Frailty Related to the Exposure to Particulate Matter and Ozone: The Korean Frailty and Aging Cohort Study.

This study aims to identify the association between the concentration of particulate matter <2.5 µm (PM2.5), <10 µm (PM10), and ozone (O3) and frailty. The Korean Frailty Scale (KFS, 0-6 points) assessing physical, psychological, and social frailty, was applied to 2912 community-dwelling older adults between April 2016 and December 2017. Daily average concentrations of PM2.5, PM10, and O3 (2015-2017) were obtained and matched with the residential areas. The frailty risk associated with exposure to PM2.5, PM10, and O3 was evaluated using multiple logistic regression after adjusting for age, sex, BMI, lifestyle, socioeconomic status, and comorbidity. Participants were categorized into robust (0 points, 28.7%), pre-frail (1-2 points, 50.1%), and frail (≥3 points, 21.2%) groups. Each 1 µg/m3 increase of PM2.5 and PM10 increased the odds ratios (ORs) and 95% confidence intervals (CIs) of the frail group compared to the robust group: 1.055 (1.002, 1.112) and 1.095 (1.060, 1.131), and the pre-frail group: 1.053 (1.017, 1.090) and 1.062 (1.037, 1.087), respectively. Each 1-ppb increase of O3 increased the OR (95% CI) of the frail group: 1.041 (1.023, 1.059) and the pre-frail group: 1.005 (0.985, 1.025). PM2.5, PM10, and O3 may be associated dose-dependently with the frailty.

Relationship between Dietary Habits and Control of Lipid Profiles in Patients with Dyslipidemia Using Pravastatin.

We investigated the association between dietary habits, evaluated using the modified Mini Dietary Assessment Index for Koreans (MDA), and lipid control among patients aged ≥20 years who had used pravastatin for dyslipidemia for 6 months. Participants were administered questionnaires regarding sociodemographic characteristics and lifestyle factors. Odds ratios and 95% confidence intervals for the control of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and total cholesterol (TC) at 6 months for each category of the modified MDA items were calculated through multivariate logistic regression analysis. The odds for controlled LDL-C was higher among those who consumed cholesterol-rich foods <1 time/week (3.27, 1.25-8.57) than for those who did so ≥4 times/week. The odds for controlled TG was higher among those who always consumed dairy products (2.96, 1.36-6.44), ate protein-rich foods three times/day (2.94, 1.06-8.10), and had a regular eating schedule (3.02, 1.30-7.00) than among those who did not have any of these. The odds for controlled TC was higher among those with a regular eating schedule (3.47, 1.55-7.76) than among their counterparts. Patients with dyslipidemia should consume less cholesterols, consume more dairy and protein-rich foods, and follow a regular eating schedule to control lipid profiles.

Effects of morbidity on smoking cessation: a national smoking cessation program.

BACKGROUND: In smokers with chronic diseases, we examined the abstinence rates over 6 months and its affecting factors in the context of the Korea National Health Insurance Service (NHIS) smoking cessation program. METHODS: To identify 6-month abstinence, we extracted a sample of 15,017 participants using the multi-stage stratified cluster sampling method from the 359,047 individuals enrolled in the 2016 NHIS smoking cessation program and 1500 smokers responded to the telephone survey. From this group, 1245 individuals (48.50 ± 12.55 years; men 89.8%) were enrolled, as they had no missing information for confounding variables. We compared chronic disease distribution between participants and current smokers in the 2016 Korea National Health and Nutrition Examination Survey. We evaluated the factors affecting continuous abstinence rate (CAR) across patients with different chronic diseases: hypertension, diabetes mellitus (DM), dyslipidemia (DL), chronic obstructive pulmonary disease, and major depressive disorder (MDD). RESULTS: While participation of DM patients was high, the participation of DL patients was relatively low. The CAR over 6 months was 44.74%. The adjusted odds ratio (OR) for continuous abstinence over 6 months was significantly lower in the MDD group than in the no-MDD group (OR 0.43, 95% confidence interval [CI] 0.21 to 0.85). The factors of program completion (complete versus incomplete: OR 3.11, 95% CI 2.43 to 3.98), region (non-metropolitan areas versus Seoul metropolitan area: OR 1.28, 95% CI 1.01 to 1.61), and nicotine dependence (severe versus light or moderate: OR 0.64, 95% CI 0.50 to 0.83) were significantly associated with CAR. CONCLUSIONS: The smoking cessation program was not actively recruiting smokers with chronic diseases. The CARs in each disease group were not different from those in the non-disease groups, except that the MDD group had a lower CAR over 6 months than the no-MDD group. Recruiting smokers with chronic diseases and improving their CARs depends on the careful identification of their characteristics.

