• Journal of Korean Academy of Nursing
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• v.26 no.4
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• pp.768-781
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• 1996

The problem of care of patients and families with Alzheimer's disease has become a conscious raising social policy issue in Korea. The government of the Republic of Korea has become cognizant of the situation and has begun searching for ways to remedy it. Thus, there is a need for a comprehensive under-standing of the situation in which patients and their families are struggling and the enormous problems of care. With a realization of the urgent need, this study was done to investigate the situation and the care needs of families with patients with Alzheimer's Disease, and to compare the effectiveness of services utilized by the families in terms of cost and effects on patient's conditions and on family live. The Subjects for the study were 29 families with hospitalized patients, 25 families utilizing hospital outpatient clinics, 14 families utilizing day care facilities, and 16 families with homebound patients. A total of 84 families were interviewed by four trained interviewers using structured and semistructured questionnaires. The data produced from these interviews included : the patient's stage of Alzheimer's disease, patient's bizarre behavior, hours spent on patient care per day, family burden and quality of life, direct and indirect costs encountered in the care of patients, and the families' evaluation of the effectiveness of the services received. The data were analyzed to determine the relationships between family charactersistics, patient's conditions and services utilization. The effectiveness of each of the service entities was assessed through families evaluation and hoped for service and comparisons were made between services in terms of the cost-effectiveness ratios. After initial comparison of cost-effectiveness ratios, further analysis was done to compare between groups for incremental effectiveness for each incremental unit of cost to determine the most cost-effective service entities. The findings of the study are as fellows : 1. The choice of living arrangement and the types of services are a function of the stage of Alzheimer's condition and the economic status of the family. 2. Comparision of the cost of care showed that most expenses were encountered in by families with hospitalization, families using outpatient services, and families using day care services in that order. The least expense was involved in the care of homebound patients. The economic burden felt by families was in the same order as expenses. 3. The average number of hours spent on daily patient care was 9.9 hours for the outpatient clinic users, 9.7 hours for homebound patients, and 5.4 hours for day care users. 4. There were significant differences in the patient's conditions (CDRL), bizarre behaviors and the families's burden by living arrangement and /or types of service. However, no significant difference was found between groups in the family's quality of life. 5. The families rated the services of day care center as most effective for the care of the patients and families, except for a few families who had experienced some improvement in the patient's conditions. The outpatient clinic users expressed psychological comforts mainly in that the patient was being taken care of. For those hospitalized patients, families expressed the comfort of being relieved of the burden of care and that the patient is being professionally cared for. Form the analysis of the costs, hours of patient care, patient's bizarre behaviors, family's quality of life and burdens, and family's evaluation of services, it is concluded that up to the mid stage of Alzheimer's condition, the utilization of day care center services is found to be the most cost-effective, and toward the end stage of the Alzheimer's disease, it is hoped that there will be a establishment of long term or short term in-patient facilities for the protection of patients and preservation of the integrity of families for less cost. Thus. it was concluded that the family centered system of care is the most effective for Korea with systematic support systems developed for the care of patients and their families according to the needs of families as the patient's condition deteriorates.

• Journal of Korean Public Health Nursing
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• v.16 no.1
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• pp.13-29
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• 2002

The purpose of this study was to describe about elders with dementia, their families, and their living environment by visiting the households where demented elders resided. The findings will be used as a basis to develop future individualized adjustment programs for demented elders and their families living in communities. The study participants were 64 demented elders and their families who were registered to a dementia counseling center at Nam-Gu community health center located in Inchon, Korea. Data were collected for two months, from May to June 2001. The length of data collection for each home visit ranged from 1.5 to 2.5 hours. Conclusion are as follows based on these study findings: Those demented elders had more than one chronic health problem in addition to their pre-existing dementia condition. Two thirds of the demented elders were not receiving any specific treatment for dementia. They showed a moderate level of independence in basic ADL, but were mostly residing at home because of lack of ability to perform more delicate and complicate routine daily activities by themselves. In addition, the primary caregivers were not well adjusted to the care-giving activities for their demented family members due to the lack of knowledge and information about dementia. The caregivers were mostly women including daughters-in-law, woman spouses and daughters, over a half of whom perceived their physical and mental health status as poor. Their image toward the demented elders was considerably negative. while their level of knowledge on dementia was moderate. The burden for the care-giving was high, whereas their coping method was passive. As the difference in image toward elderly before and after the onset of dementia in their family member increases, the caregiver burden also increased. The main resource of social support for the caregivers was their children. The caregivers showed high level of needs for knowledge and information on dementia, and day care service was the most preferred type of service by the caregivers. There was lack of safety in the living environments for the demented elders and their families, and in the surrounding environments to prevent dementia-related symptoms. Considering that home-based family care-giving is the most culturally appropriate model of providing care for the demented elders in Korea, we need to develop and apply an individualized adjustment program for the demented elders and their families.

