Time-dependent association between the economic activity restriction due to health condition and mental illness: Finding from 15-year prospective cohort study

Background and Objectives The Economic Activity Restriction (EAR) due to health conditions is being utilized as a foundational measure for the European indicator Healthy Life Years (HLY). The EAR group is experiencing limitations not only in economic activities but also in overall activities, and it is a population with a high likelihood of transitioning to mental illness due to health condition. However, few studies have investigated the relationship between EAR and mental illness. Therefore, the purpose of this study was to identify the association between EAR due to health conditions and mental illness for those aged 45 and older in South Korea. Methods We obtained data from the 2006–2020 Korean Longitudinal Study of Aging. EAR was assessed using self-reported questionnaires based on the Global Activity Limitation Indicator. mental illness was assessed based on the diagnosis data for participants who had been diagnosed. After excluding missing values, the data of 9,574 participants were analyzed using the chi-square test, log-rank tests, and time-dependent Cox proportional hazard model to evaluate the association between EAR and mental illness. Results Out of the 9,574 participants gathered at baseline, the mental illness rate was 4.8 %. The hazard ratio (HR) of mental illness in those in the “very probable” of EAR was 2.351 times higher (p-value <0.0001) compared with “not at all” of EAR. In model 1 which includes under 64 years, HR of mental illness in “very probable” of EAR was 3.679 times higher (p-value: 0.000) and in “probable” of EAR was 2.535 time higher (p-value: 0.001) compared with “not at all” of EAR. Conclusion If we provide opportunities to participate in community activities or provide the mental health promotion programs for middle-aged population who are experiencing EAR due to health condition... (AU)

Effect of intensity of persistent social isolation on mental health in the late middle-aged and older population: results of the Korea Longitudinal Study of Ageing (2006-2020).

BACKGROUND: Social isolation (SI) was recently identified as a significant public health issue in the United States. Consequently, several studies on the association between SI and mental health were conducted. However, few studies have considered the duration and intensity of SI. In the present study, a longitudinal analysis was conducted to determine the effect of the intensity of persistent SI on the mental health status of late middle-aged and older Koreans. METHODS: After excluding missing values, data on 6200 participants were analyzed using the group-based trajectory model (GBTM) from the first to fifth Korean Longitudinal Study of Ageing (KLoSA) to categorise the SI trajectory (SIT). The Chi-square test, t-test, analysis of variance, and time-lagged generalised estimation equations were utilised from the fifth to eighth KLoSA to determine the association between SIT and the incidence of cognitive decline (the group with a Korean version Mini-Mental State Examination score of 23 or lower), cognitive function score, and depression score. RESULTS: Four SIT groups were identified in the GBTM analysis. These were the non-SIT (21.7%), mild (46.8%), moderate (21.1%), and severe SIT (10.4%) groups. Compared to the non-SIT group, the severe SIT group experienced a greater incidence of cognitive decline (odds ratio = 1.57, P < 0.0001) as well as poorer cognitive function scores (B = -0.63, P < 0.0001) and depression scores (B = 0.90, P < 0.0001). Furthermore, stratified analysis by sex and age showed that mental health status was inversely proportionate to the intensity of SIT, particularly in males and patients, aged 65 years and above. CONCLUSION: A close association was observed between SIT and mental health. This finding highlighted the need for policies and institutional measures to reduce the incidence of mental health deterioration among vulnerable groups due to the intensity of SI.

Association between Perceived Activity Restriction Due to People's Perception of Aging and Unmet Medical Needs among Middle-Aged and Elderly People: A Population-Based Study.

