• KSAN
  • Contact us
  • E-Submission

Korean J Adult Nurs : Korean Journal of Adult Nursing

OPEN ACCESS
mobile search button mobile menu button
Search
Advanced Search
ABOUT
BROWSE ARTICLES
EDITORIAL POLICY
FOR CONTRIBUTORS

Articles

Page Path

Original Article

Geriatric Syndrome and Mortality among Community-dwelling Older Adults in Korea: 3-year Follow-up Study

Si Eun Lee, MSN, RN1, Gwi-Ryung Son Hong, Ph.D., RN2
Korean Journal of Adult Nursing 2017;29(1):98-107.
Published online: February 28, 2017

1PhD Candidate, College of Nursing, Hanyang University, Seoul

2Professor, College of Nursing, Hanyang University, Seoul, Korea

Corresponding author: Lee, Si Eun College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Tel: +82-2-2220-0700, Fax: +82-2-2295-2074, E-mail: sieun0@hanyang.ac.kr
• Received: January 23, 2017   • Accepted: February 27, 2017

Copyright © 2017 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 31 Views
  • 0 Download
  • 2 Crossref
prev next

Full Article

Download PDF Download PDF
  • Purpose
    The purpose of this study was to investigate the effect of geriatric syndrome on mortality among community-dwelling older adults in Korea.
  • Methods
    Data were obtained from the Actual Living Condition of the Elderly and Welfare Need Survey, with a baseline study in 2008 and a 3-year follow-up of mortality data. The mortality risk was measured using the hierarchical Cox proportional hazard model.
  • Results
    In Cox regression analysis, male (Hazard Ratio [HR], 2.53; 95% Confidence Interval [CI], 2.12~3.01), old age (HR, 2.14; 95% CI, 1.82~2.53), low education level (HR, 1.31; 95% CI, 1.04~1.65), limitation in instrumental activities of daily living (HR, 1.91; 95% CI, 1.60~2.28), depressive symptoms (HR, 1.21; 95% CI, 1.01~1.43), and frailty (HR, 2.32; 95% CI, 1.78~3.03) significantly affected mortality risk.
  • Conclusion
    Based on the results of this study, nursing intervention programs should be provided to decrease preventable death in older adults.
  • Key Words: Aged; Mortality; Syndrome
Figure 1.
Conceptual framework of this study.
kjan-29-98f1.jpg
Figure 2.
Flow diagram of study participants.
kjan-29-98f2.jpg
Figure 3.
Kaplan-Meier survival curves for frail.
kjan-29-98f3.jpg
Table 1.
Characteristics of Participants at Baseline 2008 (N=8,298)
Variables Categories Total (n=8,298) Survivors (n=7,630, 91.9%) The deceased (n=668, 8.1%) x2 p
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Gender Female 4,840 (58.3) 4,550 (59.6) 290 (43.4) 66.48 ＜.001
Male 3,458 (41.7) 3,080 (40.4) 378 (56.6)
Age (year) 65~74 5,417 (65.3) 5,147 (67.5) 270 (40.4) 198.12 ＜.001
≥75 2,881 (34.7) 2,483 (32.5) 398 (59.6)
  72.97±5.83 72.62±5.57 76.99±7.08
Educational level No education 3,014 (36.3) 2,717 (35.6) 297 (44.5) 20.91 ＜.001
Elementary school 3,135 (37.8) 2,918 (38.2) 217 (32.5)
≥Junior high school 2,149 (25.9) 1,995 (26.2) 154 (23.0)
Cognitive impairment Yes 2,049 (24.7) 1,811 (23.7) 238 (35.6) 46.72 ＜.001
No 6,249 (75.3) 5,819 (76.3) 430 (64.4)
Limitation in IADLs Yes 2,073 (25.0) 1,764 (23.1) 309 (46.3) 175.47 ＜.001
No 6,225 (75.0) 5,866 (76.9) 359 (53.7)
Urinary incontinence Yes 136 (1.6) 125 (1.6) 11 (1.6) 0.01 .987
No 8,162 (98.4) 7,505 (98.4) 657 (98.4)
Number of falls in the past year (range: 0~10) 0 6,941 (83.6) 6,402 (83.9) 539 (80.7) 16.75 ＜.001
1~2 1,039 (12.5) 955 (12.5) 84 (12.6)
≥3 318 (3.9) 273 (3.6) 45 (6.7)
  2.13±1.99 2.07±1.93 2.68±2.48
Depressive symptoms (range: 0~15) Yes 2,498 (30.1) 2,204 (28.9) 294 (44.0) 66.79 ＜.001
No 5,800 (69.9) 5,426 (71.1) 374 (56.0)
  5.26±4.52 5.10±4.47 7.04±4.66
Frailty Not frail 3,331 (40.1) 3,181 (41.7) 150 (22.5) 191.58 ＜.001
Intermediate 4,251 (51.2) 3,874 (50.8) 377 (56.4)
Frail 716 (8.7) 575 (7.5) 141 (21.1)

