302、0.130、0.214,且差异有统计学意义(P<0.05).最终确定的评价指标体系包括3个一级指标(服务结构、服务过程、服务结果),21个二级指标,127个三级指标.结论:本研究初步确立的社区居家智慧化医养结合服务模式评价指标体系具有一定科学性和可靠性,可为相关研究提供一定参考.

目的 了解东部地区社区居家医养结合服务老年人生命质量状况,并探讨其影响因素,为我国政府制定促进健康老龄化政策提供理论依据.方法 采用多阶段分层抽样的方法,对苏州、广州两地接受社区居家医养结合服务的老年人进行问卷调查.使用欧洲5维健康量表(EQ-5D量表)计算其健康效用值,单因素分析使用秩和检验,多因素分析使用Tobit回归模型.结果 社区居家医养结合服务老年人健康效用值中位数为0.699.在5个维度中,存在困难比例依次为日常活动能力(56.8％)、行动能力(55.0％)、自我照顾能力(50.8％)、疼痛/不适(42.0％)、焦虑/抑郁(24.7％).Tobit回归模型结果显示:城镇职工基本医疗保险、月收入1 001～5 000元、未患有慢性病、每日睡眠时间6～8h是东部地区社区居家医养结合服务老年人健康相关生命质量的保护因素.结论 东部地区社区居家医养结合服务老年人生命质量较差,需采取针对性措施改善社区居家医养结合服务老年人生命质量.

OBJECTIVE:To explore the factors that influence institutional care for the disabled elderly in China and the key factors that influence individuals based on the Andersen model.DESIGN:Cross-sectional survey.SETTING:The research was conducted in 18 cities in Henan Province, China.MAIN OUTCOME MEASURES:A multistage, stratified sampling design was employed. The χ2 test was used to compare the differences in basic information of the disabled elderly. A binary Logit model was used to examine the factors influencing the willingness to institutionalise elderly people with disabilities. The determinants of willingness to care in an institution were also explored in a stratified study by gender, age and region to identify the key differences affecting institutionalisation. The Andersen model was used as the theoretical framework to infer the impact strength of each model.RESULTS:Of the 2810 disabled elderly people in Henan, China, 7.4% of the elderly had a willingness for institutional care. In the binary logistic regression analysis, whether living alone (OR (95% CI)=0.596 (0.388 to 0.916)), medical payment method (basic medical insurance for urban employees: OR (95% CI)=2.185 (1.091 to 4.377)), having mental illness (OR (95% CI)=2.078 (1.044 to 4.137)) had a statistically significant difference (p<0.05) on the impact on the willingness of the disabled elderly to receive institutional care. Validation of the fitted coefficients of the model revealed that the needs factor had the most significant effect on the enabling variable, while the predisposing factor had more minerally effect.CONCLUSIONS:Several factors influence the willingness of the disabled elderly to institutionalise. Therefore, it is recommended that relevant authorities take targeted measures to focus on the disabled elderly to identify more precise elderly care services to deal with the ageing crisis.

目的:了解我国老年人认知功能障碍现状及其影响因素,为改善老年人认知功能现状、制定干预措施提供参考.方法:采用2018年中国健康与老年人追踪数据,筛选3523名60岁及以上老年人作为研究对象,使用简易智能状态检查表对老年人认知功能进行评判.运用卡方检验和二分类logistic回归模型分析老年人认知功能障碍的影响因素.结果:老年人认知功能障碍检出1110人,检出率31.5％.回归分析显示年龄≥70岁、农村、单身、睡眠时间>9小时、无社会参与活动、存在抑郁症状是老年人认知障碍的危险因素;教育水平为小学是老年人认知障碍的保护因素.结论:老年人认知功能障碍患病率较高,年龄、居家地址、婚姻状况、睡眠时长、社会参与状况和抑郁状况是老年人认知功能障碍产生的影响因素.

