Decision-making preferences on end-of-life care for older people: Exploration and comparison of Japan, the Hong Kong SAR and South Korea in East Asia.

AIMS AND OBJECTIVES: The aim of this study was to examine and compare decision-making preferences on end-of-life care for older people in Japan, the Hong Kong SAR and South Korea. BACKGROUND: Cultural values and beliefs influence decision-making on end-of-life care. DESIGN: A cross-sectional design was adopted. METHODS: Community-dwelling people aged ≥65 with additional requirements were recruited in 2016-2017 in the three regions. Their decision-making preferences on end-of-life care were assessed using Pang et al.'s questionnaire. These preferences and their sociodemographic and personal experience variables were compared and analysed using univariate and multiple logistic regressions. The STROBE checklist was followed. RESULTS: This study involved 415 participants. In all three regions, the most preferred decision maker and person with whom to discuss end-of-life care issues was a family member. Participants in the Hong Kong SAR were less likely to select a family member as their preferred decision maker than those in Japan (adjusted odds ratio = 0.129). Koreans were less likely to discuss end-of-life care issues with medical professionals than people in Japan (adjusted odds ratio = 0.278). More than 70% of the participants in each region indicated that they would not prefer to leave an advance directive to decide their end-of-life care. CONCLUSION: Older Asians prefer to make their own decisions after consulting others. Family members play an important role in helping older people plan their preferred end-of-life care arrangements, even acting as decision makers when older people become incapable of deciding for themselves. RELEVANCE TO CLINICAL PRACTICE: Sufficient information should be provided to older people and their families for the older people to determine their preferred care. Helping families to understand and support the planned care and advance directives is a strategy for maximising family compliance with the care. Continuous efforts should be made to promote advance care planning and advance directives.

Effects of a nurse-led multicomponent intervention for frail older adults living alone in a community: a quasi-experimental study.

BACKGROUND: Given the rapid aging of the population in Korea, efforts to slow down or prevent frailty, to support the health of older adults, should be an important public health priority. This may allow them to continue living within the community by keeping their functional independence for as long as possible. This study aimed to evaluate the nurse-led multicomponent intervention for community-dwelling pre-frail or frail elderly on physical and psychosocial outcomes. METHOD: A non-equivalent control pre-, post-, and follow-up test design was used with a sample of 126 prefrail or frail older adults (62 in the experimental and 64 in the control group). The 12-week multicomponent intervention for the experimental group comprised physical exercise, cognitive training, and nutrition and disease management education. Outcome variables (Timed Up and Go Test results and measures of frailty, handgrip strength, depression, social activity, and social support) were measured both pre- and post-intervention, and after the 12-week follow-up period. RESULTS: For each group, we assessed the significant interaction of time with frailty, depression, social activity, and social support, as well as Timed Up and Go Test results. In the experimental group, levels of depression decreased while levels of social support and social activity increased from each measurement period to the next, within the 12-month study period; those in the control group were relatively stable over time. CONCLUSIONS: The results indicate that nurse-led multicomponent intervention was effective for improving physical and psychosocial function of the (pre)frail older adults living alone in Korea, suggesting that older adults can take proactive roles in conducting their daily life and managing their health. A strategy for disseminating widely sustainable nurse-led multicomponent interventions should be developed for community-dwelling frail elderly who live alone.

Advance care planning and advance directive awareness among East Asian older adults: Japan, Hong Kong and South Korea.

