Gwi-Ryung Son Hong

Falls among Koreans 45 years of age and older: incidence and risk factors

AIM The aim of the study was to determine the incidence of falls according to age and risk factors among Korean adults 45 years of age and older. BACKGROUND Falling is a known critical incident that results in injuries and limits the daily activities of older adults. METHOD The 2006 Korean Longitudinal Study of Aging, a publicly available database, was used for this study, which was conducted in 2006 with a total of 10,254 respondents. The variables used in this study were selected from the demographic and health sections of the larger study. FINDINGS The overall incidence of any type of fall was 4.0%, and the incidence of injurious falls tended to increase with increasing age; however, people below 65 years of age had a greater proportion of injurious falls than any of the older adult groups. All types of falls were more likely to occur among older adults and those with arthritis, visual deficits, cognitive impairments and depression. In addition, older age, visual deficits, weak grip, cognitive impairment and depression were key risk factors for falls requiring treatment and those resulting in difficulties in activities of daily living. Falls resulting in hip fractures occurred more frequently among women, people with visual deficits and those with depression. CONCLUSION Future assessments of the incidence and risk factors for falls and studies of fall interventions should begin with younger age groups, namely those 45 years of age and older.

Are Wandering and Physically Nonaggressive Agitation Equivalent

OBJECTIVE The authors examined equivalence of wandering and physically nonaggressive agitation (PNA) as concepts. DESIGN A cross-sectional correlational design was used. SETTING Participants were recruited from 22 nursing homes and 6 assisted living facilities in two states. PARTICIPANTS Ambulatory residents meeting DSM-IV criteria for dementia (N = 181) were studied. MEASUREMENTS Video-tapes for up to twelve 20-minute observations per participant were coded for wandering using an empirically derived taxonomy of ambulation patterns. Separate raters coded the same tapes for six PNA behaviors on the agitation behavior mapping instrument. RESULTS Most participants (73.5%) wandered; all showed PNA behaviors. Factor analyses yielded an one-factor solution for wandering (explained variance = 43.66%) and a two-factor solution for PNA (explained variance = 53.45%). Overall wandering correlated significantly with PNA Factor 1 (df =179, r = 0.68, p <0.001) and Factor 2, but at a lower value (df = 179, r = 0.26, p <0.01). CONCLUSION Findings depict wandering and PNA as overlapping, but nonequivalent phenomena. Evidence supporting construct validity of wandering was more robust than that for PNA. Results have implications for accuracy in scientific and clinical detection and labeling of wandering and agitation.

Relationship between familiar environment and wandering behaviour among Korean elders with dementia

AIM To explore the relationship between wandering behaviour and familiar environment in community-residing persons with dementia in Korea. BACKGROUND Numerous non-pharmacological interventions have been developed to decrease behavioural symptoms and to increase the quality of life among persons with dementia. Although the concept of familiarity is very important and environmental interventions using the concept should have been developed for persons with dementia, no study examining even the direct relationship between familiar environment and wandering has yet been published. DESIGN A descriptive, cross-sectional survey design. METHODS A convenience sample was gathered of 77 non-institutionalised, community-dwelling persons with dementia and their family caregivers in Seoul and Wonju, South Korea. Descriptive statics, Pearsons correlations, t-tests, and multiple regressions were used in the data analysis. RESULTS The mean age of persons with dementia was 76.9 years (SD 8.0) and their mean cognitive level score using the Mini-Mental State Examination was 13.51 (SD 6.10). Most persons with dementia (71.4%) had been diagnosed with known types of dementia such as Alzheimers disease, multiple infarct dementia, mixed type or Parkinsons disease with dementia. A familiar feeling with the environment was associated with cognitive impairment (r = 0.32, p < 0.01) and physical dependency in activities of daily living (r = -0.38, p <0.01). In addition, a familiar feeling with the environment (r = -0.56, p < 0.001) and physical dependency in activities of daily living (r = 0.56, p < 0.001) were strongly related to wandering behaviour. Familiarity and physical dependency in activities of daily living were the significant predictors for overall wandering and they explained 45% of the total variance. Cognitive impairment was the only significant predictor on the subscale of spatial disorientation. CONCLUSIONS It was found that a familiar feeling with the environment was an important factor affecting persons with dementias cognitive and functional abilities as well as specific features of wandering. However, future research using a more reliable method is necessary to confirm the findings obtained in this study. RELEVANCE TO CLINICAL PRACTICE This study suggested that providing persons with dementia with a familiar feeling in daily clinical practice through establishment of familiar physical as well as psychosocial environment may have benefit to decrease wandering behaviour.

