The Correlation between Carotid Intima-Media Thickness and Neutrophil to Lymphocyte Ratio in Prediabetes Patients / 가정의학회지

Background@#Prediabetes is a metabolic state between normoglycemia and diabetes and is known to carry a higher risk of developing overt diabetes and cardiovascular disease (CVD). The relative and absolute risks of all-cause mortality, CVD, coronary heart disease, and stroke in prediabetes patients, as well as in diabetic patients, is higher than that in patients with normoglycemia. Carotid intima-media thickness (cIMT) is a method used to stratify CVD risk. In this study, we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) correlates with cIMT in prediabetes patients. @*Methods@#From January 1, 2016, to February 20, 2021, 581 adults their 30s–70s who underwent carotid ultrasonography as part of a comprehensive medical examination at the Dongtan Sacred Heart Hospital were enrolled. Statistical analysis using SPSS presented t-test and chi-square test significance levels into a group with normal cIMT (nIMT; cIMT <1 mm) and a group with thick cIMT (tIMT; cIMT ≥1 mm). Binary logistic regression analysis was performed to confirm the correlation between NLR and cIMT. @*Results@#In prediabetic adults, age, hemoglobin A1c (HbA1c), systolic blood pressure, and NLR were significantly higher in the tIMT group than in the nIMT group. In the regression analysis, NLR, age, and HbA1c were significantly correlated with cIMT. @*Conclusion@#NLR was significantly higher in the tIMT group than in the nIMT group; therefore, NLR may be used to assess CVD risk in prediabetes patients.

Association between Timed Up and Go Test and Subsequent Functional Dependency

BACKGROUND@#This study aimed to evaluate the association between baseline results of the Timed Up and Go (TUG) test and subsequent functional dependency occurrence.@*METHODS@#From the National Health Insurance Service-Senior Cohort database, we identified 39,519 people who participated in the National Screening Program for Transitional Ages at the age of 66 during 2007–2008. Impaired mobility was defined as taking 10 seconds or longer to perform the TUG test. Functional dependency occurrence was defined as the initiation of receiving national Long-Term Care Insurance services—home care or admission to long-term care facilities. Cox proportional hazard regression models were used to assess the hazard ratios (HRs) for dependency occurrence according to baseline TUG test results.@*RESULTS@#The mean follow-up period was 5.7 years. Occurrence rates of dependency were 2.0 and 3.4 cases per 1,000 person-years in the normal and impaired TUG groups, respectively. Impaired mobility was associated with a higher risk of functional dependency occurrence (adjusted HR [aHR], 1.65; 95% confidence interval [CI], 1.40–1.95; P < 0.001). Additionally, in the subgroup analysis for the participants with intact baseline activities of daily living, impaired mobility was associated with a higher risk of dependency occurrence (aHR, 1.65; 95% CI, 1.33–2.04; P < 0.001).@*CONCLUSION@#The TUG test might be a useful predictive marker of subsequent functional dependency occurrence. Intervention to prevent functional dependency may be helpful for older adults with impairment on the TUG test.

The Impact of Depression on Cardiovascular Disease: A Nationwide Population-Based Cohort Study in Korean Elderly / 가정의학회지

Background@#Depression is suggested to be associated with cardiovascular disease, including ischemic heart disease and cerebrovascular disease. This study investigated the impact of depression on cardiovascular disease in the elderly population in Korea. @*Methods@#This retrospective cohort study was performed using the Senior Cohort database released by the Korean National Health Insurance Services from January 1, 2008 to December 31, 2012, or January 1, 2009 to December 31, 2013. The study group constituted participants newly diagnosed with depression, but not cardiovascular disease. The control group constituted participants with no past history of depression or cardiovascular disease, and were not diagnosed with depression during the follow-up period. During the 5-year follow-up period, development of ischemic heart disease or cerebrovascular disease was assessed. Depression and cardiovascular disease were identified using the International Classification of Diseases, 10th revision, Clinical Modification codes. The data was analyzed using Cox proportional hazards model. @*Results@#The hazard ratio (HR) between depression and ischemic heart disease was 1.38 (95% confidence interval [CI], 1.23 to 1.55) and the HR between depression and cerebrovascular disease was 1.46 (95% CI, 1.32 to 1.62), after adjusting all confounding variables. @*Conclusion@#Independent of other cardiovascular risk factors, depression increased the risk of ischemic heart disease by 38% and cerebrovascular disease by 46% among older adults in Korea. Since depression may increase the risk of cardiovascular disease, future research should focus on the diagnosis and prevention of cardiovascular disease in people with depression.

