Online health information use by participants in selected senior centres in Korea: current status of internet access and health information use by Korean older adults

chung j., gassert c.a. & kim h.s. (2010) Online health information use by participants in selected senior centres in Korea: current status of internet access and health information use by Korean older adults. International Journal of Older People Nursing 6 , 261–271
doi: 10.1111/j.1748‐3743.2010.00238.x Aims and objectives. The purpose of this research was to describe how older adult internet users from senior centres in Korea accessed and used health information on the internet and the perceived barriers that prevented internet use. Background. Increasingly, patients are using health‐related information available on the internet. Internet based health information has influenced patient knowledge and expectations regarding healthcare. However, there are few studies about the use of internet for health information by older adults, and even less is known about older adults in Korea. Design. Based on the Access to Information framework developed by McCreadie and Rice, this quantitative study with a qualitative adjunct explored the older adults’ use of internet for health information. Methods. A convenience sample of 91 community‐dwelling older adults in Korea was recruited from 10 randomly selected senior centres, using the modified Kaiser Family Foundation Survey as the basis for structured interview. Results. Half of older internet users (n = 13) had used online health information and found it was helpful. Barriers to internet use were: no interest (90.8%); too complicated (75%); no experience in using internet (～50%); too expensive (～50%); or disability (10%). Qualitative findings revealed that the prime reason for non‐use of the internet was related to literacy and level of education due to historical background. Conclusions. The results of quantitative and qualitative analysis supported that the internet users were relatively younger, more educated, male, had a higher income, received more support from others and all from large senior centres. Implications for practice. This study is important because the results can provide valuable insights into the potential for health education and health communication for older adults in Korea using the internet. It could affect health promotion, policy and education for older adults in Korea.     

Health literacy and preventive health care use among Medicare enrollees in a managed care organization

BACKGROUND: Many older adults in Medicare managed care programs have low health literacy, and this may affect use of preventive services. OBJECTIVES: To determine whether older adults with inadequate health literacy were less likely to report receiving influenza and pneumococcal vaccinations, mammograms, and Papanicolaou smears than individuals with adequate health literacy after adjusting for other covariates. RESEARCH DESIGN: Cross-sectional survey; home interviews with community dwelling enrollees. SUBJECTS: Medicare managed care enrollees 65 to 79 years old in four US cities (n = 2722). MEASURES: Short Test of Functional Health Literacy in Adults and self-reported preventive service use. RESULTS: In bivariate analyses, self-reported lack of preventive services was higher among individuals with inadequate health literacy than those with adequate health literacy: never had an influenza vaccination: 29% versus 19% (P = 0.000); never had a pneumococcal vaccination: 65% versus 54% (P = 0.000); no mammogram in the last 2 years: 24% versus 17% (P = 0.017); never had a Papanicolaou smear: 10% versus 5% (P = 0.002). After adjusting for demographics, years of school completed, income, number of physician visits, and health status, people with inadequate health literacy were more likely to report they had never received the influenza (OR, 1.4; 95% CI, 1.1-1.9) or pneumococcal vaccination (OR, 1.3; 95% CI, 1.1-1.7), and women were less likely to have received a mammogram (OR, 1.5; 95% CI, 1.0-2.2) or Papanicolaou smear (OR, 1.7; 95% CI, 1.0-3.1). CONCLUSIONS: Among Medicare managed care enrollees, inadequate health literacy is independently associated with lower use of preventive health services.     

Gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone

This study examined gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone in Korea, and the variables influencing these symptoms. Data from a total of 317 older adults in the 2011 Korean National Survey were used. Upper limb mobility, lower limb mobility, activities of daily living, instrumental activities of daily living, and depressive symptoms were measured. Data were analyzed using multiple regression analysis. Low‐income older men and women living alone experienced depressive symptoms. Regression analysis showed that lower limb mobility and age together explained 35.4% of the variance in depressive symptoms in men. Subjective health status explained 16.7% of the same in women. These findings suggest that low‐income older adults living alone should be carefully monitored by public healthcare managers to improve their physical and mental health, considering gender‐specific elements.     

