Journal of Korean Gerontological Nursing最新文献

Purpose: This systematic review evaluates the effectiveness of medication self-management education programs (MSEP) for older adults by analyzing the core characteristics and reported outcomes of successful interventions. Guided by King's Goal Attainment Theory, this study identifies which program elements, such as scope, provider, and duration, are associated with positive clinical and psychosocial outcomes, aiming to provide evidence-based recommendations for practice and future research amid rising polypharmacy and inappropriate medication use.

Methods: A systematic review searched seven databases (up to September 3, 2024) for randomized controlled trials and quasi-experimental studies of medication self-management education for adults 65+. Inclusion followed PICOTS-SD (Participants, Intervention, Comparison, Outcomes, Time, Setting, and Study Design). Quality was assessed (RoB 2.0, ROBINS-I). Data were narratively synthesized, mapping program characteristics to King's theory (e.g., interaction, transaction) to analyze goal attainment pathways.

Results: The 34 included studies demonstrated that MSEP are broadly effective in improving both clinical and psychosocial outcomes. Specifically, comprehensive, multi-session interventions were frequently associated with significant improvements in psychosocial outcomes such as quality of life and self-efficacy, particularly when delivered by multidisciplinary teams or nurses. In contrast, medication-specific programs (14 studies), often led by pharmacists, proved highly effective in enhancing key clinical outcomes, including medication adherence and the reduction of drug-related problems.

Conclusion: MSEP effectively enhance adherence. In accord with King's Goal Attainment Theory, effectiveness is achieved via a 'transactional' process. Programs strong in 'interaction' (multi-session, nurse-led) achieve psychosocial 'goal attainment', while 'action'-focused programs (pharmacist-led, specific) achieve clinical 'goals'. The theory may underscore the need for tailored interventions.

Purpose: This study examined the risk of dysphagia and frailty in community-dwelling older adults and identified related factors including general characteristics, depression, daily singing, and healthy lifestyle.

Methods: A descriptive correlational study was conducted with 183 older adults aged 65 or older from senior and welfare centers in Korea. Data were collected through self-reported questionnaires between January and February 2025. Measurements included risk of dysphagia, frailty, depression, and healthy lifestyle (smoking, drinking, exercise, and nutrition). Data were analyzed using descriptive statistics, chi-square test, t-tests, ANOVA, Pearson's correlation, and multiple regression.

Results: The prevalence of pre-frailty was 46.4% (n=85), and the risk of dysphagia was 30.6% (n=56). Dysphagia risk, frailty, depression, daily singing, and healthy lifestyle showed significant correlations. The number of comorbid conditions (β=.26, p<.001), depression (β=.16, p=.037), nutrition (β=-.16, p=.040) were significant predictors of risk of dysphagia with an adjusted R² of 20.0% (F=8.58, p<.001). For frailty, significant predictors were dysphagia risk (β=.27, p<.001), number of comorbid conditions (β=.23, p<.001), nutrition (β=-.22, p<.001), high school education or above (β=-.15, p=.010), and physical activity (β=-.15, p=.006), with an adjusted R² of 49.9% (F=13.92, p<.001).

Conclusion: The number of comorbid conditions, dysphagia risk, nutritional status, and physical activity were identified as major influencing factors of frailty. Screening for dysphagia risk among older adults with multiple comorbidities, along with interventions to improve nutrition and physical activity, may contribute to the prevention of dysphagia and frailty in this population.

Purpose: This study examined age-specific prevalence and associated factors of activities of daily living (ADL) disability.

Methods: This cross-sectional analysis used first-year data from a longitudinal study. Participants were 564 older adults residing in nursing homes or long-term care hospitals. Data were analyzed using chi-square test and logistic regression.

