Chen Yi-Heng, Lin Li-Chan, Chuang Li-Lan, Chen Mei-Li
Associate Professor, Department of Nursing & Institute of Long-Term Care, Mackay Medical College, Taiwan, ROC.
Professor, School of Nursing, National Yang-Ming University, Taiwan, ROC.
Worldviews Evid Based Nurs. 2017 Dec;14(6):484-491. doi: 10.1111/wvn.12243. Epub 2017 May 16.
Older adults in residential settings frequently suffer from functional decline, mental illness, and social isolation, which make them more vulnerable to spiritual distress. However, empirical evidence of the interrelationships between physiopsychosocial variables and spiritual well-being are still lacking, limiting the application of the biopsychosocial-spiritual model in institutional healthcare practice.
To explain the mechanisms by which these variables are linked, this cross-sectional study tested a causal model of predictors of spiritual well-being among 377 institutionalized older adults with disability using a structural equation modeling approach.
The primary variables in the hypothesized model were measured using the Barthel Index for functional ability, the Geriatric Depression Scale-short form for depression, the Personal Resources Questionnaire 85-Part 2 for perceived social support, and the Spiritual Well-Being Scale for spiritual well-being.
The model fit indices suggest that the hypothesized model had a reasonably adequate model fit (χ = 12.18, df = 6, p = .07, goodness-of-fitness index [GFI] = 0.99, adjusted GIF index [AGFI] = 0.93, nonnormed fit index [NFI] = 0.99, comparative fit index [CFI] = 0.99). In this study, perceived social support and depression directly affected spiritual well-being, and functional ability indirectly affected spiritual well-being via perceived social support or depression. In addition, functional ability influenced perceived social support directly, which in turn influenced depression and ultimately influenced spiritual well-being.
This study results confirm the effect of physiopsychosocial factors on institutionalized older adults' spiritual well-being. However, the presence and level of functional disability do not necessarily influence spiritual well-being in late life unless it is disruptive to social relationships and is thus bound to lead to low perceived social support and the onset of depression.
The findings address the fact that the practice of spirituality is multidimensional and multileveled. Psychosocial interventions for institutionalized elders with disabilities should focus on increasing nurse-patient interaction and providing access to meaningful social activities to improve mental health and spiritual well-being.
居住环境中的老年人经常遭受功能衰退、精神疾病和社会隔离之苦，这使他们更容易陷入精神困扰。然而，生理心理社会变量与精神健康之间相互关系的实证证据仍然不足，限制了生物心理社会 - 精神模型在机构医疗实践中的应用。
为了解释这些变量之间的联系机制，本横断面研究使用结构方程建模方法，对377名机构化残疾老年人的精神健康预测因素因果模型进行了测试。
假设模型中的主要变量使用巴氏指数评估功能能力、老年抑郁量表简版评估抑郁、个人资源问卷85 - 第2部分评估感知社会支持、精神健康量表评估精神健康。
模型拟合指数表明，假设模型具有合理充分的模型拟合度（χ = 12.18，自由度 = 6，p = 0.07，拟合优度指数[GFI] = 0.99，调整后的GIF指数[AGFI] = 0.93，非规范拟合指数[NFI] = 0.99，比较拟合指数[CFI] = 0.99）。在本研究中，感知社会支持和抑郁直接影响精神健康，功能能力通过感知社会支持或抑郁间接影响精神健康。此外，功能能力直接影响感知社会支持，进而影响抑郁并最终影响精神健康。
本研究结果证实了生理心理社会因素对机构化老年人精神健康的影响。然而，功能残疾的存在和程度不一定会影响晚年的精神健康，除非它对社会关系造成干扰，从而必然导致低感知社会支持和抑郁的发生。
研究结果表明精神实践是多维度和多层次的。针对机构化残疾老年人的心理社会干预应侧重于增加护患互动，并提供参与有意义社会活动的机会，以改善心理健康和精神健康。