Factors influencing the adaptation to skilled nursing facilities among older Korean adults

This study was conducted to identify the factors that influence the level of adaptation of older Korean adults to skilled nursing facilities. The subjects were 500 adults aged 65 or older who were living in six different skilled nursing facilities in Seoul and Gyeong‐gi‐do, South Korea. The measures were a demographic form, Health Self‐Rating Scale, Activities of Daily Living Scale, Self‐Efficacy Instrument, Korean Simple Depression Scale, Quality of the Facility Scale and Facility Adaptation Scale. The analyses showed that the prediction model was significant (F = 128.624, P < 0.001). The value of the adjusted R² was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was activities of daily living (β = ?0.564), followed by self‐efficacy (β = 0.321), quality of the facility (β = 0.164), depression (β = 0.133), decision to enter a skilled nursing facility (β = 0.122), perceived health status (β = 0.064) and age (β = ?0.010). This cross‐sectional study provides preliminary evidence that the level of adaptation of older Korean adults to skilled nursing facilities is related to their activities of daily living, self‐efficacy, depression, decision to enter a skilled nursing facility, perceived health status and age, and to the quality of the facility.     

Self-care ability among home-dwelling older people in rural areas in southern Norway

Scand J Caring Sci; 2012; 26; 113–122
Self‐care ability among home‐dwelling older people in rural areas in southern Norway Introduction: The growing number of older people is assumed to represent many challenges in the future. Self‐care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self‐care ability is closely related to perceived health, sense of coherence and nutritional risk. Aim: The aim of this study was to describe self‐care ability among home‐dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation. Methods: A cross‐sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health‐related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+ years), and 1050 respondents were included in the study. Data were analysed with statistical methods. Results: A total of 780 persons were found to have higher self‐care ability and 240 to have lower self‐care ability using the Self‐care Ability Scale for the Elderly. Self‐care ability was found to be closely related to health‐related issues, self‐care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self‐care ability were to have higher self‐care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age. Conclusions: When self‐care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency.     

Upstream thinking and health promotion planning for older adults at risk of social isolation

wilson d.m., harris a., hollis v. & mohankumar d. (2010) Upstream thinking and health promotion planning for older adults at risk of social isolation. International Journal of Older People Nursing 6 , 282–288
doi: 10.1111/j.1748‐3743.2010.00259.x Aims and objectives. To raise awareness of social isolation, and provide an approach to first conceptualise and then prevent social isolation among older community‐dwelling persons. Background. Older adults comprise a vulnerable population for social isolation and its associated health risks. Design. Literature review. Methods. Canada’s Population Health Promotion Model was chosen as a comprehensive tool to understand and prevent social isolation. Research studies were sought to identify key health determinants and evidence‐based options for preventing social isolation. Results. Around 1 out of 6 older persons are socially isolated and three health determinants are of prime importance: (i) income and social status; (ii) personal health practices and coping skills and (iii) social support networks. Evidence‐based interventions targeted to these health determinants are suggested. Conclusion. Nurses are a key group to advocate for actions needed to prevent social isolation. Implications for practice. Nurses can play a vital role in minimising social isolation through a variety of educational, prevention and political lobbying activities.     

Health literacy in geriatric patients: An integrative review of the literature

The concept of health literacy is a recent addition to healthcare literature, appearing in the early to mid 1990s. Health literacy refers to individuals' ability to understand their healthcare issues and effectively care for themselves in the healthcare system. Individuals' health literacy abilities vary greatly and can be viewed on a continuum ranging from adequate to marginal to inadequate. Repeated research has demonstrated that older individuals, the geriatric patient population, are at risk of inadequate or marginal health literacy. This risk impacts health outcomes and cost for caring for the older people in our society who are the consumers of a large quantity of healthcare services. The demographic data from the research show that multiple factors influence an individual's health literacy. Besides age, individuals with less education, lower income, "blue collar" jobs, and poor health status (mental and physical) can be at risk of marginal or inadequate health literacy. Providing care to low health literacy patients is complicated by commercially prepared healthcare materials and presentations that are often written well above the average national literacy level. Studies in this review examine various approaches to healthcare education and provide viable options for educating those with low health literacy. This review stresses the importance of healthcare professionals identifying older individuals with marginal or inadequate health literacy and being able to provide education in an effective manner to this segment of the population.     

