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Purpose: Vitamin D has a crucial role in our metabolic health. We aimed to examine associations of vitamin D status and its related dietary pattern (DP) with prevalent risk of metabolic syndrome (MetS) in 9,237 Korean adults aged 19–64 years based on the National Health and Nutrition Examination Survey. Methods: Vitamin D status was examined by serum 25-hydroxyvitamin D (25(OH)D). A vitamin D-related DP associated with 25(OH)D levels was derived using reduced rank regression (RRR). Associations of vitamin D status and its related DP with MetS prevalence were examined using multivariable logistic regression models adjusted for potential confounders. Results: Men with sufficient vitamin D status had a 44% lower risk of MetS prevalence (OR: 0.56; 95%CI: 0.36–0.87) compared to those with deficiency. A vitamin D-related DP derived using RRR was characterized by high intakes of vegetables, fish, fruits, and nuts and low intakes of eggs, oils, and mushrooms in this study population. Among men, the DP was significantly associated with a lower risk of MetS prevalence, showing a 12% (95%CI: 4–20%) reduction in risk for a one-unit increase in the DP score. However, there was no significant association among women. Conclusion: The study's findings suggest that a sufficient vitamin D status and a related DP with high intakes of vegetables, fish, fruit, and nuts were associated with the risk of MetS, particularly in Korean male adults. [ABSTRACT FROM AUTHOR]

Purpose: Selection-optimization-compensation (SOC) models have been proposed and applied to various populations to examine successful aging from a multidimensional perspective. This study aimed to develop a scale to measure SOC strategy among late middle-aged women (aged 50 to 64 years) and to test its validity and reliability. Methods: Preliminary items were developed through a literature review and interviews. Overall, 32 preliminary items were confirmed via two rounds of expert content validity analysis and a pilot survey. Data were collected from 299 late middle-aged women and analyzed using IBM SPSS/PC+ version 27.0. Construct validity, criterion validity, and reliability tests were conducted. Results: The SOC strategy scale, reflecting the characteristics of late middle-aged women and developed through exploratory factor analysis, comprised 19 items across four factors: goal-oriented selection, compensation for loss, outcome optimization, and ability-based optimization. The scale explained 66.9% of the variance in total factors, with a Cronbach's α of .95. Statistically significant correlations with the reference scale (r=.30, p<.001) were observed. Conclusion: The developed scale demonstrated high validity and reliability, thus representing a viable instrument for measuring SOC strategy among late middle-aged women. Using this scale to assess the use of SOC approaches in these women can improve our understanding of the aging process and help establish supportive programs for their aging journeys. [ABSTRACT FROM AUTHOR]

This study is an analysis of the personal and social meanings of married women's experiences caring for their aging mothers as the eldest daughter in Korean society. Semi-structured interviews were conducted with seven participants for this study. The interviews were conducted in Korean, and the collected data were analyzed using descriptive phenomenological analysis in four categories: "being the eldest daughter and daughter-in-law in a patriarchal society with nothing but duties"; "the pain of taking care of my mother that invades my daily life"; "The compassion of an eldest daughter who can't turn a blind eye to her mother's miserable life."; and "Support from society to overcome the psychological difficulties of caregivers and help older adults in their daily lives". The study participants felt emotional pain in caring for their mothers, and it was difficult for them to simultaneously play the roles of daughter-in-law, wife, and mother. However, they felt compassion for their mothers' lives in a patriarchal society and believed they could compensate for their mothers' hardships by caring for them. The participants emphasized the need for specialized in-home services that address the specific health needs of the older adult, along with counseling services for their caregivers. In Korean society, when daughters care for their mothers, it strengthens the shared history and emotions between mothers and daughters, affirming female solidarity. Based on the above findings, policy and practical measures are recommended to ensure that daughters who provide care for their mothers can deliver stable care. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) is commonly defined as a transitional subclinical state between normal aging and dementia. A growing body of research indicates that health behaviors may play a protective role against cognitive decline and could potentially slow down the progression from MCI to dementia. The aim of this study is to conduct a bibliometric analysis of literature focusing on health behaviors and MCI to summarize the factors and evidence regarding the influence of health behaviors on MCI. Methods: The study performed a bibliometric analysis by retrieving publications from the Science Citation Index and Social Sciences Citation Index subdatabases within the Web of Science Core Collection. Utilizing VOSviewer and CiteSpace software, a total of 2,843 eligible articles underwent co-citation, cokeywords, and clustering analyses. This methodology aimed to investigate the current status, trends, major research questions, and potential future directions within the research domain. Results: The bibliometric analysis indicates that research on healthy behaviors in individuals with MCI originated in 2002 and experienced rapid growth in 2014, reflecting the increasing global interest in this area. The United States emerged as the primary contributor, accounting for more than one-third of the total scientific output with 982 articles. Journals that published the most articles on MCI-related health behaviors included "Journal of Alzheimer's Disease," "Neurobiology of Aging," "Frontiers in Aging Neuroscience," and other geriatricsrelated journals. High-impact papers identified by VOSviewer predominantly cover concepts related to MCI, such as diagnostic criteria, assessment, and multifactorial interventions. Co-occurrence keyword analysis highlights five research hotspots in health behavior associated with MCI: exercise, diet, risk factors and preventive measures for dementia, cognitive decline-related biomarkers, and clinical trials. Conclusion: This study provides a comprehensive review of literature on health behavior in individuals with MCI, emphasizing influential documents and journals. It outlines research trends and key focal points, offering valuable insights for researchers to comprehend significant contributions and steer future studies. [ABSTRACT FROM AUTHOR]

Purpose: Visual impairment, hearing impairment, and masticatory discomfort each influence quality of life (QoL). However, little is known regarding the impact of their coexistence on QoL. Therefore, we aimed to investigate the influence of the coexistence of visual impairment, hearing impairment, and masticatory discomfort on QoL among middle-aged adults aged 40-64. Methods: This study involved a secondary data analysis utilizing the data from years 1 and 2 of the eighth Korea National Health and Nutrition Examination Survey. To evaluate the influence of the coexistence of visual impairment, hearing impairment, and masticatory discomfort on QoL, we conducted a complex sample hierarchical multiple regression analysis. Results: When visual impairment, hearing impairment, and masticatory discomfort coexisted, the QoL was significantly lower than in individuals without any of these conditions. Conclusion: The coexistence of visual impairment, hearing impairment, and masticatory discomfort was negatively correlated with QoL. Therefore, it is important to prepare for old age through appropriate health management during middle age. [ABSTRACT FROM AUTHOR]

Crime is often considered a behavior of teenagers and young adults, peaking in adolescence, and declining with age. A growing body of research, however, has demonstrated that the age–crime relationship is neither universal, as the contours of the age–crime distribution vary across countries, nor uniform, as it varies over time. We argue that the dynamics of the age–crime relationship can best be understood through a lens situating birth cohorts within the broader sociohistorical contexts in which they enter their formative years. We apply this framework to the Republic of Korea, a country that has experienced rapid demographic transitions accompanied by decades of economic development and social upheaval after the Korean War. Our findings suggest that the age–crime distribution in Korea has shifted substantially since the mid‐1970s, moving from the quintessential age–crime curve characteristic of Western countries to one in which the modal age at arrest is now concentrated in middle age. We find that much of this change can be attributed to the aging of a specific birth cohort—the 86 generation—whose members were dually disadvantaged by being born during a fertility boom and entering young adulthood during the pro‐democracy student movements in the 1980s. [ABSTRACT FROM AUTHOR]

