Journal of Preventive Medicine and Public Health

Original Articles

Frailty Index Predicts Future All-cause Mortality and Quality of Life: A 2-Year Follow-up Study Among Korean Older Adults From a Population-based Cohort Study: Woolim Ko, Hyunsuk Jeong, Hyeon Woo Yim; J Prev Med Public Health. 2025;58(6):572-580. Published online November 10, 2025; DOI: https://doi.org/10.3961/jpmph.25.210

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Abstract Summary PDF Supplementary Material: Objectives
The frailty index (FI), a proxy measure of accelerated biological aging, predicts adverse outcomes in older adults. We investigated whether the FI predicts mortality in a community-based Korean older adult population and its association with subjective health status over 2 years.
Methods
This prospective cohort study included 936 community-dwelling individuals aged ≥60 years. The FI, calculated from 28 self-reported baseline variables, was scored on a scale from 0 to 1 (<0.25: non-frail; 0.25-0.34: mildly frail; ≥0.35: moderately to severely frail). The primary outcome was 2-year all-cause mortality. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Quality of life was assessed using the European Quality of Life Five-Dimension Three-Level (EQ-5D-3L), with the proportions reporting extreme problems and prevalence ratios of problems across frailty groups. Analyses were conducted using the GENMOD procedure in SAS version 9.4.
Results
Of the 936 participants, 111 (11.9%) were non-frail, 230 (24.6%) were mildly frail, and 595 (63.6%) were moderately to severely frail. The prevalence of moderate to severe frailty increased with age. The moderate-severe frailty group had a ≥5-fold increased risk of mortality compared to the non-frail group (adjusted RR, 5.79; 95% CI, 1.39 to 24.07). Among those completing follow-up, the moderate-severe frailty group reported more problems across all EQ-5D-3L domains at 2 years.
Conclusions
Frail older adults are at increased risk of mortality, but this risk was significant only for those in the moderate-to-severe frailty category at 2-year follow-up. The FI is a valuable predictor of premature death and health challenges in older adults.; Summary

Korean summary
2년의 추적 관찰 기간 동안, 기저 시점의 중등도에서 중증의 노쇠 상태에 있던 노인은 노쇠하지 않은 노인에 비해 사망 위험이 5배 이상 높았으며, EQ-5D-3L로 평가한 다양한 삶의 질 영역에서도 더 큰 어려움을 겪는 것으로 나타났다. 이러한 결과는 특히 중등도에서 중증의 노쇠 상태가 임상적 위험뿐만 아니라 주관적 삶의 질을 개선하기 위한 우선적 개입이 필요할 수 있음을 시사한다. 본 연구는 노인의 건강 결과를 향상시키기 위해서는 개별 질환 관리뿐 아니라 노쇠 상태를 체계적으로 평가하고 관리하는 것이 중요함을 제안한다.

Key Message
During the two-year follow-up period, older adults who were moderately to severely frail at baseline had a more than fivefold higher risk of death compared with those who were non-frail, and they also experienced greater difficulties across various quality-of-life domains as measured by the EQ-5D-3L. These findings suggest that moderate to severe frailty may require high-priority interventions to improve not only clinical risks but also subjective quality of life. This study indicates that, to improve health outcomes in older adults, it is important to systematically assess and manage frailty in addition to addressing individual diseases.

Integrating Cognitive and Motor Dual-task Training to Prevent Fall Risk Among Community-dwelling Elderly in Thailand: A Randomized Controlled Study: Wilawan Jattanond, Chatchada Sutalangka, Ploypailin Namkorn, Ekalak Sitthipornvorakul, Siripatra Atsawakaewmongkhon, Boonsita Suwannakul, Aunyachulee Ganogpichayagrai, Sitang Kongkratoke, Raksuda Taniguchi, Wilawan Chaiut; J Prev Med Public Health. 2025;58(6):609-619. Published online August 19, 2025; DOI: https://doi.org/10.3961/jpmph.25.165

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Objectives
Falls are a leading cause of morbidity and mortality among older adults, often resulting in severe injuries and a loss of independence. Dual-task training, which integrates cognitive and motor exercises, has emerged as a promising intervention for fall prevention. This study aimed to evaluate the effects of a structured cognitive and motor dual-task training program on fall risk, balance, and cognitive function in community-dwelling older adults.
Methods
Seventy-two participants aged 60 years or older were randomly assigned to either an intervention group (IG, n=36) or a control group (CG, n=36). The IG underwent 3 sessions per week for 8 weeks (totaling 24 sessions) that incorporated simultaneous cognitive and motor exercises, while the CG continued their usual total body stretching exercise. Assessments were conducted at baseline, week 4, and week 8, and included gait speed (10-meter walk test), functional performance (Timed Up and Go test), cognitive function (Montreal Cognitive Assessment), and quality of life (World Health Organization Quality of Life Assessment).
Results
Participants in the IG demonstrated significant improvements in functional performance (p<0.05) and enhanced cognitive function compared to the CG after both 4 weeks and 8 weeks of training. Functional performance and cognitive function significantly improved after 8 weeks of training (p<0.01). However, the intervention did not produce changes in gait speed or quality of life.
Conclusions
Integrating cognitive and motor dual-task training into fall prevention programs may enhance functional stability and cognitive resilience in older adults. Future studies should investigate long-term adherence and determine the optimal training intensity.

Summary

Key Message
Integrating cognitive–motor dual-task training into fall-prevention programs can significantly enhance balance, mobility, and cognitive responsiveness in older adults. This approach improves adaptability to real-world challenges, reduces fall risk, and supports independent living. Evidence-based, engaging training protocols can further promote long-term safety and quality of life in aging populations.

Citations

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Marks Ray
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Associations Between Multiple Falls and Mental Health Indices in Korean Older Adults: A Cross-sectional Study: Chaelyn Lim, Hyun-Jin Son, Byung-Gwon Kim, Byeng-Chul Yu, Jiwon Kim, Young-Seoub Hong; J Prev Med Public Health. 2025;58(3):269-277. Published online January 14, 2025; DOI: https://doi.org/10.3961/jpmph.24.482

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Abstract Summary PDF Supplementary Material: Objectives
This study was performed to investigate the prevalence of falls, mental health issues, and health behaviors among older adults, as well as to analyze the association between multiple falls and mental health status in this population.
Methods
We utilized data from the 2017, 2019, and 2021 Korean Community Health Survey, a nationwide survey organized by region and conducted by the Korea Disease Control and Prevention Agency. Participants were categorized into no-fall, single-fall, and multiple fall groups based on responses to an index question regarding fall experiences and the number of such incidents reported in the survey. The chi-square test was applied to understand the characteristics of the elderly population in the community. Subsequently, multinomial logistic regression analysis was conducted to clarify the association between falls and mental health.
Results
Integrated data analysis revealed that 11.3% of participants experienced a single fall, while 5.7% reported multiple falls. Participants from low-education and low-income backgrounds exhibited relatively high rates of falls. Additionally, non-drinkers and non-smokers reported falls more frequently than their counterparts who consumed alcohol and smoked. Multinomial logistic regression revealed significant associations between multiple falls and mental health factors. In particular, the severity of depression was directly proportional to the likelihood of experiencing multiple falls, with an odds ratio of 2.95 (95% confidence interval, 2.49 to 3.50).
Conclusions
We identified associations between various mental health-related factors—including sleep duration, subjective stress, the presence of depression, and Patient Health Questionnaire-9 score—and the occurrence of multiple falls.; Summary

Korean summary
본 연구는 한국의 65세 이상 노인을 대상으로 낙상 경험과 정신건강 지표 간의 연관성을 분석한 단면 연구이다. 다회 낙상은 수면 시간, 주관적 스트레스, 우울감, PHQ-9 점수 등 다양한 정신건강 요인과 유의한 관련이 있었으며, 특히 우울증이 심할수록 낙상 발생 위험이 높아지는 경향을 보였다.

Key Message
Multiple falls among Korean older adults were significantly associated with mental health-related factors, including sleep duration, subjective stress, and Patient Health Questionnaire-9 (PHQ-9) scores. These results emphasize the need for comprehensive interventions targeting both physical and mental health to prevent recurrent falls in the elderly.

Determinant Factors of Mortality in Pre-elderly and Elderly Patients With COVID-19 in Jakarta, Indonesia: Thresya Febrianti, Ngabila Salama, Inggariwati , Dwi Oktavia; J Prev Med Public Health. 2023;56(3):231-237. Published online May 31, 2023; DOI: https://doi.org/10.3961/jpmph.23.008

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Abstract PDF

Objectives
This study aimed to identify risk factors associated with coronavirus disease 2019 (COVID-19) mortality in pre-elderly and elderly individuals in Jakarta, Indonesia.
Methods
We employed a case-control study design, utilizing secondary data from the Epidemiology Surveillance, Immunization Prevention, and Disease Control Sections of the DKI Jakarta Provincial Health Office, collected from December 2020 to January 2021. The study included 188 cases and an equal number of controls. Cases were COVID-19 patients confirmed to have died, as reported by hospitals and communities and subsequently verified by healthcare workers. Control subjects were patients who completed a 14-day isolation period and had been officially declared recovered by healthcare professionals. The dependent variable was the mortality of COVID-19 patients in the January 2021 period. The independent variables consisted of demographic data (age and sex), clinical symptoms (cough, runny nose, anosmia, diarrhea, headaches, abdominal pain, muscle pain, and nausea/vomiting), and comorbidities (hypertension, heart disease, and diabetes). Multivariate analysis was conducted using multiple logistic regression.
Results
The multiple logistic regression analysis revealed several factors associated with COVID-19 fatalities in Jakarta: age of 60 years or older (odds ratio [OR], 4.84; 95% CI, 3.00 to 7.80), male (OR, 2.38; 95% CI, 2.41 to 3.68), dyspnea (OR, 3.93; 95% CI, 2.04 to 7.55), anosmia (OR, 0.13; 95% CI, 0.04 to 0.46), and heart disease (OR, 4.38; 95% CI, 1.04 to 18.46).
Conclusions
The control and prevention of COVID-19 among elderly individuals require particular vigilance. When a COVID-19 case is detected within this demographic, prompt treatment and medication administration are crucial to mitigate the presenting symptoms.

