Trajectories of Cognitive Function and Their Associated Factors in Community-Dwelling Older Adults by Living Arrangement Using the Korean Longitudinal Study of Aging

Background@#The purpose of this study was to describe the distinct cognitive trajectories for 8 years according to living arrangement among community-dwelling older adults using the Korean longitudinal study of ageing. @*Methods@#We analyzed data from a final sample of 3,049 community-dwelling older adults aged 65 years or older who participated in at least three cognitive function measures in an 8-year period (2012-2020). Cognitive function was assessed by Korean mini mental state examination. Latent class growth model analysis was applied to determine the number and shape of trajectories of older adults according to living arrangement.Multinomial logistic regression analysis was used to determine risk factors for cognitive function trajectories. @*Results@#We identified five trajectory patterns in cognitive function among older adults living alone; ‘high-stable (35.6%)’, ‘high-declining (32.5%)’, ‘moderate-steep declining (6.2%)’, ‘low-stable (18.9%)’, and ‘low declining (6.8%)’. In older adults living with family, there were four trajectory patterns; ‘high-stable (46.4%)’, ‘high-declining (32.0%)’, ‘low-stable (15.9%)’, and ‘low-declining (5.7%)’. Age, instrumental activities of daily living, and depression were common factors of cognitive changes in both older adults living alone and those living with family members. However, monthly incomes was only associated with the risk of cognitive function in older adults living alone. @*Conclusions@#We found that cognitive function trajectories among older adults may differ depending on the type of living arrangement. Therefore, further studies and health policies are required for avoiding cognitive impairment by living arrangement among older adults based on the results of this study.

Determining Optimal Cut-off Score for the Braden Scale on Assessment of Pressure Injury for Tertiary Hospital Inpatients / 중환자간호학회지

Purpose@#: This study aims to establish an optimal cut-off score on the Braden scale for the assessment of pressure injury to detect pressure injury risks among inpatients in a South Korean tertiary hospital. @*Methods@#: This retrospective study used electronic medical records, from January to December 2022. A total of 654 patients were included in the study. Of these, 218 inpatients with pressure injuries and 436 without pressure injuries were classified and analyzed using 1:2 Propensity Score Matching (PSM), and the generalized estimating equation was performed using SPSS Version 26 and the R Machlt package program. @*Results@#: The cut-off value on the Braden scale for distinguishing pressure injury was 17 points, and the AUC (area under the ROC curve) was 0.531 (0.484–0.579). The sensitivity was 56.6% (45.5–67.7%) and the specificity was 69.7% (66.0– 73.4%). With 17 points, the Braden scale cut-off distinguished those who had pressure injuries from those who did not at the time of admission (p ＜ .03). In the pressure injury group, the Braden score on the day of the pressure injury was 14, with significant results in all subcategories except the moisture category. @*Conclusion@#: Our findings revealed that a cut-off value of 17 was optimal for predicting the risk of pressure injuries among tertiary hospital inpatients. Future studies should evaluate the optimal cut-off values in different clinical environments. Additionally, it is necessary to conduct multicenter large sample studies to verify the effectiveness of a 17 value in PI risk assessments.

Effectiveness of exercise for improving physical and renal function in older adults with pre-dialysis chronic kidney disease: A systematic review and meta-analysis / 중환자간호학회지

Purpose@#: Exercise may prevent the worsening of chronic kidney disease (CKD) and progression of cardiovascular diseases in patients with CKD. This review aims to identify the best type of exercise modality and summarizes the beneficial effects of exercise on physical and renal function among older adults with pre-dialysis CKD. @*Methods@#: A systematic search of PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SCOPUS, and domestic database was performed for randomized controlled trials (RCTs) assessing the effect of exercise intervention on older adults with pre-dialysis CKD published until February 2023. A random-effects metaanalysis was conducted. The risk of bias was assessed using a Cochrane tool for assessing the risk of bias in RCTs (RoB 2.0). @*Results@#: The systematic review included 11 RCTs (n = 591, average age 60.2–76), of which 8 could be included for meta-analysis. Exercise was significant in increasing peak oxygen consumption and knee muscle strength among physical functions, and also in improving glomerular filtration rate among kidney functions. @*Conclusion@#: Exercise has beneficial effects on physical and renal function among older adults with pre-dialysis CKD. In the future, it is necessary to verify the effectiveness of exercise by subdividing it by type, intensity, duration, and delivery.