Survival Analysis of Patients with Alzheimer’s Disease: A Study Based on Data from the Korean National Health Insurance Services’ Senior Cohort Database / 가정의학회지

Background@#Korea’s rapidly aging population has experienced a sharp rise in the prevalence of dementia. Patients with Alzheimer’s disease (AD), which is estimated to be about three-quarters of all patients with dementia, tend to have higher mortality rates compared with patients without Alzheimer’s disease. In this study, a survival analysis of patients with AD was conducted in order to provide knowledge to those who provide medical care to these patients. @*Methods@#Data on individuals over 65 years old in 2004 were extracted from the Korean National Health Insurance Services’ Senior Cohort database (2002–2013). The subjects were 209,254 patients, including 2,695 who were first diagnosed with AD (the AD group) and 206,559 that had not been diagnosed with the disease (non-AD group). To investigate the independent effect of AD on survival, the Cox proportional-hazards model, hazard ratios (confidence interval of 95%), and the Kaplan-Meier method were used. @*Results@#Mean survival time in the AD group was 5.3±3.3 years, which was about 2.5 years shorter than that in the non-AD group (7.8±2.4 years). The mortality rate in the AD group (66.3%) was higher than that in the non-AD group (26.3%). The adjusted hazard ratio in the AD group was 2.5 and, therefore, it was found that the AD group had a 2.5-fold higher risk of death than the non-AD group. @*Conclusion@#Overall, AD has a large, independent impact on survival. Survival time was shorter, and the mortality rate and risk were generally higher in the AD group, compared with the non-AD group.

Association between Timed Up and Go Test and Subsequent Functional Dependency

BACKGROUND@#This study aimed to evaluate the association between baseline results of the Timed Up and Go (TUG) test and subsequent functional dependency occurrence.@*METHODS@#From the National Health Insurance Service-Senior Cohort database, we identified 39,519 people who participated in the National Screening Program for Transitional Ages at the age of 66 during 2007–2008. Impaired mobility was defined as taking 10 seconds or longer to perform the TUG test. Functional dependency occurrence was defined as the initiation of receiving national Long-Term Care Insurance services—home care or admission to long-term care facilities. Cox proportional hazard regression models were used to assess the hazard ratios (HRs) for dependency occurrence according to baseline TUG test results.@*RESULTS@#The mean follow-up period was 5.7 years. Occurrence rates of dependency were 2.0 and 3.4 cases per 1,000 person-years in the normal and impaired TUG groups, respectively. Impaired mobility was associated with a higher risk of functional dependency occurrence (adjusted HR [aHR], 1.65; 95% confidence interval [CI], 1.40–1.95; P < 0.001). Additionally, in the subgroup analysis for the participants with intact baseline activities of daily living, impaired mobility was associated with a higher risk of dependency occurrence (aHR, 1.65; 95% CI, 1.33–2.04; P < 0.001).@*CONCLUSION@#The TUG test might be a useful predictive marker of subsequent functional dependency occurrence. Intervention to prevent functional dependency may be helpful for older adults with impairment on the TUG test.