AIM: Population aging is a global phenomenon, and East Asian countries are no exception. However, the use of advance care planning (ACP) and advance directives (ADs) are not widespread in East Asia. This study aimed to examine the awareness of ACP/ADs and its related factors among community-dwelling older persons in Japan, Hong Kong and South Korea. METHODS: This was a cross-sectional, cross-cultural questionnaire conducted among a convenience sample of community-dwelling persons. The questionnaire included information regarding awareness of ACP/ADs and personal information. Multiple logistic regression was used assess relationships between awareness of ACP/ADs and potential related factors. RESULTS: The sample consisted of 404 community-dwelling older adults: 174 (43.0%) from Japan, 132 (32.7%) from Hong Kong and 98 (24.3%) from South Korea. In total, 122 participants (30.2%) had heard of ACP/ADs. Multiple logistic regression analysis revealed that an educational level >12 years was significantly associated with increased ACP/ADs awareness (adjusted odds ratio [AOR]: 2.19, 95% confidence interval (CI): 1.18-4.07, P = 0.01). The rate of those who have heard of ACP/ADs was significantly higher among Japanese than South Koreans were (AOR: 4.54, 95% CI: 1.64-12.58, P < 0.01), those from Hong Kong than South Korea (AOR: 5.15, 95% CI 1.89-14.0, P < 0.01) after some variables with significant differences among the three countries were controlled. CONCLUSIONS: In particular, support tailored to the targets' educational levels will be required. It is also suggested that support is needed to enhance awareness of ACP/ADs in East Asia, although there is a difference in degree of awareness among the three countries. Geriatr Gerontol Int 2021; 21: 71-76.

The effects of medication adherence and health literacy on health-related quality of life in older people with hypertension.

AIM AND OBJECTIVE: This study investigated the effects of medication adherence and health literacy on health-related quality of life in vulnerable older people with hypertension. BACKGROUND: Health literacy is particularly critical for providing accurate information regarding correct medication intake to improve medication adherence. Additionally, health-related quality of life is directly related to impairment from chronic disease. DESIGN: A descriptive, cross-sectional study design was used. The participants were 160 low-income older people with hypertension registered in 16 public health centres in Busan, South Korea. They had received "visiting nursing services" for at least 6 months until the latest date and had belonged to the priority group of visiting nursing services. METHODS: The Morisky Medication Adherence Scale, the Newest Vital Signs and EuroQol-5 Dimensions were used to assess medication adherence, health literacy and health-related quality of life, respectively. RESULTS: Medication adherence and health literacy were significantly associated with health-related quality of life in vulnerable older people with hypertension, although exercise and subjective health were more significant factors affecting health-related quality of life than medical adherence and health literacy. Level of education, monthly income and employment status were not associated with health-related quality of life. CONCLUSIONS: To effectively promote health-related quality of life in this population, medication adherence and health literacy of patients should be considered when developing health interventions, including subjective health and exercise. IMPLICATIONS FOR PRACTICE: To effectively promote health-related quality of life in vulnerable older people, medication adherence and health literacy of patients should be assessed, and patient-centred intervention strategies that consider their individual differences should be developed.

Job Satisfaction and Subjective Well-Being Among Midwives: Analysis of a Multinational Cross-Sectional Survey.

INTRODUCTION: There is a considerable amount of empirical evidence to indicate a positive association between an employee's subjective well-being and workplace performance and job satisfaction. Compared with nursing research, there is a relative lack of consistent scientific evidence concerning midwives' subjective well-being and its determinants related to domains of job satisfaction. The purpose of the study was to examine the association between the domains of job satisfaction and components of subjective well-being in hospital midwives. METHODS: This cross-sectional descriptive study involved 1190 hospital midwives from 7 countries. Job satisfaction was measured by the McCloskey/Mueller Satisfaction Scale. Subjective well-being was conceptualized in the study by the 2 components (the affective and the cognitive component). The affective component of subjective well-being (ie, emotional well-being) was assessed by the Positive and the Negative Affect Scale. The cognitive component of subjective well-being (ie, life satisfaction) was measured by the Personal Well-Being Index. Pearson correlations and multiple regression analyses were used to determine associations between variables. RESULTS: Findings from correlation and regression analyses indicated an overall weak association between the domains of job satisfaction and components of subjective well-being. Satisfaction with extrinsic rewards, coworkers, and interaction opportunities accounted for only 13% of variance in the cognitive component (life satisfaction). The affective component (emotional well-being) was weakly associated with satisfaction with control and responsibility. DISCUSSION: The low amount of variance suggests that neither component of subjective well-being is influenced by the domains of job satisfaction. Further studies should focus on identifying other predictors of subjective well-being among midwives. A better understanding of how specific job facets are related to the subjective well-being of midwives might assist employers in the design of counseling and intervention programs for subjective well-being of midwives in the workplace and workplace performance.

Job satisfaction and leaving intentions of midwives: analysis of a multinational cross-sectional survey.