Factors Related to Suicidal Ldeation in Community-Dwelling Older Adults with Multimorbidity Using Data From the 2017 Korean Community Health Survey

Background@#Multimorbidity and suicide rates are on the rising among older Korean population. Recent studies have shown that multimorbidity is associated with increased suicidal ideation. Thus, this study was to investigate individual factors of suicidal ideation among older Korean adults with multimorbidity. @*Methods@#A cross-sectional study was conducted using a subsample (n=20,533) with multimorbidity aged 65 over of the 2017 Korean community health survey. Binary logistic regression model assessed the association of physical activity, sitting times, self-reported sleep duration, and depression with suicidal ideation in older adults with multimorbidity. @*Results@#Overall, 2,790 (13.6%) of the sample reported suicidal ideation within the past year. Logistic regression analysis showed that women, low monthly family income, low physical activity, long sitting times, inappropriate sleep duration and depression were significantly associated with increased risk of suicidal ideation in older adults with multimorbidity. @*Conclusions@#To reduce the rate of suicidal ideation in older adults with multimorbidity, healthcare providers should be aware of the importance on routine assessment for physical activities, sleep pattern, and mental status of older adults in clinical settings. Particularly, female and low-income older adults with multimorbidity should be prioritized for early detection and individualized suicide prevention based on our findings.

Factors Influencing Dementia-Screening Behaviors of Community-Dwelling Adults Using the Korean Community Health Survey in 2018

Background@#This study aimed to identify factors influencing dementia-screening behaviors among community-dwelling middle-aged and older adults using the Korean Community Health Survey data in 2018. @*Methods@#This cross-sectional study included community-dwelling adults aged ≥50 years. We used data related to socio-demographic and health-related factors and subjective cognitive function. We conducted a chi-squared test and multiple logistic regression analysis with weighted analysis. @*Results@#Of 108,050 participants (men, 46.6%; ≥65 years old, 41.5%), only 13.4% (20,404 participants) performed dementia-screening. Using multiple logistic regression, we found that advanced age, female, and unemployed, having a low level of education, low monthly family income, and rural residence, no alcohol intake, no-smoking, hypertension, cognitive dysfunction, and awareness of the dementia helpline service center were positively associated with dementia-screening behaviors. @*Conclusions@#This study suggests the application of holistic approaches to improve dementia-screening behaviors among middle-aged and older adults considering their socioeconomic and health related conditions. Our findings highlight that government health programs should consider socio-economic status and awareness of dementia helpline services in designing dementia prevention programs.

Dyadic Interventions for Heart Failure Patients and Their Family Caregivers: A Systematic Review / 중환자간호학회지

Purpose@#: This systematic review was conducted to identify which dyadic intervention could be implemented for heart failure patient–family caregiver dyads to improve patient and/or their family caregivers outcomes.Method : Eleven databases were searched from their inception to July, 2021. This review considered any randomized controlled trials that evaluated the effectiveness of intervention including heart failure patient-family caregiver dyads. Two reviewers independently evaluated the methodological quality using the Cochrane Collaboration’s tool for assessing risk of bias and extracted details of the included studies. The studies included in this review were not suitable for meta-analysis and therefore the results were presented as a narrative summary. @*Results@#: Six studies including 900 dyads were included and mainly primary family caregiver of patients was spouse. Majority of dyadic intervention were focused on psychoeducational intervention excepting one study on mobile health intervention. All studies included in this review focused on patients’ outcomes compared to family caregivers’ outcomes and dyadic outcomes. Individual interventions improved quality of life among heart failure patients and their family caregivers in two articles. The overall quality of selected articles was low. @*Conclusions@#: This study provides moderate support for the use of a dyadic intervention to improve quality of life among heart failure patients and their family caregivers. More rigorous high-quality studies investigating interventions to meet the needs of patient and family caregivers in heart failure care are needed.

