Search

Objective: This study aims to identify classes based on the trajectory of depressive symptoms and to examine the impact of trajectory classes of depressive symptoms on longitudinal changes in cognitive function in older adults with diabetes. Methods: This is a secondary data analysis of 572 older adults with diabetes using data from the 5th (2014) to 8th (2020) wave of the Korean longitudinal study of aging. Analysis of latent class growth and the effect of trajectories of depressive symptoms on cognitive function was examined using a latent growth curve model. This analysis has been found to be functional in change trajectories and in describing the direction of the trajectory. Results: The trajectory of depressive symptoms was classified into four classes: low‐stable (36.89%), high‐decreasing (20.28%), low‐increasing (18.71%), and high‐persistent (24.13%). Compared with the high‐persistent class, higher initial levels of cognitive function were observed in the high‐decreasing and low‐stable classes. Compared with the high‐persistent class, a slower rate of cognitive decline was observed in the low‐stable class (B = 0.410, p =.021). Conclusions: Continuous monitoring of depressive symptoms and early management of depressive symptoms for community‐dwelling older adults with diabetes can help prevent the cognitive decline and delay the deterioration of cognitive function. [ABSTRACT FROM AUTHOR]

Aim: As life expectancy increases worldwide, the prevalence and the disease burden of diabetes in older adults are also increasing. This study aimed to examine sex differences in the reciprocal relationship between glycemic control and depressive symptoms among older adults with diabetes by using longitudinal data at two timepoints. Methods: Wave 1 (W1, 2016–2017) and wave 2 (W2, 2018–2019) data from the Korean Frailty and Aging Cohort Study were used. Finally, 416 older adults with diabetes who satisfied the inclusion criteria were analyzed (215 males, 201 females). The reciprocal relationship between depressive symptoms and glycosylated hemoglobin A1c (HbA1c) levels was examined using a cross‐lagged panel model. Results: HbA1c levels and depressive symptoms at earlier time points were the most significant factors contributing to HbA1c levels and depressive symptoms at later timepoints. The relationship between HbA1c level and depressive symptoms differed according to sex. The cross‐path from depressive symptoms (W1) to HbA1c levels (W2) was positively statistically significant in males (β = 0.18, SD = 0.05, P = 0.001). The path from HbA1c levels (W1) to depressive symptoms (W2) was positively statistically significant in females (β = 0.12, SD = 0.06, P = 0.032). Conclusions: Early management of blood glucose levels and depressive symptoms is important in older adults with diabetes. Moreover, glycemic control through social activities in the community could be effective in relieving depressive symptoms in older females with diabetes, and managing depressive symptoms and glucose levels together could be effective in glycemic control in older males with diabetes. Geriatr Gerontol Int 2024; 24: 32–39. [ABSTRACT FROM AUTHOR]