The aggregate-level age-crime distributions in Western countries are predominantly right-skewed and adolescent-spiked. Based on Western data, Hirschi and Gottfredson (1983) asserted that this age-crime pattern is universally invariant across time and places. This study's overall goal is to rigorously examine Hirschi and Gottfredson's invariant premise within a non-Western country, focusing on the stability and change in the age-crime patterns of South Korea from 1980 to 2019. Specifically, two research questions are addressed: (1) whether the average age-arrest curves in South Korea diverge from the invariant premise after adjusting for period and cohort effects; (2) how period and cohort effects modify the age-arrest curves. To examine these questions, I applied the age-period-cohort-interaction model (APC-I) to analyze the official age-specific arrest statistics for various offense types from 1980 to 2019 in South Korea. Findings suggested that the age-crime patterns of homicide, assault, and fraud are characterized by spread-out distributions and advanced peak ages. After adjusting for period and cohort effects, most of the age-crime curves are still robustly divergent from the age-crime distributions found in Western countries. Cohort and period effects have modified the age-crime patterns, but arrests in South Korea are largely concentrated among midlife age groups older than 30. These results provide additional compelling evidence contesting Hirschi and Gottfredson's invariance thesis, underscoring the substantial impact of country-specific processes, historical context, and cultural factors on the age-crime relationship. [ABSTRACT FROM AUTHOR]

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

This study examined specific clinical risk factors for age-related loss of skeletal muscle mass in late middle-aged women with sarcopenia. This Korean nationwide cross-sectional study analyzed data from 2814 community-dwelling women aged from 50 to 64 years old and screened them for sarcopenia. This study examined various risk factors such as age; height; weight; body mass index; waist circumference; skeletal muscle mass index; systolic and diastolic blood pressure; smoking and drinking habits; fasting glucose levels; triglyceride; and cholesterol levels. Complex sampling analysis was used for the data set. Prevalence of sarcopenia with a weighted prevalence of 13.43% (95% confidence interval: 2.15–15.78). The risk factors for sarcopenia were height, body mass index, waist circumference, skeletal muscle mass index, systolic blood pressure, diastolic blood pressure, triglyceride level, and total cholesterol level (p < 0.05). Weight, fasting glucose level, drinking status, and smoking status were not significant (p > 0.05). These results are expected to contribute to the existing literature on sarcopenia and identify potential risk factors associated with the development of sarcopenia in late middle-aged females. By acknowledging prevalence and recognized risk factors, healthcare professionals may augment their proficiency in recognizing and discerning potential instances of sarcopenia in female patients. [ABSTRACT FROM AUTHOR]

Purpose: It is important for middle-aged patients who have undergone acute treatment for coronary artery disease to voluntarily improve their lifestyle and risk factors based on their recognition as patients with chronic diseases. This study conducted individual education to improve risk factors and tried to verify its effectiveness. Methods: The hypothesis was verified by applying a randomized controlled pre- and post-test design through random assignment of two groups. Middle-aged (40–64 years) patients who underwent percutaneous coronary intervention for the first time were recruited from a university hospital in Seoul, Korea. For the experimental group, based on the Self-Determination Theory, risk factor- tailored counseling and education were provided individually for one hour based on the education booklet, and telephone counseling was conducted twice for 12 weeks. Differences in autonomous motivation, resilience, self-care compliance and biochemical indicators measured after 12 weeks in the experimental group and the control group were compared. Data were analyzed using SPSS/WIN ver. 22.0. Results: The autonomous motivation, resilience, and self-care compliance of the experimental group were significantly higher than those of the control group (p <.05). Body mass index (p =.005) and current smoking rate (p <.001) were also significantly decreased in the experimental group but there was no significant difference in other biochemical parameters. Conclusion: For middle-aged patients with first coronary intervention, risk factor-tailored education emphasizing autonomy by nurses should be provided early after discharge. Trial registration: This study was retrospectively registered in the Clinical Research Information Service and the identification number is KCT0008698(11/08/2023). [ABSTRACT FROM AUTHOR]

Background Korean society has witnessed a rapid increase in the number of single-person households at risk for loneliness or solitary deaths. This study aims to evaluate the effectiveness of safety and care services (SCS) on the psychological outcomes and housing satisfaction of Korean middle-aged and older adults living alone. Methods This study was a randomized controlled trial on residents of public rental housing. A total of 40 people underwent a 3-month intervention. For the experimental group, a caring service IoT solution was installed in participants' houses, and coordinators provided services using IoT information. The control group received only visits by coordinators. Results The experimental group showed significant positive changes in depressive symptoms. An interaction effect of time and condition was observed, indicating that the loneliness scores of the experimental group were significantly reduced, whereas those of their counterparts were negligible. Both groups showed significant decreases in suicidal thoughts. Housing satisfaction in both groups significantly increased over time, but group differences were observed. Conclusions This study demonstrated the positive effects of SCS on depressive symptoms, suicidal thoughts and housing satisfaction for people living alone, suggesting that technology can be a useful tool for helping vulnerable people. [ABSTRACT FROM AUTHOR]

This descriptive study aimed to identify the factors influencing obstructive sleep apnea (OSA) by age between middle-aged and elderly people. These groups have not been evaluated separately until now. This study is a secondary analysis of data from the Eighth Korea National Health and Nutrition Examination Survey 2021. Of the 3942 participants with OSA in this study, 2397 were middle-aged and 1545 were elderly, and 2509 had low risk and 1433 had moderate–high risk. Age-specific factors related to their OSA were identified using complex sample logistic regression. Factors associated with OSA in middle-aged individuals included the number of household members, smoking, subjective health, and subjective body image. Smoking and subjective health were significantly related to OSA in elderly people. Not smoking was 0.23 times less likely than smoking to be associated with OSA, and 0.3 times less likely when participants were healthy than when unhealthy. Hence, influencing factors differed depending on the age of individuals with OSA. Therefore, to develop public health measures, it may be more effective to establish intervention strategies to improve symptoms and prevent complications in middle-aged and elderly patients with OSA by distinguishing and applying influential age-specific factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: The food system accounts for ~40% of human-generated greenhouse gas (GHG) emissions. Meanwhile, daily diet selection also impacts human nutrition status and health. OBJECTIVES: This study aimed to use the alternate Mediterranean Diet (aMED) score to evaluate the quality of a low-GHG emission diet and the association with risk of developing metabolic syndrome (MetS). METHODS: A total of 41,659 healthy participants without MetS 40 y of age or older were selected from the Health Examinees Study, an ongoing cohort study in South Korea from 2004. A dietary GHG emissions database was compiled following a national project and literature review. MetS was defined according to the Adult Treatment Panel III criteria of the National Cholesterol Education Program. The participants were grouped into quintiles based on 2,000 kcal–standardized daily diet-GHG emissions (Q1: the lowest energy-adjusted diet-GHG emissions). A multivariable logistic regression model was used to analyze the risk for MetS at follow-up. The aMED score was used to assess the diet quality of the different diet-related GHG emission groups. RESULTS: Females with lower energy-adjusted diet-related GHG emissions had significantly lower risks of developing MetS (푝=0.0043) than those with the highest energy-adjusted diet-related GHG emissions. In addition, the Q1 group, in comparison with the other groups, had a higher aMED score (3.02 for males and 3.00 for females), which indicated that the participants in this group had a diet that more closely matched the Mediterranean diet. DISCUSSION: These findings provide a reference for dietary guidance and other policies aimed toward improving dietary intake and reducing diet-related GHG emissions in South Korea and worldwide. [ABSTRACT FROM AUTHOR]