Association between Timed Up and Go Test and Subsequent Functional Dependency

Associated Factors for Target Blood Pressure Achievement after Triple Combination Therapy in Hypertensive Patients

BACKGROUND: The prevalence of hypertension reaches 29% in adults over 30 years of age in the Korean population; however, the control rate is merely 44%. The aim of this study was to investigate the associated factors for target blood pressure achievement after triple combination therapy in hypertensive patients. METHODS: From February 2016 to May 2018, 10 family physicians recruited 348 patients, who newly started a triple combination antihypertensive medication. Target blood pressure was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg after 6 months of triple combination therapy. Multivariate logistic regression analyses were performed to analyze the associated factors for target blood pressure achievement. RESULTS: Among the 348 study participants, 317 completed 6 months of treatment. The target achievement rate was 76.3% (242/317). The mean absolute difference and 95% confidence interval (CI) for the SBP and DBP were 10.8 mmHg (8.8 to 12.7) and 6.4 mmHg (5.1 to 7.8), respectively (P<0.05). The odds ratio (OR) for the target blood pressure achievement increased in those with college education or higher (OR, 2.69; 95% CI, 1.22–5.92), those with dyslipidemia (OR, 1.74; 95% CI, 1.01–2.99), and those who were satisfied with the medication (OR, 29.91; 95% CI, 3.70–241.92). CONCLUSIONS: The presence of dyslipidemia and patient's satisfaction with the medication were associated with target blood pressure achievement in our analyses. Our findings suggest the importance of patient's factor in the control of blood pressure.

The Impact of Depression on Fracture in Elderly: A Nationwide Population-Based Retrospective-Cohort Study

BACKGROUND: Fractures should be actively prevented in the elderly because recovery from the damage of fractures is slow and fractures can cause both physical and psychological pain in the elderly. Previous studies have reported that depression is related to falls or low bone mineral density (BMD). This study aimed to evaluate the risk of fracture according to the depression status among the elderly.METHODS: This study used the National Health Insurance Corporation cohort data to examine 96,188 elderly people aged >65 years who were examined in 2007 and 2008. The chi-square test was used to determine the general characteristics and fracture incidence in patients with depression and healthy controls, and the hazard ratio was calculated using the Cox proportional hazards model corrected for general characteristics. The Kaplan-Meier method predicted the risk of fracture in two groups during the observation period.RESULTS: In the depressed group, 23.2% (441 of 1,904) of the patients had a fracture during the 5-year follow-up period; however, in the control group, only 17.5% (16,470 of 94,284) had a fracture (P < 0.001). In addition, multivariate analysis of the adjusted variables showed that the risk of fracture in the depressed group was 1.34 times higher than that in the control group. The risk of fracture in women was 1.71 times higher than that in men, and the risk of fracture increased with age.CONCLUSION: The risk of fracture in the elderly who were depressed was significantly higher than that in the elderly who were not depressed.

Associated Factors for Target Blood Pressure Achievement after Triple Combination Therapy in Hypertensive Patients

BACKGROUND@#The prevalence of hypertension reaches 29% in adults over 30 years of age in the Korean population; however, the control rate is merely 44%. The aim of this study was to investigate the associated factors for target blood pressure achievement after triple combination therapy in hypertensive patients.@*METHODS@#From February 2016 to May 2018, 10 family physicians recruited 348 patients, who newly started a triple combination antihypertensive medication. Target blood pressure was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg after 6 months of triple combination therapy. Multivariate logistic regression analyses were performed to analyze the associated factors for target blood pressure achievement.@*RESULTS@#Among the 348 study participants, 317 completed 6 months of treatment. The target achievement rate was 76.3% (242/317). The mean absolute difference and 95% confidence interval (CI) for the SBP and DBP were 10.8 mmHg (8.8 to 12.7) and 6.4 mmHg (5.1 to 7.8), respectively (P<0.05). The odds ratio (OR) for the target blood pressure achievement increased in those with college education or higher (OR, 2.69; 95% CI, 1.22–5.92), those with dyslipidemia (OR, 1.74; 95% CI, 1.01–2.99), and those who were satisfied with the medication (OR, 29.91; 95% CI, 3.70–241.92).@*CONCLUSIONS@#The presence of dyslipidemia and patient's satisfaction with the medication were associated with target blood pressure achievement in our analyses. Our findings suggest the importance of patient's factor in the control of blood pressure.