AIM: To investigate the relationship between turnover intentions and job satisfaction among hospital midwives from seven countries and to determine how the related variables differ between countries. BACKGROUND: Studies investigating professional turnover and job satisfaction among midwives are limited in scope. METHOD: A cross-sectional descriptive survey was used to investigate the intended turnover and job satisfaction relationship among 1190 hospital midwives in European and Asian countries. Data were collected using a set of questionnaires that included questions regarding the leaving intentions of midwives and the McCloskey/Mueller satisfaction scale. RESULTS: Midwives were least satisfied with their extrinsic rewards and professional opportunities and with the balance between family and work. Significant differences were found in all domains of job satisfaction according to midwives' intentions to leave their current workplace in hospital or profession of midwife, and to work abroad. CONCLUSION: There are some general satisfying and dissatisfying elements for the profession of midwife across different countries. IMPLICATIONS FOR NURSING MANAGEMENT: The results highlight the importance of understanding midwives' leaving intentions and related factors across different countries. To prevent midwife turnover, health-care managers should gain greater insight into the early stage of midwives' turnover intention.

[The effects of a cognitive enhancement group training program for community-dwelling elders].

PURPOSE: In this study a cognitive enhancement group training program of 10 sessions was provided for community-dwelling elders and the effects on cognitive function, depression and quality of life were tested. METHODS: A quasi-experimental study using a nonequivalent control group, pre-post design was used. The participants were 87 elders whose cognitive function was within the normal range. Of these elders, 45 were assigned to the experimental group and 42 to the control group. The intervention was conducted once a week for 10 weeks. Chi-square test, t-test, paired t-test, Wilcoxon rank sum test and Wilcoxon signed rank test were used to analyze the data. RESULTS: After the program, the cognitive function (t=-2.85, p=.006), depression (z=2.82, p=.005) and quality of life (t=2.79, p=.007) of the experimental group was significantly better than those of the control group. Especially, immediate recall (z=2.45, p=.014) and concentration (z=2.58, p=.010) in the subcategory of cognitive function were significantly better than that of the control group. CONCLUSION: The findings indicate that the cognitive enhancement group training program was effective in enhancing the cognitive function, depression and quality of life for elders and could therefore be considered as a positive program for emotional and cognitive support for community-dwelling elders.

[Prevalence of hyperhomocysteinemia and related factors in a community-based health examination survey: a cross-sectional study].

BACKGROUND: Many previous studies have shown that elevated homocysteine in the serum is a well known risk factor for cardiovascular disease and this is associated with other risk factors for cardiovascular disease, but any Korean data on this is limited. OBJECTIVES: This study aimed to calculate the prevalence of hyperhomocysteinemia and to analyze the relation between elevated homocysteine and the lifestyle factors of Korean adults. METHODS: We conducted a cross-sectional survey that included 650 men and 743 women (age range, 20 to 79 years) who were residents of Gwangju City in Gyeonggi-do. These subjects participated in the health interview and examination survey from November to December 2005. The total homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride in the serum were measured. All the participants had their body composition measured such as height and weight, and we obtained health-related behavioral information through the self-entry questionnaire. RESULTS: Very right-handed skewed distributions of homocysteine were shown in men and women. The prevalence of hyperhomocysteinemia was 22.6% in men and 13.7% in women in Gwangju city. On the multiple logistic regression analysis, hyperhomocysteinemia was associated with age (OR=1.02, 95% CI=1.01-1.04), male gender (OR=1.60, 95% CI=1.02-2.52), severe general physical activity (OR=0.32, 95% CI=0.15-0.69) and nutrient consumption (OR=0.49, 95% CI=0.31-0.76). CONCLUSIONS: There is a great prevalence of hyperhomocysteinemia in adults of Gwangju City, Korea and it was associated with both genetic factors and lifestyle risk factors. This study can suggest that comprehensive lifestyle modification is needed in order to diminish the prevalence of hyperhomocysteinemia and to prevent CVD.

[Estimation of nursing costs by a Patient Classification System(PCS) in ICU].

