Factors affecting advance directives completion among older adults in Korea.

Objective: Advance directives (ADs) provide an opportunity for patients to enhance the quality of their end-of-life care and prepare for a dignified death by deciding treatment plans. The purpose of this study was to explore the multiple factors that influence the advance directives completion among older adults in South Korea. Methods: This was a secondary analysis of a cross-sectional study of 9,920 older adults. The differences in ADs based on subjects' sociodemographic characteristics, health-related characteristics, and attitude toward death were tested using the chi-squared and t-test. A multinomial logistic regression model was used to identify the influencing factor of ADs. Results: The number of chronic diseases, number of prescribed medications, depression, insomnia, suicide intention, and hearing, vision, or chewing discomfort were higher in the ADs group compared to the non-ADs group. The influencing factors of the signing of ADs included men sex, higher education level, exercise, death preparation education, lower awareness of dying-well, and experience of fracture. Conclusion: Information dissemination regarding ADs should be promoted and relevant authorities should consider multiple options to improve the physical and psychological health of older adults, as well as their attitude toward death to increase the ADs completion rate.

Development and Analysis of the Job Description for Dementia Care Center Nurses in Korea Using Developing a Curriculum (DACUM).

The current study aimed to develop and analyze a dementia care center nurse (DCCN) job description using Developing a Curriculum (DACUM) in Korea. Seven DCCN panels participated in the DACUM workshop to define the duties and tasks. The developed duties and tasks were validated with a survey that included the importance, difficulty, frequency, and educational needs of the duties and tasks. Descriptive statistics were used to analyze the data collected from August to September 2020. Nine duties and 111 tasks were identified, with "dementia screening" ranking the highest among the duties and "management of cognitive programs" ranking the lowest. The task with the highest rank based on the determinant coefficient and educational needs was "conducting the first stage of the diagnostic test," whereas the task with the lowest rank was "recording special issues." Findings can be used as fundamental data for designing educational programs aimed at enhancing the competencies of DCCNs and as a tool for evaluating their job performance. [Journal of Gerontological Nursing, 49(10), 29-35.].

Changes in the health status and health-related quality of life of community-dwelling older adults living alone: one-year follow-up from a cohort study.

Background: The percentage of older adults living alone is rapidly increasing, improving the health status and health-related quality of life (HRQoL) in this group is becoming a more significant public health issue. This study aimed to examine the changes in the HRQoL of older South Korean adults living alone and identify the factors that affect their HRQoL. Methods: A longitudinal study design was followed. Data were collected at baseline and 1-year follow-up. Participants consisting of 789 older adults living alone in S*City aged>65 years completed a cohort survey regarding health status and HRQoL from August 2018 to August 2019. Trained interviewers conducted face-to-face interviews with the participants using a validated questionnaire (physical health, mental health, social health, and HRQoL). Generalized estimating equations were used to assess the change in health status and the interaction effect of time and gender. Then, a stepwise multiple logistic regression analysis was performed to identify factors related to HRQoL. Results: Time differences were observed in the subjective evaluation of health status (SEH), IPAQ scores, frailty, nutritional status, and depression. Gender differences were observed in the SEH, IPAQ, frailty, loneliness, depression, and social support. The interaction between time and gender was observed in the IPAQ and HRQoL. At baseline, SEH, depressive symptoms, gender, frailty, and age were associated with HRQoL. After one year, HRQoL was associated with SEH, frailty, depressive symptoms, cost of living, suicidal thoughts, gender, social support, loneliness, and suicide attempts. Conclusion: Our results highlight that HRQoL is associated with physical health, mental health, and social support. Future detailed studies are needed to determine whether governments and communities can prevent depression, loneliness, and suicidal thoughts through psychological support and provide economic support to improve the quality of life of older adults living alone.

Social Frailty among Community-Dwelling Older Adults during the COVID-19 Pandemic in Korea: A Cross-Sectional Study.

Social frailty among older adults has become a growing concern from a public health perspective in the context of the coronavirus disease 2019 (COVID-19) pandemic. This study's aim was to investigate the influence of various aspects of social frailty in community-dwelling older adults during the COVID-19 pandemic. This study carried out a secondary analysis of data collected from the 2020 National Survey of Older Koreans and performed multinomial logistic regression analysis to identify the predictive factors of social frailty. The affected factors for the social frailty group were health conditions (depression), behavioral and metabolic risk factors (exercise, nutritional status, current smoking status, drinking frequency), intrinsic capacity (cognitive functions, activities of daily living), and digital literacy (use of smartphone or tablet PCs). Since multidimensional factors could affect older adults' social frailty, comprehensive strategies are urgently needed to reduce their rate of social frailty.

Health service challenges at senior centres in an urban South Korean community: A mixed-method approach focusing on nurses' roles.