Effect of 16-week Kouk-Sun-Do exercise on physical fitness, emotional state, and immunoglobulin A in community-dwelling elders in Korea

The purpose of this study was to determine the effects of 16-week Kouk-Sun-Do (KSD) exercise on physical fitness, emotional state, and immunoglobulin A (IgA) in community-dwelling elders in Korea. A total of 19 elders in the intervention group and 20 elders in the control group participated. The KSD exercise with low-intensity exercise was performed over a 45-minute session, three times a week for a 16-week period. The results show the effectiveness of KSD exercise on the physical fitness, emotional state, and IgA, and KSD can be identified as a feasible type of low-intensity exercise for elders. The findings suggest the need to determine clinical significance of KSD for patients in specific clinical settings; nurses with training in KSD can play a key role in implementing movement-based nursing interventions for specific health outcomes.

Wandering behaviour of persons with dementia in Korea: investigation of related factors.

Objectives: Despite being identified as a significant clinical phenomenon, wandering of persons with dementia (PWDs) has not been studied in Korea. As an initial trial, various factors chosen from the literature for their predictive relationships to wandering of Korean PWDs were evaluated in this study. Method: A total of 160 PWDs residing in 14 long-term care facilities participated in this study. The Mini-Mental State Exam (MMSE), Physical Activities of Daily Living (PADL) and Korean-translated Revised Algase Wandering Scale (Nursing Home version) (KRAWS-NH) were used to assess participants’ degree of cognitive impairment, functional ability and wandering behaviour on six dimensions: persistent walking (PW), specific patterns (SP), spatial disorientation (SD), escape behaviour (EB), attention shift (AS) and negative outcomes (NO). Demographic, personal and environmental data were also collected. Results: The MMSE score was a significant negative predictor for KRAWS-NH overall and subscales except for EB; while age, PADL and history of falls were positive predictors for SD and NO. Total number of residents in a room was a significant negative predictor for EB and AS. Conclusion: Different factors found in PWDs may contribute to different aspects of wandering behaviour. Further studies on factors influencing multiple facets of wandering in various cultural settings are warranted.

Factors Associated With Self-reported and Medically Diagnosed Urinary Incontinence Among Community-Dwelling Older Women In Korea

Purpose: The purpose of this study was to examine the prevalence of urinary incontinence (UI) in community-dwelling Korean women 60 years or older, and to identify factors associated with self-reported and medically diagnosed UI. Methods: This study was a secondary analysis of data from the 2008 Actual Living Condition of the Elderly and Welfare Need Survey, which used a stratified two-stage cluster sampling method to select a representative sample of 8,961 elderly Korean women. Results: Of the 8,961 women in this study, 579 (6.5%) had self-reported UI, and 209 (2.3%) were medically diagnosed with UI. As patient age and exercise ability of the upper extremities increased, risk for self-reported UI decreased (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96–0.99; OR, 0.99; 95% CI, 0.98–0.99, respectively). In contrast, as the number of limited instrumental activities of daily living (IADL) increased, the risk for self-reported UI increased (OR, 1.30; 95% CI, 1.24–1.35). Overweight women were 1.94 times more likely to have self-reported UI compared to underweight women. Women with a history of stroke or asthma were more likely to have self-reported UI compared to women with no history. Also, women who reported being in good health were less likely to have UI, compared to women who reported being in poor health (OR, 0.47; 95% CI, 0.31–0.70). Medically diagnosed UI was negatively associated with the number of limited IADL and exercise ability scores for the lower extremities (OR, 0.86; 95% CI, 0.80–0.92; OR, 0.98; 95% CI, 0.97–0.99, respectively). In contrast, as the exercise ability score for the upper extremities increased, so did the risk for medically diagnosed UI (OR, 1.02; 95% CI, 1.01–1.03). Conclusions: An interventional program for home visit health services is needed for incontinent women who are highly dependent on others for IADL.

