• Journal of the Korean Statistical Society
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• v.36 no.1
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• pp.129-148
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• 2007

Frailty estimates from the proportional hazards frailty model often lead us to conjecture the heterogeneity in frailty such that the variance of the frailty varies over different covariate groups (e.g. male group versus female group). For such systematic heterogeneity in frailty, we consider a regression model for the variance components in the proportional hazards frailty model, denoted by the MLFM. However, in many cases, the observed data do not show any statistically significant preference between the homogeneous frailty model and the heterogeneous frailty model. In this paper, we propose a Bayesian model averaging procedure with the reversible jump Markov chain Monte Carlo which selects the appropriate model automatically. The resulting regression coefficient estimate ignores the model uncertainty from the frailty distribution in view of Bayesian model averaging (Hoeting et al., 1999). Finally, the proposed model and the estimation procedure are illustrated through the analysis of the kidney infection data in McGilchrist and Aisbett (1991) and a simulation study is implemented.

• Journal of dental hygiene science
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• v.23 no.4
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• pp.378-388
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• 2023

Background: With increasing interest in health in old age, aspects of oral aging are being considered. The Korean Academy of Geriatric Dentistry recently proposed the diagnostic criteria for oral frailty in older adults in Korea. This study aimed to conduct a cross-sectional survey of factors related to oral frailty among community-dwelling older adults and identify differences in oral frailty status according to age and sex. Methods: Among 217 older adults aged ≥60 years who visited a senior center in Wonju, 206 completed all tests for oral frailty. Among them, data from those with a Korean Version of the Modified Barthel Index score ≥90 were used in the final analysis. After evaluating oral frailty diagnostic factors such as chewing ability, occlusal force, tongue pressure, oral dryness, oral cleanliness, and swallowing function, oral hypofunction was determined according to the oral frailty diagnostic criteria. Subsequently, the evaluation results were compared based on sex and age. Results: Significant differences in chewing ability, maximum occlusal pressure, and maximum tongue pressure were observed between sexes. However, these differences did not affect oral frailty diagnosis. All diagnostic factors of oral frailty, except for the risk of oral dryness and swallowing dysfunction, showed significant differences with age. However, no significant difference was observed in the prevalence of oral frailty. Additionally, this study found no relationship between sex and oral frailty factors using the oral frailty diagnostic criteria. However, it also found that age plays a significant role as an oral frailty diagnostic indicator, in addition to oral dryness and swallowing function. Conclusion: Sex and age did not affect oral frailty diagnosis. However, patients' chewing ability, occlusal force, and tongue pressure were affected by sex and age. Therefore, sex and age should be considered when diagnosing and intervening in oral frailty in the future.

• Research in Community and Public Health Nursing
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• v.29 no.4
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• pp.429-439
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• 2018

Purpose: The aim of this study is to identify core keyword of frailty research in the past 35 years to understand the structure of knowledge of frailty. Methods: 10,367 frailty articles published between 1981 and April 2016 were retrieved from Web of Science. Keywords from these articles were extracted using Bibexcel and social network analysis was conducted with the occurrence network using NetMiner program. Results: The top five keywords with a high frequency of occurrence include 'disability', 'nursing home', 'sarcopenia', 'exercise', and 'dementia'. Keywords were classified by subheadings of MeSH and the majority of them were included under the healthcare and physical dimensions. The degree centralities of the keywords were arranged in the order of 'long term care' (0.55), 'gait' (0.42), 'physical activity' (0.42), 'quality of life' (0.42), and 'physical performance' (0.38). The betweenness centralities of the keywords were listed in the order of depression' (0.32), 'quality of life' (0.28), 'home care' (0.28), 'geriatric assessment' (0.28), and 'fall' (0.27). The cluster analysis shows that the frailty research field is divided into seven clusters: aging, sarcopenia, inflammation, mortality, frailty index, older people, and physical activity. Conclusion: After reviewing previous research in the 35 years, it has been found that only physical frailty and frailty related to medicine have been emphasized. Further research in psychological, cognitive, social, and environmental frailty is needed to understand frailty in a multifaceted and integrative manner.

• Korean Journal of Community Nutrition
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• v.26 no.5
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• pp.382-395
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• 2021

Objectives: This study examined the nutritional status according to frailty status in the elderly at home. Methods: The participants were a total of 76 elderly at home living in Seo-gu, Gwangju, Korea. The nutritional status and frailty status were analyzed using the Nutrition Quotient for Elderly (NQ-E) and the Korean version of the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight Scale (K-FRAIL), respectively. Results: The distribution of frailty status was robust (17.1%), pre-frailty (38.2%) and frailty (44.7%), and its distribution was significantly different in genders, age groups and the number of medications. The mean NQ-E score was 47.0 for total subjects, indicating a low grade. The scores of balance, diversity and dietary behavior factors were within the low grade, while the score of the moderation factor was within the medium-high grade. According to the frailty status, pre-frailty and frailty showed significantly higher scores for sugar-added beverages intake in the moderation constructs than robust. Robust showed significantly higher scores for the exercise hours and perception level for one's health than pre-frailty and frailty. Conclusions: These results suggest that nutrition status is associated with frailty status. Regular nutrition education and visiting nutrition service should be established to improve the balance and diversity of food intake and improve the dietary behavior of the elderly at home.