Depressive symptomatology among Turkish older adults with low incomes in a rural community sample

Aims and objectives. To identify the characteristics that are associated with depressive symptomatology among Turkish older adults with low income. Background. Depression is a major threat to mental health in older people, but little is known about older adults with low income at risk for depressive symptomatology in Turkey. Design. This was a cross‐sectional study, based in one area of Istanbul. Methods. The sample included 132 older adults in a rural setting living in Istanbul, Turkey. The participants were 55 years of age or older and chosen from among older adults with low income. Data were collected through a structured interview conducted in the homes of the participants. Results. High depressive symptoms (Geriatric Depression Scale ≥11) were reported by 50% of the participants. Compared with non‐depressed individuals, those with depressive symptomatology were more likely to be women, widowed, lack health insurance and to live alone. Depressed participants significantly more often reported chronic health conditions compared to non‐depressed participants (OR = 4·11, 95% CI = 1·35, 12·57). Overall well‐being scores were significantly higher in men and in the non‐depressed group. The result of the Pearson correlation provided support for the association between depression scores and overall well‐being scores (r = ?0·60). Conclusions. Depressive symptomatology is prevalent within Turkish older adults with low income. Further research is needed to examine potential risk factors associated with depressive symptomatology for this population. Relevance to clinical practice. Findings may assist health care professionals in assessing high‐risk older people who could benefit from interventions aimed at minimizing depressive symptoms.     

The mediating role of health professionals' recommendation in the uptake of colorectal cancer testing among older Chinese adults

The purpose of this study is to examine the mediating effect of health professionals' recommendations on the relationship between the characteristics of older Chinese adults and the use of colorectal cancer testing. This was a cross‐sectional population‐based telephone survey. A total of 2004 Chinese adults aged 50 or above were recruited between 2 and 28 May 2007 to complete an anonymous telephone survey. The survey covered demographics, perceived health status and susceptibility to cancer, utilization of complementary medicine, family history of cancer, and cancer screening behaviour. The uptake of flexible sigmoidoscopy/colonoscopy was 12%, of which only 3.4% had been recommended by health professionals. The effects of gender, a history of serious disease, perceptions related to health status and visiting doctor regularly on the flexible sigmoidoscopy/colonoscopy uptake were mediated by a health professional's recommendation. A health professional's recommendation can be a catalyst for the decision of undergoing a colorectal cancer screening test in older adult people, in particular for those who are more health‐conscious. As health professionals can play a crucial role in the development of successful population‐based colorectal cancer screening program, efforts should be made to facilitate them in making recommendations for colorectal cancer screening to targeted high‐risk group.     

Trends and variations in infant mortality among 47 prefectures in Japan

Objectives To determine IMR trends and regional variations among 47 prefectures in Japan and to identify associated population‐based factors. Methods We conducted an ecological study of infant mortality rate (IMR) by analyzing publicly available data from the Ministry of Health, Labour and Welfare of Japan. Outcome measure for trend is the IMR for each of 47 prefectures from 1999 to 2007; for variation, IMRs for 2006 and 2007 in each prefecture were averaged. We considered as covariates prefecture‐level variables related to public health, socio‐economic status, clinical services and health care facilities. We conducted multivariate statistical analyses to determine covariates most strongly associated with both 1999–2007 IMR trends and 2006–2007 IMR. Results The mean IMR decreased from 3.42 deaths per 1000 live births (range 2.1 to 5.1) in 1999 to 2.54 (range 1.5 to 4.4) in 2007; reductions were greater in prefectures with higher concentrations of public health nurses (PHNs) and nurses. In 2006–2007, nine prefectures had IMRs ≤ 2.25; eight had IMRs ≥ 3.0. When low‐, moderate‐ and high‐IMR prefectures were compared, per capita PHNs, maternal education, centralized water supply and household income were identified as significant covariates. Conclusions Both national and prefecture‐level IMR in Japan decreased from 1999 to 2007; however, the degree of reduction varied by prefecture. Given that more nurses and PHNs per capita were associated with greater IMR reductions from 1999 to 2007 and more PHNs with lower 2006–2007 IMRs, distribution of preventive health services may play a major role in reducing regional disparities in IMR.     