Background and Objectives: The older members of a population might experience unmet medical needs, despite desiring medical care due to activity limitations driven by their perception of aging. This study conducted a cross-sectional analysis of the association between perceived activity restriction (PAR) due to people's own perception of aging and unmet medical needs (UMN) in late middle-aged and older Koreans based on the Korean National Health and Nutrition Examination Survey (KNHANES). Materials and Methods: The 2016-2020 KNHANES was used to analyze a total of 2008 participants among groups aged 45 years or older by applying individual weights imposed from the raw data. The independent variable of PAR was assessed using self-reported questionnaires based on the global activity limitation indicator. Also, the dependent variable of UMN, referring to the state in which a patient's medical care or service was insufficient, inadequate, or lacking, was assessed using a single question. After excluding missing values, the data on 2008 individuals were analyzed using a chi-square test, weighted logistic regression, and a stratified analysis of gender, age, and the presence of chronic illnesses. Results: The group that experienced PAR had an OR 2.13 higher (odds ratio [OR]: 2.13; 95% confidence interval [CI]: 1.27-3.56) to present UMN than the group that did not experience PAR. Furthermore, the results of the stratified analysis indicated that, in the group of female participants with chronic illness and in the group of elderly people, experiencing PAR was associated with a higher experience of UMN. Conclusions: There was a close association between PAR and UMN. In particular, when PAR occurred in the group of female participants with chronic illness and in the group of elderly people, the incidence rate of UMN was also found to be high. This finding highlights the need for policies and institutional measures to reduce UMN within vulnerable groups with an increased risk of medical inaccessibility due to activity restriction.

Influence of job satisfaction on SRH and happiness among Korean disabled workers: findings from the panel survey of employment for the disabled 2016-2018.

Background: An understanding of the economic life activities of persons with disabilities (PWD) is important. Their ability to perform tasks and an increase in their income are more likely to yield an improvement in their Self-Rated Health (SRH) and happiness. However, there is still a lack of understanding of the specific associations among PWD in South Korea. Thus, this study conducted a longitudinal analysis of the association between job satisfaction and SRH, happiness among the Korean PWD. Methods: After excluding missing values, data on 1,637 participants at baseline (1st wave) were analyzed using the chi-square test, t-test, Analysis of Variance (ANOVA) and generalized estimating equation (GEE) model for data from 1st to 3rd Panel Survey of Employment for the Disabled (PSED). All analyses were conducted using the SAS statistical software package, version 9.4. Results: Compared to very high job satisfaction group, low job satisfaction group was more likely to experience negative SRH [odds ratio (OR): 3.497, value of p: <0.0001] and experience low happiness (B: -0.291, value of p: <0.0001). Furthermore, in terms of the overall satisfaction with current job among the PWD, compared to the 'very satisfied' group, 'very unsatisfied' group had higher negative SRH (OR: 5.158, value of p: 0.003) and lower happiness (B: -0.327, value of p: <0.0001). Conclusion: This study suggests that increasing job satisfaction of PWD possibly leads to decreased negative SRH and to increased happiness, resulting in better SRH and happiness. Furthermore, it suggests the establishment of systemic, policy-oriented measures to enhance the employment opportunities for disabled individuals in Korea and create an inclusive working environment that aligns with their respective job responsibilities.

Association between social isolation and subjective cognitive decline in Korean older adult population: A nationwide cross-sectional study in South Korea.

This study aimed to analyze the association between social isolation (SI) and subjective cognitive decline (SCD) in Koreans aged 65 years or older. The cross-sectional study of the Korea Community Health Survey (KCHS) was conducted on 72,904 individuals aged 65 years or older. SI was defined using five indicator, and an increasing number of SI indicators signifies a higher level of SI. SCD was defined as self-observed impairment of more frequent or worsening memory loss or confusion within the previous 12 months. The cognitive function questionnaire included questions regarding SCD. Chi-square test and weighted logistic regression analysis were used to analyze the association between SI and SCD. SI group had higher odds of SCD experience rate than the non-SI (AOR:1.15, 95 % CI: 1.08-1.22). Subgroup analysis showed that when SI occurred in the non-Moderate or Vigorous Physical Exercise (MVPE) group, SI group was more likely to experience SCD compared with the non-SI (AOR: 1.17, 95 % CI: 1.10-1.25). However, when SI occurred in the MVPE group, there were not find out the association between SI and SCD. The results of this study showed that the SI group had a higher rate of SCD than the non-SI group. Particularly, a strong association was observed in the non-MVPE. Therefore, even if SI occurs, SCD can be prevented by educating individuals regarding the importance of participating in MVPE and depression.

