Heejung Kim

Emerging roles for telemedicine and smart technologies in dementia care.

Demographic aging of the world population contributes to an increase in the number of persons diagnosed with dementia (PWD), with corresponding increases in health care expenditures. In addition, fewer family members are available to care for these individuals. Most care for PWD occurs in the home, and family members caring for PWD frequently suffer negative outcomes related to the stress and burden of observing their loved one’s progressive memory and functional decline. Decreases in cognition and self-care also necessitate that the caregiver takes on new roles and responsibilities in care provision. Smart technologies are being developed to support family caregivers of PWD in a variety of ways, including provision of information and support resources online, wayfinding technology to support independent mobility of the PWD, monitoring systems to alert caregivers to changes in the PWD and their environment, navigation devices to track PWD experiencing wandering, and telemedicine and e-health services linking caregivers and PWD with health care providers. This paper will review current uses of these advancing technologies to support care of PWD. Challenges unique to widespread acceptance of technology will be addressed and future directions explored.

Home modification by older adults and their informal caregivers

The purpose of the study was to examine dyadic factors of home modification in frail older adults and their informal caregivers for improving health care at home in the United States. A secondary data analysis used the National Alliance for Caregiving and the American Association of Retired Persons caregiver survey dataset. Among randomly selected samples from 7 states in the U.S., 737dyads of informal caregivers and frail older adults were selected based on age and medical conditions. Descriptive analyses and a hierarchical binary logistic regression analysis were performed. The study findings showed that the prevalence of home modification in the survey population was 42.20% in the United States. The home modifying group was likely to live together in a rural area, to consist of older care-recipients and younger caregivers, and to be Caucasian (p<.05). Physically functional impairments were the strongest factors of home modification (p<.01), while older adults living with heart disease were more likely to modify their homes (p=.03). In conclusion, older adults and their caregivers factors clearly affect home modification for health care at home. Our findings revealed that home modification represents an important contribution to multidisciplinary care and is based on comprehensive assessments, multidisciplinary decision-making processes, and careful planning of individualized interventions. Relevant policy suggestions may enhance the effectiveness of home modification to support aging in place in the United States.

Concept analysis of family homeostasis.

AIMnTo report a concept analysis of family homeostasis.nnnBACKGROUNDnAs family members are a majority of informal caregivers, negative consequences from caregiving duty create a vicious cycle in the family unit resulting in ongoing health crises and care challenges.nnnDESIGNnConcept analysis.nnnDATA SOURCESnForty empirical studies published from 1956-2012 were selected by searching five electronic bibliographical databases and by a manual search conducted from 2012-2013. Search terms included family homeostasis, homeostasis in family, homeostatic care and family equilibrium. Clinical experiences in nursing practice were used for constructing cases and clinical implications.nnnMETHODSnWalker and Avants method guided this analysis.nnnRESULTSnFamily homeostasis is defined as the capacity and mechanisms by which equilibrium is re-established in the family after a change occurs. Five critical attributes are identified: (1) predetermined setpoint; (2) self-appraised antecedents; (3) interdependence; (4) tendency to stability; and (5) feedback mechanisms. Antecedents include any type of causative change beyond the tolerable limit, while consequences encompass intermediate and long-term outcomes as well as equilibrium itself.nnnCONCLUSIONnFamily homeostasis provides a conceptual rationale of family caregiving. While care recipients remain the primary beneficiaries of healthcare provision, homeostatic mechanisms are required to support the family caregivers valuable contribution in the caring process to enhance family well-being. Further study should expand the definition and settings of family to reflect healthcare needs of diverse types of families and from the perspectives of different healthcare providers.

A secondary data analysis of Internet use in caregivers of persons with dementia

This paper is a secondary data analysis to investigate relationships among caregiver stress appraisal, self‐rated health and health‐related Internet use.

The Direct and Indirect Effects of Computer Uses on Student Success in Math

To promote the academic success of middle school students, the authors examined the effects of computer uses on mathematics self-efficacy and mathematics performance of students, paying focused attention to immigrant students. They analysed the effects of computer use for schoolwork and gaming of middle school students applying a Structural Equation Modeling SEM to Trends in International Mathematics and Science Study TIMSS USA. The results showed that when students frequently used computer for schoolwork, they revealed high mathematics self-efficacy, which in turn led to high mathematics performance. On the other hand, the students that used computer for gaming frequently indicated low mathematics self-efficacy and mathematics performance. The authors study results highlight the importance of guiding students to use computers properly, which is directly and indirectly associated with students self-efficacy and performance in mathematics.

