社会支持度与老年人听力障碍预后的关系研究

Relationship of social support with prognosis of hearing loss in the elderly

摘要:

目的 探讨社会支持度与老年人听力障碍预后的关系。方法 入选2008年1月～2014年12月在中山大学附属第三医院耳鼻咽喉头颈外科因听力障碍就诊的门诊及住院患者中资料齐全并可持续随访的130例＞60岁的老年患者，调查其就诊主诉、发病到就诊时间、对诊疗的顺从性、预后以及其所获得的社会支持度。结果 （1）就诊主诉。老年人因听力障碍而就诊时，除了中青年人中常见的听力下降、耳鸣、听不清等主诉之外，还有“把电视机声音调大、没听见婴儿哭声、错过电话、错过敲门声”等导致干扰家人生活以及误事等原因。听力障碍发生后，仅22%的患者能在1周内就诊。（2）社会支持度。130例听力障碍老年人的社会支持度明显低于健康中青年人常模及中青年听力障碍患者对照组，主要在主观支持、支持利用度两个维度，差异显著。（3）顺从性。因为医疗保障不足、交通不便等诸多原因，听力障碍老年人对诊疗的顺从性差，仅49%的患者能选择并执行医生推荐的诊疗方案，30%的患者中断治疗，21%的患者放弃干预。（4）预后。诊疗结束时，较好耳的听力仅5例达正常水平，轻度、中度、重度及极重度聋分别为49例、40例、22例和14例。结论 听力障碍老年人因为对听力保健常识以及干预措施的知晓率低，在医疗费用、就诊时间等方面的保障缺乏，以致于听力障碍发生后不能及时就诊、难以选择最佳诊疗方案甚至于中断治疗或放弃干预，最终严重影响预后。

Abstract:

Objective To analyze the relationship of social support with prognosis of hearing loss in the elderly. Methods Clinical data of 130 in- and out-patients (more than 60 years old) with hearing loss admitted in our hospital from January 2008 to December 2014 were collected in this study. Their chief complaints, time from onset to hospital admission, treatment compliance, prognosis and social support were analyzed. Results (1) Chief complaints. Besides hearing loss, tinnitus, and disable to hear clearly which were also common in young patients, some complaints which interfered family life or caused delay in business, such as turning TV volume louder and louder, failed to hear infant crying, and missing phone calling or door-knocking, were the chief complaints of the elder patients. But as the onset of hearing loss, only 22% elderly visited a doctor within a week. (2) Social support. The social support gained in elderly patients was significantly lower than that in normal healthy group and the younger patients group. Obvious differences were seen in the dimensions of subjective support and utilization of support. (3) Compliance. Because of insufficient medical insurance, inconvenient transportation and other reasons, the treatment compliance was poor in the elderly patients with hearing loss (only 49% of them choosing and complying with the treatment plan recommended by doctors, 30% discontinuing the treatment, and 21% giving up the intervention). (4) Prognosis. According to the results of pure tone auditory, when the treatment was over, only 5 cases got normal hearing, and 49 suffered slight, 40 moderate, 22 severe, and 14 profound hearing loss. Conclusion Due to the lack of knowledge on hearing healthcare and intervention for hearing disorder, and to the lack of medical costs, time to visit and other aspects, the elderly patients when suffering from hearing loss are not able to see a doctor in time, and are difficult to choose the best diagnosis and treatment program, even some of them discontinue or abandon intervention. As a result, the prognosis of hearing loss is influenced heavily.