• 한국노년학
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• v.37 no.3
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• pp.747-762
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• 2017

Recently, as the number of patients with dementia using nursing homes increases, the interest about the quality of care services is increasing. Job satisfaction of caregivers is very important factor in the quality of care service. In addition, as perception of human rights is heightened, human rights behavior in nursing homes is also recognized as an important factor. The purpose of this study is to investigate the structural relationship between job satisfaction and human rights behavior, job stress, and social support of dementia workers who have significant influence on quality of care service. For this purpose, 210 questionnaires were collected from 300 dementia workers working in the elderly nursing home, day night care center, and domiciliary visit care center in Gyeonggi province. After excluding 13 questionnaires, the questionnaires were analysed by AMOS and SPSS 21.0. The results of the analysis are following. It was found that job stress significantly affects the social support directly (-.276). Also, social support significantly affects job satisfaction (.315). On the other hand, human rights advocacy has a direct effect on job satisfaction (.175) and an indirect effect (.102), showed a total effect of (.277). This shows that social support partially mediates human rights advocacy and job satisfaction. Job stress had a direct effect on job satisfaction(-.217) and an indirect effect(-.095), indicating a total effect of (-.312), and social support partially mediated job stress and job satisfaction Could know. The results of this study suggest that in order to improve the job satisfaction of the dementia workers, it is necessary to increase the human rights advocacy behavior and reduce the job stress in an environment that recognizes the social support.

• Korea Journal of Hospital Management
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• v.21 no.2
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• pp.37-49
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• 2016

The purpose of this study is to investigate the level of competition between Public Health Centers (PHCs) and private clinics (PCs) by examining the number of patients that used PHCs vs. PCs, estimating the total amount of revenue generated from outpatient services at both PHCs and PCs, thereby analyzing the financial impacts on PCs derived from the PHCs. We utilized 2011 National Inpatient Sample data (NIS). Using the 20 table containing general information on each individual claims, we integrate it with the 40 table which contains all the diagnostic codes for each claim. Then, we disaggregate the bundled claims into the original individual claims. Overall, 3.1% of outpatient visits are made at PHCs while the rest was made at the PCs (96.9%). Among the total claim costs of 6.34 billion USD (as of 2011), PHCs occupy 2.0% (124 million USD), and 98.0% are contributed to PCs (6.21 billion USD). The estimated economic losses of PCs due to PHCs are summarized as follow; the maximum potential loss is estimated at 198 million USD in total and 7,099 USD per clinic when we include all patient types; the minimum loss is estimated at 71 million USD in total and 2,540 USD per clinic where Medical Aid recipients and the elderly (aged 65 and over) are excluded. Our results confirm the potential economic effect on PCs due to PHCs providing outpatient services. PCs and PHCs are the most important players providing primary care in Korea. Unnecessary competition between PCs and PHCs is not desirable. Health authorities should carefully examine the healthcare services currently provided by PHCs and their impacts on PCs.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.6
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• pp.2847-2852
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• 2016

Background: Although the breast cancer incidence rate in Japan is lower than in western countries, the age-specific rates have markedly increased in recent years, along with the problems of declining birth rate and an aging population. Materials and Methods: We examined past trends of age-specific breast cancer incidence using data from the Osaka Cancer Registry from 1976 to 2010, and estimated future trends until 2025 based on the changes observed and population dynamics using a log linear regression model. Results: The age-specific breast cancer incidence rate has increased consistently from the 1970s, and the rates have caught up with those of Japanese-Americans in the US. Assuming the increasing tendency of age-specific breast cancer incidence to be constant, the average annual incidence of breast cancer will increase 1.7-fold from 2006-2010 to 2021-2025. Furthermore, the number of patients aged 80 years should increase 3.4-fold. Conclusions: The medical demand for breast cancer care in Japan may increase explosively in the future, particularly among the elderly. We need to prepare for such a future increase in demand for care, although careful monitoring is needed to confirm these results.

