Effect of combination of medical care and nursing on the quality of life and mental state of elderly patients with chronic kidney disease in Shanghai suburbs

doi:10.3969/j.issn.1674-8115.2022.07.009

Abstract

Abstract: Objective

·To explore the effect of the combination of medical care and nursing on the quality of life and the anxiety/depression symptom of the elderly patients with chronic kidney disease (CKD) in Shanghai surburbs.

Method

·The elderly patients with CKD living in two nursing homes in Qingpu District, Shanghai were selected. The anxiety symptom was assessed by Generalized Anxiety Disorder Scale-7 (GAD-7), the depression symptom was assessed by The Geriatric Depression Scale (GDS), and the quality of life was assessed by The MOS 36-item Short Form Health Survey (SF-36). According to whether they had anxiety/depression symptom, they were divided into one group with mental symptoms (group A) and the other group without mental symptoms (group B). Then, the patients in group A were randomly divided into medical care and nursing-combined intervention group (group A1) and conventional group (group A2). Except group A1, group A2 and group B both adopted the traditional chronic disease management mode. The correlations of the scores of SF-36 in 8 dimensions with the GAD-7 score and the GDS score were analyzed. Multivariate Logistic regression analysis was used to analyze the independent risk factors of life quality of elderly patients with CKD. The mental symptoms and the quality of life before and after the 6-month interventions were compared to evaluate the combination of medical care and nursing.

Results

·A total of 80 elderly patients with CKD were enrolled, including 54 cases (67.5%) in group A and 26 cases (32.5%) in group B, whose incidences of anxiety symptom and depression symptom were 37.5% and 30.0%, respectively. Group A included 27 cases in group A1 and 27 cases in group A2. The GAD-7 score and the GDS score were negatively correlated with the scores of 6 dimensions of quality of life (physiological function, role-physical, general health, vitality, role-emotional, and mental health), respectively (P<0.05). Logistic regression analysis showed that anxiety/depression symptom was an independent risk factor of the quality of life of elderly CKD patients. After the combined intervention of medical care and nursing for 6 months, the scores of GAD-7 and GDS in group A1 were significantly lower than those before intervention (P<0.05), while there was no statistical difference in the scores before and after the intervention in group A2. Before intervention, the scores of 8 dimensions of quality of life in group A1 and A2 were significantly lower than those in group B (P<0.05), and there was no significant difference between A1 and A2 groups. After 6 months of intervention, the scores of 6 dimensions in group A1 were significantly higher than those in group A2 and those in group A1 before the intervention (P<0.05), and there were no obvious changes in role-physical and social functioning.

Conclusion

·The anxiety/depression symptom of elderly patients with CKD in Shanghai surburbs can reduce their quality of life; the combination of medical care and nursing can improve the anxiety/depression symptom of these patients and their quality of life as well.

Key words: medical care and nursing, chronic kidney disease (CKD), quality of life, anxiety, depression

CLC Number:

R692.5

WANG Yakun, XU Jiarui, WU Qianqian, ZHANG Xiaohua, ZHU Yingchun, BAI Shoujun. Effect of combination of medical care and nursing on the quality of life and mental state of elderly patients with chronic kidney disease in Shanghai suburbs[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(7): 904-910.