Objectives: Although home‐visit healthcare programs in Korea are expected to expand, providing hands‐on experience to nursing students may be limited. This study aimed to develop and evaluate a problem‐based learning (PBL) simulation module that reflects home‐visit healthcare services provided by public health centers for pre‐frail older adults. Design and Sample: The simulation module, including PBL as prebriefing, was developed by the researchers and revised based on expert reviews. The module was evaluated using a mixed‐method embedded one‐group post‐test‐only design with focus group interviews (FGIs). Quantitative data (n = 29) were collected between April and June, 2021. FGIs (n = 10) were conducted twice in June 2021, and qualitative data were analyzed using an inductive content analysis approach. Results: The average score of the Simulation Design Scale was 4.67 ± 0.36. The overall mean score of the Educational Practices Questionnaire was 4.75 ± 0.37. Three themes emerged from the FGIs: immersive learning experience, changes in perspective on nursing, and enhanced nursing competency. Conclusion: This PBL‐based simulation module was evaluated as a systematic learning process in which nursing students could become self‐directed learners, interacting and collaborating with colleagues, instructors, and environments. The module encourages them to practice home visit services. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether cognitive frailty, compared with physical frailty or cognitive impairment alone, substantially increased the risk of long‐term care (LTC) initiation in community‐dwelling older adults. Methods: Subjects comprised a total of 39 148 participants aged 66 years from the Korean National Health Insurance–Senior cohort database. Cognitive frailty was defined as the coexistence of physical frailty and cognitive impairment, which was measured by the Timed Up and Go test and the Korean Dementia Screening Questionnaire–Prescreening, respectively. A stratified Cox model was estimated to explore the association of frailty status with LTC initiation. Results: The baseline prevalence of cognitive frailty was 8.7%. During a mean follow‐up of 5.3 years, 646 older adults started receiving LTC services. Compared with the robust group, older adults with cognitive frailty showed the highest risk of LTC initiation (hazard ratio [HR], 2.65; 95% confidence interval [CI], 2.08–3.35), followed by those with cognitive impairment (HR, 1.62; 95% CI, 1.26–2.07) and physical frailty (HR, 1.50; 95% CI, 1.25–1.81). Furthermore, cognitive frailty in depressed older adults (HR, 3.16; 95% CI, 2.31–4.33) showed a higher risk of LTC initiation than in nondepressed older adults (HR, 2.10; 95% CI, 1.46–3.04). Conclusions: Cognitive frailty was a significant predictor of LTC initiation among community‐dwelling older adults, particularly if they are depressed. Early detection and timely intervention may help to delay LTC initiation in older adults with concurrent cognitive frailty and depression. Geriatr Gerontol Int 2023; 23: 117–123. [ABSTRACT FROM AUTHOR]

Aim: To identify the factors associated with retention intention among Registered Nurses in South Korean nursing homes. Background: Although nurses are not mandatory personnel, Korean nursing homes employ Registered Nurses. Introduction: Determining the factors related to Registered Nurses' retention intention is important for their job stability and ensure provision of quality care. Methods: This mixed‐methods study employed a sequential explanatory design. A self‐reported questionnaire survey was conducted between May 1 and July 3, 2019, with 155 Registered Nurses providing direct care from 37 nursing homes. In‐depth qualitative interviews were conducted with 10 participants from August 1 to September 30, 2019. Data were analyzed using multilevel analysis for quantitative study and thematic analysis for qualitative study. Results: The participants' average age was 48.48 years. Personal factors related to retention intention were Registered Nurses' role, educational level, and job satisfaction. Institutional factors were ownership, number of beds, and working environment. The qualitative study revealed five themes: "Satisfaction with meaningful relationships," "Potential for professional growth," "Nursing service accompanied by emotional labor," "Poor working environments in nursing homes," and "Unprotected nursing expertise." Discussion: A nursing home's work environment is related to the Registered Nurses' retention intention. Most Registered Nurses in Korea received low wages, lacked access to career management programs, and experienced emotional labor. Conclusion: This study highlighted the personal and institutional factors related to retention intention among Registered Nurses in South Korean nursing homes. Implications for nursing and nursing policy: A law that designates Registered Nurses as an essential nursing home workforce is required. Further, nursing homes should increase the number of Registered Nurses to improve working conditions and thereby job satisfaction. It is also necessary to foster a working environment that facilitates professional development opportunities and job clarity. [ABSTRACT FROM AUTHOR]

