الفهرس 
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Abstract
europathy is a condition that results from damage to, or dysfunction of, the nervous system. Most of the damage exists in the peripheral nervous system, which lies beyond the spine and brain, caused neuropathic symptoms (W.H.O, 2015). Neuropathy is a leading cause of chronic pain, which persists for three months or more. About 8% of people who report chronic pain suffer from some form of neuropathy, which affects about 20, 000 people in the U.S. and 15 million in the U.S. and Europe combined, according to the American chronic Pain Association (W.H.O, 2016)
Older adults with peripheral neuropathy have the possibility of deficits in postural stability and lower extremity functioning. Impairments in lower extremity physical functioning are key contributors to loss of physical independence and have a major impact on quality of life (W.H.O, 2020)
The Aim of the study:
The aim of this study is to assess quality of life for older adults with neuropathy through:
1. Assessing older adults’ knowledge about neuropathy.
2. Assessing older adults’ practices toward care of neuropathy.
3. Assessing quality of life domains for older adults with neuropathy as (physical, social, emotional, psychological).
4. Assessing health needs and problems of older adults with neuropathy.
Research questions:
1- What is the quality of life for older adults with neuropathy?
2- Is there a relation between older adult’s knowledge about neuropathy and socio - demographic characteristics?
3- Is there a relation between quality of life among older adults with neuropathy and knowledge about neuropathy?
4- Is there a relation between quality of life for older adults with neuropathy and practices toward care of neuropathy?
5- Is there a relation between quality of life for older adults with neuropathy and health needs and problems?
Setting:
The study was conducted at Internal Medicine in El- Demerdash Hospital which affiliated to Ain Shams University Hospitals.
Sampling:
A purposive sample will be used to conduct this study which was estimated 218 older adults with neuropathy. The following inclusion criteria set for sample selection as follows.
Inclusion criteria
1-The older adults aged from 60 years and above.
2-The older adults were complaining of neuropathy syndrome for at least one month.
3-The sample contain male or female clients.
Data Collection:
Data obtained through an interview with the older adults, using the following tools:
First tool: A pri-designed questionnaire was developed by investigator and it was written in simple Arabic and English Languages, it included the following five parts.
Part (I): socio- demographic characteristics of older adults with neuropathy.
Part (II): Data regarding older adults’ knowledge about neuropathy
Part (III): Data regarding older adults’ practices toward care of neuropathy
Part (IV): Data regarding older adults’ QOL.
Part (V): Data regarding older adults’ health needs.
The second tool: older adults’ medical records to assess health status which composed of the following 3 sections:
Medical history question concerning (family history, past history, present neuropathy complications).
Laboratory investigations.
Prescribed medication.
Third tool: Neurological examination scale by (Sartor, et al., 2018) it was used to measure the properities of older adult’s neuropathy. It was consisted of:
I. Physical assessment measurement, body mass index (BMI)
II. Peripheral neuropathic pain (the leads assessment of neuropathic symptoms and signs (LANSS). Such as pain assessment and sensory testing.
III. Neurological test according to W.H.O (2016)
Pilot study:
Conducted at the beginning of the study for 22 older adults (10% of the total sample) to investigate the feasibility of data collection tools, content, validity, clarity, and simplicity as well as to estimate the time that was needed for each sheet to be filled in. Obtained results were used as a guide to reconstruct the tools with changes needed on the data collection tools. All older adults shared in the pilot study were excluded from the main study sample.
Results:
The main findings of the study can be summarized as the following;
As regards characteristics of the studied older adults it found that, 59.6% of older adults were male and age group ranged from 65: 70 years, 68.8% married, 20.2% were illiterate, 44.0 % depends on health insurance, 40.4% were at the expense of the state and 57.3% lived in urban area.
As regard to the total knowledge about neuropathy disease, it found that there were 38% of older adult had satisfactory knowledge about the neuropathy diseases and 62% of them had unsatisfactory knowledge.
As regard to the total practices toward the care of neuropathy, it found that, 77.5 % of older adults were poor level of practices while 6.4% had good level of practices.
As regard to the total effects of older adults’ diseases on quality-of-life aspects, it found that, 77.1 % of older adults, quality of life was highly affected negatively according to physical health aspects, 40.4% of them affected psychologically, 53.2% of them had highly negative effect by spiritual aspects, and socioeconomically effect on 40.8% of them.
As regard to the total health needs, it found that, 69.3% of study sample of older adult’s unachieved health needs while 31.7% of them, health needs were achieved.
As regard to the complications of neuropathy, it found that the elderly with neuropathy suffer from skin ulcer 61.9% falling to the ground for 36.7%, addiction to painkillers 32.1%, insomnia for 23.4%, and as a complication of neuropathy.
As regard to the neuropathic pain sensation, it found that 71.6% of older adults with neuropathy neuropathic mechanism were likely to be contributing to pain.
As regard to the total quality of life for older adults with neuropath diseases, it found that, 34.9 % of older adults suffer from poor quality of life while 38.1% of them had average level of quality of life and only 27.0% of them had good level.
In relation to the older adult’s knowledge about neuropathy and socio - demographic characteristics, it determined that, only there were not significant statistical differences between total knowledge for older adults and sociodemographic characteristics with (x2 = 0.503 and P=> 0.05) also there were not significant statistical differences between total knowledge for older adults and other sociodemographic characteristics with (x2 = 4.653, 2.581, 2.442, 2.094, and 4.128 respectively and P=> 0.05)
In relation to the quality of life among older adults with neuropathy and knowledge about neuropathy, it found that, there is insignificant statistical relation between total older adults’ knowledge about neuropathy and Quality-of- life level with X2 = 1.624 and P value >0.05.
In relation to the quality of life among older adults with neuropathy and practices toward care of neuropathy it found that, there is a significant statistical relation between total older adults’ knowledge about neuropathy and Quality-of-life level with X2 = 16.761 and P value < 0.05.
In relation to the quality of life among older adults with neuropathy and health needs, it found that, 22.5% of unachieved health needs of older adults had poor level of quality of life while, 7.8% of achieved health needs had good level. There was insignificant statistical relation between total older adults’ health needs and Quality-of-life level with X2 = 1. 278 and P value >0.05.
Conclusion:
In conclusion the finding of the study revealed that, older adults age ranged from 60-70 years, two third of older adult had unsatisfactory knowledge about the neuropathy diseases. As well as more than three quarters of them had poor level of practices. Also, there were more than two thirds of them had unachieved health needs and more than one third of them suffered from quality of life. Finally, there was no significant relation between total knowledge and sociodemographic characteristics as well as insignificant statistical relation with QOL, while significant statistical relation between total older adults’ practices about neuropathy and their QOL level.
Recommendation:
In the light of the finding of the present study, the following recommendations are suggested:
1. Continuing long-term medical follow-up, in all clinics and specialized centers, to detect complications of neuropathy and its impact on the quality of life of the affected elderly is necessary to assess the level of quality of life of the elderly.
2. Educational program about prevention of neuropathic disease and care of peripheral neuropathy for older adults to raise their awareness and improve their practices.
3. Further studies to provide nursing intervention about raising older adults’ awareness toward prevention of neuropathy and improving QOL.
4. Further studies on large geographical scale and on larger sample size to emphasize on the most common health problems and health needs of older adults with neuropathy.