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The Effects of Elderly Frailty on Adverse Outcomes

노인 허약이 부정적 결과요인에 미치는 영향

  • 이정욱 (신라대학교 보건행정학과)
  • Received : 2020.04.27
  • Accepted : 2020.08.07
  • Published : 2020.08.31

Abstract

The aim of this study was to examine empirically the causal relationship between significant adverse outcomes of elderly frailty. The 2017 National Survey on Old Adults was used to test this, but only nine variables necessary for the hypothesis test were abstracted from it. The results of the hypothesis test are summarized as follows. The sub-variables of adverse outcomes, such as disabilities in daily living activities, disabilities in instrumental daily living activities, and health care utilization, were analyzed empirically by inputting sub-variables of six frailty factors into hierarchical regression analysis. In the final model, the physical activities, emotional control, and social support were verified as significant variables influencing the disabilities in daily living activities. These included the following: physical activities, sensory functions, cognition, emotional control and social support as those influencing disabilities in the instrumental daily living activities; and nutrition, physical activities, sensory functions, emotional control, and social support as those influencing the health care utilization. Based on the results of the hypothesis test, it is necessary to develop and implement personalized health management programs that specifically identify elderly weakness factors that affect adverse outcomes, such as disabilities or health care utilization.

본 연구는 노인허약의 유의미한 부정적 결과요인들을 검증해 그 인과적 관계를 실증하는 데 연구 목적을 두었다. 이를 검증하기 위해 본 연구는 전국노인실태조사 자료 중 2017년도 조사 자료를 활용하되 본 연구에서 설정한 가설 검증에 필요한 9개 변수만을 추출해서 활용하였다. 가설 검증 결과를 요약하면 다음과 같다. 6가지의 허약요인의 하위 변수들을 위계적 회귀분석에 투입해 부정적 결과요인의 하위 변수인 일상생활활동 장애, 도구적 일상생활활동 장애, 의료서비스 이용에의 영향관계에 대한 실증 결과 일상생활활동 장애에 미치는 영향 실증 결과에서는 최종 모형에서 신체활동, 감정 조절, 사회적 지지가 유의한 영향변수로 검증되었고 도구적 일상생활활동 장애에 미치는 영향 실증 결과에서는 최종 모형에서 신체활동, 감각기능, 인지력, 감정 조절, 사회적 지지가 유의한 영향변수로 검증되었으며 의료서비스 이용에 미치는 영향 실증 결과에서는 최종 모형에서 영양, 신체활동, 감각기능, 감정 조절, 사회적 지지가 유의한 영향변수로 검증되었다. 본 연구의 가설 검증 결과에 기초할 때 장애나 의료서비스 이용과 같은 부정적 결과에 영향을 미치는 노인허약요인을 구체적으로 식별해 그에 상응하는 개별화된 건강관리프로그램의 개발 및 실행이 필요하다.

