Geographic proximity to neighborhood resources and depression among older adults in South Korea.

OBJECTIVES: Older adults are closely connected to their neighborhoods and they spend more time there than younger adults. Because their mobility is often impeded by diminished health and functioning, access to neighborhood health and social services is essential for their well-being. This article examines whether geographic proximity to these types of neighborhood resources is associated with depression among older adults in South Korea. METHODS: Data are from A Profile of Older Adults: 2015 which sampled 1,455 community-dwelling individuals ages 60 and older in South Korea. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the outcome. We measured geographic proximity to neighborhood destinations, which included the time it takes the respondent to go to the grocery store, hospital, government office, senior center, social service center, and bus stop. We conducted latent profile analyses (LPA) with a distal outcome using the BCH method to determine whether geographic proximity to neighborhood resources is associated with depression. RESULTS: The LPA identified three distinct subgroups of geographic proximity to neighborhood resources: High Access (10%), Moderate Access (41%), and Low Access (49%). Low Access (b = 3.71, p < .001) and Moderate Access (b = 3.00, p < .001) groups had higher levels of depression compared to those in the High Access group. DISCUSSION: Our findings suggest that access to essential services in one's neighborhood is associated with lower levels of depression, which supports existing evidence that age-friendly community initiatives are important to older adults' psychological well-being.

Zenker's Diverticulum: Can Protocolised Measurements with Barium SWALLOW Predict Severity and Treatment Outcomes? The "Zen-Rad" Study.

Although barium swallow imaging is established in the investigation of Zenker's diverticulum (ZD), no agreed measurement protocol exists. We developed a protocol for measuring ZD dimensions and aimed to correlate measurements with symptoms and post-operative outcomes. This prospective study included patients with confirmed ZD who underwent flexible endoscopic septal division (FESD) between 2014 and 2018. ZD was confirmed on barium radiology with measurements reviewed by two consultant radiologists. Symptom severity pre- and post-FESD was measured using the Dysphagia, Regurgitation, Complications (DRC) scale. Regression analyses were conducted to identify dimensions associated with therapeutic success, defined as remission (DRC score ≤ 1) 6 months after index FESD. In total, 67 patients (mean age 74.3) were included. Interobserver reliability (intraclass correlation coefficients-ICCs) was greatest for pouch width (0.981) and pouch depth (0.934), but not oesophageal depth (0.018). Male gender (60.9%) was associated with larger pouch height (P = 0.008) and width (P = 0.004). A positive correlation was identified between baseline DRC score and pouch depth (ρ 0.326, P = 0.011), particularly the regurgitation subset score (ρ 0.330, P = 0.020). The index pouch depth was associated with FESD procedure time (rho 0.358, P = 0.041). Therapeutic success was achieved in 64.2% and was associated with shorter pouch height (median 14.5 mm vs. 19.0 mm, P = 0.030), pouch width (median 19.9 mm vs. 28.8 mm, P = 0.34) and cricopharyngeal length (median 20.2 mm vs. 26.3 mm, P = 0.036). ZD dimensions may be feasible and were evaluated using Barium radiology. Specific parameters appear to correlate with severity and post-FESD outcomes, which aid with pre-procedural planning.

Long-term success of flexible endoscopic septal division with the stag beetle knife for Zenker's diverticulum: a tertiary center study.

OBJECTIVES: Flexible endoscopic septum division is an established treatment for Zenker's diverticulum (ZD); however, long-term outcome data are lacking. We aimed to evaluate the long-term efficacy of flexible endoscopic septal division (FESD) using the stag beetle knife for ZD and identify predictors of symptom recurrence. METHODS: Patients undergoing the procedure between 2013 and 2018 were prospectively enrolled. Procedures were performed by a single operator. Symptom severity pre- and postprocedure was recorded using the dysphagia, regurgitation, and complications scale. Symptom recurrence was defined as a total score > 1 after the index procedure. Time-to-event analyses were performed using Kaplan-Meier plots, with multivariable analyses performed using Cox regression models. RESULTS: Altogether, 65 patients (mean age 74.0 years, 60% male) were included. Previous stapling had been performed in 44.6% of patients. Over the mean posttreatment follow-up period of 19 months, 5.6% of the treatment naïve group and 34.5% of the recurrent group underwent repeated FESD (P = 0.003), with rates of symptom remission and improvement of 75.4% and 92.7%, respectively. Recurrence at 48 months was higher in patients with recurrent ZD (84.7%) than in treatment-naïve patients (10.7%). On multivariable analysis, recurrent disease (hazard ratio [HR] 20.8, P = 0.005) and younger age (HR 0.96/year, P = 0.047) were associated with symptom recurrence. CONCLUSIONS: In patients with treatment-naïve ZD, flexible endoscopic septal division is safe and provides durable symptom remission. However, in patients with poststapling recurrence, the risk of recurrence is high and time-dependent.