AIMS: We aim to identify challenges and recommendations for senior centre health services focusing on nurses' roles in an urban South Korean community. BACKGROUND: Senior centres can potentially provide easily accessible and cost-effective health services to older adults. It is essential to identify current challenges to improve health services. METHOD: This study used an explanatory sequential mixed-methods design. Quantitative descriptive data were obtained from a survey of all nurses at senior centres in Seoul (n = 30). For the qualitative data, focus group interviews were conducted with various senior centre stakeholders (n = 15). RESULTS: Two main themes, discrepancy between services and needs and reform senior centres, were identified with six subthemes. CONCLUSIONS: Challenges identified included insufficient availability to meet health service needs, overlapping health services, and no legal clarification of nurses' roles. Recommendations to improve the senior centre health services include to focus on the centres' main goals, function as health and welfare hubs, establish legal guidelines, and provide adequate nurse staffing. IMPLICATION FOR NURSING MANAGEMENT: The senior centres need to hire more nurses and define nurses' occupational roles legally for the centres to serve as a hub connecting medical care and welfare.

Factors influencing subjective cognitive function among community-dwelling older adults.

BACKGROUND: Subjective cognitive decline (SCD) is one of the most common complaints in older adults and may increase risk factors for dementia. Therefore, it is important to identify and manage risk factors for subjective cognitive function (SCF). PURPOSE: This study aimed to investigate factors influencing SCF in community-dwelling older adults. METHODS: With a cross-sectional research design, 164 older adults responded to questionnaires. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Scheffé-test, Pearson's correlation coefficient, and multiple regression with SPSS 23.0. RESULTS: Participating in religious activities, sleeping well, a lower number of comorbidities, better perceived health status, lower depression, and higher self-esteem were associated with better SCF. Overall, approximately 24.9% of the variability in SCF was explained by perceived health status, religion, and depression. CONCLUSION: Multifaceted aspects must be considered when developing interventions to improve SCF in community-dwelling older adults who complain of experiencing SCD.

Factors Related to Self-Confidence to Live Alone in Community-Dwelling Older Adults: A Cross-Sectional Study.

BACKGROUND: Many older adults prefer to live alone in their own homes, with age-related issues in physical movement, regardless of their cultural background. Importantly, however, to identify the features of successfully ageing in place (AIP), and foster independent living among these individuals, this study explored their level of self-confidence to live alone and its related factors. METHODS: We conducted a cross-sectional study using secondary data from an earlier study with older adults living alone in South Korea recruited by convenience sampling methods (N = 936, mean age = 77.1 years, 76.1% female). Data regarding the general, health-related, and social characteristics as well as self-confidence to live alone were collected via face-to-face interviews in 2019. Self-confidence to live alone was measured with a numeric rating scale of 0 to 10. RESULTS: The average self-confidence score to live alone was 6.59. A regression analysis showed that mould exposure at home, depression, emergency department visits, and loneliness hinder self-confidence to live alone. Meanwhile, such self-confidence was facilitated by independency in instrumental activities of daily living (IADL), interactions with family members, social service utilisation, and social support. CONCLUSIONS: This study suggests that healthcare providers need to consider the importance of self-confidence to live alone and influencing functional, mental, social, and environmental factors to promote quality of life as well as successful AIP for older adults living alone. Further, self-confidence to live alone could be a new practical index in the field of health and ageing to screen the successful AIP of older adults living alone.

Psychosocial risk profiles among older adults living alone in South Korea: A latent profile analysis.

OBJECTIVES: This study explored the psychosocial risk profiles and various characteristics associated with profile membership among Korean older adults living alone. METHODS: Our analyses were based on a cross-sectional cohort of 1030 community-dwelling older adults (≥ 65 years) living alone in one Korean city. Latent profile analysis was used to identify psychosocial risk profiles across a wide range of psychosocial dimensions (depressive symptoms, suicidal ideation, cognitive dysfunction, loneliness, and perceived social support). We then explored the characteristics associated with distinct profiles by conducting bivariate and regression analyses. RESULTS: The three-profile was selected as the best solution: a group with high cognitive dysfunction, high loneliness, and low social support (profile 1), a group with low psychological risks and high social support (profile 2), and a group with high depression and high suicidal ideation (profile 3). Regression analyses showed that a lower frequency of interaction with neighbors or families, a greater frailty score, and lower quality of life were significantly associated with profile 1 or profile 3 than with profile 2 (p < .05). Further, being male and having a poorer nutritional status was more significantly related to profile 3 than profile 2 (p < .05). CONCLUSIONS: Findings provide evidence for healthcare professionals when developing interventions to prevent and reduce these psychosocial risks for older individuals living alone. In particular, factors associated with profile membership identified in the study may facilitate more tailored interventions.

Daily Time Use by Activity of Community-Dwelling Older Koreans: Focus on Health Management.

