Development of a web-based care networking system to support visiting healthcare professionals in the community.

BACKGROUND: The role of visiting health services has been proven to be effective in promoting the health of older populations. Hence, developing a web system for nurses may help improve the quality of visiting health services for community-dwelling frail older adults. This study was conducted to develop a web application that reflects the needs of visiting nurses. METHODS: Visiting nurses of public health centers and community centers in South Korea participated in the design and evaluation process. Six nurses took part in the focus group interviews, and 21 visiting nurses and community center managers participated in the satisfaction evaluation. Focus group interviews were conducted to identify the needs of visiting nurses with respect to system function. Based on the findings, a web application that can support the effective delivery of home visiting services in the community was developed. An artificial intelligence (AI) algorithm was also developed to recommend health and welfare services according to each patient's health status. After development, a structured survey was conducted to evaluate user satisfaction with system features using Kano's model. RESULTS: The new system can be used with mobile devices to increase the mobility of visiting nurses. The system includes 13 features that support the management of patient data and enhance the efficiency of visiting services (e.g., map, navigation, scheduler, protocol archives, professional advice, and online case conferencing). The user satisfaction survey revealed that nurses showed high satisfaction with the system. Among all features, the nurses were most satisfied with the care plan, which included AI-based recommendations for community referral. CONCLUSIONS: The system developed from the study has attractive features for visiting nurses and supports their essential tasks. The system can help with effective case management for older adults requiring in-home care and reduce nurses' workload. It can also improve communication and networking between healthcare and long-term care institutions.

Effect of Health Shocks on Poverty Status in South Korea: Exploring the Mechanism of Medical Impoverishment.

BACKGROUND: South Korea has the highest out-of-pocket burden for medical expenses among the Organisation for Economic Co-operation and Development (OECD) member countries and has no formal sickness benefit system, along with United States and Switzerland, greatly increasing the risk of poverty due to a sudden illness. METHODS: We identify the causal effect of health shocks on poverty status and explore the mechanisms of medical impoverishment by analyzing longitudinal data from 13 670 households that participated in the representative Korean Welfare Panel Study (KOWEPS) from 2007 to 2016. In this study, we define a health shock as a case in which no household members were hospitalized in the previous year, but together they had more than 30 days of hospitalization in this year. The propensity score matching method was combined with a mediation analysis in this work. RESULTS: The proportion of households in absolute poverty increased by 4.6-8.0 percentage points among households that experienced a health shock compared with matched controls. The selection effects due to health shock were estimated to be 5.6-8.2 percentage points. On average, a sudden hospitalization reduces annual non-medical expenditures and equivalized disposable income by just over 3.2 million KRW (2500 USD) and 1.2 million KRW (1000 USD), respectively. Health shock induces impoverishment after one year through both the medical expense and work capacity pathways, which explain 12.8% and 12.8% of the total effect, respectively. However, when we decompose the mediation effect of a health shock on poverty status after two years, we find that a health shock leads to poverty mainly through labor force nonparticipation (9.9%). CONCLUSION: Income stabilizing scheme to protect households that experience a health shock should be introduced as a policy alternative to confront the issue of medical impoverishment.

Development of Guidelines on the Primary Prevention of Frailty in Community-Dwelling Older Adults.

BACKGROUND: Despite the increasing number of older adults as the population ages, there is a lack of frailty prevention guidelines for community-dwelling older adults. The Korean Frailty and Aging Cohort Study conducted systematic review on contributors to frailty and developed guidelines on the primary prevention of frailty in community-dwelling older adults. METHODS: This study updated a previous systematic review of contributors to frailty by adding the most recent articles. Based on this updated systematic review, experts in geriatrics and gerontology developed guidelines for preventing frailty using the Delphi method. RESULTS: These guidelines categorized the recommendations into physical activity, resilience, oral health, management of non-communicable diseases, involvement in society, smoking cessation, and eating various kinds of food. CONCLUSION: Unlike previous frailty-related guidelines, this study developed evidence-based frailty prevention guidelines based on a systematic review. The guidelines are expected to contribute to the healthy aging of community-dwelling older adults by the primary prevention of frailty.

Reinforcement Effects of Social Network Intervention during Nutritional Supplementation in Frail Older Adults.

