Journal of agricultural medicine and community health (농촌의학ㆍ지역보건)

Korean Society for Rural Medicine and Community Health (한국농촌의학지역보건학회)
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Structural Equation Modeling Based on PRECEDE Model for the Quality of Life in the Elderly with Dementia in Rural Area

농촌지역 치매노인의 삶의 질 구조모형 - PRECEDE 모형 기반

  • Mi-Soon, Song (Department of Nursing, The Graduate School of Chungnam National University) ;
  • Hyun-Li, Kim (Department of Nursing, College of Nursing, Chungnam National University)
  • 송미순 (충남대학교 대학원 간호학과) ;
  • 김현리 (충남대학교 간호학과)
  • Received : 2022.10.12
  • Accepted : 2022.12.12
  • Published : 2022.12.30
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Abstract

Purpose: This study was designed to test structural equation modeling of the quality of life of elderly diagnosed dementia living in the community in order to provide guidelines for development of intervention and strategies to improve their quality of life. Methods: The participants in the study were elderly who visited the public health center in C rural between May 30 and september 15, 2017. Data collection was carried out through one-on-one interviews. Demographic factors, knowledge, Attitude, Self-Efficacy, social support, accessibility, request for Information, health practice, depression, subjective memory complaints, dependence scale and quality of life were investigated. Results: The final analysis included 192 elderly. Fitness of the hypothesis model was appropriate(χ2=192.89, p=.000, GFI=0.90, SRMR=0.08, NNFI=0.94, CFI=0.95, PNFI=0.72, RMSEA=0.07). Depression, subjective memory complaints and dependence were found to be significant explaining varience in quality of life. Social support, dementia preventive behavior and health practice had an indirect effect on the quality of life. Conclusions: To improve the quality of life of elderly diagnosed dementia living in the community, comprehensive interventions are necessary to manage knowledge, attitude, self-efficacy, social support, health practice, depression, subjective memory complaints and dependence that can contribute to enchance the quality of life of elderly diagnosed dementia living in the community.

본 연구는 농촌지역 치매노인의 삶의 질에 영향을 미치는 요인을 파악하기 위하여 PRECEDE 모형을 적용하여 관련요인들 간의 관계를 분석하여 모형을 구축하고, 모형의 적합도를 검증하고자 하였다. PRECEDE 모형의 단계에 따른 사정요인을 문헌을 참고하여 선정하고, 치매 선별검사를 통하여 치매 진단받은 대상자들을 일대일 면접조사하였다. 연구 결과 치매노인 삶의 질은 건강변인인 우울과 주관적 기억 감퇴 및 의존성에 의해 가장 많은 영향을 받는 것으로 파악되었다. 또한 건강변인에 직접 영향을 미치는 요인은 강화요인인 사회적 지지와 행동요인인 치매예방행위와 건강실천행동으로 파악되었다. 이는 강화요인과 행동요인은 삶의 질에 직접적인 영향을 미치지는 않았지만, 건강에 직접적 영향을 미쳐서 결과적으로 삶의 질에 영향을 주는 간접 영향변수로 확인되었다. 그리고 소인요인인 치매지식, 치매태도, 자기효능감은 행동에 영향을 미치는 요인으로 파악되었다. 즉 PRECEDE 모형의 단계별 요인 중 소인요인, 강화요인, 행동, 건강요인이 연결망을 이루어 삶의 질에 영향을 주는 것으로 확인되었다. 그러나 가능요인은 환경요인에 영향을 미쳤지만 삶의 질에는 영향을 미치지 않았다. 이는 대상자들의 사회적 물리적 환경이 농촌이라는 지역적 소외, 낮은 교육수준과 고령이라는 한계를 반영한 결과라고 생각한다. 그러므로 농촌지역 치매노인의 삶의 질을 향상시키기 위한 간호프로그램 계획 시 PRECEDE 모형을 적용한 다면적인 사정 요인들을 대상자의 특성를 반영하여 포괄적으로 구성할 필요가 있다고 생각한다.