An Integrative Review of Health-related Quality of Life in Patients with Advanced Heart Failure

PURPOSE: Even though advanced heart failure (HF) severely affects the patient's health-related quality of life (HRQoL), there is little information regarding this issue. This review is aimed to describe the relevant clinical characteristics of patient with advanced HF and identify factors influencing HRQoL in these patients. METHODS: Empirical articles were searched from electronic databases issued from January 2000 to June 2018 with using the key terms ‘heart failure’ and ‘quality of life’. There were a total of 22 articles that met the inclusion criteria and were analyzed for this study. RESULTS: First, nine studies among 22 studies clearly stated that their participants were samples of patients with advanced HF. Most reviewed studies showed the New York Heart Association (NYHA) class as the criteria for identifying advanced HF. Second, the level of HRQoL varied depending on the measurement tools utilized by the researchers. Third, the NYHA class, gender, and symptoms were mainly associated with HRQoL in patients with advanced HF. Also, nurse- or physician-led intervention, exercise, spiritual-focused intervention, and palliative care improved the HRQoL of the patients with advanced HF. CONCLUSION: This study found that the clear application of criteria for advanced HF and the development of advanced HF-specific HRQoL measurement was needed. Prospective studies should be considered for identifying differences in the levels and factors influencing HRQoL in patients with early stage or advanced HF to design patient-centered care.

A Concept Analysis on Patient-Centered Care in Hospitalized Older Adults with Multimorbidity / 중환자간호학회지

PURPOSE: The aim of this study was to explore the attributes, antecedents, and consequences of patient-centered care (PCC) for older adults with multimorbidity in acute care hospitals.METHODS: The concept analysis performed by Walker and Avant was used to analyze PCC. Fifteen studies from the literature related to PCC appear in systematic literature reviews in the fields of theology, medicine, psychology, and nursing.RESULTS: PCC in acute care hospitals was defined according to the five attributes of ‘maintaining patient autonomy’, ‘empowering self-care’, ‘individualized and relationship-based care’, ‘shared decision-making’, and ‘creating a homelike environment’. Antecedents of PCC were found to be a respect for patients' preferences, qualifications of the nursing staff, care coordination and integration, and organizational support. Consequences of effective PCC were a functional status; health-related quality of life; satisfaction with care, mortality, and medical costs from the perspective of the patient and family; and quality of care and therapeutic relationships from nurses' viewpoints.CONCLUSION: PCC as defined by the results of this study will contribute to the foundation of institutionalization and the creation of a safe and healthy acute care hospital culture focused on patients' preferences and values.

Anemia as a Risk Factor of Mortality and Rehospitalization in Patients with Heart Failure : An Integrative Review / 중환자간호학회지

PURPOSE: Heart failure (HF) is considered an important medical burden with rehospitalization and mortality. Anemia is a major risk factor associated with the severity of HF. To improve the understanding of the impact of anemia in the population with HF, we explored the prevalence of anemia, its guidelines, relationship between anemia and mortality or rehospitalization, and limitation of reviewed papers of various populations with HF.METHODS: We used Whittemore and Knafl's integrative review methodology (2005), and thirty research papers were analyzed. PubMed, CINAHL, Cochrane, PsychInfo, Embase, Web of Science were searched for papers published between January 1960-June 2018.RESULTS: Anemia in individuals with HF was primarily defined using the World Health Organization guideline. The prevalence of anemia in patients with HF varied from 9% to 56.7%. Moreover, such a condition significantly increases the prevalence of mortality or rehospitalization in patients with HF. The analyzed majority were non-prospective cohort study including secondary data analysis.CONCLUSION: Anemia in individuals with HF is a significant risk factor of mortality and rehospitalization. Prospective cohort studies should be designed to identify the optimal value for screening anemia and the impact of anemia on rehospitalization and mortality among HF patients.