Figures/Tables 5

TrendMD

References 26

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Item	Group A1 （n=27）	Group A2 （n=27）	Group B （n=26）	P value
Male/n （%）	12 （44.4）	15 （55.6）	16 （61.5）	0.684
Age/year	74.1±10.2	72.4±8.4	73.6±8.2	0.721
Nursing home （A/B）/n	12/15	14/13	12/14	0.702
Marital status （married/divorced/widowed）/n	17/3/7	15/5/7	15/5/6	0.801
Smoking/n （%）	10 （37.0）	9 （33.3）	9 （34.6）	0.412
High school or above/n （%）	11 （40.7）	10 （37.0）	10 （38.5）	0.891
Hypertension/n （%）	14 （51.9）	13 （48.1）	12 （46.2）	0.109
Diabetes/n （%）	9 （33.3）	8 （29.6）	8 （30.8）	0.531
Coronary heart disease/n （%）	7 （25.9）	8 （29.6）	6 （23.1）	0.682
Hyperuricemia/n （%）	17 （63.0）	18 （66.7）	17 （65.4）	0.711
Cerebral stroke/n （%）	6 （22.2）	5 （18.5）	5 （19.2）	0.752
CKD stage/n （%）				0.669
Stage 1‒2	4 （14.8）	2 （7.4）	3 （11.5）
Stage 3	9 （33.3）	8 （29.6）	11 （42.3）
Stage 4	11 （40.7）	13 （48.1）	9 （34.6）
Stage 5	3 （11.1）	4 （14.8）	3 （11.5）
Dialysis mode/n （%）				0.672
Non-dialysis	25 （92.6）	24 （88.9）	25 （96.2）
Haemodialysis	1 （3.7）	2 （7.4）	1 （3.8）
Peritoneal dialysis	1 （3.7）	1 （3.7）	0 （0）

Item	Group A1 （n=27）	Group A2 （n=27）	Group B （n=26）	P value
Male/n （%）	12 （44.4）	15 （55.6）	16 （61.5）	0.684
Age/year	74.1±10.2	72.4±8.4	73.6±8.2	0.721
Nursing home （A/B）/n	12/15	14/13	12/14	0.702
Marital status （married/divorced/widowed）/n	17/3/7	15/5/7	15/5/6	0.801
Smoking/n （%）	10 （37.0）	9 （33.3）	9 （34.6）	0.412
High school or above/n （%）	11 （40.7）	10 （37.0）	10 （38.5）	0.891
Hypertension/n （%）	14 （51.9）	13 （48.1）	12 （46.2）	0.109
Diabetes/n （%）	9 （33.3）	8 （29.6）	8 （30.8）	0.531
Coronary heart disease/n （%）	7 （25.9）	8 （29.6）	6 （23.1）	0.682
Hyperuricemia/n （%）	17 （63.0）	18 （66.7）	17 （65.4）	0.711
Cerebral stroke/n （%）	6 （22.2）	5 （18.5）	5 （19.2）	0.752
CKD stage/n （%）				0.669
Stage 1‒2	4 （14.8）	2 （7.4）	3 （11.5）
Stage 3	9 （33.3）	8 （29.6）	11 （42.3）
Stage 4	11 （40.7）	13 （48.1）	9 （34.6）
Stage 5	3 （11.1）	4 （14.8）	3 （11.5）
Dialysis mode/n （%）				0.672
Non-dialysis	25 （92.6）	24 （88.9）	25 （96.2）
Haemodialysis	1 （3.7）	2 （7.4）	1 （3.8）
Peritoneal dialysis	1 （3.7）	1 （3.7）	0 （0）

Dimension of SF-36	GAD-7 score	GDS score
Physical functioning	-0.362^①	-0.291^⑥
Role-physical	-0.442^②	-0.378^⑦
Bodily pain	0.092	0.117
General health	-0.421^③	-0.391^④
Vitality	-0.492^④	-0.481^④
Social functioning	0.045	0.049
Role-emotional	-0.418^⑤	-0.268^⑧
Mental health	-0.501^④	-0.582^④

Dimension of SF-36	GAD-7 score	GDS score
Physical functioning	-0.362^①	-0.291^⑥
Role-physical	-0.442^②	-0.378^⑦
Bodily pain	0.092	0.117
General health	-0.421^③	-0.391^④
Vitality	-0.492^④	-0.481^④
Social functioning	0.045	0.049
Role-emotional	-0.418^⑤	-0.268^⑧
Mental health	-0.501^④	-0.582^④

Factor	OR （95%CI）	P value
Gender （female=0/male=1）	0.877 （0.318‒0.956）	0.006
Age （every 1 year added）	1.189 （1.024‒3.073）	0.000
Educational level （junior high school or below=0/high school or above=1）	0.993 （0.498‒0.998）	0.018
Diabetes （no=0/yes=1）	1.652 （1.102‒3.834）	0.020
Dialyses （no=0/yes=1）	3.154 （1.496‒8.887）	0.000
Anxiety/depression symptom （no=0/yes=1）	2.134 （1.019‒5.883）	0.002