Nurses' knowledge of health literacy,communication techniques,and barriers to the implementation of health literacy programs: A cross‐sectional study

Nurses' health literacy knowledge and communication skills are essential for improving patients' health literacy. Yet, research on nurses' health literacy knowledge and perception is limited. The study aimed to evaluate nurses' health literacy knowledge, communication techniques, and barriers to the implementation of health literacy interventions. A cross‐sectional study was used, and a total of 1697 nurses in 104 community hospitals in Thailand completed self‐report measures. Approximately 55% of the participants had heard about the concept of health literacy; 9% had received formal training specific to interaction with patients with low health literacy. About 50% of the nurses were aware of their patients' low health literacy; therefore, they applied the recommended communication techniques for them. Delivery of effective health literacy training was hampered by a lack of assessment tools, health literacy training and specialists, educational materials, and health provider time. Hospital administrators, nurse managers, health leaders should develop strategies to create environments and resources supporting health literacy interventions.     

Health literacy and health outcomes in HIV seropositive persons

Inadequate health literacy has been associated with worse health status and more hospitalizations. We examined the influence of personal characteristics and health literacy on body change distress, depressive symptoms, and HIV symptom intensity in a convenience sample of 489 HIV-seropositive adults throughout the United States. Health literacy was measured with the Rapid Estimate of Adult Literacy in Medicine (REALM) instrument. Those with higher health literacy scores reported more body change distress, depressive symptoms, and HIV symptom intensity. Being Latino and having higher health literacy scores were associated with poorer health outcomes. These results challenge the utility of the REALM to examine the relationship between health literacy and adverse health status.     

Multicenter Study of Limited Health Literacy in Emergency Department Patients

Objectives:  The objective was to evaluate the prevalence of limited health literacy and its association with sociodemographic variables in emergency department (ED) patients.
Methods:  This was a cross-sectional survey in three Boston EDs. The authors enrolled consecutive adult patients during two 24-hour periods at each site. They measured health literacy by the short version of the Test of Functional Health Literacy in Adults (S-TOFHLA). Using multivariate logistic regression, the authors evaluated associations between sociodemographic variables and limited health literacy, as classified by S-TOFHLA scores.
Results:  The authors enrolled 300 patients (77% of eligible). Overall, 75 (25%; 95% confidence interval [CI] = 20% to 30%) of participants had limited health literacy. Limited health literacy was independently associated with older age (compared to 18–44 years, odds ratio [OR] 4.3 [95% CI = 2.0 to 9.2] for 45–64 years and OR 3.4 [95% CI = 1.4 to 8.5] for ≥65 years), less education (compared to high school graduates, OR 2.7 [95% CI = 1.1 to 7.3] for some high school or lower and OR 0.43 [95% CI = 0.21 to 0.88] for some college or higher), and lower income (OR 2.8 [95% CI = 1.2 to 6.6] for ≤$40,000 compared to >$40,000). Although ethnicity, race, and language were associated with limited health literacy in unadjusted analyses, the associations were not significant on multivariate analysis.
Conclusions:  In this sample, one-quarter of ED patients would be expected to have difficulty understanding health materials and following prescribed treatment regimens. Advanced age and low socioeconomic status were independently associated with limited health literacy. The ability of a significant subgroup of ED patients to understand health information, especially during illness or injury, requires further study.     