IADLs=instrumental activities of daily living.

Table 2.
Risk Factors of Mortality among Older Adults in Korea (N=8,298)
Variables Model 1 Model 2 Model 3
HR (95% CI) p HR (95% CI) p HR (95% CI) p
Gender
   Male (vs. Female) 2.60 (2.18~3.09) ＜.001 2.64 (2.22~3.14) ＜.001 2.53 (2.12~3.01) ＜.001
Age (years old)
   ≥75 (vs. 65~74) 2.32 (1.97~2.73) ＜.001 2.29 (1.94~2.70) ＜.001 2.14 (1.82~2.53) ＜.001
Educational level   .002   .008   .034
   No education (vs.≥Junior high school) 1.46 (1.16~1.84) .001 1.39 (1.10~1.75) .005 1.31 (1.04~1.65) .022
   Elementary school 1.10 (0.89~1.36) .369 1.07 (0.87~1.33) .509 1.05 (0.85~1.30) .657
Cognitive impairment
   Yes (vs. No) 1.32 (1.19~1.57) .001 1.25 (1.06~1.49) .010 1.17 (0.99~1.40) .070
Limitation in IADLs
   Yes (vs. No) 2.28 (1.99~2.71) ＜.001 2.09 (1.75~2.49) ＜.001 1.91 (1.60~2.28) ＜.001
Number of falls in the past year       .152   .284
   1~2 (vs. 0)     0.98 (0.78~1.24) .859 0.91 (0.72~1.15) .438
   ≥3     1.35 (0.99~1.84) .058 1.22 (0.90~1.67) .204
Depressive symptoms
   Yes (vs. No)     1.40 (1.19~1.66) ＜.001 1.21 (1.01~1.43) .034
Frailty
   Intermediate (vs. Not frail)         1.45 (1.18~1.77) ＜.001
   Frail         2.32 (1.78~3.03) ＜.001

IADLs=instrumental activities of daily living; HR=hazard ratio; CI=confidence interval.

