한국노년학

한국노년학회 (The Korean Gerontological Society)
권호 표지
DOI QR코드

DOI QR Code

70대 고령자의 10년간의 인지기능수준 변화의 유형화: 성별 및 배우자 상실경험을 중심으로

10-year trajectories of cognitive functions among older adults: Focus on gender difference and spousal loss

  • 민주홍 (제주대학교 생활환경복지학부) ;
  • 김주현 (서울대학교 생활과학대학 웰에이징.시니어산업 최고위과정)
  • Min, Joohong (Jeju National University, Faculty of Human Ecology & Welfare) ;
  • Kim, Joohyun (Seoul National University, College of Human Ecology)
  • 투고 : 2019.12.15
  • 심사 : 2020.01.09
  • 발행 : 2020.02.28
⟨ 이전 논문 다음 논문 ⟩

초록

본 연구는 초고령노인의 인지기능을 생애과정이라는 연속선상에서 이해하고자 70대 이후 10년간의 인지기능의 변화를 살펴보고, 인지기능 변화에서 집단 내 차이에 주목하여 서로 다른 궤적의 유형을 살펴보고자 하였다. 또한 배우자 상실과 성별이 인지기능 변화궤적의 다양성과 어떠한 관련이 있는지를 살펴보고자 하였다. 이를 위해 2006년(1차)부터 2016년(6차)까지 총 6차년도 '고령화연구패널'의 응답자 800명을 대상으로 잠재유형성장분석과 다항로지스틱 분석을 실시하였다. 주요 분석결과는 다음과 같다. 잠재유형성장분석 결과, 분석대상자들의 인지기능 변화궤적은 세 가지의 유형, 인지기능의 초기값이 높고 이를 유지하는 [고기능 유지형], 초기값이 낮으며 이후 지속적인 감소를 보이는 [저기능 감소형], 그리고 중간수준의 초기값을 유지하는 [중기능형]으로 구분되었다. 다항로지스틱 분석을 통해 유형과 결혼상태 및 성별과의 관련성을 살펴본 결과, 성별과 결혼상태를 함께 고려하는 경우 여성이 남성에 비해 [고기능 유지형]에 비해 [저기능 감소형]이나 [중기능형]에 속할 가능성이 유의하게 높았다. 성별을 고려하지 않는 경우에는 결혼상태와 인지기능 변화유형과의 관련성이 유의하게 나타나, 유배우상태가 유지된 사람들에 비해 조사기간 중 사별을 경험한 사람들은 [고기능 유지형]에 비해 [저기능 감소형]에 속할 확률이 유의하게 높은 것으로 나타났다. 이와 같은 연구결과는 고령자들의 인지기능 변화가 하나의 궤적을 따르기보다는 다양한 궤적 유형이 존재한다는 점을 보여준다. 또한 이러한 인지기능의 다양성을 이해하는데 있어 성별과 결혼상태, 특히 결혼상태를 배우자 존재 여부의 고정된 상태가 아닌 배우자 상실과 같이 결혼상태에서의 변화 경험을 함께 고려하는 것이 필요하다는 점을 시사한다.

The purpose of this research is to investigates 10-year trajectories of cognitive functions among older adults in their 70s to understand changes in cognitive functions as a continuum until very late life. This study also examines differences in trajectories of cognitive functions by gender and by changes in marital status, especially widowhood. Among participants of the Korean Longitudinal Study of Ageing(KLoSA), the sample of this study includes 800 older adults in their 70s during the first study wave (2006) and those who reported their cognitive functions for six consecutive study waves (2006, 2008, 2010, 2012, 2014, and 2016). The analyses were conducted in two steps. First, we conducted Latent Class Growth Analyses(LCGA) to investigated heterogeneous trajectories of cognitive functions in 10 years. Then, we performed multinomial logistic regression. Three heterogeneous trajectories of cognitive functions were identified. One group of 48.7% of older adults showed high cognitive function at baseline and maintained it over 10 years. Second group of 14.7% of older adults reported low cognitive function scores at baseline and showed continuous decline over time. Third group of 36.6% were showed mid-level cognitive functions and maintained their functions over time. We also found significant gender differences but not significant differences in marital status when we consider both in our model; however, the we found significant differences in changes in marital status when we did not consider gender in the model. The results suggest that the importance of considering dynamics of gender and changes in marital status to understand changes in cognitive functions in later life.

