• 대한간호학회지
• /
• 제34권8호
• /
• pp.1483-1490
• /
• 2004

Community-based centres were surveyed to determine the frequency of and risk factors for falls among elderly Koreans. We examined fall-related risk factors, including physiological and physical health, psychosocial functions, self-reported physical capacity and activity, vision, and the use of medication, among 351 elderly people aged 65 years or older, with ambulatory. Forty-two per cent of elderly Korean subjects reported at least one episode of falling in the previous 12 months, $38\%$ of whom had consequences that required either the attention of a physician or hospitalization. Factors significantly associated with an increased risk of falling were a restricted activity during the previous five years (adjusted OR 1.3), use of alternative therapy (adjusted OR 2.7), low knee flexor and extensor-muscle strength (adjusted OR 1.21 and 1.20), and poor balance with closed eyes (adjusted OR 8.32). We conclude that falls among older persons living in the community are common in Korea and that indicator of bad health and frailty or variables directly related to neuromuscular impairment are significant predictors of the risk of falling.

• 지역사회간호학회지
• /
• 제13권3호
• /
• pp.444-455
• /
• 2002

Purpose: This study was performed to develop the case management program that can provide the qualitative health care service to satisfy the increasing needs for health care elderly and prevent the increase in medical cost cased by prolonged and repetitive hospitalization. Method: The survey was completed as follows. First, 290 elderly patients who would be soon discharged in 4 hospitals are participated in the survey on needs of nursing care and case management programs. Second, 70 professionals working at 5 hospitals including doctors, nurses, social workers and so on are participated in the survey on the case management team operation. Result: Level of needs to Nursing care and case management programs showed so high. Professionals suggested on the case management team operation. Finally, based on the survey and literature review, the case management program was developed. Conclusion: In this study, the specific models for the five case management services were suggested. It is thought that the service provision by the case management team based on the multi-disciplinary case management program model suggested in this study would be suggested as a constituent of the effective health care delivery system for the hospitalized elderly patients.

• 한국콘텐츠학회논문지
• /
• 제17권8호
• /
• pp.290-300
• /
• 2017

이 연구는 의료서비스를 이용함에 있어 서로 성격이 다른 사립병원과 국공립병원을 선택하는 결정 요인은 무엇인지를 분석하는 것을 목적으로 한다. Andersen의 행동모형 이론을 적용하여 욕구요인, 가능성 요인, 개인적 요인을 결정요인으로 하는 모형을 개발하였다. 분석 자료는 한국의료패널 2008년부터 2013년까지 6년 동안의 자료 데이터 중 입원서비스를 이용한 건수를 기준으로 하였고, 분석대상은 18세 이상자로 제한하였으며, 최종 분석에 사용한 입원의료이용 건수는 14,365건이다. 로지스틱 회귀분석 결과에 따르면, 국공립병원 선택요인은 대체로 Andersen의 행동모형이 잘 적용되는 것으로 나타났다. 특히, 사회경제적 약자들인 노인, 저소득층, 국가 유공자 및 의료급여자, 만성질환자, 장애가 있는 환자들은 사립병원보다는 국공립병원을 더 선택하였다. 따라서, 저소득 취약계층에 적정한 의료서비스를 제공하기 위해서는 국공립병원에서 제공하는 의료서비스의 강화가 필요하다는 정책적인 시사점을 발견하였다.

• 간호행정학회지
• /
• 제4권2호
• /
• pp.351-361
• /
• 1998

The purpose of this study was to explore whether there is a point within the range of physical impairment after which the cost of home care exceeds the cost of nursing home care among the elderly who require long-term care. The provision of long-term care for the elderly is a major health policy issue, in part due to the aging of the American population and dramatic increase in health care costs. The framework for this study was guided by Pollak's(1973)model of costs of alternative care settings for the elderly. This study used a retrospective, descriptive correlational design. Physical impairment was measured by the modified Index of Activities of Daily Living(Katz et al. 1963). Cost of care was measured by the average cost per patient per day. The sample for this study included 67 patients receiving long-term care at home from the Long-term Home Health Care Programs (LTHHCPs) and 67 patients receiving long-term care in nursing homes. Data were collected on patient characteristics. including activities of daily living and cognitive impairment. and on the number of physician visits. emergency room visits. and hospitalization from the patient records. For each patient. Medicaid cost data for home care services/or nursing home services were collected from the financial department of each home care agency or nursing home. The living costs and informal care costs were estimated for home care patients. The results indicated that the home care sample and the nursing home sample were similar in terms of gender. ethnic background. and marital status. The elderly patients in the home care sample were: however. younger and less physically impaired than those in the nursing home sample. The hypotheses of this study were supported: For elderly persons with physical impairment scores below 12(possible range of 0 to 14), cost of care was lower in home care than in the nursing home care setting. However, for elderly persons with physical impairment scores above 12. the cost of care was higher in home care than in the nursing home care setting. Thus. in this sample for elderly patients with extreme physical impairment, the cost of home care exceeded the cost of nursing home care.