Results: The mean age of the participants was 83.58 years, and 65.4% had severe ADL disability. Severe ADL disability was significantly associated with being female in the young- old group (odds ratio [OR]=4.18, 95% confidence interval [95% CI]=1.04~16.83); incontinence (OR=3.22, 95% CI=1.58~6.55), dietary change (OR=4.74, 95% CI=1.47~15.26), low calf circumference (OR=3.09, 95% CI=1.10~8.66), suspected cognitive impairment (OR=3.27, 95% CI=1.35~7.96), and long-term care hospital residence (OR=2.41, 95% CI=1.09~5.36) in the mid-old group; and incontinence (OR=3.87, 95% CI=2.13~7.05), low calf circumference (OR=6.38, 95% CI=2.65~15.34), suspected cognitive impairment (OR=2.24, 95% CI=1.02~4.94), and long-term care hospital residence (OR=3.04, 95% CI=1.42~6.54) in the old-old age group.

Conclusion: Findings highlight the need for age-specific management strategies: muscle strengthening and exercise programs for young-old females, integrated and simultaneous management for the mid-old, and strategies to maintain core physiological functions for the old-old. These findings support long-term care policies and contribute to developing care systems in an aged society.

Purpose: This study aimed to examine the impact of an integrated care program implemented by a public health sub-center on the health and quality of life of older adults living alone in a rural area. The integrated care program included art therapy, craft therapy, horticultural therapy, recreational activities, yoga, walking exercises, health screening, and health education.

Methods: This study was conducted as one-group pretest-posttest pre-experimental design with 32 participants. Data were analyzed using SPSS Statistics 27.0 and G*Power 3.1.9.7. Data were analyzed using frequency, percentages, minimum, maximum, mean, standard deviation, paired t-test, and one-tailed Wilcoxon signed-rank test.

Results: Participants in the integrated care program showed significant improvements in cognitive function (z=-2.25, p=.012), depression (z=-2.87, p=.001), health-related quality of life (t=-3.21, p<.001), but systolic blood pressure was elevated (t=4.62, p<.001).

Conclusion: It is necessary to expand the role of public health sub-center as providers of integrated care programs to improve cognitive function in elderly individuals living alone in rural area, reduce depression, and enhance health-related quality of life.

Purpose: This study examined the relationship between fall history and life satisfaction in older adults, focusing on the mediating role of depressive symptoms.

Methods: This descriptive correlational study analyzed data from 10,078 participants in the 2023 National Survey of Older Koreans. Data were analyzed using descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), and the PROCESS macro with bootstrapping to assess the indirect effect of depressive symptoms.

Results: Participants' mean age was 74.13±6.81 years, and approximately two-thirds were female (61.6%) and married (59.0%). Depressive symptoms significantly mediated the association between fall history and life satisfaction among older adults (indirect effect=-.05, 95% confidence interval=-0.07 to -0.04).

Conclusion: To enhance life satisfaction, systematic screening and continuous monitoring should be established for older adults at risk of falling. Healthcare providers should also develop and apply individualized interventions aimed at alleviating depressive symptoms, thereby improving life satisfaction in this population.

Purpose: This study investigated the factors associated with the retention of registered nurses (RNs) in Korean nursing homes (NHs).

Methods: A cross-sectional design was adopted to investigate individual and organizational predictors of RN retention. Data were collected in August 2022 from 163 RNs and 38 NH administrators using structured questionnaires and organizational records. All-subsets regression was conducted at the NH level. To ensure consistency with the unit of analysis, individual-level variables were aggregated to the NH level.

Results: All-subsets regression analyses revealed that for-profit ownership was associated with lower retention, while longer tenure and greater resilience were associated with higher retention rates.

Conclusion: These findings highlight the need for targeted strategies that support psychological resilience and employment continuity to enhance RN retention in NHs. Strengthening the nursing workforce may also contribute to better care quality for residents.

Purpose: This study aimed to investigate the moderating effect of digital device use on the relationship between social exclusion and depression among older adults.

Methods: A secondary data analysis was conducted using the 2020 National Survey of Older Koreans. Data from 5,656 young-old adults (aged 65~74 years) and 4,274 old-old adults (aged≥75 years) were analyzed. Descriptive statistics, chi-square tests, and hierarchical regression analyses were employed.

Results: Social exclusion was positively associated with depression in both age groups. Digital device use significantly moderated this relationship in the old-old group (β=-.06, p=.001), attenuating the effect of social exclusion on depression.