Keywords

References

  1. C. S. Park, B. M. Kim, "A comparative study on the impact of Korea and Japan's aging population structure on the labor market", Jeonju: National Pension Research Institute, 2018.
  2. Ministry of Economy and Finance, Improving the "quality of life" that "people feel" through active financial management: Focus on "Youth jobs, low birth rate and aging, innovation growth, safety", Sejong: Ministry of Economy and Finance, 2018.
  3. E. S. Yim, K. H. No, "The effects of related factors on health-related quality of life for the frail elderly", J Korean Acad Community Health Nurs, Vol.21, No.1, pp.12-20, 2010. DOI: https://doi.org/10.12799/jkachn.2010.21.1.12
  4. S. M. Kwon, J. S. Park, "A comparision on frailty, health promotion behavior, and perceived health status in the elderly according to the type of residency", Journal of Agricultural Medicine & Community Health, Vol.35, No.1, pp.1-12, 2010. DOI: https://doi.org/10.5393/jamch.2010.35.1.001
  5. Winograd, C. H., Gerety, M. B., Chung, M., Goldstein, M. K., Dominguez, Jr., F., & Vallone, R., "Screening for frailty: Criteria and predictors of outcomes", Journal of American Society, Vol.39, No.8, pp.778-784, 1991. DOI: https://doi.org/10.1111/j.1532-5415.1991.tb02700.x
  6. Buchner, D. M. & Wagner, E. H., Preventing frail health, "Clinics in Geriatric Medicine" , Vol.8, No.1, pp.1-18, 1992. https://doi.org/10.1016/S0749-0690(18)30494-4
  7. Raphael, D., Cava, M., Brown, I., Renwick, R. Heathcote, K., Weir, N., Wright, K., & Kirwan, L., "Frailty: A public health perspective", Canadian Journal of Public Health, Vol.86, No.4, pp.224-227, 1995.
  8. Nourhashemi, F., Andrieu, S., Gillette-Guyonnet, S., Vellas, B., Albarede, J. L., & Grandjean, H., "Instrumental activities of daily living as a potential marker of frailty: A study of 7364 community-dwelling elderly women(the EPIDOS study)", The Journal of Gerontology: Series A, Vol.56, No.7, pp.448-453, 2001. DOI: https://doi.org/10.1093/gerona/56.7.m448
  9. Sternberg, S. A., Schwartz, A. W., Karunananthan, S., Bergman, H., & Clarfield, A. M., "The identification of frailty: A systematic literature review", Journal of the American Geriatrics Society, Vol.59, No.11, pp.2129-2138, 2011. DOI: https://doi.org/10.1111/j.1532-5415.2011.03597.x
  10. Gobbens, R. J. J., Luijkx, K. G., Wijnen-Sponselee, M. T., & Schols, J. M. G. A., "Towards an integral conceptual model of frailty", The Journal of Nutrition, Health & Aging, Vol.14, No.3, pp.175-181, 2010. DOI: https://doi.org/10.1007/s12603-010-0045-6
  11. Bergman,, H., Béland, F., & Perrault, A., "The global challenge of understanding and meeting the needs of the frail older population", Aging Clinical and Experimental Research, Vol.14, No.4, pp.223-225, 2002. DOI : https://doi.org/10.1007/bf03324442
  12. Campbell, A. J. & Buchner, D. M., "Unstable disability and the fluctuations of frailty", Age and Ageing, Vol.26, pp.315-318, 1997. DOI: https://doi.org/10.1093/ageing/26.4.315
  13. Clegg, A., Young, J., Lliffe, S., Rikkert, M. O., & Rockwood, K., "Frailty in elderly people", The Lancet, Vol.382, pp.19-25, 2013. DOI: https://doi.org/10.1016/s0140-6736(12)62167-9
  14. Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., & McBurnie, M. A., "Frailty in older adults: Evidence for a phenotype", The Journals of Gerontology: Series A, Vol.56, No.3, pp.146-157, 2001. https://doi.org/10.1093/gerona/56.3.M146
  15. Gobbens, R. J. J., Luijkx, K. G., Wijnen-Sponselee, M. T., & Schols, J. M. G. A., "Frail elderly, Identification of a population at risk", Vol.38, pp.65-76, 2007.
  16. Hogan, D. B., MacKnight, C., & Bergman, H., "Models, definitions, and criteria of frailty", Aging Clinical and Experimental Research, Vol.15, pp.1-29, 2003. https://doi.org/10.1007/BF03324472
  17. Levers, M. J., Estabrooks, C. A., & Ross, K. J. C., "Factors contributing to frailty: Literature review", Journal of Advanced Nursing, Vol.56, No.3, pp.282-291, 2006. DOI: https://doi.org/10.1111/j.1365-2648.2006.04021.x
  18. Markle-Reid, M. & Browne, G., "Conceptualizations of frailty in relation to older adults", Journal of Advanced Nursing, Vol.44, No.1, pp.58-68, 2003. DOI: https://doi.org/10.1046/j.1365-2648.2003.02767.x
  19. Rockwood, K., Hogan, D. B., & MacKnight, C., Conceptualisation and measurement of frailty in elderly people, Drugs & Aging, 17(4), 295-302, 2000. https://doi.org/10.2165/00002512-200017040-00005
  20. Strawbridge, W. J., Shema, S. J., Balfour, J. L., Higby, H. R., & Kaplan, G. A., "Antecedents of frailty over three decades in an older cohort", The Journal of Gerontology: Series B, Vol.53, No.1, pp.9-16, 1998. DOI: https://doi.org/10.1093/geronb/53b.1.s9
