• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제22권4호
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• pp.7-17
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• 2016

Purpose: As our population ages and becomes an elderly society the number of elderly care hospitals is rapidly increasing. Because physical functions and spatial perception in the elderly decrease with age, these hospitals require more systematic and intelligent space designs. The design of these spaces are even more complex because they must accommodate medical programs to treat various different diseases and ailments and also because there are many first time patients and irregular short term patients that seek out outpatient treatment services. Also by analyzing the spatial configuration systems and systematic relationships between each of the functional spaces of the outpatient treatment service departments for hospitals specialized in care for the elderly by focusing on the hallway and corridor systems of these hospitals, the according characteristics and trends were examined. Methods: Based on preceding research, the types of hallway and corridor systems of these hospitals were categorized into five types, including gallery corridors, middle corridors, hall-type, mixed type and cyclic type corridors, and into six types according to function including by medical diagnosis, patient registration, examination, administration and convenience and shared common space to derive any interconnecting relationships between the corridor systems. Also by comprehensively examining the types and combined utilization of the corridor types and the integration and the intelligibility of the space syntax, any trends within the corridor system were derived. The elderly care hospitals examined in this research study were twelve hospitals that opened after the year 2000 in Korea with more that 150 sick beds with areas larger than $1000m^2$ and with all outpatient medical service related rooms located entirely on a single floor of the hospital. Results: The following results could be confirmed based on this research study. 1) The spaces where medical diagnosis and examination occurred were adjacent, and the movement lines for first time patients and re-visiting patients were taken into consideration by separating the treatment space. 2) This research study confirmed that the larger the size of the hospital was, there were more detailed categorizations of treatment services and that there was a tendency for treatment areas to be separated and independent from examination areas. 3) There was a tendency for integration and intelligibility to decrease the more complex and diverse the combination of hall types designed into the corridor systems of these hospitals was. cyclic type corridors dramatically decreased the intelligibility of the corridor systems of these hospitals. 4) The priority rank of these spaces were confirmed to be highest in the order of registration, diagnosis, examination, treatment, administration and shared common spaces. However it was confirmed for the local integration that the diagnosis scope had the highest priority rank. Implications: There were exceptional cases confirmed where the number of unit spaces did not have an absolute effect on integration and intelligibility. These results can be interpreted to mean that this can be overcome through efficient architectural planning.

• 농촌의학ㆍ지역보건
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• 제35권1호
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• pp.13-20
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• 2010

이 연구는 노인장기요양보험제도가 시행되는 시점에서 구강위생상태가 개선되기 위한 우리나라 노인의 실정에 맞는 구강관리프로그램의 개발을 위한 기초 자료를 제공하고자 하는 목적으로 실시하였다. 2007년 12월에서 2008년 6월까지 충북 목천에 있는 노인요양병원 한 곳의 노인환자 53명을 관리군으로 선정하여 구강검사 및 구강위생검사를 한 후, 간병인에게 잇솔질 교육과 의치관리교육을 실시하고, 교육 받은 간병인이 1일 1회 구강위생관리를 지도하도록 하였다. 대조군으로는 대구광역시 달성군 가창에 있는 노인요양병원의 노인환자 52명을 선정하여 관리군과 같은 조사를 실시하였다. 3개월간의 구강위생관리 실시 후, 구강관리의 효과를 평가하여 다음과 같은 결과를 얻었다. 구강위생관리를 실시 전 대조군과 관리군의 일반적인 특성, 질병의 유병률, 구강상태, 구강위생상태에는 유의한 차이가 없었고, 치아우식증에서는 유의한 차이가 있었다. 3개월 후의 두 군을 비교한 결과, 치면세균막점수는 구강관리 실시 후 관리군에서 19.0점 유의하게 감소하였고(P=0.01), 대조군에서는 1.2점 증가하였다(p=0.566). 구강관리 실시 전 치면세균막점수를 통제한 후 그 효과의 차이를 살펴본 결과 관리군과 대조군 간에 구강위생, 치면세균막 점수에서 유의한 차이가 있었다(P=0.01). 구강위생상태의 변화는 대조군에서 치면세균막이 중등도 이상 발견된 비율이 82.7%에서 76.9%로 4.8%P 감소했고 관리군은 84.9%에서 58.5%로 26.4% 감소하여 두 군 간에 유의한 차이가 있었다(p=0.004). 설태가 다량 발견된 비율은 대조군에서 90.4%에서 94.2%로 3.8% 증가했고, 관리군은 90.6%에서 59.1%로 31.5% 감소하여 두 군 간에 유의한 차이가 있었다(p=0.001). 의치 오염도는 대조군에서 중등도 이상인 비율이 75%에서 78.8%로 3.8% 증가했고, 관리군은 73.6%에서 43.4%로 30.2% 감소하여 두 군 간에 유의한 차이가 있었다(p=0.001). 이 연구는 장기요양 노인 환자들에게 3개월 동안 간병인을 통한 구강관리를 시행한 결과, 구강위생상태가 개선됨을 확인할 수 있었다. 본 연구결과는 장기요양 노인환자에 대한 구강건강관리프로그램의 개발에 있어서 중요한 기초자료를 제공할 수 있을 것으로 사료된다.