Relationship between functional limitations due to subjective cognitive decline and falling focusing exercise intensity: Results from the Korean Community Health Survey.

Background: To explore the association between functional limitation due to subjective cognitive decline (SCD) and falling by focusing on exercise intensity in the Korean population aged 45 years and older. Study Design: The 2019 Korean Community Health Survey (KCHS) was used to analyze 35,387 people by applying individual weights imposed from the raw data. Methods: To analyze the association between functional limitation due to SCD and falling in the Korean population aged 45 years and older, weighted logistic regression analysis and weighted zero-inflated Poisson regression analysis were used. Results: In both the middle-aged group and the older adult group, the functional limitation due to SCD had a higher fall experience rate and more falls than the non-functional limitation due to SCD group. Additionally, the middle-aged group and the moderate or vigorous physical exercise (MVPE) group had a higher fall experience rate and number of falls than the non-MVPE group; however, the older adult group walking regularly and performing MVPE had a lower fall experience rate and number of falls than the non-exercise group. Conclusions: Active participation in exercise is encouraged and should lead to fewer falls in older adults. Furthermore, a group with functional limitations due to SCD should be provided with exercise guidelines and a community program and facilities that enable regular participation should be developed.

Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020).

OBJECTIVES: This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA). METHODS: After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA. RESULTS: The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years. CONCLUSIONS: There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.

Association between private health insurance and medical use by linking subjective health and chronic diseases.

This empirical study identifies the negative aspects of private health insurance (PHI) by analyzing the association between subjective health conditions, 2 weeks of outpatient care, chronic diseases, and hospitalizations for 1 year. We used frequency analysis, χ2 testing, an analysis of variance, and logistic and multiple logistic regression models to analyze the association between PHI and subjective health conditions, outpatient care, chronic disease status, and hospitalization. The PHI group had good subjective health but had more outpatient care for 2 weeks. There were few chronic diseases in the private insurance group, and there was no significant difference in hospitalizations for 1 year. Hospitalization may occur when essential medical care is required, regardless of health insurance type. This study confirmed that as the PHI lowers the burden of personal medical expenses, the PHI can lead to an increase in the medical resource expenditures on the outpatient medical service and higher public health costs. The government should work to redefine the role of private and national health insurance. Also, the effectiveness of PHI should be reevaluated so that it does not lead to indiscriminate use of medical services by minimizing the burden of private insurance.

Association between activity restriction due to fear of falling and mortality: Results from the Korean longitudinal study of aging.

AIM: To analyze the correlation between activity restriction due to fear of falling and mortality among Koreans aged ≥45 years. METHODS: After excluding missing values, the data of 411 participants from the first to sixth waves of the Korean Longitudinal Study of Aging were analyzed using the χ2 -test, log-rank tests and Cox proportional hazards model. RESULTS: In model 1, which did not include activity restriction due to fear of falling as an independent variable, the death rate increased by 1.024-fold (hazard ratio 1.024, 95% confidence interval 1.000-1.050, P = 0.0498) as the number of falls increased by one. In model 2, which included activity restriction due to fear of falling as an independent variable, participants with experience of activity restriction showed 1.993-fold higher mortality (hazard ratio 1.993, 95% confidence interval 1.112-3.572, P = 0.0205) than those without such experience. In addition, as the number of falls in the group with chronic diseases increased by one, the mortality rate increased by 1.028-fold (hazard ratio 1.028, 95% confidence interval 1.001-1.057, P = 0.043). CONCLUSIONS: There was a close relationship between activity restriction due to fear of falling and mortality. Therefore, this study can serve as the foundation for policies and institutional measures to reduce the mortality rate of groups with activity restrictions due to fear of falling. Geriatr Gerontol Int 2022; 22: 168-174.