This study aimed to examine the daily time use by activity and identified factors related to health management time (HMT) use among 195 older adults (mean age = 77.5, SD = 6.28 years; 70.8% women) attending a Korean senior center. Descriptive statistics were analyzed and gamma regression analyses were performed. Participants used the most time on rest, followed by leisure, health management, daily living activities, and work. The mean duration of HMT was 205.38 min/day. The mean score for the subjective evaluation of health management (SEHM) was 13.62 and the importance score for SEHM was 4.72. Factors influencing HMT included exercise, number of chronic conditions, fasting blood sugar level, low density lipoprotein level, and cognitive function. HMT and frailty significantly predicted SEHM. HMT interventions focus on promoting exercise and acquiring health information to improve health outcomes among older adults in senior centers.

Association of Social Frailty with Physical Health, Cognitive Function, Psychological Health, and Life Satisfaction in Community-Dwelling Older Koreans.

Social frailty affects various aspects of health in community-dwelling older adults. This study aimed to identify the prevalence of social frailty and the significance of its association with South Korean older adults' health status and life satisfaction. This study involved a secondary data analysis of the 2017 National Survey of Older Koreans. From the 10,299 respondents of the survey, 10,081 were selected with no exclusion criteria. Multiple regression analyses were conducted to identify the factors related to life satisfaction. Compared with the robust and social prefrailty groups, the social frailty group had higher nutritional risk (χ² = 312.161, p = 0.000), depressive symptoms (χ² = 977.587, p = 0.000), cognitive dysfunction (χ² = 25.051, p = 0.000), and lower life satisfaction (F = 1050.272, p = 0.000). The results of multiple linear regression, adjusted for sociodemographic and health-related characteristics, indicated that social frailty had the strongest negative association with life satisfaction (ß = -0.267, p = 0.000). However, cognitive function was significantly positively associated with life satisfaction (ß = 0.062, p = 0.000). Social frailty was significantly correlated with physical, psychological, and mental health as well as life satisfaction in community-dwelling older South Koreans. Therefore, accounting for the social aspect of functioning is an essential part of a multidimensional approach to improving health and life satisfaction in communities.

Development of a Community-Based Integrated Service Model of Health and Social Care for Older Adults Living Alone.

The number of elderly people living alone worldwide is increasing, and the responsibility of the state in this context is emerging. This study aimed to develop a community-based integrated service (CBIS) model of health and social care for older adults living alone. The model was designed based on a literature review of previous community care models and per older adults' health and daily life needs. Thereafter, feedback on the integrated model was taken from older adults living alone by conducting a survey (n = 1023) and focus group interviews, after which the opinions of the Public type Health Management Promotion Council were considered and content validity was confirmed. The model, comprising eight healthcare services and five social care services, was tested on 22 older adults for two weeks to assess its feasibility and preliminary efficiency. Each service included screening, assessment, providing service, evaluation, and quit. Participants rated their overall satisfaction with the services as 9 out of 10. Care navigators reported feeling comforted and discovered their own sense of being while providing the services. We believe that the CBIS model may foster independence among community-dwelling older adults living alone, thereby improving their quality of life through "aging in place".

Gender differences in health status, quality of life, and community service needs of older adults living alone.

OBJECTIVES: The aim of this study was to identify gender differences in the health status, community service needs, and quality of life of older adults living alone in an urban city in South Korea. METHODS: A cross-sectional descriptive correlational design was used. The study sampled 1023 older adults (≥65 years) living alone in S* City, during the period from August to October in 2018. Trained interviewers conducted face-to-face interviews with the participants, using the UCLA Loneliness Scale, Short Form Geriatric Depression Scale - Korean version, ENRICHD Social Support Instrument (ESSI), the Mini-Mental State Examination Standard Version (MMSE-2SV), and Health-Related Quality of Life (EQ-5D). RESULTS: 77.8% were women and the mean age was 77.38 years (men = 74.65, women = 78.16). Women had lower socioeconomic and health status than men. Men felt more lonely, depressed, and had suicidal thoughts more frequently than women. Women had more needs regarding care, residential environment, movement, connection, and emergency services than men. In men, depressive symptoms, suicidal thoughts, loneliness, and right-hand grip strength were identified using the EQ-5D. The EQ-5D was also used to explain depressive symptoms, suicidal thoughts, cognitive function, and physical activity in women. CONCLUSION: Health status and community service needs were dependent on gender; therefore interventions should be tailored according to gender. Our research found that to decrease depression and suicidal thoughts, improve physical health, and enhance quality of life for older adults living alone, interventions need to be designed to decrease male loneliness and to enhance female cognitive function.

Feasibility of an Integrative Activity Program for Older Adults With Low Education and Mild Dementia.