• 성인간호학회지
• /
• 제16권3호
• /
• pp.470-479
• /
• 2004

Purpose: The purpose of this study was to identify an influence of self-esteem and familysupport on powerlessness of hospitalized elderly patients with chronic disease. Method: The subjects were 151 hospitalized elderly patients, age over 60, with chronic disease and admitted for at least 1 week. The data were collected by individual interview using a structured questionnaire during the period from July 10th to August l0th, 2003 from three general hospitals in Busan. The data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation, hierarchical multiple regression. Result: The level of self-esteem, family support, and powerlessness was 38.00, 38.26, and 38.38, respectively. There was a significant positive correlation between self-esteem and family support and a negative correlation between self-esteem and powerlessness and between family support and powerlessness. Self-esteem and family support were each significant predictor of powerlessness. Conclusion: This study showed the hospitalized elderly patients need greater family-support and higher self-esteem to relieve the level of powerlessness. I suggest to study for replication in a larger sample size and considering the lengths of hospitalization for generalization of this study and to develop individual intervention programs for increasing family support and self esteem and testify their effects on the relief of powerlessness of the elderly.

• 기본간호학회지
• /
• 제5권1호
• /
• pp.47-64
• /
• 1998

This study was conducted to collect the baseline data of physical health status and nursing needs of the elderly for developing an educational program for nursing professionals. The data was collected from 287 people who were 65 years old or older belonging to a selected 8 out of the 39 welfare centers in Pusan during the period from February 25 to November 30, 1996. Socio-demographic characteristics, frequency of hospitalization, and the prevalence of chronic illnesses were measured to assess the physical health status of the center's elderly admitted to the hospital during the period of data collection. The 5-point Likert-type scale composed of 20 items was used. The data was analyzed with the Statistical Package for the Social Sciences Program (SPSS PC+). The results were summarized as follows : 1. The proportion of elderly subjects with chronic illnesses was 73.6%. Among 6 types of chronic illnesses, hypertension was the most prevalent(23.7%), cardiovascular disease was the second(18.1%), gastrointestinal disease the third(17.1%), musculosskeletal disease the fourth(12.9%), liver and biliary disease the fifth(12.5%), and diabetes the sixth. 2. The average score of the subjects' health status was 3.649 on the 5-point Likert scale. Among the 6 factors related to physical health, personal hygiene was the strongest factor(4.612) ; elimination was the second(4.491) ; sensation the third(4.369), outside activity the fourth(3.675), digestion the fifth(3.331), and sexual life the sixth. 3. Gender, marital status, religion, educational level, family structure, living arrangements, and perceived health status were significantly related to the elderly's physical health status. 4. Among the nursing needs of the elderly, emotional support and care was the strongest need(74.2%) ; physical therapy was the second(73.2%) ; education about diease control the third(64.8%) ; medication the fourth(63.8%) ; and the range of motion exercise the fourth(61.0%).

• Annals of Geriatric Medicine and Research
• /
• 제20권3호
• /
• pp.125-130
• /
• 2016

Background: Conventionally, elderly hip fracture patients are assessed by orthopedists to decide whether they need geriatric intervention. We aimed to evaluate the effect of perioperative geriatric intervention on healthcare outcomes in patients undergoing surgery for hip fractures. Methods: Our care model for hip fracture surgery resembles a combination of a routine geriatric consultation model and a geriatric ward model. We retrospectively reviewed the medical records of patients aged ${\geq}65years$ undergoing surgery for hip fracture at a single tertiary hospital from January 2010 to December 2013. We assessed comorbidity, indwelling status, fracture type, and mode of anesthesia. We also evaluated in-hospital expenditure, duration of admission, disposition at discharge and 1-year mortality as clinical outcomes. We developed a propensity score model using the variables of age, cholesterol, and creatinine and examined the effect of perioperative geriatric intervention on intergroup differences of clinical variables. Results: Among 639 patients, 138 patients received the geriatric intervention and 501 patients received the usual care. Univariate analysis showed that factors such as age; Charlson comorbidity index; and serum levels of cholesterol, albumin, and creatinine differed significantly between these 2 groups. There was no significant difference between the groups in terms of 1-year mortality, disposition at discharge, and in-hospital expenditure in the propensity matched model. However, the duration of hospitalization was shorter in the intervention group ($8.9{\pm}0.8days$) than in the usual care group ($14.2{\pm}3.7days$, p=0.006). Conclusion: This care model of geriatric intervention for patients with hip fracture is associated with reduced hospitalization duration.

