• Journal of dental hygiene science
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• v.24 no.1
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• pp.1-8
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• 2024

Background: Oral frailty is defined as the functional decline of the oral function due to aging, and it is associated with frailty and chronic disease. Most of the frailty intervention is for adults aged 65 years and older. However, early intervention for preventive disorder is most important. The objective of this study was to identify the age at which oral frailty surpass the "normal" range. Methods: This cross-sectional study included 719 adults (aged 30~89 years) residing in Gangwon province in May 2023. Risk of oral frailty was assessed using criteria from The Korean Academy of Geriatric Dentistry including oral function such as swallowing and mastication, and frailty. Frailty was assessed using the Kihon Checklist. To determine when oral frailty surpass the "normal" status, statistical analysis including chi-squared tests and multiple logistic regression analysis were performed using R (ver. 4.3.1). Results: There were 388 (54.0%) individuals who had a "normal" status risk of oral frailty. The risk of oral frailty was higher in the 50~54 age group compared to the 30~34 age group (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.28~0.91), after adjusting for gender, education, income, occupation, and frailty (OR 0.46, 95% CI 0.22~0.94). This means that from 50~54 years old, regardless of gender, education, income, occupation, or frailty condition, there is a distinction from the "normal" status. Conclusion: We found that intervention for oral frailty is needed starting from age 50 years. This is the stage where early indications of oral frailty become apparent. Early intervention for oral frailty can lead to a decrease in the prevalence of diseases and medical expenditure. Therefore, early intervention in middle-aged adults of oral frailty is necessary to improve the quality of life related to oral health.

• Journal of the Korean Data and Information Science Society
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• v.20 no.1
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• pp.203-209
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• 2009

Frailty models are useful for the analysis of correlated and/or heterogeneous survival data. However, the inferences of fixed parameters, rather than random effects, have been mainly studied. The prediction (or estimation) of random effects is also practically useful to investigate the heterogeneity of the hospital or patient effects. In this paper we propose how to extend the prediction method for random effects in HGLMs (hierarchical generalized linear models) to log-normal semiparametric frailty models with nonparametric baseline hazard. The proposed method is demonstrated by a simulation study.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.2
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• pp.129-140
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• 2023

Purpose : This study was conducted to investigate and analyze the physical health of older Koreans with sarcopenia and locomotive syndrome and identify the related factors. Methods : In this study, the sarcopenia and locomotive syndrome evaluations were applied to 210 elderly people, and the sarcopenia group was 36, the locomotive syndrome group was 164, and the normal group was 10. After group selection, a physical health status survey was conducted. The physical health status was assessed via body composition analysis, physical characteristics survey including measurement of waist and calf circumference, investigation of diseases currently being diagnosed by a doctor, and frailty measurements. The collected data were statistically analyzed using one-way ANOVA, the Kruskal-Wallis test, and the Chi-square test. Results : There were significant differences between groups in all elements of physical characteristics including body mass index, waist circumference, and calf circumference. Among them, a consistent result was found that the normal group had the largest amount of muscle mass and the sarcopenia group had the least amount of muscle mass in the factors related to muscle mass. However, the factors relating to fat mass and obesity also showed significant differences between the groups, but the results were not consistent. Considering the group differences in current diseases, a significant difference was only detected for osteoporosis among 12 diseases. Moreover, those in the sarcopenia group had the highest rate of osteoporosis. And there was no significant difference between the groups in the total score of the frailty measurement, but there was a significant difference between the groups in the frailty measurement levels. Conclusion : This study on physical health status confirmed that muscle mass-related factors, osteoporosis, and frailty levels were significantly related to sarcopenia and locomotive syndrome.

• Journal of dental hygiene science
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• v.23 no.4
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• pp.320-329
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• 2023

