[A Structural Equation Model of Health-Related Quality of Life among Older Women Following Bilateral Total Knee Replacement].

PURPOSE: This study aimed to develop and test a structural equation model of health-related quality of life among older women following bilateral total knee replacement based on a literature review and Wilson and Cleary's model of health-related quality of life. METHODS: One hundred ninety three women who were diagnosed with osteoarthritis, were older than 65 years, and were between 13 weeks and 12 months of having a bilateral total knee replacement were recruited from an outpatient clinic. Data were collected from July 2017 to April 2018 using a structured questionnaire and medical records. Data were analyzed using SPSS/WIN 22.0, AMOS 22.0, and Smart PLS 3.2.4. RESULTS: The fitness of the hypothetical model was good, with coefficients of determination (R²) ranging between .28 and .75 and predictive relevance (Q²) between .26 and .73. The standardized root mean square residual of the model fit indices for the hypothetical model was .04; which explained 64.2% of physical and 62.5% of mental health-related quality of life. Self-efficacy, symptom status, functional status, and general health perceptions had a significant direct effect on physical health-related quality of life, while social support, symptom status, and general health perceptions had a significant direct effect on participants' mental-health-related quality of life. CONCLUSION: To improve the physical and mental quality of life of older women who receive bilateral knee replacement, nursing-based intervention strategies that reduce symptoms, improve functional status, and increase health perceptions, self-efficacy, and social support are needed. The most important factor is the symptom status.

Risk factors of repeated falls in the community dwelling old people.

This study aimed to provide evidence for the development of an algorithm to identify older adults with a high risk for repeated falls, along with strategies to prevent repeated falls, by analyzing the known physical, psychological, and environmental factors related to falls in older adults. One hundred fifty-seven community-dwelling older adults aged 65 years or older who experienced a fall within the past year were enrolled in this study. Participants' physical, psychological, environmental, and fall prevention-related characteristics were surveyed using structured questionnaires to identify the risk factors for repeated falls. The use of antidepressants, depression score, and compliance with fall prevention behaviors were found to differ significantly between the two groups, and the use of antidepressants and depression were found to be significant predictors of repeated falls. Depression should be considered as a major variable when developing an algorithm to identify the risk of repeated falls among older adults living at home. Also, the practice of fall prevention behaviors was higher in the repeated-falls group, likely due to that group's efforts to prevent additional falls.

[Factors Influencing Quality of Life of Alcoholics Anonymous Members in Korea].

PURPOSE: The purpose of this study was to determine quality of life (QOL) related factors in Alcoholics Anonymous (AA) members based on PRECEDE Model. METHODS: A cross sectional survey was conducted with participants (N =203) from AA meeting in 11 alcohol counsel centers all over South Korea. Data were collected using a specially designed questionnaire based on the PRECEDE model and including QOL, epidemiological factors (including depression and perceived health status), behavioral factors (continuous abstinence and physical health status and practice), predisposing factors (abstinence self-efficacy and self-esteem), reinforcing factors (social capital and family functioning), and enabling factors. Data were analyzed using t-test, one way ANOVA, Tukey HSD test and hierarchical multiple regression analysis with SPSS (ver. 21.0). RESULTS: Of the educational diagnostic variables, self-esteem (ß=.23), family functioning (ß=.12), abstinence self-efficacy (ß=.12) and social capital (ß=.11) were strong influential factors in AA members' QOL. In addition, epidemiological diagnostic variables such as depression (ß=-.44) and perceived health status (ß=.35) were the main factors in QOL. Also, physical health status and practice (ß=.106), one of behavioral diagnostic variables was a beneficial factor in QOL. Hierarchical multiple regression analysis showed the determinant variables accounted for 44.0% of the variation in QOL (F=25.76, p<.001). CONCLUSION: The finding of the study can be used as a framework for planning interventions in order to promote the quality of life of AA members. It is necessary to develop nursing intervention strategies for strengthening educational and epidemiological diagnostic variables in order to improve AA members' QOL.

Factors influencing falls in the frail elderly individuals in urban and rural areas.

BACKGROUND: Falls in older people commonly cause morbidity and mortality, loss of independence, and poor quality of life. Differences in residential environments might influence falls experienced by elderly people in urban and rural areas. AIM: The purpose of this study was to provide data through the comparative analysis of physical and environmental factors influencing falls in the frail elderly individuals in urban and rural areas, which might be used for developing the fall prevention program. METHODS: A total of 534 frail elderly individuals living in regional communities were assessed over 2 months. Discomfort when walking, avoiding falls, awareness of falls, physical activity, fear of falling, depression, and a safety score for the home environment were measured. RESULTS: Frail elderly individuals in urban and rural areas had significant differences in terms of their prior experience of falls; the number of falls; the intake of hypertension medication, arthritis medication, and painkillers, respectively, discomfort when walking; physical activity; and the safety score of their home environments. There were significant differences between the frail elderly individuals living in urban and rural areas with the highest incidence of falls with regard to their education level, marital status, residential types, the intake of arthritis medication and painkillers, walking discomfort, physical activity, and the safety score of their home environments. In the factors influencing falls of frail elderly individuals in urban areas, stroke, visual impairment, and the fear of falling were significant explanatory variables. In the factors influencing falls of frail elderly individuals in rural areas, dizziness, walking discomfort and the fear of falling were significant explanatory variables. DISCUSSION: These results indicate that different factors influence falls among the elderly living in different residential areas. CONCLUSION: Based on these results, a multidimensional customized fall prevention program should be considered by various factors according to residential environments to effectively prevent falls among elderly adults.

Prevalence and Predictive Factors of Depression in Community-Dwelling Older Adults in South Korea.

The aims of the study were to investigate the levels of depression and to identify the predictors of depression among older adults in 3 different environments based on their primary place of leisure time activity, including their homes, small community halls, and senior welfare centers. A convenience sample of 833 older adults participated in the study. Instruments for measuring functional independence, social support, life satisfaction, and depression were used. The data were analyzed using a one-way analysis of variance (ANOVA) and multiple hierarchical regressions. The level of depression in older adults at home was significantly greater than the level of depression in those in both small community halls and senior welfare centers. Life satisfaction was the strongest negative predictor of depression in older adults both at home and in senior welfare centers, whereas employment status was the one in those in small community halls. Across the 3 groups, poor subjective health was the strongest positive predictor of depression. The levels of depression and predictors differed among the settings. Nurses should have a thorough understanding of these differences when planning effective strategies for managing depression in older adults.

[Effects of a fall prevention program on falls in frail elders living at home in rural communities].

PURPOSE: This study was conducted to determine the effects of a fall prevention program on falls, physical function, psychological function, and home environmental safety in frail elders living at home in rural communities. METHODS: The design of this study was a nonequivalent control group pre posttest design. The study was conducted from July to November, 2012 with 30 participants in the experimental group and 30 in the control group. Participants were registered at the public health center of E County. The prevention program on falls consisted of laughter therapy, exercise, foot care and education. The program was provided once a week for 8 weeks and each session lasted 80 minutes. RESULTS: The risk score for falls and depression in the experimental group decreased significantly compared with scores for the control group. Compliance with prevention behavior related to falls, knowledge score on falls, safety scores of home environment, physical balance, muscle strength of lower extremities, and self-efficacy for fall prevention significantly increased in the experimental group compared with the control group. CONCLUSION: These results suggest that the prevention program on falls is effective for the prevention of falls in frail elders living at home.