Keywords

References

  1. Korea National Statistical Office. (2022). Survey
  2. Center, S.M.C.D., 2015년 Survey on the awareness of dementia in Seoul. 2015
  3. Sun, W. and J.S. Oh, Policy issues for maintaining the living activity function of elderly people. Korean Institute for Health and Social Welfare, 2009
  4. Oh, S.-H. and D.-S. Yoon, A comparative study on quality of life on the elderly among urban, farm and island area. Journal of Welfare for the Aged, 2006. 32(1): p. 119-147
  5. Jing, W., R. Willis, and Z. Feng, Factors influencing quality of life of elderly people with dementia and care implications: A systematic review. Archives of gerontology and geriatrics, 2016. 66: p. 23-41 https://doi.org/10.1016/j.archger.2016.04.009
  6. Ferri, C., et al., World Alzheimer Report 2009-Executive Summary. Edited by: Prince M, Jackson J. London: AlzheimerLs Disease International, 2009: p. 1-22
  7. Fund, H., 2013 Annual Report. 2013
  8. Borowiak, E. and T. Kostka, Predictors of quality of life in older people living at home and in institutions. Aging clinical and experimental research, 2004. 16(3): p. 212-220 https://doi.org/10.1007/BF03327386
  9. Brod, M., et al., Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL). The Gerontologist, 1999. 39(1): p. 25-36 https://doi.org/10.1093/geront/39.1.25
  10. Bowling, A., et al., Quality of life in dementia: a systematically conducted narrative review of dementia-specific measurement scales. Aging & mental health, 2015. 19(1): p. 13-31 https://doi.org/10.1080/13607863.2014.915923
  11. Naglie, G., Quality of life in dementia. Canadian Journal of Neurological Sciences, 2007. 34(S1): p. S57-S61 https://doi.org/10.1017/S0317167100005588
  12. Schiffczyk, C., et al., Generic quality of life assessment in dementia patients: a prospective cohort study. BMC neurology, 2010. 10(1): p. 1-8 https://doi.org/10.1186/1471-2377-10-1
  13. Green, L. and M. Kreuter, The precede-proceed model. Health promotion planning: an educational approach. 3rd ed. Mountain View (CA): Mayfield Publishing Company, 1999: p. 32-43
  14. Woods, R.T., et al., What contributes to a good quality of life in early dementia? Awareness and the QoL-AD: a cross-sectional study. Health and quality of life outcomes, 2014. 12(1): p. 1-11 https://doi.org/10.1186/1477-7525-12-1
  15. Jung, J. and J. Kim, The cognitive and the affective characteristics of Korean older adults with subjective memory complaints. Journal of the Korean Gerontological Society, 2015. 35(3): p. 835-51
  16. Jones, R.W., et al., Dependence in Alzheimer's disease and service use costs, quality of life, and caregiver burden: the DADE study. Alzheimer's & Dementia, 2015. 11(3): p. 280-290 https://doi.org/10.1016/j.jalz.2014.03.001
  17. Kang, N., et al., The effect of knowledge on dementia and internal health locus of control on dementia preventive behaviors among the Korean older people living alone. Journal of Health Informatics and Statistics, 2015. 40(3): p. 9-19
  18. Lee, Y.K., M.R. Sung, and D.Y. Lee, Comorbidity and health habits of Seoul city elders with dementia. Journal of Korean Academy of Nursing, 2011. 41(3): p. 411-422 https://doi.org/10.4040/jkan.2011.41.3.411
  19. Sim, S., Effects of physical activities and cognitive activities for cognitive function progress on EEG and occupational performance and QOL in mild dementia (Master's thesis). Dongsin University, Naju, 2014
  20. Lee, J. and E. Lee, Study of the factors affecting behaviors for the promotion of dementia prevention: verifying the mediating effect of an attitude toward dementia. Korean Comp Gov Rev, 2016. 20: p. 89-117
  21. Logsdon, R.G., et al., Assessing quality of life in older adults with cognitive impairment. Psychosomatic medicine, 2002. 64(3): p. 510-519 https://doi.org/10.1097/00006842-200205000-00016
  22. Cho, H., A study on public's knowledge of and attitude towards dementia. Unpublished master's thesis, Hanyang University, Seoul, 1999
  23. Luszczynska, A., U. Scholz, and R. Schwarzer, The general self-efficacy scale: multicultural validation studies. The Journal of psychology, 2005. 139(5): p.439-457 https://doi.org/10.3200/JRLP.139.5.439-457
  24. Sherbourne, C.D. and A.L. Stewart, The MOS social support survey. Social science & medicine, 1991. 32(6): p. 705-714 https://doi.org/10.1016/0277-9536(91)90150-B
  25. Yesavage, J.A. and J.I. Sheikh, 9/Geriatric depression scale (GDS) recent evidence and development of a shorter version. Clinical gerontologist, 1986. 5(1-2): p. 165-173 https://doi.org/10.1300/J018v05n01_09
  26. Youn, J.C., et al., Development of the subjective memory complaints questionnaire. Dementia and geriatric cognitive disorders, 2009. 27(4): p.310-317 https://doi.org/10.1159/000205512
  27. Stern, Y., et al., Assessing patient dependence in Alzheimer's disease. Journal of Gerontology, 1994. 49(5): p. M216-M222 https://doi.org/10.1093/geronj/49.5.M216
  28. Trigg, R., et al., Predictors of quality of life ratings from persons with dementia: the role of insight. International journal of geriatric psychiatry, 2011. 26(1): p. 83-91 https://doi.org/10.1002/gps.2494
  29. Lee, G., et al., Quality of life and the associated factors in dementia. Journal of Korean Academy of Psychiatric and Mental Health Nursing, 2008. 17(3): p.273-280
  30. Kim. C. H, The effect of sleep on cognitive function and quality of life in cognitively impaired elder, 2009, Unpublished master's thesis, Kyoungbuk national university, Daegu (Korean)
  31. Ready, R.E., B.R. Ott, and J. Grace, Insight and cognitive impairment: effects on quality-of-life reports from mild cognitive impairment and Alzheimer's disease patients. American Journal of Alzheimer's Disease & Other Dementias®, 2006. 21(4): p. 242-248 https://doi.org/10.1177/1533317506290589
  32. Ha, J. Disease Awareness Process in Elderly with Early Dementia, 2007, Unpublished Ph.D's thesis, Hanyang University, Seoul(Korean)
  33. Cohen, S. and S.L. Syme, Issues in the study and application of social support. Social support and health, 1985. 3: p. 3-22
  34. Lyman, K.A., Day care for persons with dementia: The impact of the physical environment on staff stress and quality of care. The Gerontologist, 1989. 29(4): p. 557-560 https://doi.org/10.1093/geront/29.4.557
  35. McLaughlin, T., et al., Dependence as a unifying construct in defining Alzheimer's disease severity. Alzheimer's & Dementia, 2010. 6(6): p. 482-493 https://doi.org/10.1016/j.jalz.2009.09.004
  36. Park, J., et al., Efficacy of dementia prevention program for cognitive function, depression, and physical function in the elderly non-demented women-focused on senior citizens center. The Journal of Korean Society of Occupational Therapy, 2015. 23(3): p. 79-96 https://doi.org/10.14519/jksot.2015.23.3.07
  37. Lee Y.H. Systematic Review of Lifestyle and Cognitive Health: Developing Recommendations for Cognitive Health Promotion,. KHEPI research report, 2009, 2008(23)