The present study investigated the risk factors, prevalence, and characteristics of sarcopenia among men aged 50–64 years. A total of 2868 participants were enrolled in this study. Of these, 328 individuals were classified into a sarcopenia group; the remaining 2540 were assigned to a control group. This study examined several variables, including skeletal muscle mass index, age, height, weight, body mass index, waist circumference, systolic and diastolic blood pressure, fasting glucose, triglyceride and total cholesterol levels, alcohol consumption, and tobacco use. It employed a stratified, clustered, and multistage probability sampling design. Complex sampling was used for the data analysis. The prevalence of sarcopenia was 10.25% (95% CI: 8.98–11.69). All anthropometric measures, including height, weight, BMI, and waist circumference, were significantly different between the two groups (p < 0.05). In terms of blood pressure, only systolic blood pressure (SBP) was significant (p < 0.05), and fasting glucose and triglyceride levels were risk factors for sarcopenia (p < 0.05). Tobacco use differed significantly between the two groups (p < 0.05). This study reported the specific prevalence of sarcopenia and identified its risk factors among men in early old age. [ABSTRACT FROM AUTHOR]

Vaccination against COVID‐19 has been promoted as a way to protect oneself and others from infection. To ensure the comprehensive acceptance of COVID‐19 vaccines, the factors that affect COVID‐19 vaccination hesitancy should be examined. This study aimed to identify the factors that affect COVID‐19 vaccination hesitancy among Korean adults, focusing on COVID‐19 knowledge and attitudes toward vaccination. This was a cross‐sectional study conducted with 2286 Korean adults aged 20–64 years. Demographic characteristics, knowledge regarding COVID‐19, and attitudes toward vaccination were assessed. A generalized linear model with Poisson regression was used to identify factors associated with COVID‐19 vaccination hesitancy. Approximately 67% of the COVID‐19 knowledge‐related questions were correctly answered. A neutral attitude toward vaccination and relatively low vaccination hesitancy were found. COVID‐19 vaccination hesitancy was affected by individuals' attitudes toward vaccination, as well as their gender and age, but not by their knowledge. Interventions or policies considering gender and age could be helpful in reducing COVID‐19 vaccination hesitancy. Strategies to disseminate more accurate and novel information related to the COVID‐19 vaccines should be implemented. [ABSTRACT FROM AUTHOR]

Although it is generally known that the type A behavior pattern (TABP) is associated with high blood pressure, recent studies have not consistently supported this association. Therefore, it is important to determine which factors moderate and mediate this relationship. The purpose of this study was to verify the moderated mediation effect of age and relaxation in the relationship between TABP and high blood pressure among middle-aged adults in South Korea. This study utilized data from the Korea Health and Genome Study (KHGS) supported by the Korea National Institute of Health. The participants in the present study were 10,022 Korean adults aged 40 to 69. To identify the conditional indirect effect of TABP on blood pressure through relaxation, with a consideration of age, a moderated mediation model using SPSS PROCESS macro 3.10 was applied. As is generally known, TABP was associated with high blood pressure, but its relevance was reversed through relaxation. Moreover, this relationship was moderated by age, which is known to be the most powerful predictor of high blood pressure. The lower age group with TABP exhibited a higher relaxation, whereas the higher age group with TABP demonstrated a lower relaxation. The findings demonstrate the need for relaxation education, stress management, or counseling to help individuals recognize their behavior patterns and strengthen the willingness and motivation for relaxation, especially among elderly people with TABP, in order to manage their blood pressure effectively. [ABSTRACT FROM AUTHOR]

Aim: To investigate the mediating effect of sleep‐related problems on the relationship between depression and work–family conflicts (WFCs) among middle‐aged female workers. Design: Secondary analysis of cross‐sectional study. Methods: Overall, 15,718 female workers aged 40–65 years from the Sixth Korean Working Conditions Survey (KWCS) were included. Depression was assessed using the WHO‐5 wellbeing index; sleep‐related problems and WFCs were measured with five items on a Likert scale. The mediating effect of sleep‐related problems between depression and WFCs was analysed using model 4 of Hayes PROCESS macro for SPSS. Results: There was a significant positive correlation between depression and both sleep‐related problems (r = 0.225, p < 0.001) and WFCs (r = 0.124, p < 0.001). Depression also had a significant effect on sleep‐related problems (β = 0.221, p < 0.001) and WFCs (β=0.061, p < 0.001). Sleep‐related problems had a significant effect on WFCs (β = 0.282, p < 0.001). The indirect effect of depression on WFCs by mediating sleep‐related problems was β = 0.062 (95% bootstrap confidence interval = 0.057–0.068). The study also confirmed the significance of the mediating effect of sleep‐related problems in the relationship between depression and WFCs. [ABSTRACT FROM AUTHOR]

Background: The prevalence of depression is higher among midlife women, and they have less control over their diabetes during the menopausal transition. However, there is limited evidence on the association between type 2 diabetes mellitus and depression among Korean women in their midlife. This study aimed to examine the association between type 2 diabetes mellitus and depression and explore the levels of awareness and treatment of depression among Korean midlife women with T2DM. Methods: This is a cross-sectional analysis study conducted using data from the Korea National Health and Nutrition Examination Surveys of 2014, 2016, and 2018. Korean women aged 40–64 years who randomly participated in the surveys were included, and 4,063 midlife women were selected as study participants. The diabetes progression status of the participants was classified into diabetes, pre-diabetes, and non-diabetes. Furthermore, the Patient Health Questionnaire-9 was used for screening depression. Participants' awareness rate, treatment rate among incident cases of depression, and treatment rate among awareness cases of depression were also analyzed. For data analysis, the Rao–Scott χ2 test, multiple logistic regression, and linear regression were conducted using SAS 9.4 software program. Results: The prevalence of depression significantly differed between diabetes, pre-diabetes, and non-diabetes groups. However, depression awareness, treatment/incident, and treatment/awareness rates did not differ statistically between the diabetes progression status groups. Compared to the non-diabetes group, diabetes group had a higher odds ratio of depression after adjusting for general and health-related factors. Thus, the diabetes group had significantly higher PHQ-9 scores than the non-diabetes group after adjusting for covariates. Conclusions: Women in their midlife who have type 2 diabetes mellitus tend to have higher levels of depressive symptoms and are at risk of depression. However, we found no significant differences between diabetes and non-diabetes regarding the awareness and treatment rates of depression in South Korea. We recommend that future studies focus on developing clinical practice guidelines aimed at additional screening and intervention for depression in midlife women with type 2 diabetes mellitus to ensure prompt treatment and improved outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this research is to explore the relationship between age-friendly environment, social support, sense of community, and loneliness of Korean adults aged 45 and above. A total of 590 participants from a cross-sectional and secondary data from an age integration survey conducted in 2018 was used for analysis. Structural equation modelling and bootstrapping method were applied to examine the mediating role of social support and sense of community on the relationship between age-friendly environment and loneliness. Age-friendly environment was positively associated with social support ( β =. 310 , p <. 001) and sense of community ( β =. 479 , p <. 001). Social support was negatively associated with loneliness ( β = −. 190 , p <. 001). Full mediation effect of social support was observed in the pathway from age-friendly environment to loneliness (95% CI: −0.135 to −0.036). Social support was fundamental in lowering loneliness in an age-friendly environment. There was no significant association linking age-friendly environment, sense of community, and loneliness. The results support the adoption of AFE to protect people at risk of loneliness with social support mediating this relationship. [ABSTRACT FROM AUTHOR]

