• 한국산업융합학회 논문집
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• 제25권5호
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• pp.725-739
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• 2022

This study conducted with 268 female elderly who visited welfare center and senior citizen center in Changwon city to identify the dietary status according to social frailty stage using nutrition quotient for elderly (NQ-E). As a result of the survey, 75.0% of the elderly had no nutrition education. The elderly in social frailty stage was 43.7%, pre-frail was 35.1%, and robust was 21.2%. The scores of NQ-E (61.65), balance (47.78), moderation (86.18), and dietary behavior (55.23) were within the medium-high grade, while diversity (48.37) was within the medium-low grade. Among the balance factor item, there was a significant difference only in the frequency of fruit intake according to social frailty stage (p<0.05). Among the diversity factor item, there were significant differences in vegetable intake (p<0.05) and the rate of eating alone (p<0.001) according to social frailty stage. Among the dietary behavior factor item, there were significant differences in whether to strive for a healthy diet (p<0.05), exercise time and depression (p<0.001), and subjective recognition rate of health (p<0.01) according to social frailty stage. Based on these results, education focusing on various food intake is needed, and continuous support from the government and local governments is needed to connect the social support network of the elderly and support programs to prevent them from going to social frailty stage.

• 한국체육학회지인문사회과학편
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• 제57권6호
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• pp.263-272
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• 2018

본 연구는 여성노인의 허약 상태에 대한 보행 변동성과 체력의 역할을 검증하고자 하였다. 본 연구 기관의 지역사회에 거주하는 65세 이상 여성노인 168명(나이 75.07±5.40)을 대상으로 인구사회학적 특성, 신체조성, 보행 변인 및 변동성, 체력, 인지기능, 우울상태를 측정하였다. 그리고 Fried et al.(2001)의 허약진단 지표(체중감소, 정서적 고갈, 신체활동, 보행속도, 악력)를 기준으로 정상, 전-허약, 허약으로 구분하였다. 허약 상태 예측을 위한 보행 변인 및 변동성 그리고 체력의 역할을 검정하기 위해 로지스틱 회귀분석을 실시하였다. 그 결과, 나이, 교육수준, 보유한 질병 수, 일상생활수행능력 및 인지기능 점수와 우울점수를 통제 한 후 허약그룹은 정상그룹(OR=1)과 비교하였을 때, 두 다리 지지비율(OR=1.48, 95% CI=0.10-2.21, p=.049) 및 분당 보폭수(OR=2.06, 95%CI=1.20-3.43, p=.009)의 변동성이 통계적으로 높게 나타났으며, 상체근력(OR=0.49, 95%CI=0.31-0.77, p=.002)이 낮은 것으로 나타났다. 결론적으로 본 연구에서 허약의 예측인자로 나타난 두발 지지비율 및 분당 보폭수의 변동성 그리고 상체근력은 허약 상태를 예측하고 평가하는데 중요한 지표로 사용될 수 있을 것으로 판단된다.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.995-1003
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• 2021

Objective : People are living longer and the elderly population continues to increase. The incidence of degenerative spinal diseases (DSDs) in the elderly population is quite high. Therefore, we are facing more cases of DSD and offering more surgical solutions in geriatric patients. Understanding the significance and association of frailty and central sarcopenia as risk factors for spinal surgery in elderly patients will be helpful in improving surgical outcomes. We conducted a retrospective cohort analysis of prospectively collected data to assess the impact of preoperative central sarcopenia, frailty, and comorbidity on surgical outcome in elderly patients with DSD. Methods : We conducted a retrospective analysis of patients who underwent elective spinal surgery performed from January 1, 2019 to September 30, 2020 at our hospital. We included patients aged 65 and over who underwent surgery on the thoracic or lumbar spine and were diagnosed as DSD. Central sarcopenia was measured by the 50th percentile of psoas : L4 vertebral index (PLVI) using the cross-sectional area of the psoas muscle. We used the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale to measure frailty. Comorbidity was confirmed and scored using the Charlson Comorbidity Index (CCI). As a tool for measuring surgical outcome, we used the Clavien-Dindo (CD) classification for postoperative complications and the length of stay (LOS). Results : This study included 85 patients (35 males and 50 females). The mean age was 74.05±6.47 years. Using the K-FRAIL scale, four patients were scored as robust, 44 patients were pre-frail and 37 patients were frail. The mean PLVI was 0.61±0.19. According to the CD classification, 50 patients were classified as grade 1, 19 as grade 2, and four as grade 4. The mean LOS was 12.35±8.17 days. Multivariate stepwise regression analysis showed that postoperative complication was significantly associated with surgical invasiveness and K-FRAIL scale. LOS was significantly associated with surgical invasiveness and CCI. K-FRAIL scale showed a significant correlation with CCI and PLVI. Conclusion : The present study demonstrates that frailty, comorbidity, and surgical invasiveness are important risk factors for postoperative complications and LOS in elderly patients with DSD. Preoperative recognition of these factors may be useful for perioperative optimization, risk stratification, and patient counseling.