Background and Aims: As high‐quality health care encompasses patient‐centered care, this study used the perceived quality−satisfaction−behavioral intention and structure‐process‐outcome models to (1) investigate the relationships among patient experience, patient satisfaction, and the willingness to recommend a hospital and (2) estimate the indirect effects of patient satisfaction on the relationship between patient experience and the willingness to recommend a hospital. Methods: A cross‐sectional survey design was adopted to investigate data obtained from the Seoul National University Hospital Patient Experience survey administered in 2020. Responses were analyzed from 1555 patients, who had been admitted to the inpatient ward of a tertiary hospital for a period lasting more than 1 day. Results: The path model demonstrated a good fit to the relationships between patient experience, patient satisfaction, and the willingness to recommend the hospital. Patient experience directly influenced patient satisfaction (β = 0.659, p < 0.001) and the willingness to recommend the hospital (β = 0.168, p < 0.001), whereas patient satisfaction had an indirect effect (β = 0.418, p < 0.001) on the relationship between patient experience and the willingness to recommend the hospital. Conclusion: Patient experience is a critical factor that health care systems need to consider for enhancing patient‐centeredness, patient satisfaction, and the willingness to recommend a hospital. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the relationship between oral health and social activity, and explore the mediating effect of depressive symptoms on the relationship between oral health and social activity among community‐dwelling older adults in Korea. Methods: A total of 5033 community‐dwelling older adults aged ≥65 years were included in the analysis. Data were obtained from the seventh wave (2018) of the Korean Longitudinal Study of Aging. Descriptive statistics, Pearson's correlation analysis and path analysis for mediation analysis were used. Results: Path analysis showed that older adults with better oral health had more social activities (β = 0.177, P < 0.001) and fewer depressive symptoms (β = −0.174, P < 0.001). Depressive symptoms had a mediating role partially in the relationship between oral health and social activity (β = 0.014, P < 0.001). The results of in‐depth exploration using oral health subdomains showed that physical oral function and oral pain or discomfort were directly related to the social activity (β = 0.083 and β = 0.149, respectively) and indirectly mediated by depressive symptoms (β = 0.006 and β = 0.004, respectively). However, psychosocial oral function only had an indirect effect on social activity mediated by depressive symptoms (β = 0.006, P = 0.005). Conclusions: Better oral health had a significant association with higher levels of social activities, which was partially mediated by decreased depressive symptoms. It is necessary to pay more attention to oral health promotion for older adults to decrease depressive symptoms and increase participation in social activities. Geriatr Gerontol Int 2022; 22: 766–772. [ABSTRACT FROM AUTHOR]

Background: Food art therapy (FAT) has multiple modalities in which cognition, emotion, and social changes are stimulated. The purpose of this study was to design a multimodal approach to a food art therapy (MM‐FAT) program and identify its effects on cognitive ability, daily living functioning, depression, self‐esteem, self‐efficacy, self‐expression, and social functioning in individuals with mild cognitive impairment (MCI) and mild dementia by employing a mixed methods research design. Methods: The participants included 39 patients from a public dementia care centre in Seoul, Korea. The intervention group, which comprised 20 participants, received 12 MM‐FAT sessions 3 times a week for 4 weeks, and the control group, which included 19 participants, received usual care. The MM‐FAT program was evaluated based on its effectiveness on cognitive, daily living, emotional, and social functioning outcome measures at three time points using repeated measures analysis of variance. Semi‐structured interviews (n = 9) were conducted to evaluate the overall experience of the MM‐FAT program and its outcomes. Results: The findings reveal that MM‐FAT has a positive effect on the cognitive, emotional, and social functioning of individuals with MCI and mild dementia. However, there were no enhancements in individuals' daily living functioning, and the lasting effects of the intervention could not be assessed. Cognition and depression increased significantly at the end of the MM‐FAT program. Self‐expression and self‐efficacy were significantly higher in the MM‐FAT group than in the control group. The semi‐structured interviews revealed improvements in participants' behaviour, communication, and interaction. Conclusion: This mixed methods study focused on individuals with MCI or mild dementia contributes to an understanding of the effectiveness of a FAT program employing a multimodal approach. Despite the COVID‐19 pandemic, the study was able to enrich the effects of MM‐FAT on cognitive, emotional, and social functioning through qualitative findings. [ABSTRACT FROM AUTHOR]