• Journal of Korean Academy of Nursing
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• v.46 no.6
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• pp.848-857
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• 2016

Purpose: This study aimed to investigate factors affecting frailty by age groups among vulnerable elders in Korea. Methods: In this secondary analysis, data were collected from records for 22,868 elders registered in the Visiting Health Management program of Public Health Centers in 2012. Health behaviors, clinically diagnosed disease, frailty, depression and cognitive condition were assessed. Data were analyzed using stepwise regression to determine the associated factors of frailty by age group. Results: Alcohol consumption, physical activity, number of diseases, DM, CVA, arthritis, urinary incontinence, depression and cognitive condition were found to be factors significantly associated with frailty among the elders aged 65~74 (F=135.66, p <.001). Alcohol consumption, physical activity, CVA, arthritis, urinary incontinence, depression and cognitive condition were found to be factors associated with frailty in the elders aged 75~84 (F=245.40, p <.001). Physical activity, CVA, arthritis, depression and cognitive condition were factors associated with frailty in the elders over 85 years of age (F=96.48, p <.001). Conclusion: The findings show that frailty of elders and associated factors were different by age group, and common factors affecting frailty were physical activity, CVA, arthritis, depression and cognitive condition. Thus, these factors should be considered in the development of intervention program for care and prevention of frailty and program should be modified according to age group.

• Journal of the Korean Data and Information Science Society
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• v.24 no.4
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• pp.931-940
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• 2013

For analysis of clustered survival data, the inferences of parameters in semi-parametric frailty models have been widely studied. It is also important to investigate the potential heterogeneity in event times among clusters (e.g. centers, patients). For purpose of this analysis, the interval estimation of frailty is useful. In this paper we propose a visualizing method to present confidence intervals of individual frailties across clusters using the frailtyHL R-package, which is implemented from h-likelihood methods for frailty models. The proposed method is demonstrated using two practical examples.

• Journal of Korean Medical Science
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• v.33 no.51
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• pp.332.1-332.8
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• 2018

Background: The trend of aging society is occurring globally, and with it, one of the health problems that is emerging is frailty. Efforts are being made to account for the increasing prevalence of frailty, and various modifiable factors are being considered in regards to frailty. Because social contact has shown beneficial effects in terms of health in previous studies, it is increasingly being considered in relation to frailty. The purpose of this study was to assess the association of different types of social contact with frailty status. Methods: A total of 1,200 Korean elders aged 70-84 years old were included in the study. Using Fried's Cardiovascular Health Study index to categorize the frailty status, the relationship between frailty status and frequency of contact (i.e., with family members, friends, or neighbors) was analyzed using multinomial logistic regression accounting for confounders. Results: Adjusting for all covariates, frequency of contact with friends was the most statistically significant. Less frequent contact was associated with a significantly higher odds of pre-frailty: monthly (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.27-3.20), and rarely (OR, 1.87; 95% CI, 1.17-2.99), with daily contact group as reference. Also, those contacting friends monthly (OR, 5.04; 95% CI, 2.29-11.08) or rarely (OR, 3.23; 95% CI, 1.58-6.61) were more likely to be frail compared to the daily group. Conclusion: Frequency of social contact, especially with friends, is strongly associated with frailty.

• 한국노년학
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• v.41 no.3
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• pp.295-308
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• 2021

This study is a descriptive study conducted to find out the predictive factors according to the level of the frailty of the communitydwelling older adult in a rural area. Data were collected from 400 older adults aged 65 years or older living in rural areas of Gyeongsangnam-do from October 2019 to March 2020. Data were analyzed using logistic regression to examine the predictive factors according to the level of frailty. The results showed that 27.8% for robust older adults, 30.9% for pre-frailty older adults, and 41.3% for frailty older adults. As a result of analyzing the predictive factors according to the level of frailty, the predictors from the robust stage to the pre-frailty stage were grip strength, nutritional status, and depression. The predictive factors for entering the pre-frailty stage into the frailty stage were gender, nutritional status, physical performance ability, and depression. Also, it was found that the predictive factors for entering from the robust stage to the frailty stage were sex, occupation, nutritional status, physical performance ability, and depression. Through this study, it was possible to understand the level of the frailty of the older adults living in rural communities and the effects of multidimensional variables. These results can be used as basic data necessary to find a way to prevent and manage the progression of frailty among older adults in rural areas.

• The Korean Journal of Rehabilitation Nursing
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• v.11 no.2
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• pp.67-73
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• 2008

Purpose: The purpose of this study was to review and identify the meaning and components of the concept, Frailty. Method: We conducted literature review of studies that concluded the word of 'frail' or 'frailty between 1980 and 2008, and used MEDLINE, CINAHL database to select the articles. Results: Frailty is defined as a concept with multidomains, which are physical, cognitive, psychological, social. Critical characteristics of Frailty include multidominal deficiency, combined accumulation, diminished ability to keep up the independence of daily living, states beyond one's reserve capacity, dynamic relativity, proximity to adverse health outcome, aggregated symptoms. Frailty is caused by decreased physical activity, loss of sensory function, Chronic symptoms or signs, relationship with Caregiver, social isolation. Moreover, Frail elderly is at risk of falls and institutionalization. Conclusion: Frailty is very useful concept, because it has the potential to identify the elderly population at risk of adverse health outcomes. Based on this results, the appropriate tool for screening Korean Frail elderly and Nursing intervention for them needs to be developed.

• Journal of the Korean Data and Information Science Society
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• v.20 no.5
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• pp.895-903
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• 2009

The penalized partial likelihood based on restricted maximum likelihood method has been widely used for the inference of frailty models. However, the standard-error estimate for frailty parameter estimator can be downwardly biased. In this paper we show that such underestimation can be corrected by using hierarchical likelihood. In particular, the hierarchical likelihood gives a statistically efficient procedure for various random-effect models including frailty models. The proposed method is illustrated via a numerical example and simulation study. The simulation results demonstrate that the corrected standard-error estimate largely improves such bias.