  • 1.Statistics Korea. Cause of death statistics [Internet]. Daejeon: Statistics Korea; 2015. [cited 2016 December 7]. Available from:.http://meta.narastat.kr/metasvc/svc/SvcMetaDcDtaPopup.do?orgId=101&confmNo=101054&kosisYn=Y.
  • 2.Rhee JA, Yoo HJHealth status of elderly Koreans. In: Choi SJ. editor..Aging in Korea: today and tomorrow. 3rd ed. Seoul: Elderly Information Center; 2013. p. 52-66.
  • 3.Yoo HJ. Clinical implications of geriatric syndromes. Journal of the Korean Medical Association. 2014;57(9):738-42. https://doi.org/10.5124/jkma.2014.57.9.738.
  • 4.Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. Journal of the American Geriatrics Society. 2007;55(5):780-91. https://doi.org/10.1111/j.1532-5415.2007.01156.x.
  • 5.Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence: unifying the approach to geriatric syndromes. Journal of the American Medical Association. 1995;273(17):1348-53. https://doi.org/10.1001/jama.1995.03520410042024.
  • 6.Yeom JH. The effect of falling on the mortality of elderly Koreans. Korean Journal of Gerontological Social Welfare. 2015;68:389-408.
  • 7.Jeong HG, Lee JJ, Lee SB, Park JH, Huh YS, Han JW, et al. Role of severity and gender in the association between late-life depression and all-cause mortality. International Psychogeriatrics. 2013;25(4):677-84. https://doi.org/10.1017/S1041610212002190.
  • 8.Nam S, Al Snih S, Markides K. Lower body function as a predictor of mortality over 13 years of follow up: findings from Hispanic Established Population for the Epidemiological Study of the Elderly. Geriatrics and Gerontology International. 2016;16(12):1324-31. https://doi.org/10.1111/ggi.12650.
  • 9.The Education Committee Writing Group of the American Geriatrics Society. Core competencies for the care of older patients: recommendations of the American Geriatrics Society. Academic Medicine. 2000;75(3):252-5.
  • 10.Seino S, Yabushita N, Kim MJ, Nemoto M, Jung S, Osuka Y, et al. Physical performance measures as a useful indicator of multiple geriatric syndromes in women aged 75 years and older. Geriatrics and Gerontology International. 2013;13(4):901-10. https://doi.org/10.1111/ggi.12029.
  • 11.Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Got-tdiener J, et al. Frailty in older adults: evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2001;56(3):M146-56.
  • 12.Kane RL, Shamliyan T, Talley K, Pacala J. The association between geriatric syndromes and survival. Journal of the American Geriatrics Society. 2012;60(5):896-904. https://doi.org/10.1111/j.1532-5415.2012.03942.x.
  • 13.Carlson C, Merel SE, Yukawa M. Geriatric syndromes and geriatric assessment for the generalist. Medical Clinics of North America. 2015;99(2):263-79. https://doi.org/10.1016/j.mcna.2014.11.003.
  • 14.Lee YH, Kim JH, Han ES, Ryu MK, Cho YY, Chae SI. Frailty and body mass index as predictors of 3-year mortality in older adults living in the community. Gerontology. 2014;60(6):475-82. https://doi.org/10.1159/000362330.
  • 15.Korea Ministry of Health and Welfare. 2008 actual living condition of the elderly and welfare need survey. Policy Report. Reston: Korea Ministry of Health and Welfare; 2009. February. Report No.: 11-1351000-000316-12..
  • 16.Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RBEvidence-based medicine: How to practice and teach EBM. 2nd ed.. New York: Churchill Livingstone; 2000.
  • 17.Allison PDSurvival analysis. In: Hancock GR, Mueller RO, editors. The reviewer's guide to quantitative methods in the social sciences. 1st ed.. New York: Routledge; 2010. p. 413-24.
  • 18.Lee SE, Hong GRS. Predictors of suicidal ideation in community-dwelling older men: a comparison between young-old and old-old. Academy of Psychiatric and Mental Health Nursing. 2016;25(3):217-26. https://doi.org/10.12934/jkpmhn.2016.25.3.217.
  • 19.Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975;12(3):189-98.
  • 20.Lee JH, Lee KU, Lee DY, Kim KW, Jhoo JH, Kim JH, et al. Development of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K): clinical and neuropsychological assessment batteries. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences. 2002;57(1):47-53. https://doi.org/10.1093/geronb/57.1.P47.
  • 21.Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3):179-86. https://doi.org/10.1093/geront/9.3_Part_1.179.
  • 22.Won CW, Rho YG, Duk SW, Lee YS. The validity and reliability of Korean Instrumental Activities of Daily Living (K-IADL) Scale. The Journal of Korean Geriatric Society. 2002;6(4):273-80.
  • 23.Lee SE, Hong GRS. Predictors of depression among community-dwelling older women living alone in Korea. Archives of Psychiatric Nursing. 2016;30(5):513-20. https://doi.org/10.1016/j.apnu.2016.05.002.
  • 24.Yesavage JA, Sheikh JI. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist. 1986;5(1-2):165-73. https://doi.org/10.1300/J018v05n01_09.
  • 25.Cho MJ, Bae JN, Suh GH, Hahm BJ, Kim JK, Lee DW, et al. Validation of Geriatric Depression Scale, Korean version (GDS) in the assessment of DSM-III-R major depression. Journal of Korean Neuropsychiatric Association. 1999;38(1):48-63.
  • 26.Teng PR, Yeh CJ, Lee MC, Lin HS, Lai TJ. Depressive symptoms as an independent risk factor for mortality in elderly persons: results of a national longitudinal study. Aging and Mental Health. 2013;17(4):470-8. https://doi.org/10.1080/13607863.2012.747081.
  • 27.John G, Bardini C, Combescure C, Dällenbach P. Urinary incontinence as a predictor of death: a systematic review and meta-analysis. Plos One. 2016;11(7):e0158992https://doi.org/10.1371/journal.pone.0158992.
  • 28.Korea Institute for Health and Social Affairs. 2014 a national survey on the living status and welfare needs of the aged. Policy Report. Sejong: Korea Institute for Health and Social Affairs; 2014 December. Report No.: 11-1352000-001426-12..
  • 29.Santabárbara J, Lopez-Anton R, Marcos G, De-la-Cámara C, Lobo E, Saz P, et al. Degree of cognitive impairment and mortality: a 17-year follow-up in a community study. Epidemiology and Psychiatric Sciences. 2015;24(6):503-11. https://doi.org/10.1017/S2045796014000390.
  • 30.Chang SF, Lin PL. Frail phenotype and mortality prediction: a systematic review and meta-analysis of prospective cohort studies. International Journal of Nursing Studies. 2015;52(8):1362-74. https://doi.org/10.1016/j.ijnurstu.2015.04.005.