INTRODUCTION: Chronic undernutrition and a homebound state are corelated and are both important components of frailty. However, whether social network intervention combined with protein supplementation is an effective strategy to prevent functional decline among frail older adults is unclear. METHODS: 150 frail older adults participated in a 3-month, 3-armed, community-based clinical trial and were randomly assigned to one of 3 groups: high-protein supplementation (additional 27 g of protein/day), the Social Nutrition Program (additional 27 g of protein/day and social network intervention), or a control group. Those assigned to the Social Nutrition Program group received individual counseling from 1 dietitian and 1 social worker during 6 home visits and were encouraged to participate in 4 sessions of community-based cooking activities, the social kitchen program. Primary outcomes were changes in Physical Functioning (PF) and the Timed Up and Go (TUG) test and were assessed at 0 months (baseline), 1.5 months (interim), and 3, 6, and 9 months (postintervention). RESULTS: Compared with the control group, participants in the Social Nutrition Program showed an average improvement of 2.2-3.0 s in the TUG test and this improvement persisted for 3 months after the end of the program (post hoc p ≤ 0.030). The Social Nutrition Program also increased PF by 1.3 points while the control group showed a 1.4 point reduction at the end of the program (post hoc p = 0.045). Improvement in PF and TUG results was primarily observed for the socially frail subgroup of older adults in the Social Nutrition Program group rather than the physically frail subgroup. Frequency of leaving home functioned as a mediator (p = 0.042) and explained 31.2% of the total effect of the Social Nutrition Program on PF change. CONCLUSION: Our results indicate that social network intervention combined with protein supplementation can improve both the magnitude and duration of functional status among frail older community-dwelling adults.

Who Are the People Willing to Pay for Physician Home Visits?

BACKGROUND: Since the recently announced Community Care Policy, there has been an opinion that Korea needs to establish an alternative medical model such as physician home visits. This study aimed to assess the need and willingness to pay (WTP) for physician home visits among the community-dwelling Korean older population and to determine the most important factors that influence older adults to decide to use a physician home visit service. METHODS: A total of 797 people aged 60 years or older who were randomly selected from a nationwide dataset using a multi-stage stratified sampling method answered a questionnaire on the need and WTP for physician home visits. RESULTS: A total of 39.3% of participants reported that they would like a physician home visit when they need help. Among older adults who needed physician home visits (n = 313), the WTP amount for physician home visits was 21,982 ± 17,546 KRW. Logit and Tobit regression analyses showed that the higher valuated need and WTP for physician home visits was associated with a lower level of physical/psychosocial functioning measured by EuroQol-five dimensions score (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27; P = 0.035) and a higher level of satisfaction when using community-based services such as public health centers (OR, 1.32; 95% CI, 1.02-1.72; P = 0.034), social welfare centers and Gyeong-ro-dang (OR, 1.61; 95% CI, 1.04-2.50; P = 0.033; ß = 8.39; standard error, 3.63; P = 0.021). CONCLUSION: This study provides evidence that the decision to pay for a physician home visit service is based upon the complex interactions among an individual's physical and psychosocial functioning, personal experiences of service utilization, and demographic factors. The value for physician home visits should be qualified based on the empirical data of WTP, which comes from a consumer-centered perspective.

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.

Effects of Aster glehni Extract on Serum Uric Acid in Subjects with Mild Hyperuricemia: A Randomized, Placebo-Controlled Trial.

Aster glehni extracts (AGE) reduced serum uric acid levels in hyperuricemia rats in several previous studies. However, its efficacy in human has not been yet explored. This study aimed at investigating the efficacy and safety of AGE on the anti-hyperuricemia effect in subjects with slightly high serum uric acid. A randomized, double-blinded, placebo-controlled clinical trial was conducted for 12 weeks. Eligible subjects were randomly assigned to either AGE (480 mg/day) or placebo. The primary endpoint was the change in serum uric acid concentrations from baseline to follow-up time points. The secondary endpoints were the change of serum xanthine oxidase activity, and the levels of C-reactive protein (CRP) and tumor necrosis factor alpha (TNF-α) in the blood from baseline to follow-up time points. Safety was assessed by clinical laboratory parameters and adverse events reported by subjects. Six weeks of AGE supplementation significantly reduced serum uric acid level from baseline (P = .0468) but at the end of the intervention the participants did not show the beneficial effect of AGE supplementation. Also, the serum uric acid level in the AGE group was not significantly different at the follow-up time points, when compared with placebo. The mean changes of secondary endpoints from baseline to each time point did not show significant differences within and between the two groups. There were no adverse events reported by subjects or changes in safety parameters after intervention. In conclusion, AGE supplementation for 12 weeks did not show significant benefits for reducing serum uric acid concentrations in subjects with mild hyperuricemia.