Summary

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The Moderating Effect of Gender on the Relationship Between Self-neglect and Suicidal Ideation in Older Adults of Korea: Kyuhyoung Jeong, Daeyeon Jang, Boyoung Nam, Soyoung Kwon, Eunsol Seo; J Prev Med Public Health. 2022;55(5):436-443. Published online August 3, 2022; DOI: https://doi.org/10.3961/jpmph.22.083

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Abstract Summary PDF

Objectives
Previous studies have reported that self-neglect, which may be a sign of elder abuse, can result in suicide among older adults. The signs of self-neglect and its impact on the risk of suicide may differ by gender. Thus, this study explored the association between self-neglect and suicide risk in older Korean adults and examined the potential moderating effect of gender on this relationship.
Methods
Data were collected from 356 Korean adults aged 65 or older through an online survey. Multiple regression analysis was used to test the research hypothesis. First, the associations between 4 sub-dimensions of self-neglect (i.e., daily life management issues, personal hygiene issues, financial management issues, and relational issues) and suicidal ideation were examined. Then, the moderating effect of gender on these relationships was investigated by including interaction terms.
Results
Self-neglect was significantly associated with suicidal ideation in older adults. Aspects of self-neglect related to daily life management and relational factors were key predictors of suicidal ideation. Gender significantly moderated the effect of the relational dimension of self-neglect on suicidal ideation. The relational dimension of self-neglect was more strongly associated with suicidal ideation in older women than in older men.
Conclusions
The findings suggest the importance of screening older adults with signs of self-neglect for suicide risk. Special attention should be paid to older women who experience relational issues as a high-risk group for suicidal ideation. Public programs and support systems should be established to improve daily life management and promote social relationships among older adults.

Summary

Korean summary
본 연구는 노인의 자기방임과 자살생각의 관계에서 성별의 조절효과를 검증하는 데에 목적이 있다. 연구결과를 토대로 성별에 따른 노인의 자살위험 영향요인을 고려한 정책 개입의 필요성과 사회적 고립 완화를 위한 프로그램 도입 등을 제안하였다.

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Ordenamentos da imunossenescência subjacentes a autorregulação da funcionalidade em pessoas idosas
Amanda Azevedo de Carvalho, Dante Ogassavara, Jeniffer Ferreira-Costa, Thais Silva-Ferreira, José Maria Montiel
Arquivos do Mudi.2025; 29(3): e75957. CrossRef
Subgroups of self-neglect and effects on suicidal ideation among the older adults
Hyun Lee, Eunjin Lee
Development and Psychopathology.2024; 36(4): 1537. CrossRef
Enhancing healthcare access for an older population: The age‐friendly emergency department
Sangil Lee, Rachel M. Skains, Phillip D. Magidson, Nadine Qadoura, Shan W. Liu, Lauren T. Southerland
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The Effects of a 7000-Step Goal and Weekly Group Walking Program for Overweight and Obese Elderly People in Sarawak, Malaysia: A Quasi-experimental Study: Mohd Fakhree Saad, Whye Lian Cheah, Helmy Hazmi; J Prev Med Public Health. 2021;54(3):199-207. Published online April 29, 2021; DOI: https://doi.org/10.3961/jpmph.20.584

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Abstract PDF

Objectives
Physical inactivity is the fourth leading global risk factor for mortality, followed by obesity. The combination of these risk factors is associated with non-communicable diseases, impaired physical function, and declining mental function. The World Health Organization recommends physical activity to reduce the mortality rate. Thus, this study examined the effects on anthropometric measurements of a 12-week walking program for elderly people in Samarahan, Sarawak, Malaysia with a 7000-step goal and weekly group walking activities.
Methods
A quasi-experimental study was conducted involving 109 elderly people with a body mass index (BMI) ≥25.0 kg/m². BMI, body composition, and average daily steps were measured at baseline, 6 weeks, and 12 weeks. Data were analyzed using SPSS version 26.0, and repeated-measures analysis of variance with the paired t-test for post-hoc analysis was conducted.
Results
In total, 48 participants in the intervention group and 61 participants in the control group completed the study. A significant interaction was found between time and group. The post-hoc analysis showed a significant difference between pre-intervention and post-intervention (within the intervention group). The post-intervention analysis revealed an increase in the mean number of daily steps by 3571.59, with decreases in body weight (-2.20 kg), BMI (-0.94 kg/m²), body fat percentage (-3.52%), visceral fat percentage (-1.29%) and waist circumference (-2.91 cm). Skeletal muscle percentage also showed a significant increase (1.67%).
Conclusions
A 12-week walking program combining a 7000-step goals with weekly group walking activities had a significant effect on the anthropometric measurements of previously inactive and overweight/obese elderly people.

Summary

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The Association of Perceived Neighborhood Walkability and Environmental Pollution With Frailty Among Community-dwelling Older Adults in Korean Rural Areas: A Cross-sectional Study: Mi-Ji Kim, Sung-Hyo Seo, Ae-Rim Seo, Bo-Kyoung Kim, Gyeong-Ye Lee, Yeun-Soon Choi, Jin-Hwan Kim, Jang-Rak Kim, Yune-Sik Kang, Baek-Geun Jeong, Ki-Soo Park; J Prev Med Public Health. 2019;52(6):405-415. Published online October 24, 2019; DOI: https://doi.org/10.3961/jpmph.19.166

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Abstract Summary PDF Supplementary Material

Objectives
The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas.
Methods
The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants’ frailty.
Results
The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy.
Conclusions
More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.

Summary

Korean summary
본 연구는 우리나라 농촌지역 노인들이 인지하는 지역 환경과 노쇠의 연관성을 확인하기 위하여 자기보고식 설문지로 인지된 보행편의성 및 환경오염을 측정하였고, Kaigo-Yobo 평가척도로 노쇠를 평가하였다. 연구 결과, 노쇠에 영향을 미칠 것으로 예상되는 변수들을 통제한 후에도 인지된 보행편의성의 감소와 인지된 환경오염의 증가는 노쇠와 관련성이 있었다.

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Association Between Convenience of Transportation and Unmet Healthcare Needs of Rural Elderly in Korea: Youngeun Choi, Kiryong Nam, Chang-yup Kim; J Prev Med Public Health. 2019;52(6):355-365. Published online October 3, 2019; DOI: https://doi.org/10.3961/jpmph.19.172

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Abstract Summary PDF Supplementary Material

Objectives
In rural areas of Korea, where public transportation infrastructure is lacking and alternative systems are poor, the elderly experience inconveniences in using healthcare, although their need is high. This study aimed to analyze the association between the convenience of transportation and unmet healthcare needs among the rural elderly.
Methods
The data used were collected in the 2016 Community Health Survey among rural elderly individuals aged 65 or older. Dependent variable was the unmet healthcare needs, explanatory variable was the convenience of transportation. The elderly were divided into 3 groups: with no driver in the household, with a driver, and the elderly individual was the driver (the self-driving group). Covariates were classified into predisposing, enabling, and need factors. They included gender, age, education, income, economic activity, household type, motor ability, subjective health level, number of chronic diseases, anxiety/depression, and pain/discomfort. The data were analyzed using logistic regression and stratification.
Results
A significant association was found between the convenience of transportation and unmet healthcare needs. When examined unadjusted odds ratio of the group with a driver in the household, using the group with no driver as a reference, was 0.61 (95% confidence interval [CI], 0.54 to 0.68), while that of the self-driving group was 0.34 (95% CI, 0.30 to 0.38). The odds ratios adjusted for all factors were 0.69 (95% CI, 0.59 to 0.80) and 0.79 (95% CI, 0.67 to 0.91).
Conclusions
We confirmed a significant association between inconvenient transportation and unmet healthcare needs among the rural elderly even after adjustment for existing known factors. This implies that policies aimed at improving healthcare accessibility must consider the means of transportation available.

Summary

Korean summary
대중교통 인프라가 부족하고 대안적 교통수단 체계가 미흡한 농촌 지역 노인들은 의료 필요는 높으나 도보이동이나 불편한 이동수단을 이용하기 어려워 의료이용에 불편을 겪는다. 본 연구는 의료접근성 향상과 불평등한 접근성 문제에 대한 제안의 근거 마련을 목적으로 질병관리본부 지역사회건강조사 데이터를 이용하여 농촌 노인의 이동수단의 편의성과 미충족의료 경험의 연관성을 살펴보았다. 분석결과 농촌지역 노인에게 교통편 불편은 미충족의료 경험의 주된 이유로 나타났고 기존에 알려진 요인들을 보정한 후에도 이동수단의 편의성과 미충족의료 경험 사이에 유의한 관계가 있음을 확인하였다.

