基于健康行动过程取向理论的老年肌少症患者健康管理方案的构建及应用

沙文娜; 陈美红; 宁丽; 金建芬; 傅秋燕; 章启秀

doi:10.16766/j.cnki.issn.1674-4152.003081

基于健康行动过程取向理论的老年肌少症患者健康管理方案的构建及应用

doi: 10.16766/j.cnki.issn.1674-4152.003081

1.
浙江大学医学院附属杭州市第一人民医院老年医学科，浙江杭州 310000
2.
浙江大学医学院附属杭州市第一人民医院护理部
3.
浙江大学医学院附属杭州市第一人民医院心理科

基金项目:

浙江省医药卫生科技计划项目 2022KY957

详细信息

通讯作者:
宁丽，E-mail：shawenn220@126.com

中图分类号: R592
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- 被引次数: 0
出版历程
- 收稿日期: 2023-02-20
- 网络出版日期: 2023-08-28

Construction and application of health management program based on HAPA for elderly patients with sarcopenia

1.
Department of Geriatrics, Hangzhou First People ' s Hospital, Affiliated to Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China

摘要

摘要: 目的构建基于健康行动过程取向理论(HAPA)的老年肌少症患者健康管理方案，并通过前瞻性、随机研究探讨应用效果。方法采用便利抽样法，于2021年10月—2022年7月选取杭州市第一人民医院老年病科100例住院的老年肌少症患者作为研究对象。按照住院时间分为对照组与观察组，每组50例。干预结束后，最终观察组45例，对照组47例。对照组采用常规护理方法，观察组采用基于HAPA的老年肌少症患者健康管理方案。采用健康行为能力自评量表、电子握力器、简易机体功能评估法、Hb和ALB评估干预效果。结果干预后，观察组患者肌肉强度、躯体功能评分及Hb和ALB值分别为(23.79±2.02)分，(9.00±0.97)分，(126.06±3.82)g/L，(34.64±2.85)g/L，对照组分别为(21.14±1.49)分，(7.47±1.39)分，(123.12±2.88)g/L，(33.12±2.88)g/L，2组差异均有统计学意义(均P＜0.05)。干预后，观察组健康行为自我效能总分和运动、健康责任得分分别为(63.80±5.05)分，(18.42±2.18)分，(15.66±2.45)分，均高于对照组得分[(60.38±6.52)分，(16.91±3.36)分，(13.85±2.83)分]，差异均有统计学意义(均P＜0.05)。结论基于HAPA的老年肌少症患者的健康管理方案对于改善患者的肌肉强度、躯体功能、健康行为自我效能、Hb和ALB具有积极意义。
- 健康行动过程取向理论 /
- 老年肌少症 /
- 健康行为自我效能 /
- 肌肉强度 /
- 躯体功能
Abstract: Objective To construct health management program based on health action process approach (HAPA) for elderly patients with sarcopenia, and explore its application effects through prospective and randomized studies. Methods A total of 100 participants were recruited in the Geriatric Department of Hangzhou First People ' s Hospital using a convenient sampling method from October 2021 to July 2022. According to the admission time, they were divided into control group and observation group, 50 cases in each group. After intervention, 45 cases were included in the observation group and 47 cases were included in the control group, eventually. The patients in the control group were provided normal care and the patients in the observation group were provided health management program based on HAPA. The outcomes were evaluated by the self-rated abilities for health practices scale (SRAHP), electronic grip, short physical performance battery (SPPB), hemoglobin (Hb) and serum albumin (ALB). Results After intervention, scores for muscle strength and physical function, as well as Hb and ALB were (23.79±2.02) points, (9.00±0.97) points, (126.06±3.82) g/L, (34.64±2.85) g/L in the observation group and (21.14±1.49) points, (7.47±1.39) points, (123.12±2.88) g/L, (33.12±2.88) g/L in the control group, the difference was statistically significant (all P < 0.05). The total score of health behavior self-efficacy and the score of exercise, health responsibility were (63.80±5.05) points, (18.42±2.18) points, (15.66±2.45) points in the observation group and (60.38±6.52) points, (16.91±3.36) points, (13.85±2.83) points in the control group, the difference was statistically significant (all P < 0.05). Conclusion The health management program based on HAPA for elderly patients with sarcopenia has a positive effect on self-efficacy of health behavior, muscle strength, physical function and Hb and ALB among elderly patients with sarcopenia.
- Health action process approach /
- Elderly patients with sarcopenia /
- Self-efficacy of health behavior /
- Muscle strength /
- Physical function