The Relationship between Thyroid Nodules Detected through Ultrasonography and Thyroid Function Test Results in Healthy Individuals

BACKGROUND: The detection of thyroid nodules through ultrasonography (US) has improved with the development of imaging technologies and thyroid cancer screening in Korea. We evaluated the relationship between the presence of thyroid nodules on US and thyroid function test (TFT) results in healthy individuals.METHODS: We performed a retrospective review of data from 449 adults (313 men and 136 women) who underwent tests to evaluate serum thyrotropin (TSH) and free thyroxine levels, thyroid US, and if needed, fine needle aspiration cytology (FNAC).RESULTS: Of the 449 subjects, 144 subjects (32.1%) had thyroid nodules. Among the 144 with thyroid nodules, 24 (16.7%) were advised to undergo FNAC, and all of them showed normal serum TSH levels. Logistic regression analysis showed that the presence of thyroid nodules was not related to abnormalities noted on TFTs after adjusting for age, sex, smoking status, and presence of risky drinking behavior and hypertension (P=0.647).CONCLUSION: The presence of thyroid nodules on US in healthy adults was not associated with abnormal TFT results. Serum TSH check-ups during the evaluation of thyroid nodules discovered through US in asymptomatic individuals living in areas with a low prevalence of autonomous functioning thyroid nodules might not be necessary from the perspective of cost-effectiveness and subject convenience.

Development and Feasibility of a Video Recording-Based Standardized Handoff Program for Ward Nurses: A pilot study / 중환자간호학회지

PURPOSE: This study develop a Video Recording-Based Standardized Handoff (VRSH) program at shift change for ward nurses.METHOD: The study was conducted in five medical, three surgical, and one comprehensive nursing care service wards affiliated with a secondary general hospital. In this methodological study, the VRSH program was developed between April and December, 2017. It is noted that 65 nurses who were involved in the VRSH program participated in this study.RESULTS: In line with the modified Situation, Background, Assessment, Recommendation tool, the VRSH program consisted of three phases. In the VRSH program, the average time for handoff duration was 3–5 minutes per patient. More than 90% of the ward nurses were satisfied with the VRSH program since it benefited them by reducing overtime work and improving the performance, as well as effective communication, of nurses. The content analysis of nurses' VRSH program experience, revealed three categories and eight sub-categories.CONCLUSION: This study provides evidence that the VRSH program improves effective nursing performance and, the handoff communication and relationships between nurses. Future studies on large sample sizes and multiple settings are required to substantially evaluate the impact of the VRSH program on clinical outcomes.

An Evolutionary Concept Analysis of Forensic Nursing Competency / 중환자간호학회지

PURPOSE: This study aimed to clarify attributes, antecedents, and consequences of forensic nursing competency.METHOD: Rodgers' evolutionary concept analysis was used to analyze twenty nine articles on forensic nursing based on a systematic review of theology, medicine, psychology, and nursing literature.RESULTS: Forensic nursing competency consists of the following seven attributes: awareness of the medico-legal problem, multi-disciplinary integrated knowledge, education and training in forensic science, professional career development, evidence based practice in forensic nursing, collaborative forensic nursing with community partner, safety and security effective communication, and supportive relationships. Finally, we could explain the consequences of forensic nursing competency on knowledge construction in nursing, enhancing professional nursing, and establishing a human rights and social justice based approach. The antecedents of forensic-nursing competency were forensic science interest, forensic science experience, and nurses' view of person in forensic-works.CONCLUSION: Based on these results, we recommend the development of a Korean version of a scale to assess forensic nursing competency.

Knowledge, Confidence, and Learning Needs Regarding Advance Directives among Hospital Nurses / 중환자간호학회지

PURPOSE: Nurses' knowledge regarding advance directives may affect their administration of and confidence towards end of life care. This study aimed to describe the relationships of knowledge, confidence, and learning needs with advance directives among hospital nurses.METHOD: This cross-sectional study was performed at a tertiary university hospital in Seoul between September 25 and October 14, 2017. Convenience sampling was used to recruit nurses who provided bedside care and had at least 1 year of clinical experience. We used a validated self-report questionnaire.RESULTS: The mean score of knowledge, confidence and learning needs were 5.00±1.73, 29.81±7.52, and 64.54±8.48 respectively. Hospital nurses' knowledge, confidence and learning needs were significantly different according to age, job position, educational level and perceived advance directives. Knowledge regarding advance directives was significantly associated with confidence (r = .27, p < .001) and learning needs (r = .16, p = .005).CONCLUSION: Knowledge regarding advance directives was relatively low compared to the findings of previous studies. Therefore, nurses should be knowledgeable and encouraged to initiate advance directives. It is necessary to develop a standardized educational program regarding advance directives based on Korean cultures.

