Evaluating person-centered care in residential care facilities from the perspective of caregivers in South Korea: a survey.

BACKGROUND: As many older people spend their time in residential care facilities, the demand for person-centered care (PCC), which affects their quality of life, is increasing. Many residential care facility residents have cognitive problems, such as dementia and strokes. Providing quality care upholds their rights as human beings. Currently, the PCC tools used in South Korea are only translations of foreign tools into Korean, so it is necessary to develop tools for older adult care facilities that reflect the reality of Korean care facilities for older adults. This study aims to develop a tool for measuring PCC in residential care facilities for older people from the perspectives of care givers. METHODS: The draft of 34 questions was developed through literature reviews, interviews with LTC practitioners and researchers. This developed questionnaire was then administered to 402 direct caregivers working in the residential care facilities because many of the residents had cognitive problems. By measuring the interrater reliability, the items with high levels of agreement were selected and the validity of the construct was checked through factor analysis. To determine whether the domains adequately measured each concept, we calculated correlation coefficients and Cronbach's α. RESULTS: Four domains and 32 items concerning service conditions, resident's right to self-determination, a comfortable living environment for all residents, and resident and staff satisfaction are derived, thus explaining 24.7%, 23.6%, 14.6%, and 8.00% of the total variance, respectively. Cronbach's alphas for each domain are 0.965, 0.948, 0.652, and 0.525, respectively, thus demonstrating internal consistency. The inter-rater agreement is high (66.7%~100.0%). The correlation between service conditions and resident's right to self-determination (r = 0.643, p < 0.001), a comfortable living environment for all residents, resident and staff satisfaction (r = 0.674, p < 0.001), and resident's right to self-determination and comfortable living environment (r = 0.695, p < 0.001) is strong. CONCLUSIONS: It is important that caregivers recognize PCC and provide services. When evaluating the residential care services, measuring the degree of PCC should be made compulsory. If the facility becomes more person-centered, it will be possible to promote quality of life for older people. TRIAL REGISTRATION: Not applicable.

Total care expenditures and their drivers among older adults: A study on health and long-term care expenditures in South Korea.

BACKGROUND: South Korea operates two different national insurance systems: health care insurance covers medical services and long-term care (LTC) insurance covers residential care and home care services. Total care expenditures include benefits from both these insurance schemes and personal payments made for receiving these services. This study aims to identify total care expenditures per older person along with related factors and their effects on care expenditures. METHODS: We analyzed claims data of 2017 for LTC and health care insurance in Korea using multiple regression analysis. Participants were recipients of LTC insurance, aged 60 years or above (n = 650,059). The variables of interest included socioeconomic characteristics, disabilities, chronic diseases, and care needs levels. RESULTS: The total expenditures were approximately USD 9,808,922,016 for 650,059 older people (USD 15,089.28 ± 8,006.57 per person) in 2017. The benefits of national health insurance accounted for 86.03% of the total, while personal payments accounted for 13.97%. Comparing the expenditure across services, the total amount was found to be much higher for LTC services. The personal payments were similar for the two insurance schemes, and the proportion of expenses by service type (to total expenses) was greater for LTC (LTC versus health care expenditures: 63.25% versus 36.15% of the total expenditures). The total care expenditures differed significantly according to recipient characteristics. Older adults who were women, between 75-84 years old, with higher care needs levels, and who suffered from diseases and lived in the residential facilities were associated with an increase in total expenditures. Moreover, factors such as any type of disability and living alone were related to a decrease in total care expenditures. CONCLUSIONS: The increase in care expenditures should be monitored from an integrated perspective on overall health care and LTC, and to reduce care needs. In addition, we should focus on the factors involved in using (receiving) services for older individuals and complementing the lack of or inadequate services to enhance and sustain the LTC and health care service systems. Older adults receiving full basic livelihood security and living alone should receive greater attention from the perspective of social equity.

Improving the quality of long-term care services in workforce dimension: expert views from Australia and South Korea.

BACKGROUND: The long-term care workforce is an essential factor in the provision of qualified long-term care services. Identifying workforce issues can help developing countries in East Asia and the Pacific prepare for the increase in the older population. Their experiences can be used as lessons for other countries. This study aimed to identify the workforce issues that should be addressed in order to provide high-quality long-term care services for older adults. METHODS: In-depth interviews and content analysis were conducted with a purposive sample of long-term care experts. There were eight participants from Australia and 14 from South Korea. The participants were questioned on important workforce issues to improve the quality of long-term care services. These were open-ended questions that comprised ideas derived from the literature. Major themes were systematically and comprehensively classified and coded to examine recurring comments and themes. RESULTS: The issues in the two countries were very similar: labor shortages, inadequate working conditions, insufficient career and staff training, and the need of counselors or consultants for finding proper services. There were also differences in terms of competency of the service operators and their corresponding multicultural competency. CONCLUSIONS: Providing high-quality long-term care service requires multipronged approaches to workforce capacity and work environment. An adequate and competent workforce should be established to match the service needs of the older population. To improve quality, better working conditions and improved motivation to work in care for older people should be considered. Concurrently, each country would need a workforce strategy tailored to different conditions and environments. This should include policies to induce an influx into the workforce.