Decomposition Analyses of the Trend in Poverty Among Older Adults: The Case of South Korea.

OBJECTIVES: We examine the sharp increase in poverty among older adults since the mid-1990s in South Korea. METHOD: We apply decomposition analyses to quantify the contributions of demographic and household characteristics, as well as income sources, to the rise in poverty among older adults. RESULTS: A rapid increase in the number of older adults living independently, combined with an increase in the number of old older adults, largely explains the rising poverty rate among Korean older adults. At the same time, market incomes and private transfers are no longer dominant sources of income for older adults. Gradually rising public transfer incomes offset most of the decline in market and private transfer incomes. Public transfer could not counteract the formidable consequences of changing living arrangements and other changes related to a rapidly aging population. DISCUSSION: The Korean experience shows what would have happened to older adults in rich welfare states if mature old-age income security programs had not been in place. It may also provide some lessons for lower-income countries where poverty among older adults is set to become a larger problem in the coming decades.

Home-Based Primary Care for Homebound Older Adults: Literature Review.

Home-based primary care (HBPC) refers to the type of home care services which provide interdisciplinary primary care services with a comprehensive and continuous manner. Currently, it is getting much attention due to possess potential of converting primary care services from outpatient clinic to home, especially for those who are medically isolated including homebound older adults. This study examined a number of HBPCs introduced in the literature since 1990s, and summarizes the key factors with the analytic framework of 5Ps: purpose, patients, people, process, patterns. The results of this study emphasize that contents of primary care for older population should be different from those of the general population. This paper may be interpreted as the practice guideline of the following policy questions: "How can we design the HBPC if it is introduced in the nearest future?" In the future, it is necessary to have a heated debate concerning what is the most desirable primary care system for older adults.

Quality of diet and level of physical performance related to inflammatory markers in community-dwelling frail, elderly people.

OBJECTIVE: The aim of this study was to assess whether diet quality and functional status were associated with serum levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α in frail, elderly, community-dwelling individuals. METHODS: Seventy-eight frail, elderly individuals (age ≥65 y, usual gait speed <0.6 m/s and Mini Nutritional Assessment <24) participated in this cross-sectional study from the National Home Healthcare Services in Gangbuk-gu, Seoul, South Korea. Diet quality was assessed using mean adequacy ratio (MAR) of the diet, which was calculated by averaging the sum of the nutrient adequacy ratios (NAR) for the intakes of energy, protein, and 11 micronutrients. Grip strength was measured as an indicator of muscle strength, and short physical performance battery (SPPB) was measured as an indicator of physical performance. The levels of the inflammatory markers IL-6 and TNF-α were obtained from serum samples. RESULTS: MAR and NAR scores for phosphorus; vitamins A, B1, and B6; and niacin were negatively associated with IL-6 (ß = -0.006, -0.004, -0.004, -0.007, -0.004, and -0.005, respectively; P < 0.05). SPPB score, as well as NAR scores for vitamin B6, niacin, and vitamin C, were negatively associated with TNF-α (ß = -0.098, -0.006, -0.006, and -0.004, respectively; P < 0.05). CONCLUSION: MAR of the diet was inversely associated with IL-6 concentration in frail elderly individuals, and higher SPPB score was associated with lower levels of TNF-α. Results from the present study suggest that improving diet quality and physical performance might lower levels of inflammation in this frail, elderly population.

Discrimination-related health inequality and role of social capital among marriage migrant women in South Korea.