Overactive Bladder is a Distress Symptom in Heart Failure / 대한배뇨장애요실금학회지

The prevalence of Heart failure (HF) is expected to increase worldwide with the aging population trend. The numerous symptoms of and repeated hospitalizations for HF negatively affect the patient's quality of life and increase the patient's economic burden. Up to 50% of patients with HF suffer from urinary incontinence (UI) and an overactive bladder (OAB). However, there are limited data about the relationship between UI, OAB, and HF. The association between HF and urinary symptoms may be directly attributable to worsening HF pathophysiology. A comprehensive literature review was conducted for all publications between January 2000 and November 2017 using the PubMed, Embase, and Cochrane databases. HF represents a major and growing public health problem, with an increased risk of UI and an OAB as comorbidities. Possible effects of HF on urinary problems may be mediated by the prescription of medications for symptomatic relief. Although diuretics are typically used to relieve congestion, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improve survival, these classes of drugs have been suggested to worsen urinary symptoms in the presence of HF. Further research is required to understand the impact of UI and an OAB on the HF illness trajectory.

Health Literacy and Its Related Factors in North Korean Refugees

BACKGROUND: In September 2016, the number of North Korean refugees living in South Korea was 29,688. They have been struggling with health problems due to their poor health status and the differences in medical system and terminology between South and North Korea. We aimed to investigate the level of health literacy and its related factors in North Korean refugees. METHODS: This study was conducted with 142 patients who visited North Korean refugees' counseling center at Seoul Medical Center and National Central Medical Center and 100 South Korean patients who visited outpatient clinics or Health Promotion Center of Seoul Medical Center. General and health-related characteristics were surveyed through a questionnaire and health literacy was measured by using ‘Korean Adult Health Literacy Scale’. RESULTS: The average age of North Korean refugees was 48.92±11.49 years old. Almost 95% reported that their monthly income was less than 2 million KRW. The survey showed that North Korean refugees obtain health information mainly through TV, radio, and acquaintances and more than half (54.9%) said their health was bad or very bad. The mean score of North Korean refugees' health literacy was much lower than that of South Koreans (12.42±7.58 vs. 25.3±5.7, P<0.001). This discrepancy was maintained after adjusting related factors such as age, sex, and socioeconomic status with stratified analysis. CONCLUSIONS: It suggest the urgent need for policies which support for futher researches and development of education system, which may lead to the improvememt of the health literacy of North Korean regugees.

Factors Influencing Health Information Orientation in Middle-aged Community-dwelling

BACKGROUND: It is important time for middle-aged because they should shift to a healthy elderly by utilization of correct health information and healthy behaviors. The aim of this study was to investigate the level of health information orientation (HIO) and identify the factors influencing HIO according to socio-demographic and health related characteristics of middle aged in community. METHODS: A cross-sectional descriptive study was conducted by self-reported using structured questionnaires. The data was collected from June to July 2014 with 465 middle aged and 40 to 64 years old living in the community. Multiple stepwise regression analysis was used to examine the determinant of HIO. RESULTS: In the two sub-domains of HIO, health information engagement mean score was 2.30±1.09 and the health information apprehension level was 1.34±1.15 on average (maximum 4 points). Regression analysis showed that the sub-domains of HIO, the level of health information engagement was significantly higher in the 40-49 age group than 50-64 age group (β=-0.094, P=0.048) and high school or above education level (β=0.224, P<0.001). Those who pay more than 100,000 won per month (β=0.097, P=0.047) were significantly high in the level of health information apprehension. CONCLUSIONS: In order to improve the level of HIO, it is necessary to implement tailored health promotion education considering the sociodemographic and health related characteristics of the subjects. It is required in the future, the development of tools and multidimensional factors that are appropriate for the middle-aged when identifying the factors influencing of health information orientation.