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Self-efficacy to Engage in Physical Activity and Overcome Barriers, Sedentary Behavior, and Their Relation to Body Mass Index Among Elderly Indonesians With Diabetes: Qonita Rachmah, Stefania Widya Setyaningtyas, Mahmud Aditya Rifqi, Diah Indriani, Triska Susila Nindya, Hario Megatsari, Trias Mahmudiono, Wantanee Kriengsinyos; J Prev Med Public Health. 2019;52(4):242-249. Published online July 2, 2019; DOI: https://doi.org/10.3961/jpmph.19.003

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Abstract PDF

Objectives
Elderly individuals with diabetes should maintain a normal body mass index (BMI) to help control their blood glucose levels. This study investigated barriers to physical activity (PA), self-efficacy to overcome those barriers, and PA self-efficacy among elderly individuals with diabetes in relation to BMI.
Methods
This cross-sectional study included 56 participants. Data were collected by a questionnaire interview and direct measurements for anthropometric data. PA self-efficacy was measured using 8 questions describing different levels of PA, where participants rated the strength of their belief that they could engage in that activity. Self-efficacy to overcome barriers was measured using 10 questions capturing participants’ confidence in their ability to engage in PA despite different possible barriers. Mean scores for these parameters were analyzed using the chi-square test and the independent t-test.
Results
In total, 89.3% of participants had a low PA level and 58.9% had more than 3 hours of sedentary activity per day. Furthermore, 55.4% were obese and 14.3% were overweight. The mean scores for PA self-efficacy and self-efficacy to overcome barriers were 59.1± 26.4 and 52.5±13.8, respectively. PA level was related to BMI (p<0.001; r=0.116) and sedentary activity (p<0.05; r=0.274). PA self-efficacy and age were not related to BMI. Barriers to PA were associated with PA levels (p<0.05).
Conclusions
Physical inactivity was a major problem in elderly individuals with diabetes, and was correlated with higher BMI. Lower levels of PA might be mediated by sedentary activity.

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Research Support, Non-U.S. Gov't

Age and Gender Differences in the Relation of Chronic Diseases to Activity of Daily Living (ADL) Disability for Elderly South Koreans: Based on Representative Data.: Il Ho Kim; J Prev Med Public Health. 2011;44(1):32-40.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.32

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Abstract PDF

OBJECTIVES
This study investigated the gender and age differential effect of major chronic diseases on activity of daily living (ADL) disability. METHODS: Surveyfreq and Surveylogistic regression analyses were employed on the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) with a sample of 3,609 persons aged 65 - 89. RESULTS: After adjusting for potential covariates, stroke, among elderly men more so than women, had a 2-3 times greater odds of engendering ADL disability in the 65-69 (p < 0.05) and 70-79 age groups (p < 0.01). In comparison to elderly women, cancer, diabetes, and incontinence in elderly men was associated with a higher risk of ADL disability in the 70 - 79 age group (p < 0.05), and this association was also observed for pulmonary disease in the 80-89 age group. Among elderly women, however, a significant association between incontinence and ADL disability was identified in all three age groups. In addition, this association was found in pulmonary disease and diabetes in elderly women aged 70 - 79 years. Significant gender differences were observed in the association between stroke in the 60 - 79 age group and cancer in the 70 - 79 age group. CONCLUSIONS: Age and gender differences were observed in the effect of chronic diseases on ADL disability.

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English Abstract

Relationship Between Status of Physical and Mental Function and Quality of Life Among the Elderly People Admitted from Long-Term Care Insurance.: Hyeong Seon Kim, Nam Kyou Bae, In Sun Kwon, Young Chae Cho; J Prev Med Public Health. 2010;43(4):319-329.; DOI: https://doi.org/10.3961/jpmph.2010.43.4.319

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Abstract PDF

OBJECTIVES
This study was performed to determine the levels of quality of life (QOL) according to the grade of long-term care service for the elderly people who were admitted from long-term care insurance, and to reveal its association with the physical and mental functioning such as the Activity of Daily Living (ADL), the Instrumental Activity of Daily Living (IADL), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Mini-Mental State Examination-Korean version (MMSE-K). METHODS: The interviews were performed during the period from March 1 to May 31, 2009, for 958 elderly people in urban and rural areas. The questionnaire items included various indices such as the ADL, IADL, CES-D, and MMSE-K, as independent variables and the index of QOL, as the dependent ones. For statistical analysis, t-tests were used for the mean scores of QOL according to gender and the grade of long-term care services, and Spearman's correlation was used for each variable. The effects of physical and mental functioning for QOL were assessed by covariance structure analysis. The statistical significance was set at p<0.05. RESULTS: The mean scores of QOL among all the subjects was 55.4 +/- 15.62 (Grade I: 49.7 +/- 14.17, Grade II: 56.8 +/- 14.62, Grade III: 59.4+/-16.36), and it was lower according to the higher grade of long-term care insurance. In terms of the correlation matrix of the QOL and the physical and mental function factors, the QOL showed positive correlation with the ADL, IADL and MMSE-K, while it had negative correlation with depression. On the analysis of covariance, mental functioning (depression and the MMSE-K) had a greater influence on the level of QOL than the physical functioning (ADL and IADL). CONCLUSIONS: The level of the QOL in the elderly people who were admitted from long-term care insurance was lower according to higher the grade of long-term care insurance. Also, the mental functioning (depression and MMSE-K) was more influential on the level of the QOL than the physical functioning (ADL and IADL).

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Research Support, Non-U.S. Gov't

Associations of Income and Wealth with Health Status in the Korean Elderly.: Bo Hyun Park, Minsoo Jung, Tae Jin Lee; J Prev Med Public Health. 2009;42(5):275-282.; DOI: https://doi.org/10.3961/jpmph.2009.42.5.275

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OBJECTIVES
This study aimed to verify the association between wealth or income level and health status after adjusting for other socio-economic position (SEP) indicators among Korean adults aged 45 and over. METHODS: Data were obtained from the 1st wave of Korean Longitudinal Study of Ageing (households: 6,171, persons: 10,254). We used self-rated health status and activities of daily living (ADLs) as dependent variables. Explanatory variables included both net wealth measured by savings, immovables, the other valuated assets and total income including pay, transfer, property and so on. Binary logistic regression was conducted to examine the relationships. Also, in order to determine the relative health inequality across economic groups, we estimated the relative index of inequality (RII). RESULTS: The inequality of health status was evident among various wealth and income groups. The wealthiest group (5th quintile) was much healthier than the poorest group, and this differential increased with age. Likewise, higher income was associated with better health status among the elderly. However, these effects, as measured by the odds ratio and RII, showed that wealth was more important in determining health status of elderly people. CONCLUSIONS: This study suggests that economic capability plays a significant role in determining the health status and other health-related problems among the elderly. Particularly, our results show that health status of the aged is related more closely to the individual's wealth than income.

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English Abstracts

The Impact of Socioeconomic Factors on the Gender Differences of Disability and Subjective Health Among Elderly Koreans.: Gyeong Suk Jeon, Soong Nang Jang, Seon Ja Rhee; J Prev Med Public Health. 2009;42(3):199-207.; DOI: https://doi.org/10.3961/jpmph.2009.42.3.199

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Abstract PDF

OBJECTIVES
Research on the gender differences of health among older Korean people has been limited compared with the research for other stages of life. This study first examined the patterns and magnitude of the gender differences of health in later life. Second, we examined the gender differences in the health of older men and women that were attributable to differing socioeconomic conditions. METHODS: Using the nationally representative 2005 Korean National Health and Nutrition Examination Survey, the gender differences in disability and subjective poor health were assessed by calculating the age adjusted and gender-specific prevalence. Logistic regression analyses were used to assess if the differences between the men and women for health could be explained by differential exposure to socioeconomic factors and/or the differential vulnerability of men and women to these socioeconomic factors. RESULTS: Our results indicated that older women were more likely than the men to report disability and poor subjective health. The health disadvantage of older women was diminished by differential experiences with socioeconomic factors, and especially education. The differences shrink as much as 43.7% in the case of disability and 35.4% in the case of poor subjective health by the differential exposure to educational attainment. Any differential vulnerability to socioeconomic factors was not found between the men and women, which means that socioeconomic factors may have similar effect on health in both genders. CONCLUSIONS: Differential socioeconomic experience and exposure between the men and women might cause gender difference in health in old age Koreans.