• Hip & pelvis
• /
• 제35권4호
• /
• pp.246-252
• /
• 2023

Purpose: The aim of this study was to compare short-term results from use of the direct anterior approach (DAA) and the conventional posterolateral approach (PLA) in performance of bipolar hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients. Materials and Methods: A retrospective review of 100 patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty was conducted. The PLA was used in 50 cases from 2016 to 2019; since that time we have used the DAA in 50 cases from 2019 to 2021. Measurements of mean operative time, blood loss, hospitalization period, and ambulation status, greater trochanter (GT) migration and stem subsidence were performed. And the incidence of complications was examined. Results: Operative time was 73.60±14.56 minutes in the PLA group and 79.80±8.89 minutes in the DAA group (P<0.05). However, after experiencing 20 cases using DAA, there was no statistically difference in operative time between two groups (P=0.331). Blood loss was 380.76±180.67 mL in the PLA group and 318.14± 138.51 mL in the DAA group (P<0.05). The hospitalization was 23.76±11.89 days in the PLA group and 21.45 ±4.18 days in the DAA group (P=0.207). In both groups, there were no progressive GT migration, intraoperative fractures or dislocations, although there was one case of infection in the PLA group. Conclusion: Although use of the DAA in performance of bipolar hemiarthroplasty required slightly more time in the beginning compared with the PLA, the DAA may well be an alternative, safe surgical technique as a muscle preserving procedure in elderly patients with intertrochanteric fractures.

• 대한간호학회지
• /
• 제45권3호
• /
• pp.459-468
• /
• 2015

Purpose: The purpose of this study was to investigate the effects of Wheel of Wellness counseling on wellness lifestyle, depression, and health-related quality of life in community dwelling elderly people. Methods: A parallel, randomized controlled, open label, trial was conducted. Ninety-three elderly people in a senior welfare center were randomly assigned to two groups: 1) A Wheel of Wellness counseling intervention group (n=49) and 2) a no-treatment control group (n=44). Wheel of Wellness counseling consisted of structured, individual counseling based on the Wheel of Wellness model and provided once a week for four weeks. Wellness lifestyle, depression, and health-related quality of life were assessed pre-and post-test in both groups. Results: Data from 89 participants were analyzed. For participants in the experimental group, there was a significant improvement on all of the wellness-lifestyle subtasks except realistic beliefs. Perceived wellness and depression significantly improved after the in the experimental group (n=43) compared to the control group (n=46) from pre- to post-test in the areas of sense of control (p =.033), nutrition (p =.017), exercise (p =.039), self-care (p <.001), stress management (p =.017), work (p =.011), perceived wellness (p =.019), and depression (p =.031). One participant in the intervention group discontinued the intervention due to hospitalization and three in the control group discontinued the sessions. Conclusions: Wheel of Wellness counseling was beneficial in enhancing wellness for the community-dwelling elderly people. Research into long-term effects of the intervention and health outcomes is recommended.

• 보건행정학회지
• /
• 제30권1호
• /
• pp.62-71
• /
• 2020

Background: The purpose of this study is to analyze the current status and factors of elderly patients' hospitalization for hip replacement, knee replacement, and general spine surgery. Methods: National health insurance data in 2018 was provided by the National Health Insurance Service. We used multiple regression to analyze factors associated with the medical utilization of hip replacement, knee replacement, and general spine surgery in elderly patients over 65 years old. The dependent variables are the length of stay and total health expenditure. The independent variables are the demographic-social factors (sex, age, region, insurance type, income level) and surgery-related factors (institution type, location of the hospital, surgery classification). Results: The most common factor affecting surgery was the location of medical institutions. Compared with the medical institutions located in metropolitan, the length of stay in rural medical institutions was higher and total health expenditure was lower. The lower quartile of income, the higher the length of stay and total health expenditure. In addition, the variables of age, type of health insurance, and type of medical institution were statistically significant. Conclusion: In this study, we confirmed the effect of sociodemographic factors and medical institution factors on the Healthcare Utilization of spinal and joint surgery.