Critical Care Nursing Courses in Bachelor of Science in Nursing Programs: Present and Future Directions / 중환자간호학회지

PURPOSE: This study examined the status of critical care nursing education in bachelor of science in nursing (BSN) to suggest future directions.METHODS: The target of the survey was 185 BSN programs that were certified by the Korean Accreditation Board of Nursing Education as of October 31, 2016. We structurally reviewed the curriculums and the course syllabi.RESULTS: Forty-eight courses of 42 BSN programs were analyzed. Only five programs offered both theoretical and practical courses in critical care nursing; 22 offered theoretical courses and 26 offered practical courses. Most courses were offered as electives with 1 or 2 credits, and were taught by faculty who were experts in adult health nursing.CONCLUSION: The results show that there is a quantitative shortage of critical care nursing education in the curriculum of BSN programs in Korea. The lack of knowledge and skills on critical care can lead to a burden of new intensive care unit nurses and is a threat to patients' health. It is necessary to develop a practical and integrative curriculum for critical care nursing education.

Research Trends in Quantitative Nursing Studies and Quality Assessment of Intervention Studies in Patients with Heart Failure in South Korea

PURPOSE: The purpose of this review was to identify the current status of nursing studies on heart failure (HF) patients in South Korea and to suggest future study direction. METHODS: A literature review of databases such as KoreaMed, KERIS and nursing and allied health journal were searched with key terms ‘heart failure’ and ‘nursing’ for the period from January 2000 to February 2017. A total of 35 studies including 28 articles and 7 theses met the inclusion criteria. RESULTS: Twenty-seven out of 35 studies were observational studies on outpatients and most of the studies did not mention the ejection fraction and New York Heart Association functional classification class (NYHA class) in the inclusion criteria. Self-care and health-related quality of life as psychological factors, and physical activity as a biological factor, were used as main variables. However, we found it difficult to understand how much score indicates better quality of life because of an inconsistent and wide score. In quality assessment, 8 intervention studies had no serious flaws. CONCLUSION: Further studies should consider more biological and social factors influencing HF. The quality assessment with respect to nursing intervention studies in HF showed that randomized and double-blind trials are needed.

Perception on Hospice, Attitudes toward Death and Needs of Hospice Care between the Patients with Cancer and Family / 재활간호학회지

PURPOSE: The purpose of this study was to identify the perception on hospice, attitudes toward death and needs of hospice care between the patients with cancer and family. METHODS: This study used descriptive research design. The participants were 118 patients with cancer hospitalized and 118 family caregivers of patients with cancer. The data collected by questionnaires from October to December, 2013. RESULTS: There was significant difference in perception on hospice (recognition of hospice term and definition of hospice) and needs of hospice care between patients and family. Among the categories of the needs, 'medical needs' was the highest in patients and 'emotional care' was the highest in family. But there was no significant difference in attitudes toward death. There correlation between attitudes toward death and needs of hospice care was significant only in patients. CONCLUSION: Hospice care must be provided considering the death attitudes and needs of patients with cancer and family based on the understanding of perception on hospice, attitudes toward death of the patients with cancer and family.

Methodological Issues in Questionnaire Design

PURPOSE: The process of designing a questionnaire is complicated. Many questionnaires on nursing phenomena have been developed and used by nursing researchers. The purpose of this paper was to discuss questionnaire design and factors that should be considered when using existing scales. METHODS: Methodological issues were discussed, such as factors in the design of questions, steps in developing questionnaires, wording and formatting methods for items, and administrations methods. How to use existing scales, how to facilitate cultural adaptation, and how to prevent socially desirable responding were discussed. Moreover, the triangulation method in questionnaire development was introduced. RESULTS: Steps were recommended for designing questions such as appropriately operationalizing key concepts for the target population, clearly formatting response options, generating items and confirming final items through face or content validity, sufficiently piloting the questionnaire using item analysis, demonstrating reliability and validity, finalizing the scale, and training the administrator. Psychometric properties and cultural equivalence should be evaluated prior to administration when using an existing questionnaire and performing cultural adaptation. CONCLUSION: In the context of well-defined nursing phenomena, logical and systematic methods will contribute to the development of simple and precise questionnaires.