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Jeong Lee, Kyungwon Choi, Gyeong-Suk Jeon
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Predictive Model for Quality of Life of the Older Men Living Alone
Su Jin Kim, Gyeong-Suk Jeon
Journal of Korean Academy of Nursing.2020; 50(6): 799. CrossRef
Care inequality: care received according to gender, marital status, and socioeconomic status among Korean older adults with disability
Soong-nang Jang, Ichiro Kawachi
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The effects of medication adherence and health literacy on health‐related quality of life in older people with hypertension
Nam Hee Park, Mi Sook Song, So Young Shin, Ji‐hye Jeong, Hyo Young Lee
International Journal of Older People Nursing.2018;[Epub] CrossRef
Socioeconomic and Social Support Factors of Malnutrition among Korean Elderly in the Community
Su-Jin Kim, Gyeong-Suk Jeon
The Korean Journal of Health Service Management.2017; 11(3): 79. CrossRef
Activities of Daily Living, Depression, and Self-rated Health and Related Factors in Korean Elderly: Focused on Socioeconomic Status and Family Support
Seieun Oh, Young Ko
Journal of Korean Academy of Community Health Nursing.2015; 26(2): 140. CrossRef
Perceived Health, Life Satisfaction, and Cardiovascular Risk Factors Among Elderly Korean Immigrants and Elderly Koreans
Mo-Kyung Sin, Young-Ran Chae, Myoung-Ae Choe, Patrick Murphy, Jeungim Kim, Mi-Yang Jeon
Journal of Gerontological Nursing.2011; 37(3): 43. CrossRef
Analysis for the Impact of Adulthood and Childhood Socioeconomic Positions and Intergenerational Social Mobility on Adulthood Health
Jae-Hee Seo, Ho Kim, Young-Jeon Shin
Journal of Preventive Medicine and Public Health.2010; 43(2): 138. CrossRef
Trends in the Health Status of Older Koreans
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Effects of Long-term Fluoride in Drinking Water on Risks of Hip Fracture of the Elderly: An Ecologic Study Based on Database of Hospitalization Episodes.: Eun Young Park, Seung Sik Hwang, Jai Yong Kim, Soo Hun Cho; J Prev Med Public Health. 2008;41(3):147-152.; DOI: https://doi.org/10.3961/jpmph.2008.41.3.147

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OBJECTIVES
Fluoridation of drinking water is known to decrease dental caries, particularly in children. However, the effects of fluoridated water on bone over several decades are still in controversy. To assess the risk of hip fracture related to water fluoridation, we evaluated the hip fracture-related hospitalizations of the elderly between a fluoridated city and non-fluoridated cities in Korea. METHODS: Cheongju as a fluoridated area and Chungju, Chuncheon, Suwon, Wonju as non-fluoridated areas were chosen for the study. We established a database of hip fracture hospitalization episode based on the claims data submitted to the Health Insurance Review Agency from January 1995 to December 2002. The hip fracture hospitalization episodes that satisfied the conditions were those that occurred in patients over 65 years old, the injuries had a hip fracture code (ICD-9 820, ICD-10 S72) and the patients were hospitalized for at least 7days. A total of 80,558 cases of hip fracture hospitalization episodes were analyzed. RESULTS: The admission rates for hip fracture increased with the age of the men and women in both a fluoridated city and the non-fluoridated cities (p<0.01). The relative risk of hip fracture increased significantly both for men and women as their age increased. However, any difference in the hip fracture admission rates was not consistently observed between the fluoridated city and the nonfluoridated cities. CONCLUSIONS: We cannot conclude that fluoridation of drinking water increases the risk of hip fracture in the elderly.

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The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea
Naae Lee, Sungchan Kang, Woojoo Lee, Seung-sik Hwang
International Journal of Environmental Research and Public Health.2020; 17(24): 9170. CrossRef
Community water fluoridation and health outcomes in England: a cross‐sectional study
Nicholas Young, John Newton, John Morris, Joan Morris, John Langford, Jonathan Iloya, Diane Edwards, Semina Makhani, Julia Verne
Community Dentistry and Oral Epidemiology.2015; 43(6): 550. CrossRef
Exposure to Fluoride in Drinking Water and Hip Fracture Risk: A Meta-Analysis of Observational Studies
Xin-Hai Yin, Guang-Lei Huang, Du-Ren Lin, Cheng-Cheng Wan, Ya-Dong Wang, Ju-Kun Song, Ping Xu, Yi-Hsiang Hsu
PLOS ONE.2015; 10(5): e0126488. CrossRef
Effects of Life-long Fluoride Intake on Bone Measures of Adolescents
S.M. Levy, J.J. Warren, K. Phipps, E. Letuchy, B. Broffitt, J. Eichenberger-Gilmore, T.L. Burns, G. Kavand, K.F. Janz, J.C. Torner, C.A. Pauley
Journal of Dental Research.2014; 93(4): 353. CrossRef

Cohort Study on the Association between Alcohol Consumption and the Risk of Colorectal Cancer in the Korean Elderly.: Hoi Jeong Lim, Byung Joo Park; J Prev Med Public Health. 2008;41(1):23-29.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.23

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OBJECTIVES
We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. METHODS: The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. RESULTS: After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. CONCLSIONS: There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.

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Sex difference in alcohol consumption associated with colorectal cancer risk in Quzhou, China: A nested case-control study
Shi-Ming Lai, Hong-Hong Zhu, Zhi-Juan Gan, Bi-Yun Zheng, Zhao-Hui Xu, Zhi-Cheng Wang, Xiao-Fang Liao
Preventive Medicine Reports.2024; 44: 102807. CrossRef
Wine consumption and colorectal cancer risk: a meta-analysis of observational studies
Weisong Xu, Hui Fan, Zhijuan Han, Yufeng Liu, Yiping Wang, Zhenming Ge
European Journal of Cancer Prevention.2019; 28(3): 151. CrossRef
Marital status and education as risk factors for colorectal cancer
A. Ruseva, D. Tochev, Z. Boneva, Y. Assyov, L. Georgieva, D. Nikolovska
Trakia Journal of Sciences.2019; 17(3): 224. CrossRef
Consumption of beer and colorectal cancer incidence: a meta-analysis of observational studies
Cheng Zhang, Min Zhong
Cancer Causes & Control.2015; 26(4): 549. CrossRef
Alcohol Drinking, Cigarette Smoking and Risk of Colorectal Cancer in the Korean Multi-center Cancer Cohort
Sooyoung Cho, Aesun Shin, Sue K. Park, Hai-Rim Shin, Soung-Hoon Chang, Keun-Young Yoo
Journal of Cancer Prevention.2015; 20(2): 147. CrossRef
The relationship between mild alcohol consumption and mortality in Koreans: a systematic review and meta-analysis
Ji-Eun Park, Tae-young Choi, Yeonhee Ryu, Sung-Il Cho
BMC Public Health.2015;[Epub] CrossRef
Attributable fraction of alcohol consumption on cancer using population-based nationwide cancer incidence and mortality data in the Republic of Korea
Sohee Park, Hai-Rim Shin, Boram Lee, Aesun Shin, Kyu-Won Jung, Duk-Hee Lee, Sun Ha Jee, Sung-Il Cho, Sue Kyung Park, Mathieu Boniol, Paolo Boffetta, Elisabete Weiderpass
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Alcohol drinking and colorectal cancer risk: an overall and dose–response meta-analysis of published studies
V. Fedirko, I. Tramacere, V. Bagnardi, M. Rota, L. Scotti, F. Islami, E. Negri, K. Straif, I. Romieu, C. La Vecchia, P. Boffetta, M. Jenab
Annals of Oncology.2011; 22(9): 1958. CrossRef
Alcohol intake and risk of colorectal cancer: Results from the UK Dietary Cohort Consortium
J Y Park, C C Dahm, R H Keogh, P N Mitrou, B J Cairns, D C Greenwood, E A Spencer, I S Fentiman, M J Shipley, E J Brunner, J E Cade, V J Burley, G D Mishra, D Kuh, A M Stephen, I R White, R N Luben, A A Mulligan, K-T Khaw, S A Rodwell
British Journal of Cancer.2010; 103(5): 747. CrossRef
Alcohol Consumption and Digestive Cancer Mortality in Koreans: The Kangwha Cohort Study
Sang-Wook Yi, Jae Woong Sull, John Alderman Linton, Chung Mo Nam, Heechoul Ohrr
Journal of Epidemiology.2010; 20(3): 204. CrossRef
Baseline alcohol consumption, type of alcoholic beverage and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition-Norfolk study
Jin Young Park, Panagiota N. Mitrou, Christina C. Dahm, Robert N. Luben, Nicholas J. Wareham, Kay-Tee Khaw, Sheila A. Rodwell
Cancer Epidemiology.2009; 33(5): 347. CrossRef
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Huan Yang, Yanhong Zhou, Ziyuan Zhou, Jinyi Liu, Xiaoyan Yuan, Ketaro Matsuo, Toshiro Takezaki, Kazuo Tajima, Jia Cao
Cancer Epidemiology, Biomarkers & Prevention.2009; 18(9): 2522. CrossRef

Certificate Education for Geriatric Physician: Satisfaction and Feasibility.: Sung Chun Lee, Hwa Joon Kim, Hyung Joon Park, Jong Lull Yun, Chang Yup Kim, Ok Ryun Moon, Soong Nang Jang; J Prev Med Public Health. 2008;41(1):10-16.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.10

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OBJECTIVES
Korea faces a number of challenges to meet demands in the area of geriatric professional medicine in a country with a rapidly ageing population. We evaluated the satisfaction and feasibility of the current education certification for geriatric physicians. METHODS: Geriatric physicians who were deemed qualified by the Korean Geriatrics Society during the period of 2001 to 2005 (n=2,200) were asked to complete structured questionnaires sent to them by mail about their satisfaction of and need for certificates of education, as well as their opinions on their geriatric specialty training. A total of 419 physicians responded. Descriptive analysis and hierarchical regression were performed to rate the respondents.satisfaction, the characteristics of the need for clarity and utility in education certification, and the characteristics of their patients. RESULTS: Although most respondents were satisfied with their education certification, those who had more elderly patients, aged 65 or older, and those who had more cognitively impaired patients, rated their education as significantly lower than did other physicians. Both groups expressed the need for more the comprehensive care and assessment concerning of their education. Multiple regression analysis indicated that satisfaction with geriatric physician qualification was associated with a physician's age, specialty, and percentage of elderly patients. CONCLSIONS: This study suggests that the current system of education certification is limited in terms of feasibility and physician satisfaction.

