Objectives: Chronic kidney disease (CKD) patients with regular dialysis treatment for more than 3 months are called maintenance hemodialysis (MHD). The degree of patients' adherence with the doctor's advice to take medicine on time is called medication adherence, which is very important for the control of the disease and the improvement of the quality of life for MHD patients. Living alone, lack of communication with children and self-neglect are risk factors for medication adherence in the older adults. Inappropriate substance use behaviors are common among older adults with self-neglect. Family resilience denotes the ability of a family to retain the stability of its structure by relying on its internal and external resources when facing a difficult situation. Family resilience entails the combination of family beliefs, interaction styles, problem-solving skills, and emotional communication which reflect supportive and positive psychological adjustment effects to benefit older persons. This study aims to provide a theoretical basis for clinical intervention level to improve medication adherence of older patients on MHD through examineing the correlation among family resilience, self-neglect, and medication adherence based on the self-reports.
Methods: A random sampling method was used to gather information from 632 older patients receiving MHD treatment in Hemodialysis Center of Hunan Province between July to December 2021. For this purpose, a self-designed demographic questionnaire, the Family Resilience Questionnaire (FRQ), the Scale of the Elderly Self-Neglect (SESN), and the Morisky Medication Adherence Scale-4 (MMAS-4) were used to investigate the questionnaire data of the participants. Pearson correlation was used to examine the relationship between family resilience, self-neglect, and medication adherence in older patients and gain insight into their current status. AMOS 24.0 was used for mediation modeling. Bootstrap mediation effect test was used to evaluate the mediation effect among the 3 variables.
Results: The questionnaires survey showed that the scores of FRQ, SESN, and MMAS-4 were 78.60±12.49, 7.99±5.60, and 5.93±1.40, respectively; and the medication adherence rate was 18.8%. Pearson correlation analysis showed that family resilience was negatively correlated with self-neglect (r=-0.432, P<0.001), and was positively correlated with medication adherence (r=0.169, P<0.001). Self-neglect was negatively correlated with medication adherence (r=-0.217, P<0.001). Mediating effect analysis showed that the total effect of family resilience on medication adherence was significant (β=0.214, 95% CI 0.121 to 0.313, P<0.001), and the direct effect was not significant (β=0.058, 95% CI -0.073 to 0.187, P>0.05). Self-neglect played a major mediating effect between family resilience and medication adherence (β=0.156, 95% CI 0.088 to 0.240, P<0.001).
Conclusions: Family resilience, self-neglect, and medication adherence among older patients on MHD are significantly related, with family resilience primarily influencing medication adherence indirectly through self-neglect.
目的: 慢性肾脏病(chronic kidney disease，CKD)患者规律透析治疗达3个月以上称为维持性血液透析(maintenance hemodialysis，MHD)。患者遵从医嘱按时、按量和规律服药的程度称为用药依从性，对MHD患者病情的控制和生活质量的提高至关重要。独居、缺乏子女沟通及自我忽视是老年人用药依从性的危险因素，在自我忽视的老年人中普遍存在药物使用不当的行为。家庭复原力是指家庭面对困境时通过内部/外部资源保持家庭结构稳定的能力，其作为家庭信念、互动方式、问题解决、情感交流的综合体现，能够反映家庭对于老年人的支持，起到积极的心理调节作用。本研究通过对MHD老年患者进行问卷调查，探究其家庭复原力、自我忽视和用药依从性之间的关系，旨在为临床提高MHD老年患者用药依从性的干预水平提供理论依据。方法: 采用随机抽样方法选取2021年7月至12月在湖南省血液透析中心就诊的MHD老年患者作为研究对象。采用一般情况调查问卷、家庭复原力问卷(Family Resilience Questionnaire，FRQ)、老年人自我忽视量表(Scale of the Elderly Self-Neglect，SESN)、Morisky用药依从性问卷(Morisky Medication Adherence Scale-4，MMAS-4)对632名MHD老年患者进行调查，了解其家庭复原力、老年人自我忽视和用药依从性的情况。采用Pearson相关分析探索三者之间的相关性；采用AMOS 24.0构建中介效应模型；采用Bootstrap中介效应检验法检验三者的中介效应关系。结果: 问卷调查结果表明：MHD老年患者的FRQ、SESN及MMAS-4得分分别为(78.60±12.49)，(7.99±5.60)及(5.93±1.40)分，用药依从率为18.8%。Pearson相关分析结果表明：家庭复原力与老年人自我忽视呈显著负相关(r=-0.432，P<0.001)，与用药依从性呈显著正相关(r=0.169，P<0.001)；老年人自我忽视与用药依从性呈显著负相关(r=-0.217，P<0.001)。中介效应分析结果表明：家庭复原力对用药依从性的总效应显著(β=0.214，95% CI 0.121~0.313，P<0.001)，直接效应不显著(β=0.058，95% CI -0.073~0.187，P>0.05)；自我忽视在家庭复原力与用药依从性间起主要中介效应(β=0.156，95% CI 0.088~0.240，P<0.001)。结论: 家庭复原力、老年人自我忽视与用药依从性都显著相关，MHD老年患者家庭复原力主要通过自我忽视的中介效应间接影响用药依从性。.
Keywords: family resilience; maintenance hemodialysis; mediation effect; medication adherence; self-neglect.