키워드

참고문헌

  1. 김수영. (2016). 구조방정식 모형의 기본과 확장: MPLUS 예제와 함께. 서울: 학지사.
  2. 김소진. (2019). 한국 노인의 노화궤적 연구. 한국노년학회, 39(1), 37-50. doi.org/110.31888/JKGS.2019.39.1.37
  3. 김주연, 이정택. (2018). 가구형태와 인지기능: 고령자 1인 가구와 시간의 상호작용 효과를 중심으로. 조사연구, 19(1), 97-127. doi.org/110.20997/SR.19.1.4
  4. 김찬희, 김민정, 박창기. (2019). Heterogeneous Trajectories of Cognitive Function in Older Adults with Diabetes: Findings from the Korean Longitudinal Study of Aging (KLoSA). Korean Journal of Stress Research, 27(1), 1-8. doi.org/10.17547/kjsr.2019.27.1.1
  5. 남일성. (2015). 배우자 사별은 인지력을 저하시키는가?. 한국노년학회 학술발표집, 1-7.
  6. 민주홍, 최희정 (2015). 배우자 사별과 우울감과의 관계에 있어 사회참여의 매개효과. 한국가정관리학회지, 33(4), 67-82. https://doi.org/10.7466/JKHMA.2015.33.4.67
  7. 백옥미. (2013). 중노년기 우울증상과 인지기능의 관계. 정신보건과 사회사업, 41(4), 94-115.
  8. 전해숙. (2017). 초고령 노인의 우울증상 궤적: 성별차이를 중심으로. 보건교육건강증진학회지, 34(1), 25-34. doi.org/10.14367/kjhep.2017.34.1.25
  9. 한경혜, 최혜경, 안정신, 김주현. (2019). 노년학. 서울: 도서출판 신정.
  10. 중앙치매센터. (2012). 전국치매역학조사.
  11. 통계청http://kosis.kr/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ZTITLE&parmTabId=M_01_01#SelectStatsBoxDiv
  12. Antonucci, C. & Akiyama, H. (1987). Social networks in adult life and a preliminary examination of the convoy model. Journal of Gerontology, 42(5), 519-527. doi.org/10.1093/geronj/42.5.519
  13. Boelen, A. & van den Bout, J. (2003). Gender differences in traumatic grief symptom severity after the loss of a spouse. Journal of Death and Dying, 46(3), 183-198. doi.org/10.2190/6C8G-C0XR-F0Q4-VR3X
  14. Boyle P. J., Feng Z, & Raab G. M. (2011). Does widowhood increase mortality risk?: testing for selection effects by comparing causes of spousal death. Epidemiology, 22, 1-5. doi.org/1 10.1097/EDE.0b013e3181fdcc0b
  15. Carr, D. (2004). Gender, preloss marital dependence, and older adults' adjustment to widowhood. Journal of Marriage and Family, 66(1), 220-235. doi.org/10.1111/j.0022-2445.2004.00016.x|
  16. Clayton P. J. (1974). Mortality and morbidity in the first year of widowhood. Archives of General Psychiatry, 30, 747-750. doi.org/10.1001/archpsyc.1974.01760120013002
  17. Dannefer, D. (2003). Cumulative advantage/disadvantage and the life course: Cross-fertilizing age and social science theory. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(6), S327-S337. doi.org/10.1093/geronb/58.6.S327
  18. de Leon C. F. M., Kasl S. V., & Jacobs S. (1993). Widowhood and mortality risk in a community sample of the elderly: a prospective study. Journal of Clinical Epidemiolgy, 46, 519-527. doi.org/10.1016/0895-4356(93)90124-J
  19. Foverskov, E., Mortensen, E. L., Holm, A., Pedersen, J. L. M., Osler, M., & Lund, R. (2019). Socioeconomic position across the life course and cognitive ability later in life: the importance of considering early cognitive ability. Journal of Aging and Health, 31(6), 947-966. doi.org/10.1177/0898264317742810
  20. Johansson, B. Zarit, S., & Berg, S. (1992). Changes in cognitive functioning of the oldest old. Journal of Gerontology, 47(2), 75-80. doi.org/10.1093/geronj/47.2.P75
  21. Juster R. P., McEwen B. S., Lupien S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience Biobehavior, 35, 2-16. doi.org/10.1016/j.neubiorev.2009.10.002
  22. Jung, T. & Wickrama, K. A. S. (2008). An Introduction to Latent Class Growth Analysis and Growth Mixture Modeling. Social and Personality Psychology Compass, 2(1), 302-317. doi.org/10.1111/j.1751-9004.2007.00054.x|
  23. Kontis, V., Bennett, J., Mathers, C., Li, G., Foreman, K., & Ezzati, M. (2017). Future life expectancy in 35 industrialised countries: Projections with a Bayesian model ensemble. The Lancet, 10076, 1-7. doi.org/10.1016/S0140-6736(16)32381-9
  24. Kuiper, J., Zuidersma, M., Zuidema, S., Burgerhof, J., Stolk, R., Oude Voshaar, R., & Smidt, N. (2016). Social relationships and cognitive decline: a systematic review and meta-analysis of longitudinal cohort studies. International Journal of Epidemiology, 45(4), 1169-1206. doi.org/10.1093/ije/dyw089
  25. Li, G., Larson, E. B., Shofer, J. B., Crane, P. K., Gibbons, L. E., McCormick, W., ... & Thompson, M. L. (2017). Cognitive trajectory changes over 20 years before dementia diagnosis: a large cohort study. Journal of the American Geriatrics Society, 65(12), 2627-2633. doi.org/10.1111/jgs.15077|