Night Shift Work and Risk of Depression: Meta-analysis of Observational Studies

This study aimed to assess whether night shift work is associated with the risk of depression by using a meta-analysis of observational studies. We searched PubMed and EMBASE in August, 2016 to locate eligible studies and investigated the association between night shift work and the risk of depression, reporting outcome measures with adjusted odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs). In the meta-analysis of a total of 11 observational studies with 9 cross-sectional study, 1 longitudinal study, and 1 cohort study, night shift work was significantly associated with an increased risk of depression (OR/RR, 1.43; 95% CI, 1.24–1.64; I² = 78.0%). Also, subgroup meta-analyses by gender, night shift work duration, type of occupation, continent, and type of publication showed that night shift work was consistently associated with the increased risk of depression. The current meta-analysis suggests that night shift work is associated with the increased risk of depression. However, further large prospective cohort studies are needed to confirm this association.

Appetite stimulants for older persons

Anorexia is one of the most common issues in older patients. Although there is a tendency for loss of appetite in older persons due to decreased physical activity and reduced resting metabolic rate, this physiological anorexia of aging can easily develop into progressive anorexia and weight loss. This pathologic anorexia and resultant weight loss is associated with increased morbidity and mortality, especially in the frail elderly. To prevent older persons from entering a vicious cycle of frailty, that is, anorexia-malnutrition-sarcopenia-functional impairment, routine screening for anorexia and malnutrition should be implemented in geriatric clinical practice. All anorexic elderly patients should be strongly encouraged to maintain their nutrition, and appetite stimulants can be considered if non-pharmacological interventions are not effective. Although there are no US or Korea Food and Drug Administration approved medications for geriatric-specific anorexia and weight loss, several appetite stimulants can be prescribed and are used widely. Megestrol acetate is the most widely studied and commonly used of these drugs. Cyproheptadine, dronabinol, mirtazapine, corticosteroids, anabolic steroids (e.g., testosterone or oxandrolone), and growth hormone are also effective in increasing appetite or weight. However, the use of these orexigenic agents should occur only after their benefit-to-risk ratio has been carefully considered.

Diagnostic Performance of Body Mass Index Using the Western Pacific Regional Office of World Health Organization Reference Standards for Body Fat Percentage

Associations between body mass index (BMI), body fat percentage (BF%), and health risks differ between Asian and European populations. BMI is commonly used to diagnose obesity; however, its accuracy in detecting adiposity in Koreans is unknown. The present cross-sectional study aimed at assessing the accuracy of BMI in determining BF%-defined obesity in 6,017 subjects (age 20-69 yr, 43.6% men) from the 2009 Korean National Health and Nutrition Examination Survey. We assessed the diagnostic performance of BMI using the Western Pacific Regional Office of World Health Organization reference standard for BF%-defined obesity by sex and age and identified the optimal BMI cut-off for BF%-defined obesity using receiver operating characteristic curve analysis. BMI-defined obesity (> or =25 kg/m2) was observed in 38.7% of men and 28.1% of women, with a high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72% women) for BF%-defined obesity (25.2%, men; 31.1%, women). The optimal BMI cut-off (24.2 kg/m2) had 78% sensitivity and 71% specificity. BMI demonstrated limited diagnostic accuracy for adiposity in Korea. There was a -1.3 kg/m2 difference in optimal BMI cut-offs between Korea and America, smaller than the 5-unit difference between the Western Pacific Regional Office and global World Health Organization obesity criteria.

