A longitudinal study of cognitive trajectories and its factors for Koreans aged 60 and over: A latent growth mixture model.

OBJECTIVE: The purpose of this study is twofold: first, to identify cognitive trajectories of older Koreans in a population-based longitudinal panel survey and, second, to investigate the main characteristics of the identified heterogeneous classes of cognitive trajectories. METHODS: Data came from 2445 cognitively healthy persons aged 60 or older in the 2006 to 2012 Korean Longitudinal Study of Aging. Using Korean-mini mental status examination (K-MMSE) as a measure of global cognitive function, the latent growth mixture modeling approach examined potential heterogeneity of longitudinal changes over the 6 years. RESULTS: This study found that older Koreans reported an average K-MMSE score of 27 at baseline and experienced a cognitive decline every 2 years by -1.6 (2006-2008) and -1.2 (2008-2010), followed by a slight increase of 0.7 in 2012. Results from the latent growth mixture modeling analysis indicated that there were 2 heterogeneous classes of longitudinal changes in the K-MMSE over a period of 6 years: class 1 with stable cognitive function and class 2 with sharp cognitive decline over time. The sharp decline was found among those older in age and with higher level of depression at baseline. On the contrary, being male, higher education, active social engagement, and regular exercise were main characteristics of stable cognitive function. CONCLUSION: As the first to examine cognitive trajectories among older Koreans, this study highlighted heterogeneity of cognitive trajectories in the population that should be considered for developing differential intervention strategies aimed at both promoting healthy brain and delaying/preventing cognitive decline.

Validation of the K6/K10 Scales of Psychological Distress and Their Optimal Cutoff Scores for Older Koreans.

This study aims to assess the psychometric properties of the Korean versions of the Kessler 6 and 10 (K-K6/K10) to validate the two scales in relation to the Korean versions of the Geriatric Depression Scale-Short Form (K-GDS-SF) and the Center for Epidemiological Studies Depression Scale (K-CES-D) and to propose optimal cutoff scores appropriate for the elderly Korean population (n=331). Psychometric performance was assessed with sensitivity, specificity, receiver operating characteristic curves, and area under the receiver operating characteristic curve. Cutoff scores were estimated from the Youden index, the closest-to-(0,1), and the balanced score. This study found that the K-K6 and K-K10 appeared to be robust screening tools, with the K-CES-D and K-GDS-SF as reference measures. The cutoff scores for the Korean senior population are proposed to be 12/13 for the K-K6 and 20/21 for the K-K10. This study indicates that the K6 and K10 can be valid and reliable screening tools of psychological distress for Korean seniors and may also be used among the Korean American elderly in the United States for both clinical and research purposes.

Trends in income-related health inequalities in self-assessed health in Korea, 1998-2011.

This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46-59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46-59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.

Comparative analysis on determinants of self-rated health among non-Hispanic White, Hispanic, and Asian American older adults.

The purpose of the study is (1) to compare the effects of factors on self-rated health (SRH) among older non-Hispanic Whites (NHW), Hispanic, and Asian Californians and (2) to provide estimated influence size of each factor on SRH. This study analyzed secondary data drawn from the 2005 California Health Interview Survey. Binary logit regressions were used to analyze data with the Jackknife replication sampling weights. Significant differences were found in SRH among the three groups. Hispanics and Asians reported poorer health than NHW. Socioeconomic status, acculturation, and health access significantly accounted for an association between ethnicity and SRH. However, the magnitudes of their effects on SRH varied across the groups and by the factors examined. This study discusses and concludes with some recommendations on the opportunities presented by the Affordable Care Act and Healthy People 2020.

Person and environment predictors of blood alcohol concentrations: a multi-level study of college parties.

AIMS: This study builds upon previous research by assessing the relationship of breath blood alcohol concentrations (BrAC) to environmental and individual characteristics. DESIGN: We conducted a multi-level study of college parties. Our design included observational measures of party environments, a brief self-administered questionnaire, and the collection of breath samples from partygoers. SETTING: Data were collected in private residences of students living in a neighborhood adjacent to a large public university located in the Southwestern United States. PARTICIPANTS: A total of 1,304 individuals attending 66 parties participated in the study. MEASURES: Observational measures of party characteristics were made by 2 trained research assistants at each party. Four to 5 trained interviewers administered a brief field survey to partygoers at each party. In addition, the trained interviewers collected breath samples using handheld breathalyzer devices. FINDINGS: Hierarchical linear modeling analyses revealed significant variation at the party and individual levels. At the individual level, motivations to socialize were significantly associated with lower BrAC, while drinking games and providing the sample after 11:00 pm were associated with higher BrACs. At the party level, large parties were significantly associated with lower BrACs while reports of many intoxicated partygoers were associated with higher BrACs. Finally, we identified a significant gender by theme party interaction, indicating women had higher BrACs at theme parties relative to nontheme parties; however, BrACs for men were similar regardless of the type of party attended. CONCLUSIONS: Alcohol consumption among young adults in natural settings is a function of both person and environmental factors.

Preference for long-term care arrangement and its correlates for older Korean Americans.

OBJECTIVE: Care preference is important for both client's satisfaction and quality of life in long-term care. This study examines preference for long-term care arrangement and its correlates for older Korean Americans. METHODS: Data on two disability scenarios of hip fracture and stroke from a cross-section survey of 144 older Korean Americans were used to examine preferred care arrangement in terms of caregiver and care location, using multinomial logistic regression. RESULTS: Respondents expressed stronger preferences for "all informal" or "mixed" care arrangement for hip fracture scenario, but they preferred "all formal" care arrangement in the stroke scenario. Traditional value significantly decreased the odds of choosing "all formal" or "mixed" over "all informal" care arrangement. But Medicaid coverage and an independent decision-making style increased the odds of choosing "all formal" instead of "all informal" care arrangement. DISCUSSION: This study discusses the need for assessment of care preference and culturally appropriate long-term care services for minority elders.