Development and Validation of a Person-Centered Care Assessment Questionnaire for Daycare Centers for Older Adults.

Daycare services serve to prolong aging at home. This decreases both families' care burden and the government's financial burden. We identified key factors in the person-centered approach of South Korean daycare center workers to develop and validate a Korean person-centered care questionnaire. Twenty-one items were developed, and 10 expert interviews were conducted. The items were applied to 271 daycare center staff (19.2% male vs. 80.0% female, mean age = 50.68 ± 11.37 years) to evaluate their reliability and validity. Twenty items concerning intimate relationships and the environment, consumers' self-determination, and home-likeness domains were derived, explaining 40.28%, 10.44%, and 6.97% of the total variance, respectively. The overall tool's Cronbach's alpha was 0.905, demonstrating internal consistency. Inter-rater agreement ranged from 0.221 (fair) to 0.765 (good). This tool will be useful for individual staff members as well as for the National Health Insurance Service's evaluations of service quality at daycare centers.

Long-term Monitoring of Changes in Blood Pressure, Blood Glucose, and Total Cholesterol Levels among Frail Older Individuals Receiving Home Health Care Nursing in South Korea.

This study identified changes in blood pressure, blood glucose, and cholesterol levels in frail elderly adults who received home health care nursing over 8 years in Korea. Secondary data extracted from nursing records (2010-2018) of a public health center were analyzed using a mixed model of repeated measure. Study participants were elderly people (n = 499) with a mean age of 81.9 ± 5.56 years. Systolic and diastolic blood pressure decreased by 8.97 and 15.78 mmHg, and by 2.92 and 5.01 mmHg, respectively, at 4-year and 8-year monitoring. This demonstrates that home health care nursing is effective and has both short- and long-term benefits.

The effects of weight fluctuation on the components of metabolic syndrome: a 16-year prospective cohort study in South Korea.

BACKGROUND: Weight fluctuation (WF) is highly prevalent in parallel with the high prevalence of intentional or unintentional dieting. The health risks of frequent WF for metabolic syndrome (MS) have become a public health concern, especially for health care providers who supervise dieting as an intervention to prevent obesity-related morbidity or to improve health, as well as for the general population for whom dieting is of interest. The aim of this study was to investigate the long-term effect of WF on the risk of MS in Koreans. METHODS: This study analyzed secondary data from the Korean Genome and Epidemiology Study, a 16-year prospective cohort study, on 8150 individuals using time-dependent Cox regression. RESULTS: WF did not increase the risk of MS in either normal-weight or obese subjects. In an analysis of the components of MS, greater WF significantly increased the risk of abdominal obesity (HR = 1.05, 95% CI = 1.02-1.07, p < 0.001) in normal-weight individuals. However, WF did not increase the risk of hyperglycemia, low high-density lipoprotein cholesterol levels, elevated blood pressure, or raised fasting glucose in normal-weight individuals, and it did not influence any of the components of MS in obese individuals. CONCLUSION: Since WF was found to be a risk factor for abdominal obesity, which is the most reliable predictor of MS, it should be considered when addressing weight control. Further studies on cut-off points for the degree of weight loss in a certain period need to be conducted to help clinicians provide guidance on appropriate weight control.

Suicide Attempts and Associated Factors in Male and Female Korean Adolescents A Population-Based Cross-Sectional Survey.

Using data from the Korea Youth Risk Behavior Web-based Survey, this study seeks to investigate associations of suicide attempts with family, individual, and behavioral factors on the basis of gender. Among male adolescents, those who did not live with their parents, who had poor subjective academic achievement, depression, experiences of smoking and sexual coitus, drug abuse, suicidal ideation and plans were more likely to attempt suicide. Among the female adolescents, those who did not live with their parents, had depression, low self-rated health, experiences of drug abuse and sexual coitus, and expressed unhappiness, suicidal ideation and suicide plans were more likely to attempt suicide. Thus, the development of a suicide prevention program for Korean adolescents requires different approaches for males and females.