Effects of Multisensory Stimulation Using Familiarity: Persons with Dementia in Long-term Care Facility in Korea

PURPOSE The purpose of the study was to examine the effects of multisensory stimulation (MSS) using familiarity on persons with dementia (PWDs) residing in nursing homes in Korea. METHODS A nonequivalent control group with pre and posttests was used. Fifty one PWDs were included if they: 1) were over 65 yr old, 2) were diagnosed with dementia, 3) had no visual or speech impairments, 4) were able to communicate, and 5) had spent more than one month in a nursing home. The experimental group (n=25) received a 55 min MSS program twice a week for 10 weeks. The outcome variables included were cognition, activities of daily living, grip strength, depression, wandering, and aggressive behaviors. Repeated ANOVA was used for data analysis. RESULTS There were no significant differences in demographics or the main variables at pretest. Cognition, depression, wandering, and aggressive behaviors were significant over time between the two groups. Grip strength was only significant when accounting for interaction between group and time. CONCLUSION An intervention of MSS using familiarity was marginally effective in improving cognition, depression, wandering, and aggression. Future study is suggested with a larger sample and longer treatment to retest the effects of MSS.

Predictors of Depression Among Community-Dwelling Older Women Living Alone in Korea

This study examined the prevalence and predicting factors of depression among community-dwelling older women living alone in Korea. Of the 2054 older women living alone in this study, 42.9% (881) were experiencing depression. Factors associated with a higher prevalence of depression were overall difficulty with living alone, taking more than six medications, limitations of instrumental activities of daily living, limitations of muscle strength, limitations of exercise performance in upper extremities, trouble with hearing, and perceptions of poor health status. These results provide a basis for designing preventive interventional programs to decrease depression among older women living alone in Korea.

Effect of Muscle Strength Training on Urinary Incontinence and Physical Function: A Randomized Controlled Trial in Long-term Care Facilities

PURPOSE This study was done to determine whether muscle strength training programs have an impact on improving symptoms of urinary incontinence (UI) and physical function among elderly women with UI who reside in long-term care facilities. METHODS A randomized controlled trial was conducted. Participants had to be over 65 years, score over 15 score on the mini-mental state examination, and be able to walk alone or with an assistant. Seventy residents were randomly allocated to either the training group (n=35) or control group (n=35). The program consisted of 50 minutes, twice a week for 8 weeks, and included Kegels exercise, Thera-band training and indoor walking. Main outcomes were UI symptoms, peak vaginal pressure and physical functions measured with timed up and go test (TUG), one leg standing test (OLST), activities of daily living (ADL) and grip strength. Changes in outcome measurements were calculated from baseline to 4 weeks and to 8 weeks using repeated measures ANOVA. RESULTS There were significant differences in peak vaginal pressure (p<.001), TUG (p<.001), OLST (p=.012) and grip strength (p<.001) in the interaction between groups and time. CONCLUSION Future studies are suggested to confirm the effect of muscle strength training in long-term care facilities where elderly women with UI reside.

Predictors of chewing ability among community‐residing older adults in Korea

Decreased chewing ability in older adults can lead to poor nutritional and physical conditions, and eventually death. The present study examined the relationships between chewing ability and related characteristics (e.g. health promotion habits, health status and functional status), and identified predictors of chewing ability in community‐residing older adults.