Patients with diabetes must have self-efficacy to perform necessary self-care tasks. Self-efficacy has been considered as one of the primary motivators on diabetes self-care; therefore, it is essential for health care professionals to assess the self-efficacy of patients with diabetes to provide optimal care. Despite older Korean immigrants having greater difficulty in diabetes management, research on self-efficacy for them is lacking. This study aims to examine the psychometric property of the General Self-Efficacy scale Korean version for older Korean immigrants with diabetes in the United States. In this cross-sectional, methodological study, data were collected using convenience sampling. Cronbach's alpha, exploratory factor analysis, and confirmatory factor analysis were employed to examine the psychometric properties. Cronbach's alpha for the entire GSE scale Korean version is 0.81. The initial Eigenvalues show two factors, coping and confidence; however, the confirmatory factor analysis showed reasonable goodness of fit to the data (χ2(35) = 86.24, p < 0.01), χ2/df ratio = 2.46, AGFI = 0.87, GFI = 0.91, IFI = 0.90, ECVI = 0.74, CFI = 0.89, and RMSEA = 0.093 in the one-factor model. The General Self-Efficacy scale Korean version demonstrated acceptable reliability and validity. It can be used to investigate self-efficacy and to devise culturally tailored diabetes interventions. [ABSTRACT FROM AUTHOR]

Introduction: Food insecurity is an important social determinant of health, but there is limited understanding of its relationship with adult oral health. This study examined the associations between food insecurity and dental diseases (caries and periodontitis) among middle‐aged and older adults in the United States and South Korea. Methods: This study focused on middle‐aged (40–59 years) and older adults (>59 years) who participated in the 2011–2016 US National Health and Nutrition Examination Surveys (NHANES) or the 2013–2015 South Korean NHANES. The exposure was food insecurity severity (food secure/early‐stage food insecurity/middle‐stage or severe food insecurity) assessed using the 18‐item US Household Food Security Survey Module. The two outcomes were any untreated tooth decay and periodontitis measured using the Modified Community Periodontal Index of Treatment Needs. Covariate‐adjusted odds ratios (OR) with 95% confidence intervals (CI) were generated using multivariable logistic regression models. Results: Middle or severe food insecurity was associated with significantly higher odds of having untreated tooth decay than no food insecurity, but only among middle‐aged adults in the United States (OR: 1.4, 95% CI 1.2, 1.9; P =.037) and Korea (OR = 1.8; 95% CI:1.0, 3.2; P =.036) and older adults in the United States (OR: 2.6, 95% CI 1.7, 4.0; P <.001). The associations between food insecurity and periodontitis were inconsistent across age group and country. Conclusion: Differing cultural norms and access to dental services in the United States and South Korea may influence the relationship between food insecurity and oral health. Future research should explore how addressing food insecurity could help to promote the oral health of middle‐aged and older adults in diverse sociocultural contexts. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the effects of psychological distress, depressive symptoms, and emotional eating behaviors on the health-related quality of life of middle-aged Korean females. This study provides primary data for developing an intervention program to improve the health-related quality of life of middle-aged females. Methods: Middle-aged females between 35 and 64 years old, from July 22 to August 10, 2021, were included in this study. The mediating effects of depressive symptoms and emotional eating behaviors on the relationship between psychological distress and health-related quality of life were investigated. A cross-sectional survey was conducted on 325 subjects. Researchers conducted questionnaires measuring psychological distress, depressive symptoms, emotional eating behavior, and health-related quality of life. Results: The findings of this study demonstrated a correlation between the severity of a female's depressive symptoms and the degree of their psychological distress, indicating that severe depressive symptoms were associated with negative emotions, which increased emotional eating behaviors. Additionally, more severe depressive symptoms indicated a lower health-related quality of life. Higher psychological distress was associated with increased emotional eating behaviors and lower health-related quality of life. The total and direct effects of psychological distress on the health-related quality of life were statistically significant. Conclusions: In this study, psychological distress, depressive symptoms, and emotional eating behaviors affected the health-related quality of life of middle-aged Korean females. This study also confirmed that psychological distress had a direct effect on health-related quality of life. These findings serve as primary data for evidence-based intervention programs that alleviate emotional health problems, such as psychological distress and depressive symptoms in middle-aged females. Moreover, nurses can help develop effective treatment strategies to improve health-related quality of life by identifying and assessing potential symptoms of psychological distress, depressive symptoms, and emotional eating behaviors. [ABSTRACT FROM AUTHOR]

Self-determination theory (SDT) states that the self-care behaviors of patients with chronic illnesses are affected by an autonomy-supportive healthcare climate, satisfaction of autonomy, competence, and relatedness. Autonomy-supportive healthcare climate means to provide interpersonal conditions that support the person's volition, initiative, and integrity. The aim of this study was to explore the structural relationships of an autonomy-supportive healthcare climate, as well as the perception of illness consequences, autonomy, competence, and relatedness with self-care behaviors among adult outpatients with hypertension. A cross-sectional survey was conducted in 2020 across three hospitals outpatient clinics in South Korea. A questionnaire package containing instruments measuring the perception of autonomy-supportive healthcare climate, autonomy, competence, relatedness, perception of illness consequence, self-care behaviors, sociodemographic data, and disease-related characteristics among the patients. The hypothetical model was derived from the SDT. Data were analyzed to test the hypothetical model and propose the final model. Complete survey data was provided by 228 participants. Overall, the findings supported the hypothesized model (Goodness-of-Fit Index = 0.90 and Comparative Fit Index = 0.99). An autonomy-supportive healthcare climate and autonomy, competence, and relatedness directly influenced the self-care behaviors of adult hypertensive patients. However, the perception of illness consequences did not have a significant direct effect on self-care behavior. Improving the autonomy-supportive healthcare climate, as well as positive perception of illness consequences, autonomy, competence, and relatedness among patients positively affects self-care behavior. Thus, an authentic partnership between healthcare providers and hypertensive patients is required to enhance trust, cooperation, and adaptation, consequently improving self-care behaviors among patients. Autonomy-supportive healthcare climate was both directly and indirectly associated with self-care behavior that mediates autonomy, competence, and relatedness among young and middle-aged hypertensive patients. [ABSTRACT FROM AUTHOR]