Background: Oral frailty has garnered considerable interest following its identification as a risk factor for physical frailty. The Korean oral frailty diagnosis criteria have emphasized the need for extensive research on oral frailty diagnostic items and interventions. Our study performed an in-depth analysis of the tongue-palate pressure patterns in healthy community-dwelling older adults. Methods: Of the 217 older adults aged ≥60 years who visited a senior center in Wonju, 205 participants who completed tongue pressure measurement were included in the final analysis. Pressure changes over time were recorded by instructing the participants to press their tongue against the hard palate with for 7 seconds per cycle. The participants were divided into the normal and abnormal tongue pressure (NTP and ATP, respectively) groups based on whether they achieved the target tongue pressure at least once; tongue pressure patterns were compared between the groups. Furthermore, the average time taken to achieve the standard tongue pressure value was calculated for the participants in the NTP group and used to evaluate the decrease in tongue pressure in the ATP group. Results: Among the 205 participants, 40.5% had ATP. The tongue pressure graph revealed a gentle and consistent incline that was maintained even after achieving standard tongue pressure in the NTP group. The graph was more extreme in the ATP group, and the changes in the pressure type varied across individuals; the tongue pressure was only 48.4%, 40.7%, 31.9%, and 22.6% of the NTP in the participants in their 60s, 70s, 80s, and ≥90s, respectively (p<0.05). Conclusion: Tongue pressure weakness was observed in 40.5% of the healthy community-dwelling older adults. Furthermore, ATP graphs were observed in the patients with tongue pressure weakness. Thus, activities improving the oral function in community-dwelling older adults and systematic oral rehabilitation programs should be devised to promote normal swallowing.

• Journal of Chest Surgery
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• v.55 no.3
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• pp.189-196
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• 2022

Background: This study investigated the predictive value of the frailty index calculated using laboratory data and vital signs (FI-L) in patients who underwent coronary artery bypass grafting (CABG). Methods: This study included 508 patients (age 67.3±9.7 years, male 78.0%) who underwent CABG between 2018 and 2021. The FI-L, which estimates patients' frailty based on laboratory data and vital signs, was calculated as the ratio of variables outside the normal range for 32 preoperative parameters. The primary endpoints were operative and medium-term all-cause mortality. The secondary endpoints were early postoperative complications and major adverse cardiac and cerebrovascular events (MACCEs). Results: The mean FI-L was 20.9%±10.9%. The early mortality rate was 1.6% (n=8). Postoperative complications were atrial fibrillation (n=148, 29.1%), respiratory complications (n=38, 7.5%), and acute kidney injury (n=15, 3.0%). The 1- and 3-year survival rates were 96.0% and 88.7%, and the 1- and 3-year cumulative incidence rates of MACCEs were 4.87% and 8.98%. In multivariable analyses, the FI-L showed statistically significant associations with medium-term all-cause mortality (hazard ratio [HR], 1.042; 95% confidence interval [CI], 1.010-1.076), MACCEs (subdistribution HR, 1.054; 95% CI, 1.030-1.078), atrial fibrillation (odds ratio [OR], 1.02; 95% CI, 1.002-1.039), acute kidney injury (OR, 1.06; 95% CI, 1.014-1.108), and re-operation for bleeding (OR, 1.09; 95% CI, 1.032-1.152). The minimal p-value approach showed that 32% was the best cutoff for the FI-L as a predictor of all-cause mortality post-CABG. Conclusion: The FI-L was a significant prognostic factor related to all-cause mortality and postoperative complications in patients who underwent CABG.

• The Korean Journal of Applied Statistics
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• v.9 no.2
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• pp.119-134
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• 1996

Accelerated life testing (ALT) of a system is commonly used to reduce time and cost. ALT is achieved by subjecting the test systems to more severe conditions than the normal ones to obtain estimates of life distribution under normal condition. The major interest of this research is to use a model of incorporating the common environmental effect on the components serially linked into a system-so called frailty model for the system life time distribution under each stress and to discuss the related data analysis and comparison of the model with the generally used one. The profile likelihood is used to get an initial values required to compute maximum likelihood estimates and simulation is carried for comparison.

• Journal of Nutrition and Health
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• v.53 no.4
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• pp.416-430
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• 2020