PURPOSE: The objective of our study was to figure out costs of nursing services in ICU based on the PCS in order to determine an appropriate nursing fee schedule. METHOD: Data was collected from 2 hospitals from April 15-16 to April 22-23, 2003. The costs of nursing services in the ICU were analyzed by nursing time based on the nursing intensity. The inpatients in the ICU were classified by a PCS tool developed by the Korean Clinical Nurses Association(2000). RESULTS: The distribution of patients by PCS in the ICU ranged from class IV to Class VI. The higher PCS in ICU consumed more nursing time. As a result, the higher nursing intensity, the more the daily average nursing costs in the ICU. CONCLUSION: Our study provides evidence to refine the current nursing fee schedule that does not differentiate from the volume of nursing services based on nursing time. We strongly recommend that the current reimbursement system for nursing services should be applied not only to the general nursing units but also to the ICU or other special nursing units.

[A study on health behavior in people at risk for a cerebrovascular accident].

PURPOSE: This study was done to survey health behaviors in people at risk for a Cerebrovascular Accident(CVA). METHOD: From November 21 to December 29, 2005, a questionnaire survey was conducted with 171 people at risk for a Cerebrovascular Accident(LDL of above 130 mg/dl & homocysteine of above 15.0 micromol/L). Their physical composition was measured and blood was collected. RESULTS: 1. Of the subjects, 34.5% were smokers, 61.4% were drinkers, 56.7% did not exercise regularly, 57.3% did not control their weight, 26.9% preferred eating meat, and 32.2% preferred salty food. 2. The gender was different between smoking status (chi(2)=10.734, p= .001), and drinking status (chi(2)=7.185, p= .007), and the age was different between smoking status (chi(2)=6.656, p= .010), and drinking status (chi(2)=10.722, p= .001). The HbA(1)C level was different for regular exercise (chi(2)= 4.824, p=.028) and the HDL-cholesterol was different for meat-eating preference (chi(2)=7.928, p= .005). The observance of troubling signs was different for a salty food preference (chi(2)=4.313, p= .038). CONCLUSION: It is necessary to develop programs for taking care of people at risk for a Cerebrovascular Accident and test the effects of the programs in order to reduce the risk factors of CVA and enhance health behavior promotion.

Subjective memory complaints and clinical characteristics in elderly Koreans: a questionnaire survey.

OBJECTIVES: The overall objectives of the Ajou-Bundang Study for the Elderly (AB study) were to describe the current geriatric diseases and health behaviors, and to improve the visiting health service in South Korea. The particular objectives of the current study were to describe the AB study and to investigate the associations between subjective memory complaints (SMCs) and objective cognitive function, to assess the clinical characteristics of SMCs, and to measure possible differences between elderly people with and without cognitive dysfunction. METHODS: A cross-sectional study of a sample of people from the AB study was constructed to study the association between SMCs and demographic variables. SMCs, cognitive function, and demographic characteristics were ascertained. A total of 9,477 subjects aged 65 years or over were recruited from the residents of Bundang, Korea. RESULTS: SMCs were reported by 57.3% of the study participants. SMCs were correlated with advanced age and with being female. Further analyses of cognitive functions revealed that associated factor profiles differed between the participants with and without cognitive dysfunction. CONCLUSIONS: These results show that age is associated with SMCs, irrespective of the level of cognitive function. Longitudinal SMC studies should be undertaken to investigate potentially associated clinical parameters.

The PHC-cog: a brief cognitive function screening test for the elderly.

BACKGROUND: Cognitive dysfunctions such as dementia have emerged as a leading public health problem among the elderly. Its early detection is important for the management of patients, and for the educational support of other family members. Although cognitive dysfunction screening tests are available, they have not been widely utilized in community or primary care settings. AIM: To validate the PHC-cog (Public Health Center Cognitive Dysfunction Test) and to assess it as a simple and brief method for massive screening of cognitive dysfunctions in the primary care setting. MATERIALS AND METHODS: The study comprised 137 community-dwelling patients with dementia and 134 age, sex, and education-matched controls. The PHC-cog was made combining patients' and informants' questionnaires to improve performance. The PHC-cog patient's section briefly assessed the patient's cognition. RESULTS: The PHC-cog Patient's Section had a sensitivity and specificity of 0.75 and 0.92, respectively. The PHC-cog Informants' Section had a sensitivity and specificity of 0.79 and 0.83, respectively. The total method of administering the PHC-cog had a sensitivity and specificity of 0.96 and 0.82, and the two-stage method had a sensitivity and specificity of 0.92 and 0.76, respectively. CONCLUSIONS: The PHC-cog test is a simple, accurate and reliable, performance-based tool in the screening for cognitive dysfunction. The PHC-cog test is quick, and easy-to-use, and will hopefully become widely used in the cognitive screening of the aging population in the primary public medical institutions of Korea.