The population of older adults is increasing, as is the number of older adults with dementia. However, there is a lack of integrative interventions that include both cognitive training and physical exercise for older adults with dementia. The current study conducted a 12-week integrated program for older adults with low education and mild dementia; the study modified the contents developed by the National Dementia Institute. Effects of the integrated program were examined in 30 participants (16 from the experimental group and 14 from the control group). Analysis showed that the tailored integrated program increased the cognitive function of participants in the experimental group. The findings of this study suggest that using therapeutic strategies and providing person-centered care are necessary for older adults with low educational backgrounds and low literacy levels. [Journal of Gerontological Nursing, 45(3), 13-20.].

Black Radish (Raphanus sativus L. var. niger) Extract Mediates Its Hepatoprotective Effect on Carbon Tetrachloride-Induced Hepatic Injury by Attenuating Oxidative Stress.

Nonalcoholic fatty liver disease is a serious liver disorder associated with oxidative stress. Black radish (Raphanus sativus L. var. niger) extract (BRE) can lower the risk of this disease. The hepatoprotective effect of BRE containing 3-(E)-(methylthio)methylene-2-pyrrolidinethione was evaluated in human hepatocyte carcinoma (HepG2) cells and in rat livers with carbon tetrachloride (CCl4)-induced hepatic injury. BRE was administered at 125, 250, 500, and 1000 µg/mL to the oleic acid-induced HepG2 cells. Male Sprague-Dawley rats were randomly divided into seven groups: the control group, BRE group, CCl4 group, and BRE + CCl4 group. BRE was administered orally at 125, 250, 500, and 1000 mg/kg/day once daily for 7 consecutive days, followed by a single oral treatment of 1.5 mL/kg CCl4. Inhibition of lipid accumulation, serum markers of liver injury, histological evaluations, levels of oxidative stress related enzymatic and nonenzymatic antioxidants in HepG2 cells and liver tissue were investigated. The protein expression of main liver P450 isoenzymes such as cytochrome p450(CYP)2E1, the expression of nuclear factor erythroid 2-related factor-2(Nrf-2) and heme oxygenase-1(HO-1) were also studied. BRE has an inhibitory effect on lipid accumulation and caused acute hepatotoxicity manifested by increased levels of lipid peroxidation, serum alanine aminotransferase, and aspartate aminotransferase with corresponding histopathological changes and high levels of oxidative stress. BRE treatment significantly increased the level of CYP2E1, Nrf-2, and HO-1 in a dose-dependent manner. Besides, 3-(E)-(methylthio)methylene-2-pyrrolidinethione significantly increased radical-scavenging effects and the expression of Nrf-2 in oleic acid-treated HepG2 cells. These results suggest that BRE treatment reduces lipid accumulation in oleic acid-induced steatosis of HepG2 cells, and has a hepatoprotective effect against CCl4-induced liver injury in rats, possibly through Nrf-2/HO-1-mediated antioxidant effects.

The impact of self-compassion on mental health, sleep, quality of life and life satisfaction among older adults.

Given South Korea's rapidly aging population, mental health and quality of life (QoL) in older adults are increasingly becoming important. Self-compassion (SC), defined as extending compassion to oneself in times of suffering, has been found to have associations with positive mental health outcomes. This study was performed to examine associations between self-compassion and mental health symptoms, sleep disturbance, life satisfaction, and health-related quality of life (HR-QoL) among older Korean adults. The participants in this cross-sectional study included 203 older Korean adults aged 65 and over. Findings of this study suggest that self-compassion in older adults protects them from developing mental health and sleep disturbance symptoms while enhancing their life satisfaction, self-care, and usual activities. Therefore, interventions fostering self-compassion may benefit older adults' mental health and quality of life.

Seniors centre-based health intervention programmes in the United States and South Korea: A systematic review.

BACKGROUND: Despite the great need for health interventions among seniors centre participants, this matter has received little attention. AIM AND DESIGN: This systematic review aimed to identify what types of health interventions are effective and feasible for seniors centre participants. DATA SOURCES: MEDLINE, Ovid, CINAHL, Google Scholar, EMBASE, and RISS were searched. REVIEW METHODS: We searched for health intervention studies conducted in seniors centres published in English and Korean between 1990 and 2014. Of 907 screened articles, 22 studies of all types of experimental designs were selected. RESULTS: Selected studies were grouped by intervention domain: health promotion (n = 8), safety (n = 5), chronic disease management (n = 6), and comprehensive wellness (n = 3). Overall, 59.1% of the interventions were provided by nurses. The health interventions resulted in positive effects on seniors centre participants' knowledge, health behaviours, clinical indices, and hospitalization rates. Few studies reported on feasibility outcomes such as satisfaction and cost-effectiveness. CONCLUSIONS: Considering the impact and ease of access to older people at seniors centres, health interventions and services within seniors centres should be strengthened. There is potential for nursing to spearhead seniors centre health intervention programmes to enhance active ageing for participants.