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Factors Associated with Frailty According to Gender of Older Adults Living Alone
      Hye-Young Jang, Ji-Hye Kim
      Healthcare.2021; 9(4): 475.     CrossRef
    • Factors contributing to the use of complementary and alternative medicine in rural older women with chronic pain in South Korea
      Saunjoo L. Yoon, Jeong-Hee Kim
      Applied Nursing Research.2013; 26(4): 186.     CrossRef

    Download Citation

    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

    Format:

    Include:

    Geriatric Syndrome and Mortality among Community-dwelling Older Adults in Korea: 3-year Follow-up Study
    Korean J Adult Nurs. 2017;29(1):98-107.   Published online February 28, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.1.98
    Download Citation
    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
    Format:
    • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
    • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
    Include:
    • Citation for the content below
    Geriatric Syndrome and Mortality among Community-dwelling Older Adults in Korea: 3-year Follow-up Study
    Korean J Adult Nurs. 2017;29(1):98-107.   Published online February 28, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.1.98
    Close

    Figure

    • 0
    • 1
    • 2
    Geriatric Syndrome and Mortality among Community-dwelling Older Adults in Korea: 3-year Follow-up Study
    Image Image Image
    Figure 1. Conceptual framework of this study.
    Figure 2. Flow diagram of study participants.
    Figure 3. Kaplan-Meier survival curves for frail.

    Figure 1.

    Figure 2.

    Figure 3.

    Geriatric Syndrome and Mortality among Community-dwelling Older Adults in Korea: 3-year Follow-up Study

    Characteristics of Participants at Baseline 2008 (N=8,298)