Diagnostic Performance of Body Mass Index Using the Western Pacific Regional Office of World Health Organization Reference Standards for Body Fat Percentage

Associations between body mass index (BMI), body fat percentage (BF%), and health risks differ between Asian and European populations. BMI is commonly used to diagnose obesity; however, its accuracy in detecting adiposity in Koreans is unknown. The present cross-sectional study aimed at assessing the accuracy of BMI in determining BF%-defined obesity in 6,017 subjects (age 20-69 yr, 43.6% men) from the 2009 Korean National Health and Nutrition Examination Survey. We assessed the diagnostic performance of BMI using the Western Pacific Regional Office of World Health Organization reference standard for BF%-defined obesity by sex and age and identified the optimal BMI cut-off for BF%-defined obesity using receiver operating characteristic curve analysis. BMI-defined obesity (> or =25 kg/m2) was observed in 38.7% of men and 28.1% of women, with a high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72% women) for BF%-defined obesity (25.2%, men; 31.1%, women). The optimal BMI cut-off (24.2 kg/m2) had 78% sensitivity and 71% specificity. BMI demonstrated limited diagnostic accuracy for adiposity in Korea. There was a -1.3 kg/m2 difference in optimal BMI cut-offs between Korea and America, smaller than the 5-unit difference between the Western Pacific Regional Office and global World Health Organization obesity criteria.

Aspirin in the prevention of cardiovascular disease and cancer

Cardiovascular disease (CVD) is the one of the leading causes of death in Korea. Aspirin, well known for its antiplatelet function, has been used for the secondary prevention of CVD during the first few several decades. However, whether or not to have a protective effect on the primary prevention of CVD in apparently healthy people is still controversial. In addition, accumulating data suggest aspirin may have a favorable possibility on cancer incidence and mortality. We reviewed the literature, focusing on new evidence on the benefits and risks of aspirin for the prevention of CVD and cancer. Aspirin modestly decreases the risk of non-fatal myocardial infarction and cancer incidence in patients without overt CVD and at average cancer risk, but increase the risk of major bleeding. Several guidelines on the use of aspirin for the primary prevention of CVD stated the need for the prudent assessment of individual CVD risks in the target population. Currently there's no CVD risk assessment tools based on domestic data available in Korea. Also the bleeding risk and relatively high incidence of hemorrhagic stroke in Koreans make a difficult decision. Clinicians should give the patients a balanced information and discuss the effects or harms of taking aspirin on the prevention of CVD and cancer according to the updated evidence. Patient education for the prevention of CVD is more important and life style change including smoking cessation, weight reduction, and a healthy diet should be emphasized before considering aspirin.

Pro Re Nata Prescription and Perception Difference between Doctors and Nurses / 가정의학회지

BACKGROUND: Pro re nata (PRN) prescription is a frequently used prescription method in hospitals. This study was conducted to investigate actual condition of PRN prescription and whether administration error occurred because of perception difference between doctors and nurses. METHODS: From May to July 2012, a survey was conducted among 746 doctors and nurses (88 doctors and 658 nurses) working at 5 hospitals located in Seoul, Gyeong-gi, and Gangwon Province. Doctors generating PRN prescription responded to actual conditions of PRN prescription and both doctors and nurses reported whether administration error occurred due to perception difference. RESULTS: Average number of PRN prescription of surgical residents was 4.6 +/- 5.4, which was larger than that of medical residents (1.7 +/- 1.0). Surgical residents more frequently recorded maximum number of daily intake (P = 0.034) and, although not statistically significant, more often wrote exact single dosage (P = 0.053) and maximum dosage per day (P = 0.333) than medical residents. Doctors expected nurses to notify them before the administration of medication; however, nurses were more likely to conduct PRN administration by their own decision without informing doctors. In addition, some doctors and nurses experienced administration errors because of it. CONCLUSION: Standard prescription methods need to be established since there is a perception difference in PRN prescription between doctors and nurses and this could be related to administration errors.