Hospital adverse outcomes of the elderly in a tertiary referral hospital: A prospective cohort study of 9,586 admissions.

OBJECTIVE: This study aimed to evaluate the hospital adverse outcomes (HAO) of admitted older adult patients in a large prospective cohort and investigate the demographic, economic, and health-related characteristics at risk of HAO in all older adult patients admitted in the general ward of a tertiary referral hospital. MATERIALS AND METHODS: We recruited admission episodes of older adult patients aged over 65 years who were admitted at the general ward of Konkuk University Medical Center, which is a tertiary referral hospital, from September 2016 to October 2017. Out of 9,586 admission episodes, 8,263 were included. Modified from the Geriatric Screening for Care-10, six common geriatric health issues, namely, dysphagia, polypharmacy, fecal incontinence, functional mobility, depression, and dementia, were evaluated. Fall, hospital-acquired pressure ulcer (HPU), and mortality were checked daily by experienced nurses during the patients' hospital stay. A logistic regression model was used, and P < 0.05 was the threshold of significance. RESULTS: The incidence rates of fall and HPU were 1.3 % and 4.0 %, respectively. The hospital mortality was 6.1 %. Older adult patients with dysphagia or dementia upon admission were significantly associated with an increased likelihood of falls. Furthermore, age, ER admission, low income, fecal incontinence, or functional immobility increased the HPU incidence. Meanwhile, age, male, ER admission, fecal incontinence, or functional immobility significantly increased the hospital mortality. CONCLUSION: All demographic, economic, and health-related characteristics, except for polypharmacy and depression, affect the incidence of HAO. Intervention to vulnerable older adult patients with HAO risk could improve the treatment outcome.

The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center.

BACKGROUND: This study aimed to describe the experience of providing older adult patients with transitional care from an acute care hospital to home in cooperation with a public health center, in order to present the barriers to that care and suggest better organizational methods. METHODS: This was a cross-sectional study to show the results of the Geriatric Screening for Care-10 (GSC-10) and outcomes of transitional care. Among 659 hospitalized patients aged 65 years or above who lived in an administrative district, forty-five subjects were enrolled between June 24, 2019 and January 23, 2020. Within 48 hours of admission, using the 10 areas of GSC-10, they were assessed for cognitive impairment, depression, polypharmacy (5 or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence, and were reassessed before discharge. The transitional care plan (containing the treatment summary, the results of the GSC-10 assessment, and the post-discharge plan) was forwarded to a representative of the public health center, who provided continued disease management and various health care services, such as chronic disease and frailty care, and physical rehabilitation. RESULTS: Of all the participants, 64.4% had more than 1 GSC-10 concern. The most prevalent concerns were functional immobility (35.6%) and polypharmacy (22.2%). About 15.6% of the participants were readmitted to a nursing home or hospital. A total of 38 participants received the transitional care intervention. They received an average of 2.7 administered interventions. However, the rate of rejection was high (30.1%) and patients were visited an average of 16.5 days after discharge. CONCLUSION: Through our experience of providing transitional care from an acute care hospital to home in cooperation with a public health center, we expect that the transitional care suitable for the Korean medical situation could be established and successful.

Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital.

BACKGROUND: Given the association between geriatric syndrome and hospital readmission, we evaluated the suitability of geriatric syndrome screening for care (GSC) in identifying readmission risk and suggested the appropriate time for GSC. METHODS: GSC considering cognitive impairment, depression, polypharmacy (five or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence was performed among 2,663 general ward inpatients aged 65 years or older within 48 hours after admission and again before discharge between November 2016 and October 2017. From each patient, fall events, pressure ulcers, potentially inappropriate medication use, and delirium were assessed at admission. Patients were divided into two groups on the basis of readmission within 1 year after the first admission. According to the screening period (at admission and before discharge) and in-hospital decline, we applied receiver operating characteristic curve analysis to compare the prevalence of clinical concerns between the readmission and no-readmission groups. We also used multiple logistic regression analysis to evaluate the risk of readmission according to the presence of geriatric syndrome and clinical outcomes. RESULTS: The 782 readmitted patients (29.4%) showed a higher rate of poor GSC than those who were not readmitted. Polypharmacy at admission was significantly correlated with readmission risk (area under the receiver operating characteristic curve=0.602). Fall events (odds ratio [OR]=4.36; 95% confidence interval [CI], 2.36-8.05), urinary incontinence (OR=4.21; 95% CI, 3.28-5.39), and depressive mood (OR=3.88; 95% CI, 2.69-5.59) at admission were risk factors for readmission. CONCLUSION: Geriatric syndromes assessed by GSC at admission was associated with an increased risk of readmission.

