Značaj samoprocjene zdravlja za ocjenu mentalnog zdravlja i ...

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primarna od strane liječnika opće/obiteljske medicine u Dubrovačko-neretvanskoj ţupaniji. Ţene značajno više posjećuju samo liječnika opće/obiteljske medicine, a muškarci specijalistu. MlaĎi ispitanici (70-79) češće koriste zdravstvenu zaštitu, naročito specijalističko-konzilijarnu, dok stariji (80+) značajno češće posjećuju samo liječnika opće/obiteljske medicine. Lošije samoprocjenjeno opće zdravlje, tjelesni bolovi i bolja vitalnost značajni su prediktori korištenja specijalističko-konzilijarne zdravstvene zaštite u starijih osoba. Vjerojatno i granično depresivni te vjerojatno anksiozni imaju značajno veći rizik za hospitalizaciju u usporedbi s ispitanicima koji to nisu, dok kod vjerojatno i granično anksioznih postoji veći rizik korištenja specijalističko-konzilijarne zdravstvene zaštite. U starijoj dobi naĎena je visoka pojavnost depresivnosti i anksioznosti, no liječnici opće/obiteljske medicine ih vrlo rijetko prepoznaju i liječe. Planiranje javnozdravstvenih mjera s ciljem očuvanja i unaprjeĎenja mentalnog zdravlja te rane dijagnoze i adekvatnog liječenja mentalnih poremećaja treba provoditi na lokalnoj razini uvaţavajući specifičnosti regije i sociodemografske karakteristika populacije te znanstvene spoznaje o meĎusobnom utjecaju samoprocjenjenog i mentalnog zdravlja na korištenje zdravstvene zaštite. Potrebna je bolja suradnja zdravstvenih djelatnika na svim razinama zdravstvene zaštite te intersektorski pristup šire društvene zajednice kako bi se starijim osobama omogućilo odrţavanje aktivnog i samostalnog ţivota kroz što duţi period. 87
9. SUMMARY The aging of population increases the cost of health care and therefore an active and healthy aging process is an important factor of social development. The aim of this study was to investigate the importance of self-rated health on the occurrence of depression and anxiety and the impact of modifying factors on health and the use of health care by older persons in the following counties: Koprivnica-Krizevci, Istria and Dubrovnik-Neretva county, along with proposing measures for preserving mental health and an active and independent life at an elder age. The study used data collected in a comparative cross-sectional study in the international project TTB Second Decennial Survey of the Health Needs and Health Care for Older People in Europe (Elderly study) conducted in Croatia in 2006. The study included 1496 respondents of both gender aged 70 years and over who lived alone or in the same household with permanent residence in the study area. The socio-demographic data (age, gender, "live alone") and data on the use of health care (visits to family physicians, specialists and hospitalization in the last 12 months and data on the treatment of anxiety or depression in the last 4 weeks) were collected. Self-rated health and level of anxiety and depression were assessed with the SF-36 questionnaire and the HAD scale. The results showed that there were significant differences in self-rated health, prevalence of anxiety and depression and the use of health care at both primary and secondary level between the three counties studied. Respondents in the Koprivnica-Krizevci County rated their health the worst in all eight dimensions of health and most of them were depressed and anxious, while respondents in the Dubrovnik-Neretva County assessed their health the best and the least of them were depressed and anxious. Self-rated health and prevalence of depression and anxiety in respondents of the Istria County were similar to respondents in the Dubrovnik-Neretva County. The physical dimensions of health are generally rated worse than the mental ones, while depression is generally more common than anxiety in the elderly. Men rate their health significantly better than women in all eight dimensions, and women are more anxious than men. Self-rated health deteriorates and depression is more common, while the prevalence of anxiety decreases with older age. Respondents who live alone do not differ in self-rated health, the prevalence of anxiety and depression nor in the use of health care than those who do not live alone. Poor self-rated health, particularly the dimensions of mental health, is associated with anxiety and especially depression in the elderly. Older people in the Koprivnica-Krizevci County use health care less often than their peers in the other two counties. Secondary (specialist) health care is used most often in Istria, while primary health care by general practitioners/family physicians is used most often in the Dubrovnik-Neretva County. Women significantly more often visit 88