Life Satisfaction and Depression in the Oldest Old: A Longitudinal Study.

This study aimed to analyze the effect of individual differences and family variables on life satisfaction and depression in the oldest old compared with the young-old. A total of 1,799 cases from an 8-year period of the Korean Welfare Panel Study (2006-2013) were analyzed. A key finding was that life satisfaction significantly increased with time for the two groups of older adults while depression decreased. Moreover, family relationship satisfaction significantly affected both life satisfaction and depression in both groups. However, its impact was stronger for the oldest old. Finally, individual difference variables, that is, objective life conditions, such as gender, education, and religion, did not have a significant impact on life satisfaction or depression in the oldest old. The results suggest that the oldest old not only face death but also experience continuous growth from a gerotranscendence perspective.

Adsorption of organophosphates into microporous and mesoporous NaX zeolites and subsequent chemistry.

Due to the neurotoxicity of organophosphate (OP) pesticides and nerve agents synthesized as military or terror agents, their safe destruction and disposal is of considerable current importance. A representative OP, trimethyl phosphate (TMP), was adsorbed onto NaX zeolite, two mesoporous modifications, and a low-silica X zeolite. The nucleophilic chemical reactions of TMP with the zeolites were investigated by solid-state 13C and 31P nuclear magnetic resonance (NMR) and the solvent extracts by 1H, 13C, and 31P NMR. Nucleophilic substitution and subsequent hydrolysis reaction schemes are proposed. All of the zeolites have similar TMP decomposition yields, supporting the hypothesis that slow or incomplete diffusion of TMP in the microporous zeolite regions limits TMP decomposition.

Depressive Symptoms of Older Adults Living Alone: The Role of Community Characteristics.

Although some evidence suggests that community characteristics may play an important role in the development of depressive symptoms among older adults, current literature has not attended to the role of community characteristics in depression in South Korea. This study begins to address this gap in the literature by examining the relationship of community characteristics and depressive symptoms, controlling for individual characteristics. Using a cross-sectional design and probability sampling, we surveyed 949 older adults living alone in 70 communities in the Busan metropolitan area in South Korea in 2012. A multilevel logistic regression analysis was conducted to test the hypothesis that community characteristics are predictive of depressive symptoms. We find that both the proportion of older adults and the number of senior citizen facilities in a community are associated with depressive symptoms, whereas community poverty is not related to depressive symptoms. Men with lower income, with lower levels of functional abilities, and without stronger family and friend social networks have a higher risk of depressive symptoms. Implications for research, practice, and policy are discussed.

Prevalence and risk factors for self-neglect among older adults living alone in South Korea.

This study aimed to explore the prevalence of and risk factors for self-neglect among older adults who live alone. Data were obtained through face-to-face interview responses of 1,023 older adults living alone in a metropolitan area in South Korea, selected via stratified random sampling, which considered the population variables gender, age group, and district. Descriptive statistics were used to characterize the prevalence of self-neglect, and hierarchical multiple regression analysis was conducted to identify significant risk factors of self-neglect. At least 22.8% of the participants could be considered to have one form of elder self-neglect. Consistent with previous research, self-neglect was more prevalent in the older people living alone who had higher levels of depressive symptoms or a lack of family social support. Unexpectedly, self-neglect was more prevalent among respondents with higher levels of education and cognitive abilities, lower levels of medical comorbidities, and more children. Additionally, social networks of friends and use of social services (formal social support) did not affect the frequency of self-neglect. The findings have implications for gerontological practice and policy, especially for older people living alone in South Korea.