Smoking, alcohol intake, and frailty in older Korean adult men: cross-sectional study with nationwide data.

PURPOSE: Smoking and alcohol intake are major causes of negative health outcomes and may be co-inherited traits. However, little is known about the association of frailty with smoking and alcohol intake in older adults. METHODS: Community-dwelling older men (N = 1426) aged 70-84 years were divided into four groups: 1) non-smoking (< 100 cigarettes in life-time) and non-alcohol intake (< one time/month); 2) smoking (≥ 100 cigarettes) and alcohol intake (≥ one time/month); 3) non-smoking with alcohol intake; and 4) smoking and no alcohol intake. Frailty was assessed with a modified version of the Cardiovascular Health Study (CHS) frailty index, the Korean version of the Fatigue, Resistance, Ambulation, Illness, and Loss of Weight (KFRAIL) index, the Korean Frailty Index (KFI), and the Study of Osteoporotic Fracture (SOF) frailty index. Frailty risks were estimated with multiple logistic regression models after adjusting for age, income, education, residence, marital status, hospitalization, physical activity, comorbidities, and levels of vitamin B12, aspartate aminotransferase, and gamma-glutamyl transferase. RESULTS: Frailty differed according to smoking and alcohol status. Frailty in the smoking and non-alcohol-intake group was significantly higher according to the CHS frailty index (Odds ratio = 1.592; 95% confidence interval [CI] 1.032-2.455), KFRAIL (CI 1.613, 1.037-2.509), and KFI (CI 1.869, 1.115-3.131) compared with the non-smoking and alcohol-intake group. However, there was no increased frailty risk in the other study groups. CONCLUSION: Frailty prevalence differed depending on smoking status and alcohol intake in older Korean men. Therefore, we should adopt a comprehensive approach to understanding frailty in older adults that considers both smoking and alcohol intake.

Korean frailty and aging cohort study (KFACS): cohort profile.

PURPOSE: The purpose of the Korean Frailty and Aging Cohort Study (KFACS) is to initiate a nationwide, population-based prospective cohort study of older adults living in the community to assess their frailty status and explore transitions between frailty states over time in Korea. PARTICIPANTS: The KFACS is a multicentre longitudinal study with the baseline survey conducted from May 2016 to November 2017. Each centre recruited participants using quota sampling stratified by age and sex. The number of participants recruited through 2 years of baseline study from 10 centres was 3014, with each site accounting for approximately 300 participants. The inclusion criteria were: having an age of 70-84 years, currently living in the community, having no plans to move out in the next 2 years, having no problems with communication and no prior dementia diagnosis. FINDINGS TO DATE: To define physical frailty, the KFACS used a modified version of the Fried Frailty Phenotype (FFP) consisting of five components of frailty: unintended weight loss, weakness, self-reported exhaustion, slowness and low physical activity. In the baseline study of 2016-2017, 2907 of 3014 individuals fulfilled all five components of FFP. The results indicated that 7.8% of the participants (n=228) were frail, 47.0% (n=1366) were prefrail and 45.2% (n=1313) were robust. The prevalence of frailty increased with age in both sexes; in the group aged 70-74 years, 1.8% of men and 3.7% of women were frail, whereas in the 80-84 years age group, 14.9% of men and 16.7% of women were frail. Women tended to exhibit a higher prevalence of frailty than men in all age groups. FUTURE PLANS: The KFACS plans to identify outcomes and risk factors associated with frailty by conducting a 10-year cohort study, with a follow-up every 2 years, using 3014 baseline participants.

Development of a senior-specific, citizen-oriented healthcare service system in South Korea based on the Canadian 48/6 model of care.