ObjectiveTo explore the relationship between ambient PM2.5 level and outpatient visits of children with respiratory diseases in a megacity, Zhengzhou, in central China.MethodsWe collected daily outpatient visit data, air pollutant data, and meteorological data at the monitoring points of Zhengzhou from the time period 2018 to 2020 and used Spearman's rank correlation to analyze the correlation between children's respiratory outpatient visits and air pollutants and meteorological factors. Generalized additive models were used to analyze the association between PM2.5 exposures and children's respiratory outpatient visits. A stratified analysis was further carried out for the seasons.ResultsFrom 2018 to 2020, the total number of outpatients with children's respiratory diseases was 79,1107, and the annual average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3-8h in Zhengzhou were respectively 59.48 μg/m3, 111.12 μg/m3, 11.10 μg/m3, 47.77 μg/m3, 0.90 mg/m3 and 108.81 μg/m3. The single-pollutant model showed that the risk of outpatient visits for children with respiratory disease increased by 0.341% (95%CI: 0.274–0.407%), 0.532% (95%CI: 0.455–0.609%) and 0.233% (95%CI: 0.177–0.289%) for every 10 μg/m3 increase in PM2.5 with a 3-day lag, 1-day lag, and 1-day lag respectively for the whole year, heating period, and non-heating period. The multi-pollutant model showed that the risk of PM2.5 on children's respiratory disease visits was robust. The excess risk of PM2.5 on children's respiratory disease visits increased by 0.220% (95%CI: 0.147–0.294%) when SO2 was adjusted. However, the PM2.5 effects were stronger during the heating period than during the non-heating period.ConclusionThe short-term exposure to PM2.5 was significantly associated with outpatient visits for children's respiratory diseases. It is therefore necessary to strengthen the control of air pollution so as to protect children's health.

目的 探讨我国中老年人认知功能在慢性病与抑郁症状间中介作用.方法 采用中国健康与养老追踪调查2018年第四次全国追访数据,以5 208名45岁及以上中老年人为研究对象,采用SPSS 25.0进行相关性分析.结果 中老年人抑郁症状的检出率为32.7％.模型中,慢性病对中老年人抑郁症状具有统计学意义的正向预测作用(β=0.295,t=36.079,P＜0.001).认知功能在慢性病与抑郁症状之间存在的中介效应量占40.68％.结论 中老年人的慢性病、认知功能与抑郁症状相关,慢性病可以直接或通过认知功能障碍的中介作用间接影响抑郁症状.

目的:探索河南省农村老年人养老方式的选择意愿及影响因素.方法:采用多阶段整群分层随机抽样法于2019年3～8月共抽取4074例河南省60岁及以上农村老年人,进行问卷调查获取数据;运用x2检验和多元Logistic回归分析养老意愿分布的差异及影响因素;以Andersen模型为理论框架,探究倾向特征、使能资源和需求因素对农村老年人养老方式选择意愿的影响.结果:84.19％的农村老年人选择家庭养老,选择社区养老和机构养老的分别为10.14％和5.67％;多元Logistic回归分析显示,婚姻状况、学历、居住情况、残疾、患慢性病种类及老年人能力状况是影响农村老年人养老意愿选择的因素(P＜0.05);从影响因素回归模型中发现倾向特征和使能资源对因变量的影响较大.结论:河南省农村目前的养老以家庭养老为主,倾向特征、使能资源和需求因素不同程度地影响老年人选择养老方式,建议相关部门关注农村老年人生活条件和提高其健康状况,大力发展农村多元养老服务方式.

Objective To investigate whether there is a curvilinear relationship between burnout and work engagement among staff in Chinese community services for the elderly. Methods A stratified whole-group random sampling method was used to survey 244 staff members from eight communities in two cities. Data were collected using the Maslach Burnout Inventory scale (MBI) and the Utrecht Work Engagement Scale- 9 (UWES- 9). The curve estimation method explored the functional model of burnout and work engagement scales. Results Two hundred forty-four staff members completed the survey. Burnout, depersonalization (DP), and personal accomplishment (PA) were found to be related to work engagement in a cubic function ( R 2 = 0.166, P < 0.05), ( R 2 = 0.061, P < 0.05), and ( R 2 = 0.2230, P < 0.05), respectively. There was no statistically significant relationship between emotional exhaustion (EE) and work engagement ( P > 0.05). “Personal Accomplishment” is related to work engagement in a U-shaped curve. Conclusions There was a cubic function relationship between burnout and work engagement, where “personal accomplishment” was related to work engagement in a U-shaped curve. Therefore, the government and related service organizations should understand the impact of different levels of burnout on work engagement and take targeted measures to alleviate burnout and improve work engagement by targeting emotions and stroke.

目的:分析简化版批判性思维量表在医学生中运用的信度和效度.方法:采用分层抽样方法抽取某高校不同院系、不同年级的医学生共608名填写问卷,获得有效问卷598份.采用Cronbach's α系数评价量表的信度;598人分为两组,分别用于探索性因子分析和验证性因子分析以检验量表效度;从598人中随机抽取100人,15 d后进行重测,检验重测信度.采用Spearman相关分析量表的聚合效度,以原模型和其他模型的拟合指标评价该量表的区分效度.结果:简化版批判性思维量表整体Cronbach's α系数为0.865,重测信度为0.813;探索性因子分析提取出6个公因子,累积方差贡献率为72.019％,验证性因子分析显示,该量表的拟合指数较好(CMIN/DF=2.889、RMSEA=0.080、GFI=0.914、TLI=0.906、CFI=0.909、PGFI=0.659);聚合效度结果显示,6个维度间的相关系数多数小于0.5,各维度与总分之间相关系数多数大于0.5(P＜0.05);区分效度结果显示,其他15个模型与原模型相比,各拟合指标均变差(P＜0.01).结论:简化版批判性思维量表在医学生中具有较好的信度和效度,可为研究医学生批判性思维能力现状提供更为便捷的工具.