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Is socioeconomic disparity in disability improving among Korean elders?
Soong-Nang Jang, Sung-il Cho, Ichiro Kawachi
Social Science & Medicine.2010; 71(2): 282. CrossRef

Socioeconomic Inequalities in Preventive Services among the Elderly: Results from Medical Checkup, Cancer Check, and BP Check.: Heeran Chun, Il Ho Kim; J Prev Med Public Health. 2007;40(5):404-410.; DOI: https://doi.org/10.3961/jpmph.2007.40.5.404

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OBJECTIVES
Due to the assumptions of homogeneity as well as challenges in the socioeconomic position of the elderly, they have been relatively neglected in studies of health inequalities. Therefore, this study was conducted to investigate the social inequalities in preventive services among elderly men and women. METHODS: Data were obtained from a nationally representative sample of 342 men and 525 women aged 65 and over collected during the 2001 National Health and Nutrition Examination Survey. Age adjusted proportions and logistic regression were used to identify the social patterning of preventive services among elderly Koreans using various social position indicators. RESULTS: The findings of this study generally supported the presence of social gradients in preventive services among the Korean elderly. The likelihood of using the service becomes progressively higher with social position. Educational level, income, and self-rated living status were significantly associated with increased medical checkups and cancer checks. In addition, logistic regression detected educational inequalities only among older women receiving BP checks. After being stratified based on health status and chronic disease status, social disparities still existed when educational level and self-rated living status were considered. Among unhealthy individuals, place of residence was observed as a barrier to medical checkups. CONCLUSIONS: This study demonstrated strong and consistent associations between socioeconomic position and preventive services among the elderly in Korea. The results indicate that public health strategies should be developed to reduce the barriers to preventive services encountered by the elderly.

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Esther Priscilla Biamah Danquah, Samuel Agyei Agyemang, Samuel Amon, Moses Aikins
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Factors Affecting Cancer Screening Behavior in the Elderly : Based on Andersen's Model and Health Belief Model
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The Korean Journal of Rehabilitation Nursing.2020; 23(1): 58. CrossRef
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Huisu Eom, Jun-Pyo Myong, Eun-A Kim, Bohwa Choi, Soon Woo Park, Young Joong Kang
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Xi Sun, Yingchun Chen, Xuetao Tong, Zhanchun Feng, Li Wei, Donghua Zhou, Miaomiao Tian, Benyan Lv, Da Feng
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Quality of Life and its Associated Factors among Some Elderly Residents Using a Hall for the Aged in a Community.: Jin Young Lim, Jong Park, Myeong Geun Kang, So Yeon Ryu; J Prev Med Public Health. 2007;40(5):337-344.; DOI: https://doi.org/10.3961/jpmph.2007.40.5.337

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OBJECTIVES
This study was performed to investigate the level of quality of life (QOL) and to identify its related factors among the elderly using a hall for the aged. METHODS: The study subjects were 350 elderly people living in Nam Gu, Gwangju City. They were interviewed by questionnaire to collect information on social-demographic characteristics, health behaviors, health-related characteristics and QOL. We used statistical analysis methods such as T-test, ANOVA and multiple regression analysis to find which factors affected QOL. RESULTS: The characteristics relating to physical functions were as follows: presence of spouse, education, alcohol drinking, teeth condition, arthritis, frequency of visiting the hall for the aged, and depression. Age, arthritis and depression were significantly related to role limitation due to physical problems. General health was related to gender, age, and depression, and vitality was related to education, frequency of visiting the hall, and depression. Role limitation due to emotional problems was related to age and depression, and mental health was related to age, hypertension, arthritis and depression. CONCLUSIONS: This study showed QOL of the elderly was significantly influenced by socio-demographic factors, and physical or emotional conditions. To improve QOL of the elderly, we need to develop programs to promote health and to manage chronic diseases of the elderly.

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Original Articles

Medical Service Utilization and Trends among Korean Elderly in the Last One Year of Life.: Jee Jeon Yi, Ki Soon Park, Seung Hum Yu, Jeong In Kim, Jae Yong Park, Wang Kun Yoo, Sang Wook Yi; Korean J Prev Med. 2003;36(4):325-331.

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Abstract PDF: OBJECTIVES
To analyze medical service utilization and trends among the elderly in the last year of life. METHOD: The subjects of this study were people that had died at the age sixty-five and above between January 1st and June 30th 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. RESULTS: In the first half of 2000, 84.2% of the funeral-expenses-receivers (53, 063) utilized medical services during the year prior to their death; 51.0% (27, 042) were female and 49.0% (26, 021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3, 107, 935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. CONCLUSIONS: This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.; Summary

Physical Activity and Hip Fracture in Elderly People: A Cohort Study in Korea.: Kyung Eun Youn, Seung Mi Lee, Yooni Kim, Byung Joo Park; Korean J Prev Med. 2002;35(4):351-358.

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Abstract PDF: OBJECTIVE
To evaluate the relationship between physical activity and the risk of hip fracture in the elderly Korean people. METHODS: The study population was a Physical Activity Subcohort (n=8,908) extracted from the Korean Elderly Pharmacoepidemiological Cohort (KEPEC). Physical activity information was obtained from a mailed questionnaire surveys. The outcome data was collected from claims data gathered between Jan. 1993 and Dec. 1998. A hospital survey relating to potential cases was conducted to confirm the final diagnoses. The abstracted data was reviewed by a medical doctor before the final diagnoses were confirmed. A mailing questionnaire survey was performed to obtain information on potentially confounding variables, including alcohol intake, smoking habits, weight, height and postmenopausal duration. There were 79 confirmed cases hospitalized due to hip fractures between Jan. 1993 and Dec. 1998. Relative risk of physical activity scores on the hip fracture, and their 95% confidence intervals, were estimated by a Cox's proportional hazard model using SAS for Windows ver. 6.12. RESUJLTS: Compared to the reference group, the adjusted relative risk of hip fracture associated with the most physical active category; after controlling for age, weight and alcohol intake in the males, and for weight, alcohol intake and postmenopausal duration in the females, were 1.04 (95% CI=0.35-3.06) and 0.44 (95% CI=0.26-0.77), respectively. CONCLUSIONS: Physical activity may protect elderly women from hip fracture.; Summary

Reproductive History and Hip Fracture in the Elderly Women in Korea: A Cohort Study.: Seung Mi Lee, Yooni Kim, Koung Eun Youn, Byung Joo Park; Korean J Prev Med. 2002;35(4):305-312.

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Abstract PDF: OBJECTIVES
The reproductive history of women has been suggested to have a possible influence on the risk of osteoporotic fractures. The purpose of this study was to assess the association between reproductive history and hip fractures in the elderly women. METHODS: The study subjects were drawn from women members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, whose reproductive histories were available, and who were beneficiaries of the Korea Medical Insurance Corporation (KMIC) in 1993 and lived in Busan city, Korea. The information on reproductive histories, and possible confounders, were collected from mailed questionnaires. Potential hip fracture cases were collected from the claims data obtained between 1993 and 1998, with a hospital survey conducted to confirm the final diagnoses. Rate ratios and their 95% confidence intervals, were calculated using a Cox's proportional hazard model. RESUJLTS: Following up 5,219 women for 6 years, 51 cases were confirmed with hip fractures. When adjusted for age, weight and physical activity, the rate ratio of hip fractures in women who had given birth three or more times was 0.56 (95% CI: 0.25 - 1.25), compared with those who had given birth two or less times. When adjusted for age, number of births, weight and physical activity, the rate ratio in women who first gave birth when younger than 22 years was 0.60 (95% CI: 0.34 - 1.08) compared with those who had giving birth at 22 years or older. CONCLUSIONS: According to these findings, an early age when first giving birth might decrease the risk of hip fractures in elderly Korean women.; Summary

H2 Receptor Antagonists and Gastric Cancer in the Elderly: A Nested Case-Control Study.: Yooni Kim, Dae Seog Heo, Seung Mi Lee, Kyoung Eun Youn, Hye Won Koo, Jong Myon Bae, Byoung Joo Park; Korean J Prev Med. 2002;35(3):245-254.

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Abstract PDF: OBJECTIVE
To test if the intake of H2 receptor antagonists (H2-RAs) increases the risk of gastric cancer in the elderly. METHODS: The source population for this study was drawn from the responders to a questionnaire survey administered to the Korea Elderly Pharmacoepidemiological Cohort (KEPEC), who were beneficiaries of the Korean Medical Insurance Corporation, were at least 65 years old, and residing in Busan in 1993. The information on H2-RAs exposure was obtained from a drug prescription database compiled between Jan. 1993 and Dec. 1994. The cases consisted of 76 gastric cancer patients, as confirmed from the KMIC claims data, the National Cancer Registry and the Busan Cancer Registry. The follow-up period was from Jan. 1993 to Dec. 1998. Cancer free controls were randomly selected by 1:4 individual matching, which took in to consideration the year of birth and gender. Information on confounders was collected by a mail questionnaire survey. The odds ratios, and their 95% confidence intervals, were calculated using a conditional logistic regression model. RESULTS: After adjusting for a history of gastric ulcer symptoms, medication history, and body mass index, the adjusted OR (aOR) was 4.6 (95% CI=1.72-12.49). The odds ratio of long term use (more than 7 days) was 2.3 (95% CI=1.07-4.82). The odds ratio of short term use was 4.6 (95% CI=1.26-16.50). The odds ratio of parenteral use was 4.4 (95% CI=1.16-17.05) and combination use between the oral and parenteral routes (aOR, 16.8; 95% CI=1.21-233.24) had the high risk of gastric cancer. The aOR of cimetidine was 1.7 (95% CI=1.04-2.95). The aOR of ranitidine was 2.0 (95% CI=1.21-3.40). The aOR of famotidine was 1.7 (95% CI=0.98-2.80). CONCLUSION: The intake of H2-RAs might increase the risk of gastric cancer through achlorhydria in the elderly.; Summary

An Approach to Survey Data with Nonresponse: Evaluation of KEPEC Data with BMI.: Jieun Baek, Weechang Kang, Youngjo Lee, Byung Joo Park; Korean J Prev Med. 2002;35(2):136-140.