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表 1 2组老年肌少症患者一般资料比较

Table 1. Comparison of general data between two groups of elderly patients with sarcopenia

项目	观察组(n=45)	对照组(n=47)	统计量	P值
年龄(x±s，岁)	72.60±5.91	73.26±6.01	0.527^a	0.600
性别[例(%)]			0.196^b	0.658
男性	26(57.8)	25(53.2)
女性	19(42.2)	22(46.8)
文化程度[例(%)]			0.207^b	0.943
初中及以下	30(66.7)	32(68.1)
高中/中专	12(26.7)	11(23.4)
大专及以上	3(6.7)	4(8.5)
婚姻状况[例(%)]			1.174^b	0.278
已婚	36(80.0)	33(70.2)
丧偶	9(20.0)	14(29.8)
高血压[例(%)]			0.659^b	0.417
否	24(53.3)	29(61.7)
是	21(46.7)	18(38.3)
糖尿病[例(%)]			0.359^b	0.549
否	32(71.1)	36(76.6)
是	13(28.9)	11(23.4)
心血管疾病[例(%)]			0.354^b	0.552
否	26(57.8)	30(63.8)
是	19(42.2)	17(36.2)
其他基础疾病[例(%)]			0.036^b	0.849
否	38(84.4)	39(83.0)
是	7(15.6)	8(17.0)
注：^a为t值，^b为χ²值。

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表 2 2组老年肌少症患者健康行为自我效能评分比较(x±s，分)

Table 2. Comparison of health behavior self-efficacy scores between two groups of elderly patients with sarcopenia (x±s, points)

组别	例数	营养		心理调适		运动		健康责任		健康行为自我效能
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
观察组	45	15.24±2.55	16.00±2.34^a	11.15±2.93	13.71±2.12^a	14.26±3.39	18.42±2.18^a	12.64±3.38	15.66±2.45^a	53.31±7.86	63.80±5.05^a
对照组	47	15.14±2.43	16.46±2.34^a	10.89±2.24	13.14±2.45^a	14.36±2.88	16.91±3.36^a	12.55±3.83	13.85±2.83^a	52.96±6.28	60.38±6.52^a
t值		0.184	0.956	0.481	1.171	0.145	2.533	0.121	3.275	0.239	2.799
P值		0.855	0.341	0.631	0.245	0.885	0.013	0.904	0.002	0.812	0.006
注：与同组干预前比较，^aP＜0.05。

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表 3 2组老年肌少症患者肌肉强度和躯体功能比较(x±s，分)

Table 3. Comparison of muscle strength and physical function between two groups of elderly patients with sarcopenia(x±s, points)

组别	例数	肌肉强度		平衡能力		步速		坐立试验		躯体功能
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
观察组	45	19.77±2.00	23.79±2.02^a	1.84±0.76	2.93±0.61^a	1.76±0.83	3.18±0.61^a	1.73±0.80	2.89±0.57^a	5.33±1.39	9.00±0.97^a
对照组	47	19.24±1.83	21.14±1.49^a	1.72±0.82	2.28±0.74^a	1.70±0.83	2.60±0.71^a	1.64±0.91	2.60±0.64^a	5.06±1.53	7.47±1.39^a
t值		1.340	7.154	0.727	4.598	0.308	4.191	0.526	2.295	0.878	6.072
P值		0.184	＜0.001	0.469	＜0.001	0.759	＜0.001	0.600	0.024	0.382	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 4 2组老年肌少症患者干预前后营养指标比较(x±s，g/L)

Table 4. Comparison of nutritional indexes between two groups of elderly patients with sarcopenia before and after intervention (x±s, g/L)

组别	例数	Hb		ALB
组别	例数	干预前	干预后	干预前	干预后
观察组	45	118.73±3.71	126.06±3.82^a	31.26±2.08	34.64±2.85^a
对照组	47	119.27±3.29	123.12±2.88^a	30.95±2.85	33.12±2.88^a
t值		0.743	4.169	0.591	2.534
P值		0.459	＜0.001	0.556	0.013
注：与同组干预前比较，^aP＜0.05。

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