[A comparative study of Korean and Korean-American women in their health beliefs related to breast cancer and the performance of breast self-examination].

PURPOSE: This cross-sectional survey was undertaken to examine the differences of BSE (breast-self examination) performance and health beliefs between Korean and Korean-American women and to identify which factors influence the BSE based on the HBM variables. METHOD: The study subjects were recruited from both Korea(189 women) and Cleveland in Ohio, USA(146 women). The HBM variables were measured using a reliable and valid Health Belief Model Scale. The subjects were also asked whether or not they did a BSE in the last year. RESULT: The Korean-American women who performed the BSE was statistically higher than that of Korean women. Regarding to the BSE-related health belief, the scores of benefits, confidence, and health motivation was significantly higher in Korean-American. After controlling for living places, age, education, and job, barriers and confidence variables significantly explained the BSE performance of Korean and Korean-American women. CONCLUSION: There was a differences in BSE-related health belief and performance between Korean and Korean-American women. Among health belief variables, barriers and confidence were core variables predicting the BSE performance of Korean and Korean-American women together.

Effect of lifetime lactation on breast cancer risk: a Korean women's cohort study.

The objective of our study was to examine the effect of lifetime lactation on breast cancer risk among premenopausal women. The data were from a prospective cohort study with a follow-up period of 6 years in Korea (1995-2000). The cohort was composed of 110,604 premenopausal parous Korean women, aged 20 years and older, who received health insurance from the Korea Medical Insurance Corporation and who had medical evaluations in 1992 and 1994. Multivariate Cox proportional hazard models were tested, controlling for age, age at menarche, number of children, age at first pregnancy, oral contraceptive use, smoking, exercise and obesity. At baseline, 57,440 (51.9%) reported breastfeeding and 4,584 (4.1%) reported breastfeeding more than 24 months. From 1995-2000, 360 incident cases of breast cancer (61.8/100,000 person-years) occurred. Compared to parous women who had no history of lactation, a period of lactation of 13-24 months decreased the risk of breast cancer (RR, 0.7; 95% CI, 0.5-1.1), and this risk was decreased even further for those who breastfed for more than 24 months (RR, 0.6; 95% CI, 0.3-1.0). There was a clear trend of decreasing breast cancer risk with the duration of lactation (p for trend <0.001). In conclusion, our study of a large Korean cohort provides additional empirical evidence to current theoretical conjecture that lactation decreases the risk of breast cancer among premenopausal women.

Translation and validation of champion's health belief model scale with Korean women.

The Champion's Health Belief Model Scale (CHBMS) is a reliable and valid instrument developed for American women to measure beliefs about breast cancer and breast self-examination. The purpose of this study is to translate the CHBMS into Korean and to validate the scale among Korean women. The CHBMS was translated using a back-translation technique. A convenience sample of 264 women was recruited from a continuing education center, a community health center, and a university in 3 South Korean cities. The participants were asked to complete the translated Korean version of the CHBMS questionnaire. The data obtained were analyzed using a principal component analysis with varimax rotation for construct validity. Loading criterion was set at.45. Cronbach's alpha was computed for the reliability of the scale. From the analysis, two items from the Benefits domain and four items from the Motivation domain were deleted from the original scale. Thus, the final Korean version of the CHBMS (CHBMS-K) consisted of 36 items that were clustered to 6 subscales: susceptibility (5 items), seriousness (7 items), benefits (4 items), barriers (6 items), confidence (11 items), and motivation (3 items). Cronbach's alpha reliability coefficients for the 6 subscales ranged from.92 to.72. The CHBMS-K was found to be reliable and valid in scale for use with Korean women. It can be used in planning and testing interventions to improve breast self-examination beliefs and practice.