BACKGROUND: This study aimed to evaluate whether social capital could alleviate health inequality against racial discrimination and identify the critical nature of social capital that generates health inequality differences within the social context of South Korea. METHODS: Using the data of the 2009 National Survey of Multicultural Families, a nationally representative sample in which 40,430 foreign wives participated, the concentration index (CI) was used to measure the discrimination-related inequalities in self-rated health and was decomposed into contributing factors. RESULTS: The results showed a significant concentration of poor self-rated health unfavorable to foreign wives who were highly discriminated (CI 0.023, standard error [SE] 0.001, p < .001). However, when the CIs were assessed among the subgroups of different social capital, no discrimination-related inequality in health was observed among the group of linking social capital (CI 0.008, SE 0.008, p .332). The total differential decomposition method showed two major factors that generate differences in health inequality between the groups of non-linking and linking social capital: protest against discrimination (35.8 %); experiences of discrimination (28.3 %). CONCLUSIONS: The present results indicated that linking social capital can be a useful resource of health resilience factor that equalizes discrimination-related health inequality among marriage migrant women in South Korea. This study provides additional evidence that social capital needs to be placed in its political context.

Can Geographic Bridging Social Capital Improve the Health of People Who Live in Deprived Urban Neighborhoods?

The growing number of people living in deprived urban neighborhoods, which often have unhealthy environments, is of growing concern to inequality researchers. Social capital could be a resource to help such communities get ahead. In this study, we examined the differential effects of bonding and bridging social capital on self-rated health using two operational definitions, which we call personal and geographic social capital. Bonding and bridging social capital were operationally distinguished as respondents' perceived similarity to other members of a group with respect to personal characteristics (personal social capital) or as structural similarity with respect to geographical location (geographic social capital). The results showed that although both bonding and bridging social capital as defined by person-based criteria were associated with increased odds of self-rated health compared to those who reported zero participation, when defined by place-based criteria, only bridging social capital was associated with increased odds of self-rated health; no clear association was found between health and belonging to groups within the neighborhood, so-called geographic bonding social capital. The present study suggests that geographic bridging social capital can function as linking social capital that enables an upward approach depending on the political and economic contexts of urbanization.

Food choice patterns among frail older adults: The associations between social network, food choice values, and diet quality.

Social network type might affect an individual's food choice because these decisions are often made as a group rather than individually. In this study, the associations between social network type, food choice value, and diet quality in frail older adults with low socioeconomic status were investigated. For this cross-sectional study, 87 frail older adults were recruited from the National Home Healthcare Services in Seoul, South Korea. Social network types, food choice values, and diet quality were assessed using The Practitioner Assessment of Network Type Instrument, The Food Choice Questionnaire, and mean adequacy ratio, respectively. Results showed that frail older adults with close relationships with local family and/or friends and neighbors were less likely to follow their own preferences, such as taste, price, and beliefs regarding food health values. In contrast, frail older adults with a small social network and few community contacts were more likely to be influenced by their food choice values, such as price or healthiness of food. Frail older adults who tend to choose familiar foods were associated with low-quality dietary intake, while older adults who valued healthiness or use of natural ingredients were associated with a high-quality diet. The strength and direction of these associations were dependent on social network type of frail older adults. This study explored the hypothesis that food choice values are associated with a certain type of social network and consequently affect diet quality. While additional research needs to be conducted, community-based intervention intended to improve diet quality of frail older adults must carefully consider individual food choice values as well as social network types.

Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: a quasi-experimental study.

The Crisis Assistance Program (CAP) is a newly developed social protection scheme in South Korea. It was implemented in 2006 in order to assist individuals experiencing a sudden or temporary financial emergency. CAP provides temporary assistance to cover the direct user fees associated with inpatient care up to three or six million KRW (US $2673-5346). In this study, we aimed to compare the poverty dynamics in recipients versus non-recipients and to determine whether there is an association between participation in CAP and poverty transition. For the purpose, we analyzed longitudinal data from 2009 to 2011 from 55,710 people who requested CAP during a serious illness at local governmental offices throughout South Korea. During the 1.6 years of follow-up, 8712 (15.6%) of those who requested CAP fell into absolute poverty. Results showed that there was a 16% reducing effect of CAP on poverty transition (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.79-0.90, p < 0.001) and there was a 33% delay in the time to falling into poverty (time ratio [TR] 1.33, 95% CI 1.20-1.47, p < 0.001) after adjusting for covariates. In this analysis model, the risk of poverty transition induced by experiencing a serious illness decreased rapidly with time (ancillary parameter [AP] 0.61, 95% CI 0.59-0.62). The results were essentially unchanged even after performing a rigorous propensity analysis, which limited the analyses to 12,944 propensity-matched subjects (HR 0.84, 95% CI 0.77-0.91, p < 0.001; TR 1.38, 95% CI 1.18-1.61, p < 0.001; AP 0.54, 95% CI 0.52-0.57). Our findings provide additional evidence for recommending the use of a payment strategy that relieves out-of-pocket payments so as to reduce medical impoverishment. A temporary assistance scheme for people experiencing a serious illness may be an alternative healthcare financing strategy to confront the issue of health inequality among the medically and socioeconomically vulnerable.