Development and Validity and Reliability of Korean Comprehensive Assessment Tools for Geriatric Ambulatory Care

BACKGROUND: The purpose of this study was to develop and to evaluate the applicability of the Korean comprehensive geriatric assessment tools through reliability and validity testing. METHODS: We developed standard and short-form assessment tools comprised of questionnaires on medical, functional, mental, socioeconomic status and lifestyle information and functional tests. The tools were administered as test-retest on 111 elderly outpatients at four university hospitals and two welfare centers in Seoul. Weighted kappa value, kappa value, Pearson's correlation coefficients and overall percent agreement were calculated to evaluate reliability. Validity coefficient was estimated by using the reliability coefficient. RESULTS: Reliability and validity coefficients were higher than 0.50 (fair or good) for 29 of 36 items. For test-retest reliability, the median was 0.66 (range, 0.29 to 1.00) for the kappa value and 0.83 (range, 0.53 to 1.00) for the Pearson's correlation coefficients. Compared to the standard form, the short-form assessment questionnaires showed to be reliable and valid. CONCLUSION: The Korean Comprehensive Assessment Tools, both the standard form and the short form, were shown to be a reliable and valid screening medium for assessing the health status of the elderly in the ambulatory care setting. These instruments can be used conveniently for comprehensive outpatient geriatric assessment.

The Validity and Reliability of the Kaigo-Yobo Checklist in Korean Elderly

BACKGROUND: This study was done to evaluate the validity and reliability of the Kaigo-Yobo (K-Y) checklist in the Korean elderly population. METHODS: The study population included 283 men and women over 65 years who visited the three community senior's welfare centers located in Seoul and Gyeonggi province from March 29, 2011 to May 26, 2011. The Korean frailty index (FI), Japanese K-Y checklist, Cardiovascular Health Study frailty index (CHSFI), activities of daily living, and Korean Mini-Mental Status Examination were completed for each participant. Reliability was tested by internal consistency (Cronbach's alpha), as was the test-retest reliability, at a 2-week interval. Validity was tested by the area under the curve (AUC) from the receiver operating characteristics curve as a predictor of frailty according to the CHS criteria and the validity index estimated by the reliability index. RESULTS: The correlation coefficients between Korean FI and K-Y checklist, Korean FI and CHSFI, and K-Y checklist and CHSFI were 0.61, 0.43, and 0.44 respectively. The range of Kappa value for each item on the Korean FI was 0.28 to 0.60 and 0.19 to 0.65 for the K-Y checklist. Cronbach's alpha for the Korean FI was 0.58 and 0.64 for the K-Y checklist. The AUC for the Korean FI was 0.79, and 0.64 for the K-Y checklist. The validity index for the items on the Korean FI ranged from 0.28-0.53 to 0.60-0.78 and 0.19-0.44 to 0.65-0.81 for the K-Y checklist. CONCLUSION: The K-Y checklist is a valid and reliable instrument to measure frailty in the Korean elderly population. Follow-up studies are needed.

Polypharmacy in Older Patients Admitted to a General Hospital

BACKGROUND: The elderly population is rapidly growing in numbers in Korea. According to the high prevalence of chronic disease in older persons, the issue of polypharmacy becomes one of the main problems in geriatric care. In this study, we tried to investigate the current status of inappropriate multiple drug prescriptions in older patients who were admitted to general hospital. METHODS: From July 1st 2010 to July 31th 2010, a total of 163 patients of 65 years of age or over who were admitted to one general hospital were investigated. Subjects were examined with a structured questionnaire survey. They were reviewed with medical records, and all medications taken by patients were analyzed. Inappropriate prescriptions were evaluated by Beers criteria and drug-drug interactions guidelines. RESULTS: Among the 163 participants, 146 patients took daily medication in the previous week, and the average numbers of pills taken by these patients were 7.95. 24 cases (16.4%) of inappropriate prescriptions were identified by Beers criteria, and 19 cases (13.0%) manifested a potential risk for drug-drug interaction. A total 7 cases (4.8%) of overlapping prescription of similar efficacy were also identified. Also, the risk of inappropriate prescription increased, when older patients visited 2 or more physicians (p<0.01). CONCLUSION: A considerable number of cases of prescriptions probable to cause adverse events in older patients were identified, which suggests physicians need to be thoughtful and alert for the harmful effects of polypharmacy, and the necessity of a well-structured drug monitoring system for older persons. A dedicated personal physician system for older patients should also be considered, to reduce inappropriate prescriptions.