  21. K. O. Jang, "Effects of elderly people's frail prevention program on subjective health status, depression, physical fitness and quality of life for in senior center participation of the elderly", Journal of the Korea Academia-Industrial cooperation Society, Vol.18, No.5, pp.47-58, 2017. DOI: https://doi.org/10.5762/KAIS.2017.18.5.47
  22. B. J. Jeoung, "Exercise rehabilitation for frail elderly", Korean J Clin Geri, Vol.15, No.1, pp.9-13, 2014. DOI: https://doi.org/10.15656/kjcg.2014.15.1.9
  23. K. W. Choi, U. A. Park, I. S. Lee, "Factors influencing the fear of falling according to gender in frail elderly", Journal of the Korean Gerontological Society, Vol.31, No.3, pp.539-551, 2011.
  24. H. G. Kang, "Quality of life, frailty and depression in elderly in rural area", Journal of Korean Academy of Rural Health Nursing, Vol.12, No.1, pp.13-27, 2017.
  25. K. H Kim, H. J. Yoon, "Factors that affect the frailty of the elderly people over 70-year-old in a local community", Journal of the Korea Academia-Industrial cooperation Society, Vol.18, No.2, pp.313-323, 2017. DOI: https://doi.org/10.5762/KAIS.2017.18.2.313
  26. J. S. Park, Y. J. Oh, "Predictors and frailty level in the frail elderly receiving home visiting health care services", J Agric Med Community Health, Vol.41, No.3, pp.129-139, 2016. DOI: https://doi.org/10.5393/jamch.2016.41.3.129
  27. J. K. Park, S. L. Kim, "Factors affecting the elderly's frailty among the vulnerable social group", Journal of the Korean Gerontological Society, Vol.3, No.3, pp.441-456, 2014.
  28. E. M. Oh, "Development of the Korean Frailty Instrument(KFI) to assess community-dwelling older adults: Using 2008, 2011 National Survey on Older Adults", Dept of Nursing, Graduate School, Hanyang University, Doctorial Dissertation, 2015.
  29. K. S. Jeon, S. J. Park, S. R. Jang, "The relationship between frailty and health-related quality of life among Korean elderly", Annals of Geriatric Medicine and Research, Vol.16, No.4, pp.175-183, 2012. DOI: https://doi.org/10.4235/jkgs.2012.16.4.175
  30. K. S. Jeon, S. H. Cho, "Prevalence and social correlates of frailty among rural community-dwelling older adults", Annals of Geriatric Medicine and Research, Vol.18, No.3, pp.143-152, 2014. DOI: https://doi.org/10.4235/jkgs.2014.18.3.143
  31. Morley, J. E., Haren, M. T., Rolland, Y., & Kim, M. J., "Frailty, Medical Clinics of North America", Vol.90, pp.837-847, 2006. https://doi.org/10.1016/j.mcna.2006.05.019
  32. H. J. Song, Y. W. Lee, D. J. Kim, "A plan for the development of health care services for the elderly and the establishment of an efficient operating system, Seoul: KIHASA", 2004.
  33. B. J. Park, Y. J. Lee, "Integrative approach to elderly frailty", Korean Journal of Family Medicine, Vol.31, No.10, pp.747-754, 2010. DOI: https://doi.org/10.4082/kjfm.2010.31.10.747
  34. T. S. Shin, "Review and application of missing data methods: Focusing on longitudinal achievement data", Journal of Educational Evaluation, Vol.27, No.3, pp.693-725, 2014.
  35. M. H. Huh, "SPSS Statistics missing value analysis and multiple substitution", Seoul: Data Solution, 2013.
  36. H. S. Suh, K. S. Yang, N. Y. Kim, H. Y. Kim, M. K. Kim, "SPSS(PASW) regression (3rd ed.)", Seoul: Hannarae Publishing Co., 2011.
  37. Verbrugge, L. M., Flies without wings, In: Carey, R., Robine, J-M., Michel, J. P., Christen, Y., eds. "Longevity and frailty" , Heidelberg: Springer-Verlag, 2005.
  38. Walston, J. & Fried, L. P., "Frailty and the older man", Medical Clinics of North America, Vol.83, No.5, pp.1173-1194, 1999. DOI: https://doi.org/10.1016/s0025-7125(05)70157-7
  39. Boyd, C. M., Xue, Q. L., Simpson, C. F., Guralnik, J. M., & Fried, L. P., "Frailty, hospitalization, and progression of disability in a cohort of disabled older women", The American Journal of Medicine, Vol.118, No.11, pp.1225-1231, 2005. DOI: https://doi.org/10.1016/j.amjmed.2005.01.062
  40. Covinsky, K. E., Hilton, J., Lindquist, K., & Dudley, R. A., "Development and validation of an index to predict activity of daily living dependence in community-dwelling elders", Medical Care, Vol.44, No.2, pp.149-157, 2006. DOI: https://doi.org/10.1097/01.mlr.0000196955.99704.64
  41. Rockwood, K., Mitnitski, A., Song, X., Steen, B., & Skoog, I., "Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70", Journal of American Geriatrics Society, Vol.54, pp.975-979, 2006. DOI: https://doi.org/10.1111/j.1532-5415.2006.00738.x
  42. Schuurmans, H., Steverink, N., Lindenberg, S., Frieswijk, N., & Slaets, J. P. J., "Old or frail: What tells us more?". The Journal of Gerontology: Series A, Vol.59, No.9, pp.962-965, 2004. DOI: https://doi.org/10.1093/gerona/59.9.m962