• Journal of Nutrition and Health
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• 제56권2호
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• pp.155-167
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• 2023

본 연구는 제7기 (2016-2018년) 국민건강영양조사 자료를 활용하여 만65세 이상 노인 3,675명(남성 1,643명, 여성 2,302명)의 수산물 섭취 수준에 따른 에너지 및 미량 영양소와 식품 섭취의 차이를 분석하고 수산물 섭취와 노쇠의 연관성을 분석하고자 하였다. 노쇠 여부는 Fried 진단 기준을 활용하여 평가되었으며 노쇠 유병률은 남성은 13.4%, 여성은 29.7%로 분류되었다. 남녀 노인 모두 수산물 하위 1삼분위에서 상위 3삼분위로 갈수록 총 식품 섭취량, 곡류 및 채소과일류의 섭취가 유의적으로 많았던 반면 육류의 섭취는 유의적으로 낮아지는 음의 경향성을 보였다. 남녀 모두에서 수산물 섭취량이 많은 군일수록 에너지섭취량이 많았으며 여성 노인의 경우 수산물 섭취량이 많을수록 지방으로부터 섭취하는 에너지 비율이 높았다. 수산식품군의 섭취 수준에 따른 낮은 노쇠 위험도의 유의적인 경향성은 여성 노인에서만 나타났다. 여성 노인 수산물 섭취 하위 1삼분위군에 비해 상위 3삼분위군이 전노쇠 위험 (OR, 0.64; 95% CI, 0.42-0.96; p-trend = 0.045)과 노쇠 위험 (OR, 0.52; 95% CI, 0.32-0.83; p-trend = 0.008)이 유의하게 낮았다. 결론적으로 본 연구에서는 여성의 경우 수산물의 충분한 섭취가 낮은 노쇠 위험과 관련성이 있음을 제시하였다.

• 지역사회간호학회지
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• 제29권3호
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• pp.335-348
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• 2018

Purpose: This study has been conducted to develop and examine a health promotion empowerment program using a lay health leader for frail elderly. Methods: The research was organized in a nonequivalent control group pre-post test design. Data collection was performed from August 18 to October 8, 2015. The subjects included 76 frail elders aged over 65 registered in home visiting services (Experimental group=39, Control group=37). A health promotion empowerment program using a resident volunteer as a lay health leader was run for 8 weeks. Health factors (health promotion behavior, perceived health status and frailty) and empowerment factors (empowerment, social participation) were assessed. The data were analyzed by using the SPSS/WIN 18.0 program. Results: After the program, health promotion behavior, perceived health status and social participation increased in the experimental group more significantly than in the control group, but frailty decreased in the experimental group greater than in the control group. Conclusion: The health promotion empowerment program using a resident volunteer as a lay health leader was effective. Therefore, the health promotion empowerment program needs to be expanded to other frail elders. Also, a health leader should be recommended as a public health resource and systematically managed.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.827-833
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• 2020

Objective : Spine surgery is associated with higher morbidity and mortality rates in elderly patients. The modified Frailty Index (mFI) is an evaluation tool to determine the frailty of an individual and how preoperative status may impact postoperative survival and outcomes. This study aimed to determine the usefulness of mFI in predicting postoperative complications in patients aged ≥75 years undergoing surgery with instrumentation. Methods : We retrospectively reviewed the perioperative course of 137 patients who underwent thoracolumbar-instrumentation spine surgery between 2011 and 2016. The preoperative risk factors were the 11 variables of the mFI, as well as body mass index (kg/㎠), preoperative hemoglobin, platelet, albumin, creatinine, anesthesia time, operation time, estimated blood loss, and transfusion amount. The 60-day occurrences of complication rates were used for outcome assessment. Results : Major complications after spinal instrumentation surgery occurred in 34 of 138 patients (24.6%). The mean mFI score was 0.18±0.12. When we divided patients into a pre-frail group (mFI, 0.09-0.18; n=94) and a frail group (mFI ≥0.27; n=44), only the rate of sepsis was statistically higher in the frail group than in the pre-frail group. There were significantly more major complications in patients with low albumin levels or in patients with infection or who had experienced trauma. The mFI was a more useful predictor of postoperative complications than the American Society of Anesthesiologists physical status score. Conclusion : The mFI can successfully predict postoperative morbidity and mortality in patients aged ≥75 years undergoing spine surgery. The mFI improves perioperative risk stratification that provides important information to assist in the preoperative counselling of patients and their families.

• 영미문화
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• 제13권1호
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• pp.83-103
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• 2013

This paper focuses on the function of suicidal images in the history of art including literature. Death has been romanticized or repoliticized into an existential act of defiance and rebellion in literary works, so questions remain about the correlation between literary suicide and the essence of suicide. Although Jacques Ranciere insists that the order of art contrasts with the order of common people whose acts and gestures can express either their specific purposes nor the rationalities of their frustration, literary suicide reflects the outside life of readers. In fact, images of suicide produces the order of things about the real world. William Shakespeare's Hamlet handled two oppositional self-murder significantly. As Ron M. Brown pointed out, Hamlet, by choosing confrontation, seeks out an end which is voluntary, thus he avoids self-destruction and feels triumph of heroic fashion. Ophelia's self-chosen death stems from loss, frailty and the disintegration of reason, which demeans the act and diminishes her from the tragic to the pathetic(16). In the $19^{th}$ century, the resurrection of Ophelia acted as the context for later periods where life itself is fictionalized from the differing periods of network of signifier and texts. Finally, in Ophelia's case, fiction became life(Brown 285). Her suicidal image was fixed in the Victorian Culture whose visual discourse was strikingly similar to that of the men. Likewise, the ambiguities of the suicide became intertwined with the social, cultural issues of a certain period, and the paradigm of suicide was conformed to the changing needs of successive generations. However, if literary art understands that a European culture grappled with the almost impossible task and coming to terms with this strangest and most persistent of phenomena, it will be able to focus on of the multi-layered suicide by recognizing the inherent instability of the verbal sign which cannot reveal the design and grammar of truth.