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To investigate the relationship between self-care and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD) and their caregivers.
A multicentre, cross-sectional study.
COPD patients and their caregivers were recruited from four tertiary hospitals in Jinan, Shandong Province, China from March to November 2022. Data collection included demographic and clinical characteristics, patients' self-care, caregivers' contribution to patient self-care, and QOL. Statistical analysis included descriptive statistics, paired t-tests, Pearson correlations and Actor–Partner Interdependence Model (APIM) analyses.
A total of 275 valid questionnaires were collected (patients: 67.6% male, mean age 70.5; caregivers: 58.5% female, mean age 54.2). APIM analyses revealed actor effects of self-care on QOL for both patients and caregivers, as well as partner effects indicating the influence of one's self-care on the partner's QOL.
This study elucidates the dyadic relationship between self-care and QOL in COPD patients and caregivers. Higher levels of self-care maintenance by both patients and caregivers were associated with improved physical and mental QOL. Conversely, increased self-care monitoring was correlated with reduced QOL for both patients and caregivers. No significant relationship was found between self-care management and QOL.
For healthcare professionals specialising in geriatric care, our research provides more valuable guidance for the nursing of COPD patients. While maintaining vigilance is essential for both COPD patients and caregivers, our study suggests that excessive monitoring may have adverse effects on QOL, though this impact may vary depending on the underlying need for monitoring. This underscores the importance of tailored interventions that balance necessary vigilance with the potential risks of over-monitoring. By carefully considering the motivations behind monitoring, professionals can better support both patients and caregivers, ultimately enhancing self-care, improving QOL and contributing to healthy ageing.
The STROBE checklist was used to report the present study.
During the research design phase, we conducted interviews with patients and caregivers to capture pertinent issues related to their daily self-care routines. This initial step allowed us to gain an understanding of the potential differences between patients' self-care levels and caregivers' contributions to patients' self-care, while also exploring the potential impact on their health. Prior to data collection, we conducted a pilot study to identify any shortcomings in the research design and made corresponding adjustments. The phrasing of questions in the questionnaire was refined based on the feedback from patients and caregivers. During the interpretation phase, we solicited feedback from a subset of patients and caregivers to further validate our findings, thereby enhancing the clarity and relevance of our results for the target audience.
To analyse how refined living arrangements, in the context of digital access, affect elderly healthcare resource utilisation and satisfaction with healthcare needs.
A prospective cohort study. The study reporting is conformed to the STROBE checklist.
This longitudinal study utilised data from the 2018–2020 waves of the United States-based Health and Retirement Study and the 2013–2015 waves of the China Health and Retirement Longitudinal Study.
Baseline living arrangement was categorised into living alone, intergenerational living, living with spouse, nuclear living and proximate residence. Unmet healthcare needs at follow-up waves (i.e., 2020 wave of Health and Retirement Study and 2015 wave of China Health and Retirement Longitudinal Study) were classified into unmet clinical care needs and unmet preventive care needs, which were measured using three measurements on whether the participant had disorders, whether the participants use any clinical care, and whether the participants use any preventive care. Digital exclusion was assessed using a single question about internet access at baseline.
A total of 7116 participants from the China Health and Retirement Longitudinal Study cohort (female: 48.6%, mean age: 57.4 years) and 7266 from the Health and Retirement Study cohort (female: 64.9%, mean age: 65.1 years) were included. Compared with older adults living a nuclear arrangement, those living an inter-generational arrangement with digital exclusion had higher clinical care utilisation, but not necessarily lower risk of unmet clinical needs; they also had lower preventive care utilisation in the Health and Retirement Study cohort, while living with spouse led to higher preventive care utilisation in the China Health and Retirement Longitudinal Study cohort.
Living arrangements can affect older adults' healthcare utilisation and unmet healthcare needs, which can be moderated by digital exposure.
These findings suggest that healthcare providers should tailor care strategies by considering both living situations and digital literacy. Enhancing digital access, especially for those in inter-generational households, could help address unmet healthcare needs and improve overall care satisfaction.
This study using the STROBE CHECKLIST for reporting guideline.
No patient or public contribution.
By comparing data from both the United States and China, it highlights the importance of considering family structure and digital inclusion when addressing healthcare needs globally. The findings suggest that older adults in inter-generational living arrangements without digital access face higher clinical care demands but still struggle with unmet healthcare needs. This underscores the need for healthcare systems worldwide to address digital exclusion and adapt care strategies to individual living circumstances to enhance healthcare outcomes for the elderly population.
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