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Abstract PDF: OBJECTIVES
A common problem with analyzing survey data involves incomplete data with either a nonresponse or missing data. The mail questionnaire survey conducted for collecting lifestyle variables on the members of the Korean Elderly Phamacoepidemiologic Cohort(KEPEC) in 1996 contains some nonresponse or missing data. The proper statistical method was applied to evaluate the missing pattern of a specific KEPEC data, which had no missing data in the independent variable and missing data in the response variable, BMI. METHODS: The number of study subjects was 8,689 elderly people. Initially, the BMI and significant variables that influenced the BMI were categorized. After fitting the log-linear model, the probabilities of the people on each category were estimated. The EM algorithm was implemented using a log-linear model to determine the missing mechanism causing the nonresponse. RESULTS: Age, smoking status, and a preference of spicy hot food were chosen as variables that influenced the BMI. As a result of fitting the nonignorable and ignorable nonresponse log-linear model considering these variables, the difference in the deviance in these two models was 0.0034(df=1). CONCLUSION: There is a lot of risk if an inference regarding the variables and large samples is made without considering the pattern of missing data. On the basis of these results, the missing data occurring in the BMI is the ignorable nonresponse. Therefore, when analyzing the BMI in KEPEC data, the inference can be made about the data without considering the missing data.; Summary

Drug Utilization Review of Antiulcerative Agents in Korean Elderly Inpatients.: Wonsik Lee, Seung Mi Lee, Hye Won Koo, Byung Joo Park; Korean J Prev Med. 2002;35(1):41-48.

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Abstract PDF: OBJECTIVES
To review the drug prescription pattern of antiulcerative agents for elderly inpatients. METHODS: The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1994. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription. Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. RESULTS: The number of patients prescribed antiulcerative agents was 1,059 (64.9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by H2 antagonist (16.0%). Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the total omeprazole prescriptions. CONCLUSIONS: Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulcerative agents.; Summary

Factors Influencing the Intention of Admission into a Charged Nursing Home for the Elderly.: Jin Ho Chun, Young Soon Yoo, Eun Hi Cho, Byung Chul Yu, Ki Won Jeong, Sang Hwa Urm, Sung Jun Kim; Korean J Prev Med. 2001;34(1):1-8.

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Abstract PDF: OBJECTIVES
To gather information about the factors which influence the interest and intention of admission into charging nursing homes for the elderly(CNH), as these homes represent an important method for resolving the problems related to the rapid population aging occurring in Korea. METHODS: A face-to-face interview survey was carried out with 328(men 159, women 169) patients over 60 years old who were admitted at 2 university hospitals and 5 general hospitals in the Busan area between December 1998 and March 1999. Data were analyzed through t-test, ANOVA, correlation and multiple regression analysis. microgram/g RESULTS: The mean age and years of education of the study population was 67.8 and 7.7 years, and the types of chronic degenerative disease included musculoskeletal disorders(20.1%), cerebrovascular disease(17.1%), and diabetes(14.3%). The major forms of household living arrangement prior to admission were elderly alone(22.6%), and elderly couple(33.5%), while about half of them(55.5%) didn't want to live with their children in the future. Almost half were paying medication fees by themselves(46.6%). The level of actual intention of admission(3.07+/-1.39) into a CNH was lower than that of interest(3.22+/-1.33)(p<0.01). Multiple analysis revealed that the intention of admission increased with decreasing number of future supportive persons(beta=0.107), lower level of activity in daily life(beta=0.447), and longer years of education(beta=0.447) with 32.7% of R2. As for the factors which determined the admission into a CNH, the fee and facilities were considered to be most important, and professional nursing and physician's care were the most desired services. In nomenclature, they preferred "elderly hospital" or "elderly health center" to CNH. CONCLUSIONS: Interest in CNH is increasing recently, but existing studies about patient experiences in CHN are still limited. This study may form a basis for future examinations of the needs and uses for CNH. Active financial support and public information are considered by the authors to be important factors for the induction of welfare services for the elderly, through CNH.; Summary

Association between Cognitive Impairment and ADL of the Elderly in Rural Area.: Sang Kyu Kim, Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 1999;32(1):65-71.

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Abstract PDF: OBJECTIVES
The purpose of this investigation was to study the correlation between cognitive impairment and activities of daily living(ADL) in the elderly of rural area. METHODS: The study population consisted of 210 elderly people aged 65 years and older, living in a district of Kyongju City. The cognitive impairment was measured with the Korean version of mini-mental state examination(MMSE-K) and newly constructed the Korean version of mini-mental state examination (K-MMSE). Bristol activities of daily living scale developed specifically to be used with people with dementia was used to measure ADL. RESULTS: The mean scores of both MMSE-K and K-MMSE were significantly different by sex groups and by age groups, respectively(p<0.05). The mean scores of ADL were significantly different by age groups(p<0.01) not by sex groups. Among the 4 components of ADL(instrumental activities of daily living(IADL), self care, orientation, and mobility), the mean score of the orientation was significantly higher in men(p<0.01); and IADL, orientation and mobility components were significantly different by age groups(p<0.01). ADL correlated well with MMSE-K (r=0.54) and K-MMSE(r=0.52) and showed higher correlation in female (r=0.73, 0.71) than male(r=0.27, 0.29). IADL and orientation showed significant correlation with MMSE-K(r=0.52, 0.62) and K-MMSE(r=0.50, 0.63), respectively(p<0.01). CONCLUSIONS: In developing and establishing a care model for people with dementia in the community, both cognitive impairment and the activities of daily living(ADL) need to be considered.; Summary

The comparison of health-related quality of life between the institutional elderly and the community living elderly.: Kyeong Soo Park, Yong Gil Seo, Hae Sung Nam, Seok Joon Sohn, Jung Ae Rhee; Korean J Prev Med. 1998;31(2):293-309.

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Abstract PDF: The purpose of this study is to compare the level of health-related quality of life and relating factor between institutional elderly and community living elderly. The subjects were 390 from Sanatorium or Nursing home and 467 from the community, in Kwangju. The results are followed : l) A comparison of ADL between two groups, institutional elderly and community living elderly, resulted in that community elderly were more significantly independent in the areas of bathing and transfer than institutional elderly. 2) A comparison of IADL between two groups resulted in that ; Community elderly, were more independent in the areas of using telephone and transportation, food preparation, house keeping, and doing laundry. Institutional elderly were more independent in the area of handling finances. 3) In the case of poor health-related quality of life, institutional elderly showed 2.4 times in the dimension of physical fitness, l.8 times in daily activity, 2 times in social activity, 2 times in pain, 26.7 times in social support, and 0.4 times in subjective quality of life higher than community elderly. There was no significant differences in the rest of dimensions. 4) In institutional elderly, the analysis of variables related to the health-related quality, of life resulted in that; The relating factors were sex, education, and chronic illness in the dimension of physical function. Direct contact with family or significant others in the dimension of social activity. Chronic illness in the dimension of pain and perceived health status. Direct or indirect contact with family or significant others over the phone or through letters in the dimension of social support. 5) The analysis of variables relatd to the health-related quality of life showed that community elderly has more relating variables in each area than institutional elderly. The relating factors were age, sex, and chronic illness in the dimension of physical function. Education and chronic illness in the dimension of emotional status. Age and chronic illness in the dimension of daily activity and social activity. Education and chronic illness in the dimension of pain and perceived health status. Sex, education, family size in the dimension of social support. Education and chronic illness in the dimension of subjective quality-of-life. Throughout general daily activity, community elderly showed more satisfactory results than institutional elderly, but in the subjective area of health-related quality of life, such as subjective quality of life, institutional elderly, group showed more positive results. And community elderly had more relating factors than institutional elderly. For the health care of the elderly that focused on quality, of life, new approaches considering the characteristics of both group, institutional and community, living elderly, are needed.; Summary

Reliability and validity study of a life style questionnaire for elderly people.: Byiung Joo Park, Dae Sung Kim, Hye Won Koo, Jong Myon Bae; Korean J Prev Med. 1998;31(1):49-58.