Purpose: This study was conducted to assess the effects of a personalized nutritional intervention program on food security and health and nutritional status of elderly people in the city of Seoul. Methods: A total of 372 elderly adults aged 65 years or above who resided in Seoul were enrolled in this study. Personalized supplementary food supply and nutritional education based on chronic disease status, disability and cooking ability were implemented for 4 months. To evaluate the effectiveness of the program, nutrient intake, food security status, anemia status, chronic disease management, and frailty status, and prevalence of malnutrition (Mini Nutritional Assessment) were examined. Results: After the program, all subjects displayed significantly increased nutrient intake. Before the intervention, all subjects were in a state of food insecurity; however, after the intervention, 37.1% of the subjects were food secure. Moreover, the rates of being at risk of malnutrition and malnutrition in subjects were decreased and instead rate of those who improved to normal increased to 29.8% from 0% of normal rate before the prevention. The rate of subjects without anemia increased from 18.7% to 28.5% after the intervention. In addition, the rate of subjects with intensive or periodic management of chronic diseases decreased, while those with occasional management of chronic diseases increased from 0% to 4.6%. Furthermore, the rates of being at risk of frailty and frailty were decreased and the normal rate increased from 0% to 9.7% instead. Age group-based analysis showed that elderly people over 80 years showed less improvement in the management of the chronic disease status and the frailty status. Conclusion: Personalized supplementary food supplies and nutritional education improved not only the nutritional status but also disease status in vulnerable older adults, and the effects were more significant in adults aged less than 80 years.

• Therapeutic Science for Rehabilitation
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• v.13 no.1
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• pp.35-47
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• 2024

Objective : This study aimed to investigate the association between lifestyle factors and risk of frailty and depressive symptoms among older South Korean adults. Methods : This study included 10,072 individuals aged 65 or older from the 2017 National Survey of Older Koreans, a cohort of community-dwelling older South Koreans. The following lifestyle factors were assessed: physical activity, nutrition management (NM), and leisure/social activity participation (AP). Frailty was measured using the frail scale and depressive symptoms were measured using the Geriatric Depression Scale. Logistic regression analyses were performed to determine the odds ratios. Results : All lifestyle factors were associated with the risk of frailty and depressive symptoms in the study population. Regular exercise (≥3 times/wk, odds ratio [OR] = 0.59, 95% confidence interval [95% CI] = 0.52~0.91; OR = 0.66, 95% CI = 0.59~0.75), active NM (OR = 0.86, 95% CI = 0.80~0.91; OR = 0.81, 95% CI = 0.76~0.86), leisure AP (OR = 0.79, 95% CI = 0.74~0.84; OR = 0.71, 95% CI = 0.66~0.77) and social AP (OR = 0.92, 95% CI = 0.88~0.96; OR = 0.82, 95% CI = 0.78~0.87) were correlated with lower odds ratios of frailty and depressive symptoms. Conclusion : Adopting a healthier lifestyle characterized by regular exercise, balanced nutrition, and active engagement in various activities can effectively reduce the risk of frailty and depressive symptoms among the older population. Ultimately, this study emphasized the essential role of lifestyle choices in promoting the physical and mental well-being of older adults.

• The Korean Journal of Applied Statistics
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• v.29 no.7
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• pp.1311-1327
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• 2016

We propose a multi-state model for analyzing semi-competing risks data with interval-censored or missing intermediate events. This model is an extension of the 'illness-death model', which composes three states, such as 'healthy', 'diseased', and 'dead'. The state of 'diseased' can be considered as an intermediate event. Two more states are added into the illness-death model to describe missing events caused by a loss of follow-up before the end of the study. One of them is a state of 'LTF', representing a lost-to-follow-up, and the other is an unobservable state that represents the intermediate event experienced after LTF occurred. Given covariates, we employ the Cox proportional hazards model with a normal frailty and construct a full likelihood to estimate transition intensities between states in the multi-state model. Marginalization of the full likelihood is completed using the adaptive Gaussian quadrature, and the optimal solution of the regression parameters is achieved through the iterative Newton-Raphson algorithm. Simulation studies are carried out to investigate the finite-sample performance of the proposed estimation procedure in terms of the empirical coverage probability of the true regression parameter. Our proposed method is also illustrated with the dataset adapted from Helmer et al. (2001).

• The Korean Journal of Applied Statistics
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• v.33 no.4
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• pp.379-393
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• 2020

A terminal event such as death may censor an intermediate event such as relapse, but not vice versa in semi-competing risks data, which is often seen in medicine, public health, and epidemiology. We propose a Weibull regression model with a normal frailty to analyze semi-competing risks data when all three transition times of the illness-death model are possibly interval-censored. We construct the conditional likelihood separately depending on the types of subjects: still alive with or without the intermediate event, dead with or without the intermediate event, and dead with the intermediate event missing. Optimal parameter estimates are obtained from the iterative quasi-Newton algorithm after the marginalization of the full likelihood using the adaptive importance sampling. We illustrate the proposed method with extensive simulation studies and PAQUID (Personnes Agées Quid) data.