Preventive effect of protein-energy supplementation on the functional decline of frail older adults with low socioeconomic status: a community-based randomized controlled study.

BACKGROUND: Chronic undernutrition is a common condition in older people with low socioeconomic status and is clearly an important component of frailty. However, it is uncertain whether protein-energy supplementation can prevent functional decline in this group. METHODS: Eighty-seven frail older adults (usual gait speed, <0.6 m/second; Mini Nutritional Assessment, <24) were enrolled in this randomized controlled trial. Participants were randomly assigned to either an intervention group, which was provided two 200-mL cans of commercial liquid formula (additional 400 kcal of energy, 25g of protein, 9.4g of essential amino acids, 400mL of water) per day for 12 weeks, or the controls group, which did not receive this supplement. The primary outcomes were the change of the Physical Functioning and Short Physical Performance Battery. Usual gait speed, timed up-and-go test, hand grip strength, and one-legged stance were also measured as secondary outcome variables. RESULTS: Physical Functioning increased by 5.9% (1 point) in the intervention group, although no change was observed in the control group (p =.052). Short Physical Performance Battery remained stable in the intervention group, although it decreased by 12.5% (1 point) in controls (p = .039). Usual gait speed decreased by 1.0% in the intervention group versus 11.3% (0.04 m/second) in controls (p = .039). Timed up-and-go improved by 7.2% (1.1 seconds) in the intervention group and worsened by 3.4% (0.9 seconds) in controls (p = .038). There were no differences between groups in hand grip strength or one-legged stance performance. CONCLUSIONS: The results indicate that protein-energy supplementation administered to frail older adults with low socioeconomic status shows evidence of reducing the progression of functional decline.

Health-related quality of life outcomes improve after multilevel surgery in ambulatory children with cerebral palsy.

BACKGROUND: Studies evaluating multilevel surgery to treat spastic deformity and functional deficits in cerebral palsy (CP) usually focus on data from instrumented gait analysis and clinical examination without examining functional and health-related quality of life (HRQOL) outcomes. Recently, outcome measures for well-being in children with a variety of musculoskeletal disorders have also been validated specifically for CP. Therefore, this study aimed to investigate the impact of multilevel surgery on the function and HRQOL in a group of ambulatory children with CP. METHODS: In a multicenter prospective trial, 57 ambulatory children with CP, mean age 9.5 years, underwent multilevel soft tissue surgery to correct sagittal imbalance. Validated clinical outcome measures for HRQOL were administered preoperatively and postoperatively with an average follow-up time of 15.2 months. The functional and psychosocial components of the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Quality of Life Questionnaire (PedsQL), and the Functional Assessment Questionnaire Walking Score were used. RESULTS: Significant improvements in outcome scores occurred postoperatively in the following: PedsQL parent-total (17.6%; P < 0.001) and parent-physical sections (25.0%; P < 0.001), the Functional Assessment Questionnaire Walking Score (15.3%; P < 0.001), and the PODCI sections for transfers and basic mobility (15.8%; P < 0.001), sports and physical function (23.9%; P = 0.012), and global (12.9%; P < 0.001). Improvements also occurred in the PedsQL child-total (8.4%; P = 0.104) and child-physical sections (8.6%; P = 0.189), but these were not statistically significant. There were no significant changes in the PODCI parent-derived pain (-3.2%; P = 0.504) and happiness sections (1.9%; P = 0.645). CONCLUSIONS: Multilevel surgery in ambulatory patients with CP improves function and HRQOL. However, improved functional well-being does not imply improved psychosocial well-being, and patients and their families should be counseled accordingly.