Multi-national studies in the association between handgrip strength and depression in middle and older aged adults are limited. Hence, Brazil, China, Europe, Korea, United Kingdom (UK) and United States (US) datasets were utilized to investigate this association. A cross-sectional study was conducted with 51,285 participants aged >45 years. Handgrip strength scores were divided into quartiles, groups 1 (highest) to 4 (lowest) in each database, and depression measures converted to binary scores. Males in China and UK reported higher adjusted odds ratios (aORs) of depression for groups 2, 3, and 4 than for group 1. Brazil, US, and Korea reported greater aORs in groups 3 and 4 whereas Europe demonstrated increased aORs for group 4 only. Among females, China, Brazil, US, and Korea showed high aORs across all groups, while UK and Europe reported increased aORs for group 4 only. Highest ORs were reported from Korea in group 4 for males (aOR: 3·09; 95 % CI: 2·15–4·43; p < 0·001) and females (aOR: 3·74; 95 % CI: 2·78–5·03; p < 0·001). When removing the regional factor, aORs were higher in lower groups, with the highest reported from group 4 for males (aOR: 2·32; 95 % CI: 2·09–2·58; p < 0·001) and females (aOR: 2·11; 95 % CI: 1·95–2·29; p < 0·001). Being a cross-sectional study, the results were not able to establish the causal direction between handgrip strength and depression. Lower handgrip strength was associated with an increased likelihood of depression. Early assessment of handgrip strength may identify populations at-risk for depression among middle and older aged adults. • Examined multiple cohort databases of middle to older age adults published globally • An inverse association between handgrip strength and depression was detected. • The findings were not limited to a distinct nationally representative population. • Timely assessment of handgrip strength may lead to early detection of depression. [ABSTRACT FROM AUTHOR]

This study sought to assess the prevalence of intimate partner violence (IPV) victimization and to examine the sex-stratified associations between IPV and suicidal ideation in South Korea. This study used nationally representative longitudinal survey data from 2011 to 2020 of the Korean Welfare Panel Study of 9732 married adults at baseline. Participants were annually asked about IPV experiences of verbal abuse, physical threat, or physical assault over the past year in 2011–2019. Suicidal ideation in the past year was assessed in the following year 2012–2020 of IPV experiences. Using multilevel logistic regression models, we examined the associations between IPV and suicidal ideation among married adults. The prevalence of verbal abuse, physical threat, and physical assault was respectively 19.8%, 3.0%, and 1.4% in females (n = 5056); and 18.8%, 2.7%, and 1.0% in males (n = 4676). After adjusting for potential confounders (e.g., lifetime suicidal ideation and random effects of individuals and households) in the same year when participants had IPV experiences, all types of IPV experiences were statistically associated with suicidal ideation in the following year among both females and males, except for physical threat among males. We found a statistically significant association between physical threat and suicidal ideation among females (adjusted odds ratio: 2.22, 95% confidence interval: 1.62, 3.04), whereas no association was observed among males. Our findings suggest that public health interventions related to suicidal behaviors that can be attributable to experiencing IPV are necessary among both females and males in South Korea. [ABSTRACT FROM AUTHOR]

With the enforcement of the Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-of-Life Act in 2018, interest in the quality of death in South Korea is increasing. However, few studies have provided an updated perspective on a good death. This integrative review describes the attributes of a good death from the perspective of South Korean older adults. Among the 32 studies included in this review, 16 main themes representing good death were identified. Themes of maintaining dignity, not burdening others, living a meaningful life, being pain-free, and being prepared to die were commonly reported attributes of a good death in other cultures; themes further reflected in Korean culture were filial piety and parenting. In contrast, older adult characteristics such as low income and education level, bereavement experience, disease uncertainty, and depressive symptoms were associated with high levels of fear of death or negative attitudes, such as trying to avoid suffering through death. This review provides insights into the health care provider's approach to older people at the end of their life in South Korea. Consequently, this can help determine potential unmet needs that can be improved. [ABSTRACT FROM AUTHOR]

Objectives Life satisfaction is increasingly viewed as an asset associated with better general health, but its association with cognitive health and risk of dementia is less examined. We tested the hypothesis that higher life satisfaction would be associated with lower risk of dementia. Methods Participants were a nationally representative sample of adults (n = 8,021; age range: 45–93 years) from the Korean Longitudinal Study of Aging assessed every 2 years for up to 12 years. Multilevel modeling analysis examined whether life satisfaction is associated with cognitive functioning and decline. The primary analysis used Cox regression to examine the association between baseline life satisfaction and risk of incident dementia. Results Between-person differences and within-person changes in life satisfaction were associated with cognitive functioning, but life satisfaction was unrelated to the rate of cognitive decline. Higher life satisfaction was also associated with lower risk of dementia, even after accounting for demographic factors, depressive symptoms, cardiovascular and functional risk factors, health behaviors, and social contact. Discussion Satisfaction with life may function as a positive psychological resource for maintaining cognitive functioning and protecting against the risk of dementia. [ABSTRACT FROM AUTHOR]

The present study examined the impact of psychological stress related to COVID-19 on anxiety as well as protective factors against these negative psychological consequences among middle-aged and older adults in the largest outbreak areas in South Korea. Participants included 667 middle-aged and older adults (ages 40 to 76) living in the largest outbreak areas at the time of the survey based on the number of confirmed COVID-19 cases in South Korea. Path analysis was conducted. Stress related to COVID-19 and loneliness were positively associated with anxiety. However, family cohesion, resilience, health, and being married were negatively associated with anxiety. Also, family cohesion, resilience, income, and being married were negatively associated with loneliness among middle-aged and older adults in the largest outbreak areas in South Korea. As postulated by the Stress Process Model, stress related to COVID-19 may have increased loneliness and anxiety among middle-aged and older adults in the largest outbreak areas in South Korea; however, resilience and family cohesion reduced these negative consequences both directly and indirectly. Findings are discussed and implications are addressed. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the reciprocal relationships between depression and income, and gender differences in these relationships among older adults in South Korea. Methods: Using 2015 to 2019 of the Korea Welfare Panel Study (KoWePS), we studied 6,070 older adults (2,394 men and 3,676 women) aged 60 years over in 2015. The generalized estimating equation was employed to explore the effect of an individual income on depression and the reverse causal link-that of depression on income. Results: The study found the reciprocal relationships between income and depression. Income has a significant impact on depression. Higher-income was linked to decreased risks of the Center for Epidemiologic Studies Depression (CES-D) scores among older adults (B = - 0.121, p < 0.001). Estimates of the reverse causal link show that higher CES-D scores were also linked to income reduction among Korean older adults (B = - 0.007, p < 0.001). In addition, we also observed gender differences in the impact of income on depression but not in the reverse causal link. Income has more detrimental to psychological consequence for older men (B = - 0.108, p < 0.001) than older women (B = - 0.057, p < 0.001). Conclusion: The finding implies that both psychological and social protection policies for the elderly are needed in view of gender perspective. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to clarify the relationship between andropause syndrome and health-related quality of life, as well as the mediation effect of family bond among middle-aged males in South Korea. Methods: A total of 135 middle-aged males who live in B, K, and U City participated in the study, conducted from March 10 to May 31, 2021. Participants were invited to complete self-reported questionnaires measuring andropause syndrome, health-related Quality of Life (QoL), family bond, and demographic information. The data obtained were analyzed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval (5,000 bootstrap resampling). Results: The QoL of middle-aged males in South Korea showed a significant negative correlation with andropause syndrome (r=-.32, p<.001), and a significant positive correlation with family bond (r=.59, p<.001). Futher, family bond had a mediating effect between andropause syndrome and QoL (indirect effect=-4.07, 95% Boot confidence interval=-6.53~-1.97). Conclusion: Based on the results of this study, in order to improve the QoL of middle-aged males in South Korea, it is necessary to provide programs that can improve family bond along with physical and mental intervention programs to effectively alleviate andropause syndrome. [ABSTRACT FROM AUTHOR]