Background: The study aimed to delineate the genotypic features and endocrine / metabolic profiles in patients with 21‐hydroxylase deficiency. Methods: Subjects were diagnosed with 21‐hydroxylase deficiency by direct Sanger sequencing or multiple ligation‐dependent probe amplification analysis and followed up in Pusan National University Children's Hospital from July 2008 to April 2019. The genotype, phenotype, and endocrine and metabolic profiles in children and young adults with congenital adrenal hyperplasia were investigated. Results: Of a total of 33 patients, 16 (48.5%) were males. Median age was 7.4 years (range, 0.1–23.8 years). Thirty (90.9%) had salt‐wasting phenotypes. Eleven (33.3%) initially presented with abnormality in a neonatal screening test without other symptoms. Among the 17 girls, seven received genital surgery. Sixty‐five alleles from the 33 patients were evaluated. The distribution of CYP21A2 gene mutations revealed an intron 2 splice site (c.293‐13A>G or c.293‐13C>G) mutation as the most common one (22, 33.8%), followed by c.518T>A (10, 15.4%) and a large deletion / conversion (7, 10.8%), in order. One novel mutation was detected, c.332del(p.G111fs). Among the 27 patients aged >2 years, fifteen (55.6%) were obese / overweight, and ten (37.0%) needed growth hormone therapy due to short stature. Among the seven subjects aged >2 years and having high‐risk genotype, five had impaired fasting glucose, three had precocious puberty, and four used growth hormone. A greater proportion of the high current corticosteroid dose group had impaired fasting glucose than in the low‐dose group (64.3 vs 23.1%, P = 0.031). Conclusions: Early monitoring of endocrine and metabolic complications from childhood might benefit patients with congenital adrenal hyperplasia. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to identify social factors predicting improvement of frailty in community‐dwelling older adults after 2 years using a population‐based cohort study. Methods: We analyzed data from the 2016 and 2018 Korean Frailty and Aging Cohort Study. The participants of this study were 1428 community‐dwelling older adults aged 70–84 years who were recruited from 10 medical centers across different regions. Frailty was measured using the five‐item FRAIL scale, which evaluates fatigue, resistance, ambulation, illness and weight loss. Multilevel logistic regression analysis was used to examine baseline social factors that predict frailty improvement after 2 years by frailty status. Results: In frail older adults, higher participation in social activities (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02–1.34) was significantly associated with frailty improvement. In pre‐frail older adults, there were no significant social factors predicting the improvement of frailty status; however, other modifiable factors such as high and moderate levels of physical activity (OR 1.17, 95% CI 1.07–1.28, OR 1.13, 95% CI 1.03–1.25, respectively) and low depressive symptoms (OR 0.88, 95% CI 0.84–0.91) were associated with pre‐frail improvements. High levels of physical activity (OR 1.16, 95% CI 1.02–1.33) were also associated with improvements of frailty. Conclusions: Different strategies depending on the level of frailty are necessary to improve frailty status. Timely and appropriate interventions can promote frailty improvement and prevent negative health outcomes in community‐dwelling older adults. Geriatr Gerontol Int 2021; 21: 465–471. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to identify the midlife and later life factors affecting reversion from mild cognitive impairment to normal cognition after 4 years. Methods: We analyzed data from the 2012 and 2016 Korean Longitudinal Study of Aging. The participants of this study were Korean community‐dwelling adults aged ≥45 years who showed mild cognitive impairment in 2012. They were divided into midlife (<65 years) and later life (≥65 years) based on their age in 2012. Cognitive function was assessed by the Korean Mini‐Mental State Examination in 2016. Multiple logistic regression analysis was carried out to determine the factors affecting reversion by age group. Results: Among participants with mild cognitive impairment, 52.0% in midlife and 26.6% in later life reverted to normal cognition after 4 years. In midlife, higher education (OR 1.97, 95% CI 1.15–3.36), fewer chronic diseases (OR 0.78, 95% CI 0.61–0.99), lower levels of depressive symptoms (OR 0.95, 95% CI 0.90–0.99) and higher participation in social activities (OR 1.91, 95% CI 1.27–2.87) were significantly associated with reversion. In later life, higher baseline cognitive function (OR 1.30, 95% CI 1.14–1.47) and higher participation in social activities (OR 1.35, 95% CI 1.02–1.79) were significantly associated with reversion. Conclusions: The reversion rate in midlife was higher than that of later life. More modifiable factors affecting reversion were found in midlife, suggesting that assessment and intervention at an early age should be considered. Geriatr Gerontol Int 2019; 19: 1129–1135. [ABSTRACT FROM AUTHOR]