The Korean Physical Activity Questionnaire for Elderly (PAQE): Development and Evaluation of Validity and Reliability

BACKGROUND: As individuals age, there is an obvious decline in their physical activity level. Thus, this is an area where an easy to use assessment instrument is needed. But presently, there is no tool that meets this need. In addition, there is no such instrument tailored for the Korean elderly. This study aimed to fill this void by developing a physical activity assessment instrument for this particular population that is easy to use. METHODS: Item collection was performed through a literature review and a survey of 100 elderly individuals residing in a community setting. Items were selected through expert consensus; and the Physical Activity Questionnaire for elderly (PAQE) was created. For validation, 120 community dwelling elderly persons were enrolled. PAQE and an accelerometer were administered to each participant, and the questionnaire was re-administered 2 weeks later. The Spearman rho between the questionnaire and the accelerometer was calculated for concurrent validity. The Cronbach's alpha was calculated for internal consistency. Test-retest reliability was assessed by calculating the Spearman rho. RESULTS: Of the 119 participants, 80.34% were female with the average age being 72.74+/-7.29 years. Energy expenditure measured by the accelerometer was 220.36+/-96.96 kcal/day compared to 368.33+/-257.29 kcal/day measured through the developed questionnaire. Although the Spearman rho between the energy expenditure measured by the accelerometer and calculated through the recreational activity report in the questionnaire was 0.235 (p=0.011), the total energy expenditure was 0.105 (p=0.259) and the energy expenditure by household activity was 0.002 (p=0.983). The Cronbach's alpha was 0.781. The Spearman rho was 0.720 (p<0.001) for test-retest reliability. CONCLUSION: Our findings show that PAQE is a reliable questionnaire, a valid instrument for estimating energy expenditure during recreational physical activity in the Korean elderly person. However, energy expenditure of household activity did not correlate well with the accelerometer. In conclusion, the PAQE questionnaire can be used to assess kinds and frequency of household activities.

Correlation between Frailty Level and Adverse Health-related Outcomes of Community-Dwelling Elderly, One Year Retrospective Study / 가정의학회지

BACKGROUND: Frailty is considered to be a clinical syndrome characterized by decreased physiological reserves associated with a greater risk of health-related problems, hospitalization, and death. The current study examined hospitalization, falls, cognitive decline and disability between robust, prefrail and frail elderly in one year. METHODS: 110 participants aged 65 or more who visited two senior welfare centers in Seoul from February 2008 to June 2008 were surveyed again from March 2009 to June 2009 with demographic characteristics, number of chronic diseases and medication, study of osteoporotic fractures (SOF) frailty index, instrumental activity of daily living (IADL), depression, mini-mental state examination-Korean version (MMSE-K), falling history and admission history within one year. These results were compared with participants' previous survey done one year ago. RESULTS: Among total 110 subjects, 48 (44%) robust, 30 (27%) prefrail, and 32 (29%) frail subjects changed to 26 (24%), 54 (49%), and 30 (27%) respectively over the year. There were statistical significances in age, number of chronic disease, depressive mood, MMSE, falls, hospitalization, IADL disability contributing to frailty (P < 0.05). Frailty defined by SOF frailty index was associated with greater risk of adverse outcomes. Frail subjects had a higher age-adjusted risk of cognitive function decline (odds ratio [OR], 3.57), disability (OR, 9.64), fall (OR, 5.42), and hospitalization (OR, 4.45; P < 0.005). CONCLUSION: The frailty index like SOF frailty index might predict risk of falls, disability, hospitalization, and cognitive decline in the elderly, emphasizing special attention to the individuals showing frailty in outpatient examination.