This study aims to determine the influence of the constructs of the health belief model and fear of dementia on the behavioral intention to prevent middle-aged Korean adults' dementia. Applying a descriptive design, 163 middle-aged adults were recruited. Structured questionnaires were used to collect data regarding fear of dementia, behavioral intention to prevent dementia, the expanded health belief model's variables (i.e., perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cues to action, general health motivation, and self-efficacy), and other general characteristics between August and September 2019. The determinants of the behavioral intention for dementia prevention were identified through hierarchical regression analysis. The significant factors influencing the behavioral intention for dementia prevention were general health motivation and self-efficacy, accounting for 34.2% of the variance. The results revealed key factors that should be considered in future interventions to enhance adherence concerning dementia-preventive behaviors. [ABSTRACT FROM AUTHOR]

The study aimed to examine the effects of self-acupunctural hand massage using aromatic oil on the stress, fatigue, and vital signs of Korean middle-aged women. A quasi-experimental study using a pretest/posttest control group, nonsynchronized design was employed. The study participants consisted of 55 middle-aged women (27 in the experiment group and 28 in the control group), who visited a community center in Seoul, South Korea. Self-acupunctural hand massage using aromatic oil as an experimental intervention was performed once per day, 6 minutes per session for the left and right hands each, for 3 weeks. A questionnaire was designed to measure the general characteristics, stress, fatigue, and vital signs (blood pressure and pulse rate). There were significant differences in the degrees of stress, fatigue, and vital signs (blood pressure) between the 2 groups. Self-acupunctural hand massage using aromatic oil decreased the stress, fatigue, and vital signs (blood pressure) of Korean middle-aged women. Self-acupunctural hand massage using aromatic oil can be utilized as an effective nursing intervention for decreasing stress, fatigue, and vital signs (blood pressure) for middle-aged women in clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the number of farmers in Korea is declining, the proportion of older farmers aged ≥60 increases. OBJECTIVE: This study aims to analyze gender differences in working conditions, exposure to risk factors, and health problems of older crop farmers aged ≥60. METHODS: This study used data from the 5th Korean Working Conditions Survey (KWCS) data of 818 male and 985 female crop farmers aged ≥60 years. RESULTS: This study showed that older female farmers had higher ratios of living alone (45.0% vs. 13.4%, p < 0.001), lower education levels (80.7% vs. 53.4%, p < 0.001), and lower average incomes (1.565 vs. 2.036 million KRW, p < 0.001) than that of males. Among subjective scores on the exposure of risk factors, only females' repetitive motion (4.923) and awkward posture (4.415) scores were higher than that of males' repetitive motion (4.601) (p < 0.001) and awkward posture (4.159) scores (p = 0.001). However, female's health problem rates on upper limb pain (68.3%), lower extremity pain (67.6%), backache (48.4%), overall fatigue (44.8%), and headache and eyestrain (25.0%) were higher than that of male's complaint rates on upper limb pain (48.5%) (p < 0.001), lower extremity pain (53.3%) (p < 0.001), backache (35.0%) (p < 0.001), overall fatigue (39.5%) (p = 0.024), and headache and eyestrain (19.4%) (p = 0.005). The rate of depression symptoms in females (54.6%), with a high proportion of single-person households, was higher than that of males (46.9%) (p = 0.001). CONCLUSIONS: The musculoskeletal pains and depression symptoms of older female farmers are prevalent, and efforts and support are required to improve working conditions. [ABSTRACT FROM AUTHOR]

The present study examined the associations between perceptions of love and marital satisfaction and gender moderations among Korean middle-aged married men and women. Two hundred and four married middle adults aged 40 to 59 living with heterosexual spouses in Seoul participated in this study. Regression based moderation analysis was utilized using PROCESS MACRO. Results showed that the average of love perception was the moderate level, and men reported higher perceptions of love, passion, commitment, and marital satisfaction compared to women, while no gender difference in perception of intimacy. Also, love and its three components were positively associated with marital satisfaction. The moderation effect of gender on the association between perception of intimacy and marital satisfaction was significant. Specifically, women showed stronger association between perception of intimacy and marital satisfaction than men did. These results imply that love plays an important role in strengthening marital quality in general, but the intimate interactions were gendered in middle adulthood marriage context in South Korea. Highlights: The middle-aged adults in Korea perceived moderate levels of triangular love and high levels of marital satisfaction. Men reported higher perceptions of love and marital satisfaction than women, while no gender difference in intimacy. Perceptions of triangular love were positively associated with marital satisfaction in middle adulthood. Women showed stronger association between perception of intimacy and marital satisfaction than men did. Further research is needed to examine marital love by more expanded lifespan, gender, and socio-cultural perspectives. [ABSTRACT FROM AUTHOR]

Background: Middle age is a period of change, and many people consume alcohol to relieve the stress associated with this transition. The present study aims to investigate factors that influence drinking among middle-aged people. Methods: This is a secondary analysis of data on social problems and cohesion that the Korea Institute for Health and Social Affairs. Collecting data from 1,260 middle-aged people between 40 and 64 years of age, the study measured resilience, stress, and drinking. Descriptive statistics, t-tests, analysis of variance, Pearson's correlation, and multiple regression analysis were performed. Conclusion: Multiple regression analysis that investigated factors that influenced drinking had an explanatory power of 27.4%. The analysis also revealed that the following factors had effects on drinking among middle-aged people: gender, followed by smoking, marital status, difficulties in daily life due to health problems, employment status, and past experiences of violence. It is necessary to develop and implement strategies that mitigate high-risk drinking based on the factors that our study reveals. This would serve to promote a healthy lifestyle among the middle-aged while also preventing the progression to high-risk drinking. [ABSTRACT FROM AUTHOR]

This study examined the association between perceived discrimination and healthcare avoidance and delay (HAD) among transgender adults in South Korea (hereafter Korea). We conducted a nationwide cross-sectional survey of 244 Korean transgender adults in 2017. Discrimination within the last 12 months was categorized into four groups based on the reason(s) of discrimination experienced: (1) 'never experienced' discrimination, (2) 'only due to transgender identity,' (3) 'due to reason(s) other than transgender identity,' and (4) 'due to both transgender identity and other reason(s).' Korean transgender adults who experienced discrimination 'only due to transgender identity' and 'due to both transgender identity and other reason(s)' reported 1.91-times (95% CI 1.02–3.55) and 1.96-times (95% CI 1.32–2.92) higher prevalence of past 12-month HAD, respectively, than those who had no such experiences. Our findings suggest that institutional efforts are needed to protect transgender people from discrimination, which can contribute to improved access to healthcare among transgender populations in Korea. [ABSTRACT FROM AUTHOR]