• Health Policy and Management
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• v.34 no.2
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• pp.196-210
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• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

• Korean Journal of Adult Nursing
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• v.25 no.1
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• pp.24-32
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• 2013

Purpose: The aim of the study was to identify the most appropriate fall-risk assessment tool for neurological patients in an acute care setting. Methods: This descriptive study compared the reliability and validity of three fall-risk assessment tools (Morse Fall Scale, MFS; St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, STRATIFY; Hendrich II Fall Risk Model, HFRM II). We assessed patients who were admitted to the Department of Neurology, Neurosurgery, and Rehabilitation at Asan Medical Center between July 1 and October 31, 2011, using a constructive questionnaire including general and clinical characteristics, and each item from the three tools. We analyzed inter-rater reliability with the kappa value, and the sensitivity, specificity, predictive value, and the area under the curve (AUC) of the three tools. Results: The analysis included 1,026 patients, and 32 falls occurred during this study. Inter-rater reliability was above 80% in all three tools. and the sensitivity was 50.0% (MFS), 84.4%(STRATIFY), and 59.4%(HFRM II). The AUC of the STRATIFY was 82.8. However, when the cutoff point was regulated as not 50 but 40 points, the AUC of the MFS was higher at 83.7. Conclusion: These results suggest that the STRATIFY may be the best tool for predicting falls for acute neurological patients.

• Journal of the Korean housing association
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• v.19 no.4
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• pp.79-87
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• 2008

Snoezelen, multi-sensory stimulation, provides stimulation through the visual, aural, tactile, olfactory, gustatory and proprioceptive senses. Its aim is to be a relaxing, feeling of safety, novelty and stimulation with no expectations for performance. Agitated behavior of people with dementia causes significant problems and distress for cares. The objective of this research study was to test the effects of Snoezelen room on physical and verbal agitated behaviors of people with dementia. Four patients participated five sessions in Snoezelen room of 'F' dementia care facility in Sweden. Assessment instrument was basically used Cohen-Mansfield Agitation Inventory-Short Form to be rated by caregivers on a 5-point frequency scale. Pre-trial and post-trial assessments were carried out during $27^{th}$ Aug.-$27^{th}$ Sept. 2007. Result shows that Snoezelen room has some short-term positive effect on agitated behavior even though there was a considerable variation individuals responded. This result adds to the increasing evidence that Snoezelen could be a therapeutic environment for the elderly with dementia. Further research study, with larger number of participation, and a control group is required to establish more scientific evidence of Snoezelen effects on health outcome.

• Research in Community and Public Health Nursing
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• v.27 no.3
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• pp.193-201
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• 2016

Purpose: The aim of the study is to determine factors influencing quality of caregiving by caregivers for the elderly with dementia. Methods: Data were collected from 87 caregivers for elders with dementia who had visited in Busan Metropolitan Center for Dementia and D-University hospital outpatient center from July 10 to September 30, 2015. A self-reported questionnaire was used to assess the severity of the elders' dementia and knowledge of dementia, burdens and quality of caregiving by the caregivers. The SPSS 21.0 version program was used for data analysis. Data were analyzed using descriptive statistics, Pearson's correlation, t-test, ANOVA and multiple regression. Results: Significant predictors of quality of caregiving by caregivers included caregivers' burdens (explanation power 25%), knowledge of dementia (explanation power 4%) and levels of education (explanation power 3%). These factors explained 32.3% of the variances in quality of caregiving. Conclusion: Burdens on caregivers were a major factor that decreased quality of caregiving, and knowledge of dementia was a factor that increased it. These findings show that educational programs and intervention for reducing burdens and improving knowledge of dementia are necessary to improve quality of caregiving by caregivers.

• Research in Community and Public Health Nursing
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• v.27 no.4
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• pp.319-326
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• 2016

Purpose: The aim of this study is to identify factors affecting elders' intention to participate in healthcare programs. Methods: This secondary data analysis used data of 390 elderly people who lived alone and were enrolled in the Visiting Health Care Center of H-city. In 2014, questionnaires were used to collect data about demographics, social activity, depression, frailty, and intention to participate in healthcare programs. The data were analyzed by descriptive statistics and multivariate logistic regressions. Results: Among the participants, 51.8% intended to participate in the offered healthcare programs. The strongest factor affecting the intention was gender. Women were 4.85 times more likely to participate in the programs than men. The women's intention was associated positively with increased levels of frailty. The men tended to participate in the program as they got older and as the level of frailty and the number of chronic diseases increased. Conclusion: Gender-specific public healthcare programs for vulnerable elders living alone should be developed to maximize their participation in the programs and to promote good health. The healthcare programs must be tailored to the levels of the patients' physical functions.