Family management of childhood atopic dermatitis

AIMSnTo identify the variables that affect family management of childhood atopic dermatitis and establish a prediction model based on Banduras self-efficacy theory.nnnBACKGROUNDnAtopic dermatitis is a chronic recurrent skin disease and common health problem in childhood. It is necessary to use an approach that includes parental factors when considering the effective management of childhood atopic dermatitis.nnnDESIGNnA cross-sectional study design.nnnMETHODSnA convenience sample, comprising 168 Korean mothers caring for a child with atopic dermatitis under the age of 13, was recruited from the paediatric outpatient departments of two general hospitals in Seoul, South Korea. Data were collected using structured self-reported questionnaires including severity, antecedents, effort, self-efficacy and family management of childhood atopic dermatitis from 1 November 2015-28 February 2016. Descriptive statistics about the participants and variables were examined and data were analysed using structural equationxa0modelling.nnnRESULTSnThe hypothetical model had an adequate fit to the data, indicating that severity, antecedents, effort and self-efficacy influenced family management of childhood atopic dermatitis.nnnCONCLUSIONnThese results suggest that strategies to support children with atopic dermatitis and their family should consider the influence of such variables.

Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study

Background Most training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes. Objective This feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol. Methods The mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol. Results Of the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence. Conclusions A tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting.

A comparative study to identify factors of caregiver burden between baby boomers and post baby boomers: a secondary analysis of a US online caregiver survey

BackgroundBaby boomers’ position in the caregiving context is shifting from caregiver to care recipient as the population ages. While the unique characteristics of baby boomer caregivers are well established in caregiving literature, there is limited information about the next caregiving group after the baby boomers. In this study, the sociodemographic and caregiving-related characteristics of the two generations are compared and specific factors contributing to caregiver burden between baby boomer and post baby boomer caregivers are identified.MethodsThis cross-sectional and correlational study used secondary analysis of data from the National Alliance for Caregiving and the American Association of Retired Persons. A structured online survey was conducted in 2014 with randomly selected samples (nu2009=u20091069) in the United States focusing on sociodemographics, caregiving-related characteristics, and burden of care. Descriptive statistics, multivariate linear regression analyses, and Steiger’s Z-test were used to identify group differences in multivariate factors related to caregiver burden in two generational groups.ResultsBaby boomers and post baby boomers experienced caregiver burden to a similar degree. Caregiving-related factors are more likely to increase burden of care than sociodemographics in both groups. Caregiving without choice and spending longer hours on caregiving tasks were common factors that increased the burden in both generational groups (all p values <u20090.01). However, post baby boomer caregivers reported additional challenges, such as unemployment during caregiving, the dual responsibility of both adult and child care, and a family relationship with the care recipient.ConclusionsDue to the aging population of baby boomers, post baby boomers encounter different challenges related to caregiving burden, which is often considered an additional workload in their life course. Current policy and program tailored to baby boomers should be re-designed to meet the different needs of emerging caregivers. Specific vulnerable subgroups should have priority to receive the benefits of specific policies, such as those without choice and younger, working caregivers.

Health behaviors influencing depressive symptoms in older Koreans living alone: secondary data analysis of the 2014 Korean longitudinal study of aging

BackgroundGeriatric depression is a societal problem, specifically in those living alone in Korea. This study aims are to investigate (1) how sociodemographic factors, health status, and health behaviors are differently associated with depressive symptoms in older Koreans living alone compared to those living with others and (2) how living arrangements attenuated or strengthened the associations between four types of health behaviors and depressive symptoms.MethodsThis secondary data analysis was conducted using data from the 2014 Korean Longitudinal Study of Aging. A structured survey assessing sociodemographic factors, health status, and health behaviors was conducted with people aged 65 or older who lived alone (nu2009=u20091359) and living with others (nu2009=u20092864). A multiple linear regression with interaction terms was conducted between mean-centered health behaviors and the status of living alone. All statistical analyses were performed using SPSS Statistics 23.0, and the two-tailed level of significance was set at 0.05.ResultsThose living alone reported higher levels of depressive symptoms than those living with others (Mdiffu2009=u20092.129, SEu2009=u20090.005, pu2009<u2009xa00.001). The variance of depressive symptoms explained by 13 variables was 18.1% for those living alone compared to 23.7% for those living with others. Compared to health behaviors, sociodemographic factors and health status more explained depressive symptoms, specifically with psychiatric disorders, pain, and impaired functionality as risk factors. Smoking, alcohol abstinence, physical inactivity, and social inactivity were associated with more depressive symptoms. Living arrangements moderated the association between depressive symptoms and each health behavior, except for physical inactivity (all p values <u20090.001).ConclusionsOlder Koreans living alone were exposed to different risk factors for depressive symptoms compared to those living with others. Non-modifiable sociodemographic and health status factors were highly associated with depressive symptoms relative to health behaviors; thus, it is important to conduct early assessment and classification of vulnerable subgroups regarding geriatric depression. Specific assessment instruments should be prepared in practice according to living arrangements among older Koreans. Targeted interventions are essential to addressing living arrangements and modifying health behaviors to reduce smoking, alcohol consumption, and social inactivity, specifically in those living alone.