BACKGROUND: In the age of aging, Korea's current medical delivery system threatens to increase the number of medical and caring refugees. This study attempts to develop an integrated senior citizen-oriented healthcare service system in which daily care, professional care, and rehabilitation are organically organized between medical institutions and local communities, thereby meeting the daily life needs of the elderly and inducing well-being, wellness, and well-dying. METHODS: To develop the integrated healthcare system, data collection and analyses were conducted through a systematic review, literature review, benchmarking, focus group interviews, and expert consultation. RESULTS: The senior-specific, citizen-oriented healthcare service system developed in this study is designed to screen patients aged 65 or older within 24 h of being admitted, using the Geriatric Screening for Care-10. If there is reason for concern as a result of the screening, further evaluation is performed through assessment. Doctors and nurses create a care plan and a discharge plan based on the results from the screening and assessment. The nurse further uses the screening to monitor the patient's condition before discharge. Based on the screening results at the time of discharge, a transitional care plan is prepared and provided to elderly patients and/or their families. This process enables a systematic link between medical institutions and community resources, aiming for the continuous management of health issues. It also establishes a multidisciplinary treatment plan that considers patients and their families so that diseases common to the elderly are diagnosed and treated promptly. CONCLUSIONS: The most important issue for the elderly is to be able to live healthily and independently for the rest of their lives through well-being, wellness, and well-dying. The senior-specific, citizen-oriented healthcare service proposed in this study is an integrated medical treatment system for elderly users the implementation of which requires the daily care, professional care, and rehabilitation of elderly members of society to be organically organized according to the role of the patients, their families, and the caregiver.

Applicability of the 48/6 Model of Care as a Health Screening Tool, and its Association with Mobility in Community-Dwelling Older Adults.

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults. METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA. RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (ß = -10.567, P < 0.001), dysphagia (ß = -9.610, P = 0.021), and pain (ß = -7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age. CONCLUSION: The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.

Dietary Patterns Independent of Fast Food Are Associated with Obesity among Korean Adults: Korea National Health and Nutrition Examination Survey 2010-2014.

Few studies have examined the multifaceted aspects of fast food consumption and dietary patterns for their effects on obesity. We examined the independent associations of obesity with fast food consumption and dietary pattern in Korean adults using a nationally representative cross-sectional survey. A total of 19,017 adults aged 19-64 years participated in the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2014. Fast food items were removed from diet and then dietary patterns were generated. Multivariate logistic regression analysis was used to examine the odds of overweight/obesity and central obesity according to fast food consumption and dietary patterns. Fast food consumers were about 10% of Korean adults. Both the "White rice and kimchi" pattern and "Meat and alcohol" pattern were associated with low intakes of fiber, calcium, vitamin C, grains, fruit, and milk (p < 0.05). Fast food consumers had higher "Meat and alcohol" and "Grains, fruit, and milk" patterns, and they had a lower "White rice and kimchi" pattern than non-fast food-consumers. Fast food consumers were not associated with overweight/obesity, whereas participants with the "Meat and alcohol" pattern had 14% higher overweight/obesity (95% CI: 1.01, 1.28) and 16% higher central obesity (95% CI: 1.00, 1.34). Fast food consumption was not directly associated with obesity, whereas the "Meat and alcohol" pattern had independent associations with overweight/obesity and central obesity among Korean adults.

Exposure to Ambient Air Pollution and Cognitive Impairment in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study.

The aim of this study was to investigate the associations between ambient air pollutants and cognitive impairment in Korean older adults. The cognitive function of 2,896 participants aged 70 to 84 years was measured using the Korean version of the mini-mental state examination, the digit span test, the word list learning test, and the frontal assessment battery. After matching the average concentrations of particulate matter (PM) <10 µm in size (PM10) and <2.5 µm (PM2.5), NO2, CO, SO2, and O3 between 2013 and 2017, the association between air pollutants and cognitive scales was analyzed using a linear mixed regression and a multiple logistic regression analysis (after adjusting for age, sex, health related behaviors, socioeconomic status, comorbidity, and meteorological data). Exposure to PM2.5, PM10, NO2, SO2, and CO was associated with cognitive impairment above and beyond age or education level effects. Specifically, PM2.5 was negatively associated with most components of the cognitive scales (interquartile range for PM2.5: 2.0 µg/m3, odds ratio for poor global cognition: 2.28, 95% confidence interval: 1.60-3.26). These associations may be affected by sex, residence area, or alcohol intake. Conclusively, air pollutants, especially PM2.5, were associated with cognitive impairment, including global cognition, attention, memory, and executive function in Korean older adults aged ≥70 years.