We hypothesized that the haplotype of Bcl-2 genetic variants increases breast cancer risk and interacts with lifestyles in Korean women. We identified single nucleotide polymorphism (SNPs) of Bcl-2 associated with breast cancer risk after adjusting for covariates in 390 breast cancer patients and 36,726 women without any cancer that participated in the Korean Genomic Epidemiology Study (KoGES). An allelic genetic model showed that three SNPs (rs1944420, rs7236090, and rs2849382) in the Bcl-2 gene were significantly associated with breast cancer (ORs = 1.28, 0.84, and 0.79, respectively). The participants with the minor allele of the haplotype with three SNPs had 1.65-fold higher breast cancer risk than those with the major allele, after adjusting for covariates. Serum C-reactive protein concentration had a positive association with breast cancer risk. A significant interaction was also observed between the minor allele of the Bcl-2 haplotype and coffee intake (P = 0.03). A low coffee intake in women with the minor allele presented a higher breast cancer risk than a low coffee intake in those with the major allele. In conclusion, the risk of breast cancer risk was higher in post-menopausal women with the minor allele of the Bcl-2 haplotype, and consuming more than 1 cup of coffee per day reduced the risk. The results of this study could be applied to reduce the risk of breast cancer. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the health needs of adults with disabilities in South Korea according to disability type using the International Classification of Functioning, Disability and Health (ICF). An exploratory, qualitative approach using content analysis was employed. Five focus groups consisted of six to seven participants with visual impairment (PVI), hearing impairment (PHI), physical impairment (PPI), brain disorder (PBD), and intellectual disability (PID). Linking rules were used to identify how the health needs related to the ICF components of Body Functions, Activity & Participation, and Environmental Factors. The health needs related to the Environmental Factors were the most mentioned and were frequently perceived as causes of poor health conditions related to Activities & Participation and Body Function. According to what participants perceived as main health issues in the Environmental Factors, the five groups were classified into (1) Services, systems, and policies mainly affecting type (PVI and PPI); (2) Support and relationships mainly affecting type (PHI); and (3) Attitude mainly affecting type (PBD and PID). Government officials and health professionals must tailor development and provision of healthcare for people with disabilities based on health need type. Few studies have investigated the health needs of people with disabilities, although many health indicators suggest that they are facing health inequalities in South Korea. The health issues related to the Environmental Factors were often perceived in this study as causes of poor health conditions related to the Activities & Participation and Body Function, indicating the need to preferentially solve the health issues related to the Environmental Factor. According to what people with each of the five types of disabilities perceived as main health issues and what kinds of actions they expected in the Environmental Factors, they could be classified into three health need types. It is recommended that government officials and health professionals develop and provide appropriate supply-side measures of healthcare considering these different demand-side health needs according to disability type. [ABSTRACT FROM AUTHOR]

Background: Toinvestigatethe associationsbetweenresilience, social support, and meaning in lifeduring midlife and the factors related to meaning in life. Methods:In this cross-sectionalstudy conducted from May 22 to June 21, 2019, 159 South Koreans aged 40-64years were surveyed about resilience, social support, meaning in life, and personal characteristics. Descriptive statistics, t-tests, analysis of variance, bivariate Pearson's correlations, and multiple regression analyses were performed. Conclusion: The difference in resilience according to general characteristics showed significant differences in age, educational attainment, religious affiliation, and health status.Differencesin social support were significantly correlated to gender, social class, and health status. Meaning in life varied significantly according to differences in religious affiliation, social class, and health status. Resilience, social support, and meaning in life were significantly correlated. In the multiple regression model, resilience, social support, and self-rated health statussignificantly influencedmeaning in life. Strengthening resilience andsocial supportduring midlife mightincrease meaning in life, in turn,positively influencing thequality of life inold age. [ABSTRACT FROM AUTHOR]

Introduction: We explored how different chronic diseases, risk factors, and protective factors highly associated with cardiovascular diseases (CVD) are associated with dementia or Mild Cognitive Impairment (MCI) in Korean elders, with a focus on those that manifest in mid-life. Methods: A CVD-free cohort (n = 4289) from the Korean Longitudinal Study of Aging was selected to perform Cox mixed-effects proportional hazard regressions. Eighteen control variables with strong associations to CVD were chosen as explanatory variables, and Mini-Mental State Examination (MMSE) score cut-off for dementia and MCI were used as outcome variables. Results: The statistically significant (P < 0.05) adverse factors that contribute in developing dementia were age (aHR 1.07, 1.05–1.09), Centre for Epidemiological Studies Depression Scale (CESD-10) (aHR 1.17, 1.12–1.23), diagnosis with cerebrovascular disease (aHR 3.73, 1.81–7.66), living with diabetes (aHR 2.30, 1.22–4.35), and living with high blood pressure (HBP) (aHR 2.05, 1.09–3.87). In contrast, the statistically significant protective factors against developing dementia were current alcohol consumption (aHR 0.67, 0.46–0.99), higher educational attainment (aHR 0.36, 0.26–0.56), and regular exercise (aHR 0.37, 0.26–0.51). The factors with a statistically significant adverse association with progression to MCI were age (aHR 1.02, 1.01–1.03) and CESD-10 (aHR 1.17, 1.14–1.19). In contrast, the statistically significant protective factors against developing MCI were BMI (aHR 0.96, 0.94–0.98), higher educational attainment (aHR 0.33, 0.26–0.43), and regular exercise (aHR 0.83, 0.74–0.92). Conclusion: In lieu of the protective factor of MCI and dementia, implementing regular exercise routine well before mid-life and cognitive decline is significant, with adjustments made for those suffering from health conditions, so they can continue exercising despite their morbidity. Further attention in diabetes care and management is needed for patients who already show decline in cognitive ability as it is likely that their MCI impacts their ability to manage their existing chronic conditions, which may adversely affect their cognitive ability furthermore. [ABSTRACT FROM AUTHOR]

The active use of digital technology by older adults will directly promote active and healthy aging, which will have a positive effect not only on the older adults themselves but also on society in general, which is rapidly aging. But Age-based digital divide has become the new face of inequality for older adults around the world. This study aimed to explore the digital technology acceptance process and identify barriers to use among older adults, using the Technology Acceptance Model (TAM) 3 as a framework. This study used data from the 2018 Digital Divide Survey of the Ministry of Science and ICT in South Korea. The sample consisted of 1,662 older adults (aged 55+). The major findings of the study indicate that two environmental dimensions – personal perception (technology self-efficacy and perceived value) and social environment (social norms and social support) – significantly impact the intention to use digital technology among older adults. Furthermore, perceived usefulness and perceived ease of use mediate the relationship between personal and social dimensions and intention. The implications of this study on digital inclusion in older adults can be summarized as follows: it is essential to prioritize the delivery of appropriate digital training and built supportive environments from gerontological perspectives, not just to improve digital accessibility. [ABSTRACT FROM AUTHOR]

Subjective life expectancy predicts actual mortality and provides individual timeframes. This four-year longitudinal study on Korean baby boomers in middle age examines how subjective life expectancy changes as people get older and how changes in health and socioeconomic status cause these shifts. Compared to population-based actuarial life expectancies, men in their fifties overestimated their future longevity by 1.2 years and women underestimated by 4.1 years. Subjective life expectancy increased as the baby boomers aged. The fixed effects regression analyses showed that subjective longevity changed along with known health and mortality factors. An increase in socioeconomic resources predicted an increase in subjective life expectancy, while smoking or health deterioration led to decrease. Generally, baby boomers form rational expectations on their future longevity based on established correlates of health and mortality. However, women's underestimation of life expectancy warrants social concern on longevity risk. [ABSTRACT FROM AUTHOR]

Intergenerational volunteerism is a global phenomenon that aids multiple generations. Considering the positive evidence of volunteering among older adults and their desire for engagement with children, it is important to explore older adult volunteers' experiences in intergenerational programs with a specific focus on the cultural and social impacts of volunteering in educational settings. Using a phenomenological qualitative approach, 43 interviews with older adult volunteers (23 in South Korea (Korea) and 20 in the United States (US) in intergenerational programs were conducted. Participants were recruited from the Beautiful Story Grandma (BSG) in Korea and the Foster Grandparent Program (FGP) in the US in 2019. Three major themes emerged from the interviews revolving around the role of culture and other demographics in the experience of volunteering: (1) Benefits from volunteering with children that transcend demographic and geographic differences; (2) distinctive cultural factors lead to different experiences of volunteering in educational settings; and (3) operational and procedural differences of volunteer programs impact older adult volunteers' experiences in educational settings. This comparative research can inform the development of culturally responsive intergenerational volunteering programs for older adults and other generations in their communities. [ABSTRACT FROM AUTHOR]