• 한국병원경영학회지
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• 제6권3호
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• pp.130-147
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• 2001

This study is about major symptoms of elderly and medical services for elderly in long-tenn care facilities. The subject of this study was 298 patients over 00 years old staying in two geriatric hospitals and two nursing homes. The symptoms and medical services were level of patient classification from RUG(Resource Utilization Group)-III which is applied for both Medicare and Medicaid for skilled nursing facilities reimbursement system in US and designed for measuring patient characteristics and medical staff time. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). In this study, the symptoms and services were compared by facility type and they were categorized by level and compared by CMI. Major findings are as follows; 1. There were more elderly who have cognitive function problems in nursing homes than patients in geriatric hospitals. There were more patients with behavioral problems in geriatric hospitals than residents in nursing homes. These results were both statistically significant. 2. The patients in geriatric hospitals received significantly more nursing rehabilitation services, rehabilitation services and extensive services than residents in nursing homes. Other hands, special care services were provided significantly more to residents in nursing homes than elderly in geriatric hospitals. 3. ADL and depression variables had higher CMI when the symptoms were heavier condition. The CMI were not matched with levels of cognitive function problems and behavioral problems. 4. The CMI matched well significantly with levels of nursing rehabilitation services, special care services, and clinically complex services provided for the patient in geriatric hospitals and only nursing rehabilitation services in nursing homes. The CMI for rehabilitation services level and extensive services had regular trends. From the result of this study, the resource utilization level and services provided for elderly in each long-term care facilities were figured out. For the further study, it needs to have more concern about RUG-ill which classification variables were just analyzed.

• 한국콘텐츠학회논문지
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• 제20권10호
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• pp.308-325
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• 2020

본 연구의 목적은 장기요양시설의 노인보호를 위한 시설안전 실태를 파악하고, 이를 바탕으로 한국의 장기요양시설 시설안전 정책의 방향을 도출하고자 하는 것이다. 이러한 연구목적을 위해 주요국의 장기요양시설 시설안전 대응정책에 대해서 검토하고, 한국의 요양시설 안전실태를 파악하였다. 분석에서는 수도권 지역(서울, 경기, 인천) 중심으로 장기요양시설의 시설안전 실태를 분석하였다. 분석결과는 다음과 같다. 첫째, 기관의 안전관리 비교결과이다. 관련 규정 및 법률 비교결과에서 장기요양시설은 사회복지시설, 어린이집, 병원 등에 비해 안전관리가 취약한 것으로 나타났다. 둘째, 입지조건 분석결과이다. 수도권 장기요양시설이 건물의 6층 이상에 위치한 시설이 많았고, 개인시설이 법인, 지자체 시설에 비해 입지조건이 취약하다는 것을 확인하였다. 셋째, 기관의 구조/설비 결과이다. 전체적으로 배연창(화재안전창문), 배연설비, 연기 질식대비 방연마스크, 방화담요 등의 배치상태가 미흡하였다. 또, 법적 필수 설치설비가 미비한 곳도 있었고, 개인시설이 지자체, 법인 시설에 비해 시설 구조/설비구조에서 대체로 미비하였다. 넷째, 안전관리 분석에서 대응매뉴얼, 화재대비훈련 등에서 개인설립 시설이 지자체설립 시설에 비해 미흡하다는 것을 확인하였다. 이상 이러한 연구결과를 토대로 본 연구는 노인장기요양보험 장기요양시설에서 입소노인의 안전한 삶을 살 수 있는 시설환경을 위한 사회복지적 함의를 제시하였다.

