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Korean J Adult Nurs : Korean Journal of Adult Nursing

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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

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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.

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  • 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.

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    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
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    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
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    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

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