Postthyroidectomy obesity in a Korean population: does the extent of surgery matter?

PURPOSE: The purpose of this study was to investigate the prevalence of postthyroidectomy obesity, and the relationship between the extent of thyroidectomy and obesity. METHODS: A survey conducted at an outpatient clinic from June to October 2014 and retrospective charts for patients undergoing thyroidectomy at Konkuk University Medical Centers from June 2009 to December 2013 were reviewed. We compared clinical characteristics and pre- and postoperative obesity-related factors in 227 patients who underwent total thyroidectomy or lobectomy. RESULTS: Patients included 39 males and 188 females with a mean age of 46.0 ± 11.0 years; the mean follow-up period was 23.9 ± 16.7 months, and 90 of the 227 patients showed postthyroidectomy obesity. In effect of operative extent on postoperative obesity, patients who underwent TT (48.2 years) than those who underwent lobectomy (43.4 years). TT group had longer follow-up and the frequency of menopause was higher than in the lobectomy group. No differences in postthyroidectomy obesity, body weight change, or body mass index (BMI), change among 2 groups. The predictors of postthyroidectomy obesity were older age, female, heavy alcohol consumption (P = 0.029), higher preoperative BMI (P < 0.001), larger postoperative weight gain (P = 0.024), and larger BMI change. However, the extent of thyroidectomy did not affect postthyroidectomy obesity. Preoperative BMI (P < 0.001) and heavy alcohol consumption (P = 0.03) were independent factors of postthyroidectomy obesity. CONCLUSION: The extent of thyroidectomy does not affect postthyroidectomy obesity. Preoperative BMI and heavy alcohol consumption are risk factors for postthyroidectomy obesity. Studies are needed to suggest preoperative life style modification to prevent postthyroidectomy obesity.

Early Identification of Risk Factors for Mobility Decline Among Hospitalized Older Patients.

OBJECTIVE: The aim of the study was to identify the risk factors for mobility decline among hospitalized older patients early. DESIGN: This is a prospective cohort study. A total of 875 older patients were divided into two groups: older patients with and without mobility decline. The mobility level was measured using the item of functional mobility in the Geriatric Screening for Care 10. The change in mobility between admission and discharge was determined as the dependent variable. There were a total of 18 independent variables, which consisted of three demographic variables, 10 most problematic domains of geriatric care, and five other health-related variables. A multivariable logistic regression analysis was conducted to identify the risk factors for mobility decline during hospitalization. RESULTS: Of the 875 older patients, 135 (15.4%) experienced mobility decline during hospitalization. The multivariable logistic regression analysis revealed female sex, cognitive impairment, and underweight as the risk factors for mobility decline during hospitalization. CONCLUSIONS: The identified risk factors should be considered to identify patients at a risk of mobility decline early and to provide targeted interventions, which can prevent mobility decline.

Predictors of long-term abstinence rate by income level in the Korean smoking cessation programme.

BACKGROUND AND AIMS: To assess whether predictors of success in stopping smoking vary as a function of income level in Korean smoking cessation services. DESIGN: Prospective study of predictors of smoking cessation up to 6 months' follow up. PARTICIPANTS: A sample of 954 people (mean age 49.13 ± 10.69 years; 863 [90.5%] men) enrolled in the Korean National Health Insurance Service smoking cessation programme in 2015. MEASURES: The outcome measure was self-reported continuous abstinence up to 6-month follow up. Predictors were income and other sociodemographic variables as well as smoking-related variables measured at baseline. RESULTS: The continuous 6-month abstinence rate was 30.5%. The adjusted odds of 6-month continuous abstinence were lower among low-income versus the middle- or high-income smokers (OR, 0.54; 95% CI, 0.35-0.84), those with severe versus light/moderate cigarette dependence (OR, 0.72; 95% CI, 0.52-0.98), and use of bupropion versus varenicline (OR, 0.60; 95% CI, 0.39-0.91). The association between cigarette dependence and outcome was only present among low-income smokers. CONCLUSIONS: Lower income, higher cigarette dependence, and choice of bupropion versus varenicline are associated with lower chances of stopping smoking in Korean smoking cessation services, but the association with cigarette dependence is only found in low-income smokers.