• 한국산학기술학회논문지
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• 제16권4호
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• pp.2674-2683
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• 2015

본 연구는 장기요양보험급여를 받고 있는 도시지역 노인들의 장기요양등급에 따른 우울수준을 파악해 보고, 우울수준에 관련된 요인을 규명해 보고자 시도하였다. 조사대상은 대전광역시 5개구에서 장기요양보험급여를 받고 있는 노인 338명을 대상으로 하였다. 조사는 2012년 3월 1일부터 5월 31일까지의 기간 동안에 표준화된 무기명식 면접조사용 설문지를 사용하여 면접조사 하였다. 연구결과, 조사대상자의 CES-D에 의한 우울수준은 정상군(CES-D 21점미만)이 21.6%, 우울군(CES-D 21점 이상)이 78.4%이었다. 장기요양등급에 따른 우울군(CES-D 21점 이상)의 분포는 장기요양 1등급에서 83.6%, 2등급에서 82.1%, 3등급에서 67.0%로 장기요양 등급이 높을수록 우울군의 분포도 유의하게 높은 것으로 나타났다. 우울 수준과 제 요인과의 관련성을 알아보기 위해 다중로지스틱회귀분석 결과 우울수준에 대한 교차비는 65-74세 연령군보다 75세이상 연령군에서, 주관적인 건강상태가 좋다는 군보다 좋지 않다는 군에서, 취미활동을 자주한다는 군보다 거의하지 않는다는 군에서 유의하게 증가하였으며, 월수입 50만원 이하군보다 50만원 이상 군에서 유의하게 감소하였다. 이 같은 결과는 우울에 관련된 요인이 개인의 기본 속성, 경제 상태, 신체의 건강상태나 활동성 등의 다양한 요인과 관련성이 있다는 것을 시사하고 있다.

• 보건행정학회지
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• 제27권1호
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• pp.56-62
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• 2017

Background: There have been deviations in the regional rate of certification in Korean long-term care insurance (LTCI). This study aimed to explore the determinants of the rate of certification in LTCI. Methods: The panel data of the year 2010-2014 of the 227 National Health Insurance Service (NHIS) regional office were used. Making use of 26 explanatory variables (socio-demographic factors, access to the long-term care services, etc.), we estimated the random effects model using STATA SE ver. 13.0 program (Stata Corp., College Station, TX, USA) and tried to find out the determinants of the regional rate of certification. Results: Estimation results showed that the most important determinants of the regional rate of certification in LTCI are the long-term care infrastructure such as capacity or number of the homecare service institution, sanatorium, or convalescent hospital. The number of the elderly who lives alone and the dimentia patients were positively related to the regional rate of certification in LTCI. Conclusion: The estimation results implied that the regional variation in the rate of certification in LTCI has nothing to do with the NHIS regional offices or their employees. To alleviate the deviation in the regional rate of certification in LTCI, we suggested the analysis of the deviation in the survey checklist. We also proposed to found the regional comprehensive support center to prevent the geriatric illness and to improve the residents' health, etc.

• 지역사회간호학회지
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• 제28권2호
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• pp.196-205
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• 2017

Purpose: Art program has been found to enhance mood such as increasing motivation, self-expression and decreasing depression in older adults. This study was conducted to investigate the effects of clay art and drawing on depression and self-expression among elderly people at a long-term care center. Methods: The research was a pre-test and post-test non-equivalent design. Sixty older patients (clay art program=28. Drawing art program=32) over the age of 65 were recruited from 2 long-term care hospitals to participate in the 5 weeks program. Each group was scheduled with 10,120-minute evaluation sessions, twice per week. Test measures were completed before and after the 5 week intervention period for all participants. The data was collected from April 27 to May 29, 2015. It was analyzed with SPSS 22.0 using chi-square, t-test and paired t-test. Results: There were no significant difference in the levels of depression (t=0.21, p=.830) and total score of self-expression (t=-0.10, p=.919) between the two groups. However, the pre-post scores of self-expression in the clay art program (t=0.22, p=.826) were improved compared to the drawing art program (t=0.80, p=.430). Conclusion: Further studies are needed to evaluate the effectiveness of clay art program for extended senior care applications.