Physical health status of older adults with severe mental illness: The PHiSMI‐E cohort study

The objective was to use various somatic parameters as basis for investigating the physical health of older adults with severe mental illnesses (SMI). A cross‐sectional study design is performed by using baseline data from the Physical Health in SMI‐elderly (PHiSMI‐E) study. Data were collected using the Nursing Monitoring of Somatic Status and Lifestyle – Mental Health instrument in adults aged over 60 with SMI in a large Dutch mental health institute. Ninety‐nine elderly SMI patients were included. Somatic comorbidity (84.8%), use of somatic medication (77.7%) and polypharmacy (67.7%) were prevalent. Extrapyramidal symptoms were experienced by 51% of patients, mainly in the subgroup with psychotic disorders (75.6%). Unhealthy diet was reported in 16.2%, obesity in 27.3%, and physical inactivity in 57.6%. Fatigue (67.7%) and dry mouth (66.6%) were the commonest reported physical symptoms. Mean VAS score (scale 0–10) indicating participants’ self‐perceived physical health was 6.7 (SD ± 1.6). After division of the total patient group into tertiles based on the VAS scores, the lowest tertile was characterized by less physical activity, unhealthier diet, more use of medication, more fatigue, somnolence, and inner agitation. In conclusion, impaired physical health status was common in these older patients with SMI. Although they had more psychiatric and somatic comorbidity than adult SMI patients described in the literature, they had a healthier lifestyle. To reduce morbidity and premature mortality in these frail patients, it is essential that healthcare providers are aware of the high prevalence of somatic comorbidity and symptoms, and of their interactions with the psychiatric disorders. This study improves our understanding of differences in vulnerability factors of older patients with SMI. The (early) detection of somatic comorbidities may improve long‐term health outcomes of these patients.     

Association between physical activity and metabolic syndrome in older adults in Korea: Analysis of data from the Korean National Health and Nutrition Examination Survey IV

The prevalence of metabolic syndrome is consistently increasing among Korean adults and is reported to be particularly high among older adults in Korea. This paper reports the prevalence of metabolic syndrome and identifies the association between metabolic syndrome and physical activity in Korean older adults. Subjects of this study were 3653 older adults who participated in the fourth Korean National Health and Nutrition Examination Survey during the years 2007–2009. The prevalence of metabolic syndrome in the study population was 46.84%. The prevalences of abdominal obesity, elevated fasting glucose, elevated triglycerides, reduced high‐density lipoprotein cholesterol, and elevated blood pressure were 39.51, 45.53, 39.55, 48.24, and 69.14%, respectively, in the study population. Compared to subjects who reported low levels of physical activity, the odds ratios of metabolic syndrome for those who were moderately active and highly active were 0.93 and 0.63, respectively. Nurses should develop metabolic syndrome management programs that are tailored to the needs of the targeted group and that include individually adapted physical activity programs to promote health.     

Comparison of health risk behavior,awareness, and health benefit beliefs of health science and non‐health science students: An international study

This study determines the differences in health risk behavior, knowledge, and health benefit beliefs between health science and non‐health science university students in 17 low and middle income countries. Anonymous questionnaire data were collected in a cross‐sectional survey of 13,042 undergraduate university students (4,981 health science and 8,061 non‐health science students) from 17 universities in 17 countries across Asia, Africa, and the Americas. Results indicate that overall, health science students had the same mean number of health risk behaviors as non‐health science university students. Regarding addictive risk behavior, fewer health science students used tobacco, were binge drinkers, or gambled once a week or more. Health science students also had a greater awareness of health behavior risks (5.5) than non‐health science students (4.6). Linear regression analysis found a strong association with poor or weak health benefit beliefs and the health risk behavior index. There was no association between risk awareness and health risk behavior among health science students and an inverse association among non‐health science students.     

Association between sitting time and orthopedic conditions in Korean older adults

This study aimed to identify the association between sitting time and orthopedic conditions in Korean older adults. Data from adults aged ≥65 years from the 6th Korea National Health and Nutrition Examination Survey (2014–2015) were used for analysis (n = 3,011). Sitting time ≥7.5 h/day was significantly associated with knee joint (OR = 1.41, 95% CI: 1.11, 1.79), hip joint (OR = 1.54, 95% CI: 1.17, 2.03), and low back pain (OR = 1.44, 95% CI: 1.19, 1.74) when adjusted for sex, age, obesity, housing type, family income, education, and marital status in multiple logistic regression analyses. These findings imply that appropriate pain management according to sociodemographic characteristics in orthopedic conditions are necessary to reduce excessive sitting time in Korean older adults.