The Easy Dysphagia Symptom Questionnaire (EDSQ): a new dysphagia screening questionnaire for the older adults.

PURPOSE: The early detection of dysphagia, a common clinical issue among older adults, is important. However, healthcare professionals sometimes experience difficulties in applying the current screening tools to older adults. Therefore, we developed the Easy Dysphagia Symptom Questionnaire (EDSQ), a simplified tool for the older adults, and investigated its reliability and validity. METHODS: The 12-item "yes/no" EDSQ assesses dysphagia symptoms, with a total score being the sum of all "yes" responses. Each item was determined by consensus of three physiatrists after reviewing the previous dysphagia questionnaires. Participants were aged 65 years or older who either complained of or were suspected by a physician of facing swallowing disturbance. They completed the EDSQ, modified water swallow test (MWST), and videofluoroscopic swallowing study. The EDSQ's internal consistency was assessed. Correlations between the EDSQ total score and the MWST, American Speech-Language-Hearing Association's National Outcome Measurement System (ASHA NOMS) swallowing scale, and videofluoroscopic dysphagia scale (VDS) were analyzed. RESULTS: The sample comprised 51 participants (29 male, 56.9%; mean age 76.7 ± 6.6 years). Mean EDSQ total score was 4.33 ± 3.03 (range 0-12). Regarding the EDSQ's reliability, the Cronbach's α coefficient was 0.785. The EDSQ total score correlated with the MWST (r = - 0.468, p = 0.001), ASHA NOMS swallowing scale (r = - 0.635, p < 0.001), and VDS (r = 0.449, p = 0.001). The receiver-operating characteristic analysis revealed an optimal cut-off score of ≥ 5, with a sensitivity of 90.9% and a specificity of 67.5%. CONCLUSIONS: The EDSQ showed acceptable reliability and validity, indicating its applicability to older adults as a simple screening tool for safe swallowing.

Cancer Risk from Exposure to Particulate Matter and Ozone According to Obesity and Health-Related Behaviors: A Nationwide Population-Based Cross-Sectional Study.

BACKGROUND: There is little evidence of an association between cancer risk and long-term exposure to ambient particulate matter <10 µm (PM10) and ozone (O3), according to obesity and health-related behaviors. METHODS: In the 2012 Korean Community Health Survey, survey data on socioeconomic characteristics, health-related behaviors, and previous cancer history were collected from 100,867 participants. Daily average concentrations of PM10 and O3 (2003-2012) were obtained from the Korean Air Pollutants Emission Service. The cancer risks for interquartile increases in PM10 and O3 were evaluated using multiple logistic regression and were stratified by age, sex, obesity, and health-related behaviors. RESULTS: Increased cancer risk was found among obese subjects aged ≥50 years after adjusting for confounding factors [PM10: ≥60 years: OR 1.34, 95% confidence interval (CI) 1.03-1.74; 50-60 years: OR 1.40, CI 1.01-1.96; O3: ≥60 years: OR 1.12, CI 1.04-1.20; 50-60 years: OR 1.20, CI 1.08-1.33]. However, we did not observe similar trends in the nonobese subjects. Among obese subjects aged ≥50 who had been exposed to PM10, men, ever smokers, and inactive subjects were at increased cancer risk. Regarding O3, the cancer risk was significantly higher among obese adults >50 years old, regardless of sex or health-related behaviors. CONCLUSIONS: Long-term exposure to PM10 and O3 was found to increase cancer risk. In particular, the risk differed according to obesity status, age, sex, and health-related behaviors. IMPACT: The effect of air pollution on cancer risk was compounded by obesity, smoking, and physical inactivity among subjects over 50 years old.

Association of Geriatric Syndromes with Urinary Incontinence according to Sex and Urinary-Incontinence-Related Quality of Life in Older Inpatients: A Cross-Sectional Study of an Acute Care Hospital.