Background: As adults with intellectual disabilities approach older adulthood, they face unique physical and psychosocial challenges. This study explored the lived experiences of middle‐aged adults with intellectual disabilities living in their community. Method: Six sessions of Photovoice were conducted with a purposeful sample of six middle‐aged adults with intellectual disabilities in South Korea. Participants were involved with the theme selection, taking photographs related to the themes, group discussion of photo stories and sharing Photovoice outcomes. Results: Thematic analysis yielded 11 subthemes under the five major themes selected by the participants: health, free time, time in the centre, family and my future in old age. Conclusions: The study findings showed complex issues middle‐aged adults with intellectual disabilities may face in later life, including bereavement and healthy lifestyle concerns. It is important to create a space for meaningful social support and social interactions without stigma. [ABSTRACT FROM AUTHOR]

This study investigated knowledge of and attitudes toward advance directives (ADs) among middle-aged women in South Korea, their willingness to write ADs in the future, and the factors related to knowledge of and attitudes toward ADs. Methods: Data were collected using a self-administrated questionnaire completed by 154 middle-aged women aged 50 to 64 from February to March 2020. The questionnaire asked about participants' knowledge of and attitude toward ADs, willingness to write ADs in the future, experiences with life-sustaining treatment within their families, experience making decisions about life-sustaining treatment, and demographic characteristics. Results: Scores for both knowledge of and attitude toward ADs were relatively high. About 60% of participants gave wrong answers when asked if attorneys were required for writing ADs. A higher knowledge score was significantly associated with a higher attitude score (r=0.227, P<0.01). The women were more likely to be willing to write ADs in the future when they reported a middle income level rather than a lower income level (odds ratio [OR]=5.952, P<0.01), considered themselves unhealthy (OR=5.873, P<0.01), and graduated college or higher (OR=4.096, P<0.05). Furthermore, women who thought that ADs would have an impact on treatment (OR=1.869, P<0.05) and on their families (OR=1.447, P<0.05) were more likely to be willing to write an AD. Conclusion: This study shows that wrong information about ADs persists among middle-aged women, and significant factors associated with knowledge of and attitude toward ADs were identified. Targeted education programs about ADs need to be developed for middle-aged women. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to construct and test a hypothetical model of the life satisfaction of middle-aged and older people living alone. Methods: Data were collected from 214 participants in one city of South Korea from the 20th to 31st of March 2019. The assessment tools included laughter, dependency, loneliness, depression, and life satisfaction. Data were analyzed using the SPSS 25.0 and AMOS 26.0 programs. Results: The modified model was a good fit for the data. The model fit indices were x²=44.51 (p<.05), the Comparative Fit Index (CFI)=.97, Tucker-Lewis Index (TLI)=.96, and Root Mean Square Error of Approximation (RMSEA)=.06. Depression was directly influenced by dependency (β=.14, p=.005), laugh (β=-.28, p=.002), and loneliness (β=.48, p<.001). Loneliness mediated the relations among laugh, dependency, and depression. Loneliness (β=-.34, p<.001), and depression (β=-.39, p<.001) had direct effects on life satisfaction. Conclusion: These results suggest that the level of laughter and dependency is highly associated with negative emotions such as loneliness and depression in middle-aged and older people living alone. Depression and loneliness decreased life satisfaction. Nursing interventions are needed to alleviative negative emotions and increase life satisfaction by building a meticulous monitoring and supportive system that considers individual subjects. [ABSTRACT FROM AUTHOR]

Aim: For middle‐aged persons with type 1 diabetes, diabetes management is essential due to the natural effects of middle age. However, studies investigating how such individuals manage their diabetes are lacking. This study aimed to explore diabetes management experiences of middle‐aged individuals with type 1 diabetes. Methods: Data were collected through in‐depth interviews with six middle‐aged persons with diabetes. An interpretative phenomenological analysis was used for the analysis of the data. Results: The following four themes emerged: "familiarity with but no control over type 1 diabetes", "embodiment of one's unique management of type 1 diabetes", "control of one's mindset regarding diabetes management despite a limited scope of activity", and "accepting ownership of self‐management and continued management to the best of one's ability." A core theme was "living silently like robots dreaming of true freedom from type 1 diabetes." Conclusions: The findings indicate that nurses should provide education, embracing the experience in diabetes management through trial and error among persons with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Given the widely used objective measures of environmental pollution in previous research, this study investigated subjective measures in relation to mental health among middle-aged and older adults in three East Asian countries—China, Japan, and South Korea. The samples from the 2010 East Asian Social Survey included 2502 Chinese, 1794 Japanese, and 871 South Korean adults aged 40 and older. Linear regression models were used to examine the associations between mental health measure (SF-12) and 4 perceived environmental pollution indicators (ie, air, water, noise, and pollution index). Greater perceived pollution indicators, as well as the perceived pollution index, were associated with poorer mental health, even after adjusting for covariates in all three countries. Although results need to be further verified in future research, national-level efforts to improve perceptions of environmental pollution may be useful to enhance the mental health of East Asian middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Purpose: To examine the prevalence of sarcopenic obesity (SO) and its association with nutrition and lifestyle factors. Methods: Data from the 2008–2011 Korea National Health and Nutrition Examination Survey for 3937 Korean individuals aged 40 years or older with obesity defined by the modified Asia–Pacific criteria (BMI ≥ 25 kg/m2) were used. Sarcopenia was defined as an appendicular skeletal muscle mass divided by weight (%) of < 1 SD below the sex-specific mean for young adults. Logistic regression models were used for the associations controlling covariates. Results: The prevalence of SO was 52.5%. The SO group had insufficient energy intake, protein, and antioxidant micronutrients, a lower overall dietary quality, a lower physical activity, and higher rates of negative psychological factors than the non-sarcopenic obesity group (p < 0.05). After controlling for covariates, having high mean adequacy ratio scores which was calculated by averaging the sum of the nutrient adequacy ratios had a 94% lower prevalence of SO in the older individuals. Low participation in aerobic exercises had a 74% higher prevalence of SO in the older aged group, and high participation in flexibility exercises had a 11% lower prevalence of SO in the middle-aged group. Interestingly, negative psychological factors were found only in the middle-aged adults with SO (p < 0.05). Conclusion: Sarcopenia was present in over half of the middle-aged and older Korean adults with obesity. Having high dietary quality, increased physical activity, and positive psychological health were associated with a low prevalence of SO. [ABSTRACT FROM AUTHOR]

This study investigated whether there are gender-based differences in the process wherein family functions influence stress through various health behaviors in midlife adults. A cross-sectional study was done using a convenience sample of 250 middle-aged Koreans. Data on the family APGAR index, four health behaviors (i.e., seeking health information, physical activity, healthy diet, and social interaction), and stress were collected by a self-administered survey and analyzed using hierarchical multiple linear regression analyses and a PROCESS macro for SPSS. The study results showed that an indirect effect of family function on stress through health behaviors was significant in women, whereas such a relationship was not shown in men. This study found that the process wherein family function is linked with stress through health behaviors differs by gender. Developing gender-specific interventions is essential to decrease stress in midlife adults. [ABSTRACT FROM AUTHOR]