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Središnja medicinska knjižnica Va
Page 3 and 4:
Disertacija je izraĎena u Školi n
Page 5 and 6:
POPIS OZNAKA I KRATICA BDP DNŢ DZS
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stara stanovništva. U Hrvatskoj je
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vrlo je vaţno imati pouzdane infor
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dobi iznad 65 godina s udjelom od 3
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zdravstvenom stanju, sukladno opće
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što su promocija aktivnog sudjelov
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pojavnost i razvoj različitih bole
Page 19 and 20:
djelovanja i proučavanja razvoja p
Page 21 and 22:
azvojne procese te da im se prilago
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3. HIPOTEZE I CILJEVI ISTRAŽIVANJA
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osobe smještene u ustanove. Strukt
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4.5. Statistička obrada podataka D
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Raspodjela ispitanika s obzirom na
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Tablica 3. Usporedba samoprocjenjen
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muškarci ocjenjuju svoje zdravlje
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Živi sam Ne živi sam 80 80 70 70
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70 60 50 40 30 PF RP BP GH VT MH SF
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Mentalno zdravlje (MH) ostaje skoro
Page 41 and 42: Samoprocjenjeno zdravlje ispitanika
Page 43 and 44: 100% 90% 80% 70% 60% 50% 40% 30% ma
Page 45 and 46: Samoprocjenjeno zdravlje ispitanika
Page 47 and 48: Tablica 12. Prevalencija stupnja an
Page 49 and 50: Prevalencija stupnja anksioznosti o
Page 51 and 52: Anksioznost 100% 90% 80% 70% 60% 50
Page 53 and 54: Prevalencija stupnja depresivnosti
Page 55 and 56: 100% 90% 80% 70% 60% 50% 40% Vjeroj
Page 57 and 58: 70-79 80+ 100% 100% 80% 80% 60% 60%
Page 59 and 60: Tablica 21. Povezanost samoprocjenj
Page 61 and 62: specijalisti odreĎene medicinske g
Page 63 and 64: Tablica 25. Ispitanici koji su posj
Page 65 and 66: Tablica 27. Ispitanici koji su bili
Page 67 and 68: Tablica 30. Utjecaj osam dimenzija
Page 69 and 70: 6. RASPRAVA Rezultati dobiveni istr
Page 71 and 72: ţupanije govore u prilog slabije r
Page 73 and 74: nesposobnosti koja svakako dovodi d
Page 75 and 76: sami u sve tri istraţivane ţupani
Page 77 and 78: UtvrĎene razlike po spolu ukazuju
Page 79 and 80: azvoja društva u cjelini (118,119)
Page 81 and 82: Prema našim rezultatima jedna tre
Page 83 and 84: demografskih i socioekonomskih razl
Page 85 and 86: Razlozi svakako mogu biti u spoznaj
Page 87 and 88: liječnika opće/obiteljske medicin
Page 89 and 90: Prevalencija depresivnosti i anksio
Page 91: 8. SAŽETAK Starenjem stanovništva
Page 95 and 96: 10. POPIS LITERATURE 1. United Nati
Page 97 and 98: 32. European Comission. Green Paper
Page 99 and 100: 60. Snaith RP. The hospital anxiety
Page 101 and 102: 89. McFadden E, Luben R, Bingham S,
Page 103 and 104: 116. Heslin JM, Soveri PJ, Winoy JB
Page 105 and 106: service utilisation in elderly, reg
Page 107 and 108: 11. PRILOZI Prilog 1. Upitnik SF-36
Page 109 and 110: uopće ne 1 malo 2 umjereno 3 prili
Page 111 and 112: VIII. IX. X. XI. XII. XIII. XIV. 2.
Page 113 and 114: 108 Slika 3. Korelacija dimenzija z
Page 115 and 116: 110 Slika 7. Korelacija dimenzija z
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