    Variables Categories Total (n=8,298) Survivors (n=7,630, 91.9%) The deceased (n=668, 8.1%) x2 p
    n (%) or M±SD n (%) or M±SD n (%) or M±SD
    Gender Female 4,840 (58.3) 4,550 (59.6) 290 (43.4) 66.48 ＜.001
    Male 3,458 (41.7) 3,080 (40.4) 378 (56.6)
    Age (year) 65~74 5,417 (65.3) 5,147 (67.5) 270 (40.4) 198.12 ＜.001
    ≥75 2,881 (34.7) 2,483 (32.5) 398 (59.6)
      72.97±5.83 72.62±5.57 76.99±7.08
    Educational level No education 3,014 (36.3) 2,717 (35.6) 297 (44.5) 20.91 ＜.001
    Elementary school 3,135 (37.8) 2,918 (38.2) 217 (32.5)
    ≥Junior high school 2,149 (25.9) 1,995 (26.2) 154 (23.0)
    Cognitive impairment Yes 2,049 (24.7) 1,811 (23.7) 238 (35.6) 46.72 ＜.001
    No 6,249 (75.3) 5,819 (76.3) 430 (64.4)
    Limitation in IADLs Yes 2,073 (25.0) 1,764 (23.1) 309 (46.3) 175.47 ＜.001
    No 6,225 (75.0) 5,866 (76.9) 359 (53.7)
    Urinary incontinence Yes 136 (1.6) 125 (1.6) 11 (1.6) 0.01 .987
    No 8,162 (98.4) 7,505 (98.4) 657 (98.4)
    Number of falls in the past year (range: 0~10) 0 6,941 (83.6) 6,402 (83.9) 539 (80.7) 16.75 ＜.001
    1~2 1,039 (12.5) 955 (12.5) 84 (12.6)
    ≥3 318 (3.9) 273 (3.6) 45 (6.7)
      2.13±1.99 2.07±1.93 2.68±2.48
    Depressive symptoms (range: 0~15) Yes 2,498 (30.1) 2,204 (28.9) 294 (44.0) 66.79 ＜.001
    No 5,800 (69.9) 5,426 (71.1) 374 (56.0)
      5.26±4.52 5.10±4.47 7.04±4.66
    Frailty Not frail 3,331 (40.1) 3,181 (41.7) 150 (22.5) 191.58 ＜.001
    Intermediate 4,251 (51.2) 3,874 (50.8) 377 (56.4)
    Frail 716 (8.7) 575 (7.5) 141 (21.1)

    IADLs=instrumental activities of daily living.

    Risk Factors of Mortality among Older Adults in Korea (N=8,298)

    Variables Model 1 Model 2 Model 3
    HR (95% CI) p HR (95% CI) p HR (95% CI) p
    Gender
       Male (vs. Female) 2.60 (2.18~3.09) ＜.001 2.64 (2.22~3.14) ＜.001 2.53 (2.12~3.01) ＜.001
    Age (years old)
       ≥75 (vs. 65~74) 2.32 (1.97~2.73) ＜.001 2.29 (1.94~2.70) ＜.001 2.14 (1.82~2.53) ＜.001
    Educational level   .002   .008   .034
       No education (vs.≥Junior high school) 1.46 (1.16~1.84) .001 1.39 (1.10~1.75) .005 1.31 (1.04~1.65) .022
       Elementary school 1.10 (0.89~1.36) .369 1.07 (0.87~1.33) .509 1.05 (0.85~1.30) .657
    Cognitive impairment
       Yes (vs. No) 1.32 (1.19~1.57) .001 1.25 (1.06~1.49) .010 1.17 (0.99~1.40) .070
    Limitation in IADLs
       Yes (vs. No) 2.28 (1.99~2.71) ＜.001 2.09 (1.75~2.49) ＜.001 1.91 (1.60~2.28) ＜.001
    Number of falls in the past year       .152   .284
       1~2 (vs. 0)     0.98 (0.78~1.24) .859 0.91 (0.72~1.15) .438
       ≥3     1.35 (0.99~1.84) .058 1.22 (0.90~1.67) .204
    Depressive symptoms
       Yes (vs. No)     1.40 (1.19~1.66) ＜.001 1.21 (1.01~1.43) .034
    Frailty
       Intermediate (vs. Not frail)         1.45 (1.18~1.77) ＜.001
       Frail         2.32 (1.78~3.03) ＜.001

    IADLs=instrumental activities of daily living; HR=hazard ratio; CI=confidence interval.
    Table 1. Characteristics of Participants at Baseline 2008 (N=8,298)

    IADLs=instrumental activities of daily living.

    Table 2. Risk Factors of Mortality among Older Adults in Korea (N=8,298)

    IADLs=instrumental activities of daily living; HR=hazard ratio; CI=confidence interval.

    Table 1.

    Table 2.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

    ABOUT

    BROWSE ARTICLES 

    EDITORIAL POLICY

    FOR CONTRIBUTORS  

    © Korean Society of Adult Nursing.
    TOP