Relationship between staff-reported culture change and occupancy rate and organizational commitment among nursing homes in South Korea.

PURPOSE: This study aims to examine culture change in nursing homes in South Korea and to identify the outcomes of culture change implementation. DESIGN AND METHODS: Data were taken from survey responses from 223 top- or mid-level staff among nursing homes in South Korea that were selected through a proportionate random-stratified sampling method from four regions nationwide. Culture change in nursing homes was operationalized by five person-directed care (PDC) constructs and three organizational environment constructs, and outcome quality was indicated by changes to occupancy rate and organizational commitment. RESULTS: After controlling for facility characteristics, the effect of staff-reported culture change on occupancy rate and organizational commitment was analyzed through the multiple-regression method. Consistent with previous research, this study revealed positive effects of culture change for nursing homes in South Korea. The study found that staff-reported culture change correlated with occupancy rate and organizational commitment. IMPLICATIONS: Given that culture change variables were significantly related to occupancy rate and organizational commitment, the findings of the study provide a persuasive argument that policies and/or programs to support culture change in nursing homes should be enhanced. Management-level workers in these facilities should have the skills and knowledge to foster more PDC and a more person-directed environment.

Response randomization of one- and two-person rock-paper-scissors games in individuals with schizophrenia.

Randomization among successive choices is important in adaptive decision-making, particularly for strategic interactions in which the optimal strategy is a mixed strategy. Patients with schizophrenia have been reported to have deficits in random sequential behaviors arising from impaired executive function. However, whether schizophrenic patients exhibit distinct behaviors for response randomization in one- and two-person games requiring different behavioral strategies is not known. The aim of this study was to examine the response randomization of 48 schizophrenic patients and 50 healthy subjects in one- and two-person rock-paper-scissors games. Here we found that the schizophrenic patients exhibited non-random biases distinct from those of the healthy subjects (i.e., stereotypic switching in the one-person game and the tendency to choose the best response against the opponent's previous choice in the two-person game). The entropy of the choice sequences was prominently decreased in the schizophrenic patients for both games, thereby indicating an overall disturbance in the behavioral randomization in adaptive decision-making. These results suggest that the impairment of response randomization in schizophrenic patients manifests differently in interactive and non-interactive situations, which may be useful for the diagnosis and quantification of the severity of the disease.

Factors affecting burden of South Koreans providing care to disabled older family members.

This study examined the determinants of caregiving burden among South Koreans who care for their disabled older family members. A sample of 1000 primary caregivers taken from the Comprehensive Study for Elderly Welfare Policy in Seoul, South Korea was analyzed. Independent variables included the demographic characteristics of caregivers and care recipients, the severity of cognitive impairment among care recipients, care recipients' functional abilities, financial adequacy and caregivers' degree of social support. Hierarchical regression was used to predict the levels of caregivers' burden. Similar to western care providers, South Korean caregivers who were in poor health and who had little informal social support, inadequate financial resources and more weekly caregiving hours were more likely to experience intense caregiving burden. Burden was also positively related to the functional and cognitive disabilities of care recipients. The results of this study indicate that certain aspects of caregiving are unique to South Koreans. Daughters-in-law were the most common caregiver within the sample which indicates that South Korean eldercare is non-consanguineous. Identifying predictors of South Korean caregivers' burden promotes a more comprehensive understanding of cultural experiences in caring for older adults.

Caregiver burden, dementia, and elder abuse in South Korea.

The purpose of this study is to identify characteristics that would increase the likelihood that a Korean older adult with dementia being cared for by a family caregiver is at risk of being abused. This analysis was based on a sample of 481 primary family caregivers from the data of Comprehensive Study for the Elderly Welfare Policy in Seoul (2003). Multiple regression analysis was used to examine predictors among the demographic characteristics of caregivers and care recipients, the severity of cognitive impairment, functional ability, caregiver burden, and social support for the degree of elder abuse. The degree of elder abuse was significantly associated with caregiver burden, mental impairment, dependency of daily living of care recipient, and use of formal services.