• 대한간호학회지
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• 제49권2호
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• pp.203-214
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• 2019

Purpose: The purpose of this study to develop a fringed fall prevention program based on King's goal attainment theory and education. This study is applied to the personal, interpersonal, and social systems of fall high-risk patients to test its effects. Methods: This study was a nonequivalent control group pre- and post-test design. There were 52 fall high-risk patients in the experimental group and 45 in the control group. The experimental group received six sessions, with the group sessions lasting 60 minutes and the individual sessions lasting 20~30 minutes. Data were analyzed using descriptive statistics, an ${\chi}^2-test$, a paired sample t-test, and a Wilcoxon signed-ranks test utilizing IBM SPSS software. Results: For the 3-month intervention period, the fall prevention program was found to be particularly effective for patients in the experimental group (from 3.38 to 1.69 per 1000 patient days; p=.044), as opposed to the control group (from 1.94 to 1.49 per 1000 patient days; p=.300). For the 6-month follow up period, the fall prevention program was again found to be effective for patients in the experimental group (from 3.26 to 0.76 per 1000 patient days; p=.049) compared to the control group (from 1.98 to 1.01 per 1000 patient days; p=.368). Conclusion: These results indicate that the fringed fall prevention program is very effective in reducing falls, not only during the intervention period, but also after the intervention period has ended. We can therefore recommend this program for use concerning fall high-risk patients in long-term care hospitals.

• 한국농촌건축학회논문집
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• 제12권4호
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• pp.29-36
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• 2010

The purpose of this study is to have detailed data of the distribution, locations, and the amount of people in the waiting line of the nursing home. Also, we studied the accessibility to the facilities by using Web GIS to analyze the transit time it takes from the nursing home to health center and hospitals. We can provide the basic data that could contribute when future plans for the nursing homes' locations, health and medical policy are made. The results are as follows. 1. The nursing homes are stiffly concentrated in regions of Seoul and Gyeongi-do where large number of the elderly covered by long-term care insurance and the waiting line was very long for the elderlies to enter the nursing homes. In these cities of Ulsan and Jeju where number of the elderly covered by long-term care insurance is relatively small, there were less facilities. 2. The nursing homes located in urban areas had higher occupancy rate and higher number of people in the waiting line. 3. The average time taken by driving from the nursing homes and health center was 10 minutes and there was not a noticeable difference between the cities. Driving from the nursing homes to hospitals in rural areas took 22 minutes which is 2.5 times of the time taken for urban areas. Daegu-si and Incheon-si had relatively short distance from the nursing homes and the hospitals while Jeju-do had the furthest. For rural areas, it is needed for health center to be equipped with a wider medical coverage, have closely connected with hospitals to minimize the differences they have from ones in rural areas. It is also needed to have ambulances equipped for tele-medical examination and treatment system.

• 한국사회정책
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• 제25권1호
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• pp.99-123
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• 2018

본 연구는 노인장기요양보험 인정자 중에서 사망한 자의 임종 관련 의료비를 분석함으로써, 향후 임종 관련 의료비의 효율적 관리방안과 양질의 임종관리 제공방안을 모색하는데 목적이 있다. 본 연구에서 활용한 자료는 건강보험 및 노인장기요양보험 급여이용자료, 통계청 사망원인 통계자료이며, 2008년 7월 1일부터 2012년 12월 31일까지 장기요양 인정등급을 받고 같은 기간 내 사망한 자 총 271,474명을 최종 분석대상자로 하였다. 연구결과 대상자는 여성(60.6%), 75세 이상(74.7%)이 다수를 차지했고, 대부분이 2개 이상의 질환을 보유하고 있었으며, 특히 고혈압(44.3%), 치매(42.3%), 뇌졸중(29.9%) 등 비율이 높았다. 사망원인은 순환기계질환(29.8%), 암(15.3%), 선천성 기형, 변형 및 염색체 이상(14.7%) 등의 순이었고, 사망장소로는 의료기관(64.4%), 자택(22.0%), 사회복지시설(9.2%) 순이었다. 대상자의 등급인정 이후 사망까지 소요시간은 평균 516.2일이었고, 대상자 중 99.3%는 사망 전 1년간 건강보험 또는 장기요양보험 급여를 이용하였다. 특히, 1인당 평균 총 급여비는 사망한 달에 가까워질수록 규모가 커져, 사망 전 12개월 보다 사망 전 1개월에 3배 이상 높아졌다. 또한, 사망 전 1개월간 대상자의 31.8%는 연명치료 범위에 해당하는 치료를 받은 것으로 나타났다. 향후 장기요양 인정자의 임종 관련 불필요한 의료이용 감소 및 효율적 의료관리를 위해 건강보험과 장기요양보험 급여의 통합적 임종관리 전달체계 확립과 호스피스 등 임종케어의 적극적 도입을 제안한다.