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Abstract PDF: The study was done to determine the reliability and validity of a life style questionnaire for the elderly. The questionnaires were sent to 16,524 elderly people who were beneficiaries of Korean Medical Insurance Corporation in Pusan. Among the completed 9,139 questionnaires, 200 were randomly sampled and retested. Finally, 110 duplicates were collected. Weighted kappa-value and Pearson correlation coefficients were estimated to measure the reliability. Validity coefficient was estimated by using reliability coefficient. In self-self responses, reliability coefficients of the most of items were over 0.6 except some physical activity related item. Relatively high reliability was observed in smoking, alcohol related items and anthropometric items. In self-proxy responses, most of the physical activity related items were found to be less reliable than self-self responses. Smoking and alcohol related items were consistently reliable. Male showed higher validity in food related item than female. On the other hand, some of the physical activity related items and smoking and alcohol related items were less valid in male than female. With regard to bias of proxy respondents, offsprings tended to underestimate the frequency of 'house cleaning' and 'kitchen work' and overestimate the height of them. In conclusion, the life style questionnaire was found to be reliable in the most of items. But, some items related with physical activity were found to be somewhat less reliable. Sexual difference on the validity was identified in some items. With regard to bias of proxy respondents, offsprings tended to have bias in part of items of housework and anthropometry.; Summary

The Relationship between the Cognitive Impairment and Mortality in the Rural Elderly.: Byung Hwan Sun, Kyeong Soo Park, Baeg Ju Na, Yo Seop Park, Hae Sung Nam, Jun Ho Shin, Seok Joon Sohn, Jung Ae Rhee; Korean J Prev Med. 1997;30(3):630-642.

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Abstract PDF: The purpose of this study was to examine the mortality risk associated with cognitive impairment among the rural elderly. The subjective of study was 558 of 'A Study on the Depression and Cognitive Impairment in the Rural Elderly' of Jung Ae Rhee and Hyang Gyun Jung's study(1993). Cognitive impairment and other social and health factors were assessed in 558 elderly rural community residents. For this study, a Korean version of the Mini-Mental State Examination(MMSEK) was used as a global indicator of cognitive functioning. And mortality risk factors for each cognitive impairment subgroup were identified by univariate and multivariate Cox regression analysis. At baseline 22.6% of the sample were mildly impaired and 14.2% were severely impaired. As the age increased, the cognitive function was more impaired. Sexual difference was existed in the cognitive function level. Also the variables such as smoking habits, physical disorders had the significant relationship with cognitive function impairment. Across a 3-year observation period the mortality rate was 8.5% for the cognitively unimpaired, 11.1% for the mildly impaired, and 16.5% for the severly impaired respondents. And the survival probability was .92 for the cognitively unimpaired, .90 for the mildly impaired, and .86 for the severly impaired respondents. Compared to survival curve for the cognitively unimpaired group, each survival curve for the mildly and the severely impaired group was not significantly different. When adjustments models were not made for the effects of other health and social covariates, each hazard ratio of death of mildly and severely impaired persons was not significantly different as compared with the cognitively unimpaired. But, as MMSEK score increased, significantly hazard ratio of death decreased. Employing Cox univariate proportional hazards model, statistically other significant variables were age, monthly income, smoking habits, physical disorders. Also when adjustments were made for the effects of other health and social covariates, there was no difference in hazard ratio of death between those with severe or mild impairment and unimpaired persons. And as MMSEK score increased, significantly hazard ratio of death did not decrease. Employing Cox multivariate proportional hazards model, statistically other significant variables were age, monthly income, physical disorders. Employing Cox multivariate proportional hazards model by sex, at men and women statistically significant variable was only age. For both men and women, also cognitive impairment was not a significant risk factor. Other investigators have found that cognitive impairment is a significant predictor of mortality. But we didn't find that it is a significant predictor of mortality. Even though the conclusions of our study were not related to cognitive impairment and mortality, early detection of impaired cognition and attention to associated health problems could improve the quality of life of these older adults and perhaps extend their survival.; Summary

Trend of Medical Care Utilization and Medical Expenditure of the Elderly Cohort.: Kyeong Soo Lee, Pock Soo Kang; Korean J Prev Med. 1997;30(2):437-461.

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Abstract PDF: Because of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 30 years, the life expectancy of the Korean people has lengthened considerably and as a result, the number of the elderly has markedly increased. Such an increase of the number of aged population brought about many social, economic, and medical problems which were never seriously considered before. This study was conducted to assess the trend of medical care utilization and medical expenditure of the elderly. The data of each patient in the study were taken from computer database maintained for administrative purpose by the Korea Medical Insurance Corporation. The study population was 132,670 who were 60 years old or more and registered in Korean Medical Insurance Corporation from 1989 to 1993. The study subjects were predominantly female(56.3%) and 10,000-20,000 Won premium group(50.6%). The following are summaries of findings : The total increase of the number of inpatient cases was 40.5% from 1989 through 1993. The average annual increase was 3.7% in inpatient medical expenditures per case, 4.4% in inpatient medical expenditures per day and 0.08% in length of stay per case from 1989 through 1993. Cataract was the most prevalent disease of 10 leading frequent diseases in all ages from 1989 through 1993. The case mix in 1993 compared to 1989 revealed that cataract and ischemic cerebral disease were increased whereas essential hypertension and pulmonary tuberculosis were decreased. The average annual increase of medical expenditures was 3.8% in general hospitals, 6.3% in hospitals and 2.4% in clinics. From 1989 through 1993, medical expenditures used by high-cost patients accounted for about 14% to 20% of all expenditures for inpatient care, while they represented less than 2.5% of the elderly population. Time series analysis revealed that total medical expenditures and doctor's fee for inpatient will be progressively increased whereas drug expenditures for inpatient will be decreased. And there will be no change in length of stay. Based on the above results, the factors increasing medical cost and utilization should be identified and the method of cost containment for the elderly health care should be developed systematically.; Summary

The Study of Body Fat Percent Measured by Bioelectric Impedance Analyzer in a Rural Adult Population.: Baeg Ju Na, Yo Sub Park, Byung Hwan Sun, Hae Sung Nam, Jun Ho Shin, Seok Joon Sohn, Jin Su Choi; Korean J Prev Med. 1997;30(1):31-44.

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Abstract PDF: Obesity usually is defined as the presence of and abnormally amount of adipose tissue. In many epidemiologic study, obesity as a health risk factor has been estimated by Body Mass Index(BMI) in general. This study was conducted to review of body fat percent measured by Bioelectric impedance analyzer as a estimator of obesity in a rural adult population. The study subjects were 421 men and 664 women who reside in the area on the Juam lake. They were sampled by multistage cluster sampling. Their mean age was 59 years old. Body fat percent increased with age, but BMI decreased with age in this study. Body fat percent was more larger at female and elder on the same BMI. The correlation coefficient between with body fat percent and body mass index was low (r=0.4737). Body fat percent was explained by not only BMI but also sex and age (r(2)=0.63). The result suggested that it is inadequate for BMI only to estimate obesity about elderly person who reside in the rural community. The relation of body fat percent and body mass index of this study agreed with the preceding knowledges and studies in general.; Summary

A Study on the Factors related to the Cognitive Impairment of the Elderly in a Rural Area.: Kwang Wook Koh, Byung Mann Cho, Su lll Lee, Don Kyoun Kim, Bong Su Cho, Yeung Wook Kim, Young Sil Kim, Su Yong Kang; Korean J Prev Med. 1996;29(3):657-668.

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Abstract PDF: To investigate the factors which affecting the cognitive impairment of the 60 or more age group, the authors surveyed for the subjects in some area of Kyungnam Province. 201 studied subjects were tested for cognitive function with mini-mental state examination(MMSE). Information on demographic characteristics and life style has been collected through direct interview. The concentration of Al and Ca of subject's drinking water, which might be related with cognition, was measured by Inductively Coupled Argon Plasma Spectrometer. The main results were summarized as follows. 1. The prevalence rate of cognitive impairment was 18.4% in male and 45.2% in female and this sexual difference was statistically significant(p=0.03). And the uneducated or illiterated showed significantly high prevalence rate of cognitive impairment(p=0.02). 2. In stratified analysis by sex and education year, we can not see significant trend indicating the neurotoxic effects of aluminum and protective effects of calcium to the cognitive function(p>0.05). 3. The correlation between the concentration of aluminum in drinking water and the MMSE score in whole subjects showed weak negative relationship(r=-0.066). But there was no statistical significance(p=0.434).; Summary

A Study on Food Intake and Associated Factors of the Urban Poor Elderly.: Bong Soo Cho, Don Kyoun Kim, Su Ill Lee, Byung Mann Cho, Yeung Ook Kim, Kwang Wook Koh; Korean J Prev Med. 1995;28(1):59-72.

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Abstract PDF: This study was carried out to analyse the food intake and associated factors of the urban poor elderly by comparing poor district, Unbong rental apartment in Bonsong 2 dong with other areas in Pusan. 135 elderlies(men 36, women 99) in Unbong rental apartment 136 elderlies(men 45, women 91 ) in the other areas were investigated during the period of March to August in l994. The assumption that the study area represented poor district was satisfied because the age and sex distribution was not significantly different, and the income of the study area was significantly lower than that of the control area. The variables of hospitalized in previous 12 month, gastrointestinal problem, alcohol drinking, cigarette smoking did not differ significantly. But the variables of chronic disease, take medicine, perceive, vitamin supplement differed significantly between two groups. Therefore some factors associated with health state in the study area are worse than those of the control areas. At most of all variables, nutrients intake of the study area did not reach the recommended dietary allowances(RDA) for Koreans, and that nutrient intakes of the study area were significantly lower than those of the control area. The hypothesis of this study that nutrient status depends on economical status was proved. As for the score of nutritional knowledge, the study area was significantly lower than the control area. But as for the score of nutritional behavior, two areas were not significantly different. The latter is counter result of our hypothesis, owing to the effect of the confounding factors including education etc. As for the correlation of variables, not only economic status and educational level, but the score of nutritional knowledge effects strongly on nutrient status in the study area, the poor district. Therefore, adequate nutritional education to the elderly in the poor district should be considered.; Summary

An Analysis of Determinants of Elderly Medical Costs Inflation Using Deterministic Model.: Seung Hum Yu, Myong Sei Sohn, Eun Cheol Park; Korean J Prev Med. 1994;27(1):135-144.