We examined whether the relationship between activities of daily living and quality of life was mediated by depression, and identified differences of the mediating effects by age group. In this cross-sectional survey, 231 older adults were recruited from eight nursing homes. The path analysis indicated that depression played an important mediating role in the relationship between activities of daily living and quality of life. Depression appeared to be more significant for the mental health component as an outcome compared to the physical health component of quality of life. The impact of depression as a mediator for the older old group was greater than the young-middle group. This finding increases our understanding of the impact of age on the mediating effect of depression on the relationship between activities of daily living and quality of life. Healthcare providers should consider older adults' age differences when integrating physical or depression programs into clinical practice to enhance quality of life. [ABSTRACT FROM AUTHOR]

Although the varied neurotoxicity of intrathecal (IT) chemotherapy for treatment of childhood acute leukemia is well known, most are related to transient post-puncture headache, drug-induced arachnoiditis, or leukoencephalopathy after methotrexate or cytarabine. Cerebral vasospasm leading to acute infarct after IT chemotherapy is very uncommon in children. Reported herein is a rare case of diffuse cerebral vasospasm with subsequent cerebral infarct after IT cytarabine in a 7-year-old boy with acute lymphoblastic leukemia, who successfully recovered with supportive management, and a review of the literature. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the frequency and duration of nursing care activity related to mobilizing older patients in acute care settings and determining who initiates the mobility event (patient or nurse). Methods This was an observation study using time and motion. Observers shadowed 15 registered nurses (RNs) each for two to three 8-hr periods using hand-held computer tablets to collect data on frequency and duration of six mobility events (standing, transferring, walking to and from the patient bathroom, walking in the patient room, and walking in the hallway) that occurred in the nurse's presence. Chart reviews were conducted on 47 adult patients (> 65 years of age) who were cared for by the nurses during the observation periods. Descriptive statistics (mean, median, standard deviation, frequency, and proportion) were used to describe the occurrence of mobility events among all 47 patients and among a subgroup of 16 patients identified as dependent (needing human assistance of another to ambulate) at the time of admission. Results Thirty-two percent of older patients were not engaged by an RN in any mobility event during an 8-hr period. For all patients, standing and transferring were the most frequent mobility activity. Mean duration for ambulation was less than 2 min per observation period. Patients who were dependent had fewer mobility events with no events related to ambulation initiated by nurses. The majority of mobility events were initiated by patients. Conclusions Nurses infrequently initiated mobility events for hospitalized older patients and most often engaged patients in low-level activity (standing and transferring). Clinical Relevance Limited mobility (standing and transferring only) is an independent predictor of negative outcomes for hospitalized older patients. Nurses are in a key position to improve outcomes for hospitalized older patients by engaging them in mobility activity, particularly ambulation, but further research is needed to determine how best to engage nurses in these activities. [ABSTRACT FROM AUTHOR]

We report a case of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) that developed in a patient with cholangiocarcinoma after receiving oxaliplatin-based chemotherapy. A 62-year-old man had multiple hypodense lesions with delayed enhancement in the both lobes of the liver on abdominal computed tomography. He was treated with 5-fluorouracil, leucovorin and oxaliplatin (100 mg/m2). After eight cycles of treatment and a cumulative oxaliplatin dose of 780 mg/m2, he developed an unsteady gait, dysphagia, weakness of both the upper and lower limbs and impairment of all sensory modalities. Nerve conduction studies confirmed the diagnosis of AIDP. Immunoglobulin G i.v. was administered for 5 days but the neurological deficits of both his upper and lower limbs did not improve. This case highlights unusual peripheral nervous system manifestations in a patient who received chemotherapy with oxaliplatin. [ABSTRACT FROM AUTHOR]