Effects of hypertension, diabetes, and/or cardiovascular disease on health-related quality of life in elderly Korean individuals: a population-based cross-sectional survey.

PURPOSE: This study explored health-related quality of life (QoL) in Korean elderly individuals with hypertension, diabetes, and/or cardiovascular disease (CVD). METHODS: This study used a population-based cross-sectional design. Data were obtained from the Fourth Korean National Health and Nutrition Examination Survey 2008, which involved a nationally representative sample. Data on health-related QoL were collected using the EuroQoL-5 Dimension instrument and via health interviews. The sample consisted of 1,467 Korean individuals aged 60 years and older. A multiple linear regression model was used to analyze health-related QoL. RESULTS: After controlling for sociodemographic and lifestyle variables, individuals with one of the aforementioned chronic diseases had lower EuroQoL-5 Dimension scores, ranging from 0.186 among those with only hypertension to 0.469 among those with hypertension plus CVD, compared with those without a chronic disease (higher scores are indicative of more limitations). The impact of comorbid diseases was greater than that of any single disease except diabetes. CVD had a stronger negative impact on QoL than did any other single disease studied. Whereas the physical elements of QoL were influenced by all diseases, the psychological components were influenced only by hypertension plus diabetes and hypertension plus CVD. CONCLUSION: We found that both the number and the type of diseases affected QoL scores. Efforts to prevent or manage diabetes, CVD, and related risk factors should include psychological support.

Suicidal ideation and associated factors by sex in Korean adults: a population-based cross-sectional survey.

OBJECTIVE: This study investigates suicidal ideation and its associated factors by sex in Korean adults, focusing on health behaviors and health status. METHODS: Cross-sectional data of 6,969 adults (25-64 years) who completed the Fourth Korean National Health and Nutrition Examination Survey were analyzed. RESULTS: In both sexes, those who were married, had higher educational attainment or were non-smokers experienced low stress and had good self-rated health showed lower suicidal ideation. Significant factors were age for men and subjective body image and sleep time for women. In men, those aged 45-54 years showed the highest suicidal ideation rate. The effects of stress and depression on suicidal ideation were higher in men than in women. CONCLUSIONS: The development of a suicide prevention program for Korean adults requires different approaches for each sex. For working men aged 45-54 years, it should focus on the management of work-related stress and depression. For women, it should be a community support program for those who are less educated, have no job or experience a great deal of stress and depression.

Relationship Between Health-related Behavioral and Psychological Factors and Cardiovascular and Cerebrovascular Diseases Comorbidity Among Korean Adults With Diabetes.

PURPOSE: This study aims to explore the relationships between health-related behavioral and psychological factors and cardiovascular and cerebrovascular diseases (CCVD) comorbidities among Korean adults with diabetes mellitus (DM). METHODS: Data included in the Fourth Korean National Health and Nutrition Examination Survey were used. This study compared three groups: those diagnosed with DM only, DM and hypertension, DM, hypertension and CCVD using multinomial logistic regression analyses and the classification and regression tree (CART) model. RESULTS: Weight control (OR = 4.01) and depression (OR = 2.37) are related with increased odds of having hypertension and CCVD comorbidity in those with DM. The CART model suggested that the high prevalence risk groups for hypertension or CCVD comorbidities were diabetic adults aged between 51 and 69 with a body mass index of 25 and above and those aged 70 and above. CONCLUSION: For effective control of CCVD comorbidities among diabetic Korean adults, psychological support for depression and weight control need to be prioritized when managing DM. Weight control intervention needs to be reinforced for DM patients aged between 51 and 69 and that even if BMI is below 25, the occurrence of comorbidities needs to be carefully monitored for DM patients aged 70 or older.

[Analysis of the nursing interventions performed by public health nurses in health centers using the NIC].

PURPOSE: The purpose of this study was to identify nursing interventions performed by public health nurses in health centers. METHOD: Data was collected by the taxonomy of Nursing Intervention Classification (NIC 3rd: 486 nursing interventions) from 131 public health nurses in health centers and analyzed using descriptive statistics. RESULT: As its result, more than 50% of public health nurses performed 137 nursing interventions at least monthly. The most frequently used intervention class was "activity and exercise management", followed by "physical comfort promotion", "community health promotion", "life span care", "coping assistance", "self care facilitation", "information management", "nutrition support", "community risk management" and "patient education". One hundred twenty nursing interventions were rarely performed by 90% or more of the nurses. Most of them were in the physical complex domain. CONCLUSION: In conclusion, 137 interventions were performed by public health nurses at least monthly. NIC is helpful to build a standardized language for public health nursing.