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Abstract PDF: The purpose of this study compares determinants of eldery medical cost inflation with those of other age groups by analysing aggregated data with a deterministic model. The deterministic model of per capita medical cost inflation consists of increases in price, intensity of services, and medical utilization. We used a time series data (1985-1991) from National Medical Insurance and analyzed by age groups. In total population, the average increase rates of inpatient and outpatient medical costs were respectively 9.5% and 8.8% during 6 years and the major cause of inflation was the increase in service intensity in both of inpatient and outpatient cases. But in the population of 65 years old and over, the average increase rates of inpatient and outpatient medical costs were respectively 13.8% and 14.8% and the major cause of inflation was the increase in per-capita medical utilization in both of inpatient and outpatient cases. Also, the increase in service intensity of 65 years old and over was the highest of other age groups. This pattern was similar during study periods. we concluded that the level of medical cost inflation and the determinants in elderly was the highest-especially in per capita medical utilization, therefore, the inflation of medical costs in elderly will be higher than other age groups for the further in Korea.; Summary

A study on the depression and cognitive impairment in the rural elderly.: Jung Ae Rhee, Hyang Gyun Jung; Korean J Prev Med. 1993;26(3):412-429.

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Abstract PDF: For the purpose of promotion of mental health in the rural elderly, the author surveyed 558 elderlies aged 60 years or more, and assessed the prevalence rates of depression and cognitive impairment by using self-rating depression scale of Zung(SDS) and the Korean version of mini-mental state examination(MMSEK). Also the association between depression or cognitive function and socio-environmental factors were investigated. The major findings were as follows; 1. The prevalence rates of severe depression and cognitive impairment were 20.9% and 14.9% in all the elderly of both sexes, respectively. 2. The rates of depression and cognitive impairment increased with increasing age in both sex groups. The mean scores of SDS increased and the mean scores of MMSEK decreased significantly among them(P<0.01). 3. Those being female, widows or widowers, and those having low levels of physical activity, showed significantly high the mean scores of depression and had significantly low the mean scores of cognitive impairment(P<0.01). 4. The depression scores relating to decreased libido, confusion, psychomotor retardation, hopelessness and indecisiveness were relatively high in both sexes. 5. All the items of mini-mental state examination were significantly correlated with depression. 6. In stepwise multiple regression analysis on depression, MMSEK, level of physical activity, chronic disease, marital status and family income were selected as highly correlated variables, and the R2-value for these variables was 33.7%. 7. In stepwise multiple regression analysis on cognitive function, level of physical activity, age, depression, sex and marital status were selected as highly correlated variables, and the R2-value for these variables was 62.6%. The depression and cognitive impairment of the elderly were positively correlated with nearly all sociodemographic variables.; Summary

English Abstracts

Smoking and Colorectal Cancer Risk in the Korean Elderly.: Hwa Jung Kim, Seung Mi Lee, Nam Kyong Choi, Seon Ha Kim, Hong Ji Song, Yuong Kyun Cho, Byung Joo Park; J Prev Med Public Health. 2006;39(2):123-129.

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Abstract PDF: OBJECTIVES
The incidence of colorectal cancer increased greatly among the elderly in Korea, but the relationship between smoking and colon cancer remains controversial. Few studies have targeted Asian elderly people. We analyzed the smoking status, the amount smoked, and the smoking duration as risk factors of colorectal cancer to determine their association and causality. METHODS: The cohort members (n=14,103) consisted of 4,694 males and 9,409 females, and they were derived from the Korea Elderly Phamacepidemilogic Cohort (KEPEC), which was a population-based dynamic cohort. They were aged 65 years or more and they lived in Busan Metropolitan City between from 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). The baseline information was surveyed by a selfadministered mailed questionnaire; after 8.7 person-years of mean follow up period, 100 cases of colorectal cancer occurred. The adjusted relative ratio (aRR) of smoking status, the smoking amount and the smoking duration were calculated from the Cox's proportional hazard model with the never-smokers as a reference group and the Cox model controlled for age, gender, precancerous lesions of CRC, medication history of NSAIDs and antibiotics, the alcohol drinking status and BMI. RESULTS: Compared with the never smokers, the aRRs were 2.03 (95% CI=1.02-4.03) and 1.36 (95% CI=0.80-2.32) for the ex-smokers and current smokers, respectively. Statistical significant trends were not observed for the dose-relationship among the elderly, either for the mean daily amount smoked (p for trend=0.28) or for the total amount (p for trend=0.15). Still, the aRRs were 1.51 (95% CI=0.97-2.34) for the elderly who smoked less than 40 years and 2.35 (95% CI=1.16-4.74) for the elderly who had 40 years or more of smoking (p for trend=0.06). Smokers who started smoking before the age 20 had an increased aRR of 2.15 (95% CI=1.17-3.93) compared to the never smokers. CONCLUSIONS: After controlling for age, gender, precancerous lesion of CRC, medication history of NSAIDs and antibiotics, the alcohol drinking status and BMI, smoking increases the risk of colorectal cancer among elderly people. The age when starting smoking is also important.; Summary

Out-of-pocket Health Expenditures by Non-elderly and Elderly Persons in Korea.: Sung Gyeong Kim, Seung Hum Yu, Woong Sub Park, Woo Jin Chung; J Prev Med Public Health. 2005;38(4):408-414.

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Abstract PDF: OBJECTIVES
The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. METHODS: We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26, 154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. RESULTS: Out-of-pocket health expenditures for those people under the age of 65 averaged 14, 800 won per month, whereas expenditures for those people aged 65 and older averaged 27, 200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. CONCLUSIONS: The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and nonelderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.; Summary

Prevalence and Related Factors of Dementia in an Urban Elderly Population Using a New Screening Method.: Hee Young Shin, Eun Kyung Chung, Jung Ae Rhee, Jin Sang Yoon, Jae Min Kim; J Prev Med Public Health. 2005;38(3):351-358.

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Abstract PDF: OBJECTIVE
Dementia has rapidly increased with the prolongation of life expectancy and aging in Korea. This study was conducted to estimate the prevalence of, and find related factors for, dementia in an urban elderly population, using a newly developed screening method. METHODS: Seven hundred and six people, aged over 65 years-old, in Dong district of Gwangju, Korea, were recruited using stratified cluster sampling, and completed Korean version of Geriatric Mental State Schedule B3 (GMS B3-K), the Korean version of the Community Screening Interview for Dementia (CSID-K) and modified 10 word list-learning from the Consortium to Establish a Registry of Alzheimer's Disease (CERAD). Dementia was diagnosed by an algorithm derived from all three of these measures. RESULTS: The crude and age adjusted prevalence rates of dementia were 13.0 and 11.5%, respectively. Age, education, marital status and a history of cerebrovascular disease were identified as factors related with dementia. CONCLUSIONS: The new instrument, using the GMS B3-K, CSID-K and modified 10 word list-learning from the CERAD, was considered effective as a community screening and diagnostic tool for dementia. The results of this study can also be used to develop a community-based prevention and management system for dementia in the future.; Summary

The Relations of Socioeconomic Status to Health Status, Health Behaviors in the Elderly.: Sok Goo Lee, So Youn Jeon; J Prev Med Public Health. 2005;38(2):154-162.

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Abstract PDF: OBJECTIVES
To analyze the relationships of socioeconomic status (SES) to health status and health behaviors in the elderly. METHODS: Data were obtained from self-administered questionnaire of 4, 587 persons, older than 65 years, living in a community. We measured the sociodemographic characteristics, socioeconomic status, health status (subjective health status, acute disease, admission experience, dental state, chronic disease etc.), activities of daily living (ADL), instrumental activities of daily living (IADL), and mini-mental state examination-Korean (MMSEK). Binary and multinominal logistic regression analyses were employed to analyze factors affecting on the socioeconomic status of the elderly. RESULTS: With regard to the SES and health status, those with a low SES had poorer subjective health states and lower satisfaction about their physical health. Also, acute disease experiences, admission rates and tooth deciduation rates were higher in those of low SES. In the view of physical and cognitive functions, the ADL, IADL and MMSE-K scores were also lower in those of low SES. However, with regard to health behaviors, lower smoking and alcohol drinking rates were found in the low SES group, and a similar trend was shown with regular physical exercise, eating breakfast, and regular physical health check-up. From these findings, we surmise that those with low SES have a poorer health condition and less money to spend on health, therefore, they can not smoke or drink alcohol, exercise and or have a physical health check-up. CONCLUSION: This study suggests that socioeconomic status plays an important role in health behaviors and status of the elderly. Low socioeconomic status bring about unhealthy behavior and poor health status in the elderly. Therefore, more specific target oriented (esp. low SES persons) health promotion activities for the elderly are very important to improve not only their health status, but their health inequity also.; Summary

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