BACKGROUND: Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. We investigated the relationship between geriatric syndromes and UI according to gender and UI-related QOL among older inpatients. METHODS: This study was conducted among 444 older inpatients (aged 65 years and older) between October 2016 and July 2017. We examined geriatric syndromes and related factors involving cognitive impairment, delirium, depression, mobility decline, polypharmacy, undernutrition, pain, and fecal incontinence. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations. RESULTS: Geriatric syndromes and related factors were associated with UI. Mobility decline (odds ratio [OR], 4.16; 95% confidence interval [CI], 2.29-7.56), polypharmacy (OR, 3.35; 95% CI, 1.89-5.92), and pain (OR, 6.80; 95% CI, 3.53-13.09) were related to UI in both genders. Especially, delirium (OR, 7.55; 95% CI, 1.61-35.44) and fecal incontinence (OR, 10.15; 95% CI, 2.50-41.17) were associated with UI in men, while cognitive impairment (OR, 4.19; 95% CI, 1.14-15.44) was significantly associated with UI in women. Patients with depression were more likely to have poor UI-related QOL (OR, 8.54; 95% CI, 1.43-51.15). CONCLUSION: UI was associated with different geriatric syndromes and related factors according to gender. Care for patients with depression, related to poor UI-related QOL, should be considered in primary care to improve the UI-related QOL of these individuals.

Association of High-Risk Drinking with Metabolic Syndrome and Its Components in Elderly Korean Men: The Korean National Health and Nutrition Examination Survey 2010-2012.

BACKGROUND: Previous studies have examined the association between alcohol consumption and metabolic syndrome (MetS) in adults, but studies in the elderly are lacking. We examined the relationship between high-risk alcohol consumption and MetS in elderly Korean men using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire from the 2010-2012 Korean National Health and Nutrition Examination Survey. METHODS: Among 25,534 subjects, 2,807 were men >60 years of age; after exclusions, we included 2,088 men in the final analysis. We categorized the study participants into three groups according to AUDIT score: low risk (0-7), intermediate risk (8-14), and high risk (≥15 points). RESULTS: Among the study population, 17.0% of the men were high-risk drinkers, who had the highest mean waist circumference, systolic and diastolic blood pressure (BP), fasting plasma glucose (FPG), and triglyceride (TG) levels. The overall prevalence of MetS was 41.9% in the elderly men, and it was significantly higher in the group with high (48.3%) versus low (31.9%) AUDIT scores. The prevalence of MetS components (elevated BP, high FPG, high TG, and low high-density lipoprotein cholesterol) was associated with a high AUDIT score. The odds ratios (95% confidence interval) of the high-risk group for MetS, elevated BP, and high TG were 1.40 (1.03-1.89), 1.82 (1.28- 2.60), and 1.77 (1.30-2.41) after adjustment for confounding variables. CONCLUSION: AUDIT score was correlated with most MetS components in elderly Korean men.

Unmet healthcare needs of elderly people in Korea.

BACKGROUND: Elderly people often have more complicated healthcare needs than younger adults due to additional functional decline, physical illness, and psychosocial needs. Unmet healthcare needs increase illness severity, complications, and mortality. Despite this, research on the unmet healthcare needs of elderly people is limited in Korea. This study analysed the effect of functional deterioration related to aging on unmet healthcare needs based on the Korea Health Panel Study. METHODS: This cross-sectional study used data from the 2011-2013 survey of 8666 baseline participants aged 65 years and older. Unmet healthcare needs were calculated using a complex weighted sample design. Group differences in categorical variables were analysed using the Rao-Scott Chi-square test. Using logistic regression analysis, the association between unmet healthcare needs and aging factors was analysed. RESULTS: The prevalence of unmet healthcare needs in Korean elderly was 17.4%. Among them, the leading reason was economic hardship (9.2%). Adjusting for sex, age, socioeconomic characteristics, and health-related characteristics, the group with depression syndrome was 1.45 times more likely to have unmet healthcare needs than that without depression syndrome (95% CI = 1.13-1.88). The group with visual impairment was 1.48 times more likely to have unmet healthcare needs than that without it (95% CI = 1.22-1.79). The group with hearing impairment was 1.40 times more likely to have unmet healthcare needs than that without it (95% CI = 1.15-1.72). The group with memory impairment was 1.74 times more likely to have unmet healthcare needs than that without it (95% CI = 1.28-2.36). CONCLUSIONS: The unmet medical needs of the elderly are more diverse than those of younger adults. This is because not only socioeconomic and health-related factors but also aging factors that are important to the health of the elderly are included. All factors were linked organically; therefore, integrated care is needed to improve healthcare among the elderly. To resolve these unmet healthcare needs, it is necessary to reorganize the healthcare system in Korea to include preventive and rehabilitative services that address chronic diseases in an aged society and promote life-long health promotion.