  26. Lyu, J., Min, J., & Kim, G. (2019). Trajectories of cognitive decline by widowhood status among Korean older adults. International journal of geriatric psychiatry. doi.org/10.1002/gps.5168
  27. McCarrey, A., An, Y., Kitner-Triolo, M., Ferrucci, L., & Resnick, S. (2016). Sex differences in cognitive trajectories in clinically normal older adults. Psychology &Aging, 31(2), 166. doi.org/10.1037/pag0000070
  28. Min, J., Ailshire, J., & Crimmins, E. M. (2016). Social engagement and depressive symptoms: do baseline depression status and type of social activities make a difference?. Age and ageing, 45(6), 838-843. doi.org/10.1093/ageing/afw125
  29. Min, J., Li, Y., Xu, L., & Chi, I. (2018). Psychological vulnerability of widowhood: financial strain, social engagement and worry about having no care-giver as mediators and moderators. Ageing & Society, 38(11), 2356-2375. doi.org/10.1017/S0144686X17000654
  30. Ram, N. & Grimm, K. (2009). Growth Mixture Modeling: A Method for Identifying Differences in Longitudinal Change Among Unobserved Groups. International Journal of Behavioral Development, 33(6), 565-576. https://doi.org/10.1177/0165025409343765
  31. O'Connor, M. (2019). Grief: A brief history of research on how body, mind, and brain adapt. Psychosomatic Medicine, 81(8), 731-738. doi.org/10.1177/0165025409343765
  32. O'Rand, A. M. (1996). The precious and the precocious: Understanding cumulative disadvantage and cumulative advantage over the life course, The Gerontologist, 36(2), 230-238. doi.org/10.1093/geront/36.2.230
  33. Pablo A Mora, Ian M Bennett, Irma T Elo, Leny Mathew, James C Coyne, Jennifer F Culhane. (2009). Distinct trajectories of perinatal depressive symptomatology: evidence from growth mixture modeling. American Journal of Epidemiology, 169(1), 24-32. doi.org/10.1093/aje/kwn283
  34. Sasson, I. & Umberson, D. (2013). Widowhood and depression: New light on gender differences, selection, and psychological adjustment. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(1), 135-145. doi.org/10.1093/geronb/gbt058
  35. Shin, S., Kim, G., Park, S. (2018). Widowhood status as a risk factor for cognitive decline among older adults. American Journal of Geriatric Psychiatry, 26, 778-787. doi.org/10.1016/j.jagp.2018.03.013
  36. Stroebe, M. (1998). New directions in bereavement research: Exploration of gender differences. Palliative Medicine, 12(1), 5-12. doi.org/10.1191/026921698668142811
  37. Uhlenberg, P. & Gierveld, D. (2004). Age-segregation in later life: An examination of personal networks. Ageing & Society, 24(1), 5-28. doi.org/10.1017/S0144686X0300151X
  38. Utz R. L., Carr D., Nesse R., & Wortman C. (2002). The effect of widowhood on older adults' social participation: An evaluation of activity, disengagement, and continuity theories. Gerontologist, 42, 522-533. doi.org/10.1093/geront/42.4.522
  39. Vidarsdottir, H., Fang, F., Chang, M., Aspelund, T., Fall, K., Jonsdottir, M. K., ... & Gudnason, V. (2014). Spousal loss and cognitive function in later life: A 25-year follow-up in the AGES-Reykjavik study. American journal of epidemiology, 179(6), 674-683. doi.org/10.1093/aje/kwt321
  40. Ward L., Mathias J., Hitchings S. (2007). Relationships between bereavement and cognitive functioning in older adults. Gerontology, 53, 362-372. https://doi.org/10.1159/000104787
  41. Walker, K. A., Walston, J., Gottesman, R. F., Kucharska-Newton, A., Palta, P., & Windham, B. G. (2018). Midlife systemic inflammation is associated with frailty in later life: the ARIC study. The Journals of Gerontology: Series A, 74(3), 343-349. doi.org/10.1159/000104787
  42. Zaninotto, P., Batty, G. D., Allerhand, M., & Deary, I. J. (2018). Cognitive function trajectories and their determinants in older people: 8 years of follow-up in the English Longitudinal Study of Ageing. Journal of Epidemiology Community Health, 72(8), 685-694. doi.org/10.1136/jech-2017-210116
  43. Zhong, B., Chen, S., Tu, X., & Conwell, Y. (2017). Loneliness and cognitive function in older adults: findings from the Chinese longitudinal healthy longevity survey. The Journals of Gerontology: Series B, 72(1), 120-128. doi.org/10.1093/geronb/gbw037