目的 探讨老年人高血压患者的健康相关生命质量(health-related quality of life,HRQoL)状况及影响因素,为提高老年人高血压患者HRQoL提供针对性建议.方法 采用多阶段分层整群随机抽样的方法对广州、苏州和青岛的社区老年高血压患者进行问卷调查.单因素分析使用Wilcoxon秩和检验和Kruskal-Wallis H检验,多因素分析使用Tobit回归模型.结果 老年人高血压患者健康效用值为0.847(0.569,1.000),在EQ-5D量表的5个维度中的疼痛或不舒服(40.5％)存在的问题最突出.Tobit回归模型结果显示,婚姻状况(已婚:β=0.127,P=0.005＜0.05;丧偶:β=-0.069,P=0.003＜0.05)和外出频率(1 次/d:β=0.106,P＜0.001;1 次/周:β=0.204,P＜0.001;更长时间:β=0.312,P＜0.001;不确定:β=-0.423,P＜0.001)是影响高血压老年人健康相关生命质量的因素.结论 老年人高血压患者生命质量低于普通人群,政府及相关部门可根据主要因素,采取针对性措施,这对提升老年人高血压患者健康相关生命质量具有重要意义.

Abstract Purpose This study aimed to evaluate the relationship between hypertension (HTN) and type 2 diabetes mellitus (T2DM) on health-related quality of life (HRQoL) in elderly patients in the eastern coastal regions of China, which correspond to socio-demographic conditions, comorbidities and health outcomes. Methods From September 2021 to December 2021, 750 participants with HTN and T2DM over the age of 60 were recruited through multi-stage stratified sampling to conduct a cross-sectional study in the eastern coastal region of China. HRQoL was assessed using the EQ-5D-3L questionnaire. The multi-level model was developed to analyze the effects of patients' own factors and regional factors on HRQoL in patients with HTN and T2DM, using patients as level 1 and regions as level. Results The percentage of co-morbidity of HTN and T2DM in community-dwelling older adults was 14.3%, with a health utility index (0.778 ± 0.270). The multi-level model showed that the ICC was 0.797 and 0.815, respectively, which means that about 79.7% of the variance in EQ-5D health utility index was due to older adults' own factors and 20.3% of the variance was from urban level aggregation; about 81.5% of the variance in EQ-VAS scores was due to own factors and 18.5% of the variance was from urban level aggregation. Multi-level model results show that age, marital status, monthly income, number of chronic diseases, and alcohol consumption (P < 0.05) were significantly related to HrQoL in elderly patients with HTN and T2DM. Conclusion The HRQoL of older adults with HTN and T2DM is significantly lower than that of the general population, and emphasis should be placed on the prevention and management of older adults with the disease. Meanwhile, a central aspect to the management of HTN and T2DM is promoting a healthy lifestyle, and health-related knowledge should be promoted more, with emphasis on patients' mental health, to improve the HTN and T2DM of older adults.

目的 了解河南省老年人跌倒发生情况,并探讨老年人能力状况与跌倒之间的关系.方法 采用分阶段抽样的方法,对河南省60岁及以上的老年人进行问卷调查.采用二元logistic回归模型分析日常生活能力、精神状态能力、感知觉与沟通能力、社会参与能力对老年人跌倒的影响.结果 共调查5570例老年人,其中496例老年人发生了跌倒,发生率为8.9％.Logistic回归分析表明,全人群中日常生活能力受损(OR=3.060,95％CI=2.418～ 3.872)、感知觉与沟通能力受损(OR=1.449,95％CI=1.128 ～ 1.861)、社会参与能力受损(OR=1.438,95％CI=1.100～1.880)是河南省老年人跌倒的危险因素.根据性别进行分层后无论对于男性(OR=3.542,95％CI=2.445～5.130)还是女性(OR=2.826,95％CI=2.075～3.848),跌倒都受日常生活能力受损的影响.除此之外,感知觉与沟通能力受损(OR=1.543,95％CI=1.118～2.130)和社会参与能力受损(OR=1.480,95％CI=1.045～2.096)也是女性老年人跌倒的危险因素.结论 能力状况受损是老年人跌倒的危险因素,其中男性跌倒主要受日常生活能力的影响,女性跌倒受日常生活能力、感知觉与沟通能力、社会参与能力的影响.