Conclusion: These findings indicate that digital device use may serve as an effective means of alleviating and preventing depression among older adults. The results support the development of policies aimed at enhancing digital literacy for this population.

Purpose: This study was conducted to identify the level of social frailty and its influencing factors among community-dwelling older adults in South Korea using a multilevel approach.

Methods: Secondary data on 81,898 older adults (≥65 years) were obtained from the 2023 Community Health Survey and merged with community-level data (Statistics Korea and safety indices). Data were analyzed with weighted descriptive statistics, group comparisons, and multilevel ordinal logistic regression.

Results: Of the participants, 14.1% were socially frail and an additional 34.3% were at risk. In multilevel analyses, higher age, female, lower education, unemployment, and basic livelihood security were associated with increased social frailty, as were low physical activity, poor perceived environment, and depressive symptoms. Conversely, moderate alcohol use was associated with lower social frailty risk. Between-community variance in social frailty was significant, but only community level of aging showed a significant contextual effect after adjusting for individual factors.

Conclusion: Social frailty in older adults is primarily influenced by individual characteristics with a modest community context effect. Targeted interventions for vulnerable individuals, including those who are older, female, low socioeconomic status, physically inactive, or experiencing depression, together with community-level efforts in highly aged areas such as improving social infrastructure and enhancing safety, are essential to reduce social frailty.

Purpose: The purpose of this study is to identify the factors influencing generalized anxiety disorder (GAD) in older adults and to provide effective health management directions for GAD patients.

Methods: This study used data from the 9th National Health and Nutrition Survey (2022) and selected 1,666 older adults. The analysis was conducted using the SPSS 26.0 program. A complex sample chi-square test was performed to identify factors related to GAD. Complex sample logistic regression was conducted to determine the factors influencing GAD in the participants.

Results: The study results indicated that sex (p=.034), smoking (p=.042), alcohol consumption (p=.003), sleep duration (p=.005), chewing discomfort (p<.001), speaking discomfort (p<.001), and self-rated health (p=.016) were statistically significantly associated with GAD. The multivariate analysis considering the interaction between variables, sleep duration (OR=2.07, p=.031) and chewing discomfort (OR=2.49, p=.008) were identified as factors influencing GAD.

Conclusion: Chewing discomfort in older adults affects not only GAD but also leads to a decline in aesthetics and social withdrawal. Therefore, improvements in oral health policy support for oral health promotion and prevention are required. Additionally, education and interventions through community systems should be provided to address sleep issues associated with GAD.

Purpose: Urinary tract infections (UTIs) and pressure injuries are critical quality indicators in long-term care facilities (LTCFs). This study investigated the individual- and institutional-level factors associated with UTI and pressure injury experience among Korean nursing home residents.

Method: This retrospective study utilized the National Health Insurance Service database and analyzed 122,312 residents from 4,242 nursing homes who continuously resided for at least 3 months between January 2016 and December 2017. Multilevel logistic regression analyses were used to examine individual characteristics, facility attributes, and LTCF evaluation indicators.

Results: The UTI and pressure injury experience rates were 31.09% and 6.69%, respectively. Female residents exhibited significantly higher UTI risk (odds ratio [OR]=1.16, 95% confidence interval [95% CI]=1.13~1.21) but lower pressure injury risk (OR=0.73, 95% CI=0.69~0.78) than males. Lower functional grades demonstrated stepwise risk increases for both outcomes, with Grade 1 residents showing 2.97 times increased UTI risk and 8.35 times increased pressure injury risk. Facility size was a significant risk factor for UTI development. Condition-specific LTCF evaluation indicators for UTI and pressure injuries showed targeted protective effects: the Indwelling Catheter Status indicator reduced the UTI experience risk by 14%; the Pressure Injury Prevention indicator reduced the pressure injury experience risk by 12%.

Conclusion: This study identified distinct individual and institutional factors that influence adverse events in Korean nursing home residents. Condition-specific quality indicators demonstrated protective effects only for their corresponding outcomes, validating the effectiveness of tailored quality management approaches and supporting the development of targeted prevention strategies.