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The Effects of Health on Multidimensional Disability among Older Adults - An Application of the ICF (International Classification of Functioning, Disability and Health) Framework - : 건강이 노인의 다차원적 장애에 미치는 영향 - 국제기능장애건강분류틀(ICF)을 적용하여 -

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Authors

조상은

Advisor
강상경
Major
사회과학대학 사회복지학과
Issue Date
2016-08
Publisher
서울대학교 대학원
Keywords
Multidimensional disabilityHealthChronic illnessAccessibilityInfrastructureWHO’s ICF frameworkOlder adultsStructural equation modeling
Description
학위논문 (박사)-- 서울대학교 대학원 : 사회복지학과, 2016. 8. 강상경.
Abstract
This study aims to investigate the influence of health conditions and service-related environmental factors on multidimensional disability and the moderating effect of service-related environmental factors in the association between health conditions and multidimensional disability among Korean older adults. Advancements in living standards and medical technologies contributed to an increase in the older-adult population and extended life expectancies. On the other hand, these positive developments are causing chronic illnesses and disabilities in older ages. In South Korea (hereinafter Korea), 89.7% of older adults have at least one chronic illness, and 70.5% are reported to have more than two chronic illnesses. Disability in old age exacerbates older adults burden as it combines the complex characteristics of disability and aging. Thus, older adults with late-life-onset disabilities may have more serious difficulties with physical, psychological, and emotional functions and more restricted experiences in their daily lives and social participation compared to other age groups with disabilities. Furthermore, as disability appears in mid- or late-life, it may change their established life and self-identity.
Chronic illnesses are found to have a negative impact on multiple dimensions of disability among older adults. Chronic illnesses may cause physical impairment, pain, and abnormalities and can lead to damaging psychological aspects such as depression, loss of self-image and independence, and stigma and isolation. Also, chronic illnesses reduce older adults capacity for activities in their daily living and restrict their participation in physical, social, and economic activities. Although a large amount of literature reveals the close association of chronic illness and disability, some research findings suggest the possibility of an inconclusive causal relationship between the two by showing older adults who function well despite their chronic illnesses. This finding is compelling because it points to the high likelihood of the existence of factors that are able to modify or alleviate the negative effects of chronic illnesses on multidimensional disability.
Among various environmental factors, service is known to interact with older adults health conditions and to affect their level of disability. In addition, service has a positive effect on health and disability among older adults by providing programs that satisfy their needs. In particular, professional and effective services provided by senior welfare centers and social welfare service centers contribute to improvements in health status and social relationships and reduce feelings of loss and solitude, which helps older adults lead more active and meaningful lives. These centers are appropriate for older adults who have limited mobility as they are located within communities.
Based on the theoretical background and previous studies, it is important to understand disability as a multidimensional concept, how disability is affected by chronic illnesses and service-related environmental factors and the moderating roles of service-related environmental factors. However, these issues were found to be poorly addressed by previous studies. In order to overcome these limitations, this study established three objectives: first, to investigate whether chronic illnesses influence multidimensional disability among Korean older adults
second, to analyze whether service-related environmental factors affect multidimensional disability
and third, to test whether the association between chronic illnesses and multidimensional disability is moderated by service-related environmental factors.
The present study used a nationally representative data from the 2014 Survey of Living Conditions and Welfare Needs of Korean Older Persons (hereinafter 2014 Survey). A total of 10,451 Korean older adults aged 65 and over were selected for the study sample. Of all the variables included in this analysis, infrastructure and self-reliance ratio of local government have regional characteristics. The infrastructure variable was obtained from two national statistics data, Ministry of Health and Welfare Statistical Year Book 2015 and the Current State of Elderly Welfare Facilities 2015
they contain data as of 2014. The self-reliance ratio of local government was obtained from Local Finance Integrated Open System Local Finance 365. The other variables were obtained from the 2014 Survey. Using the ICF (International Classification of Functioning, Disability and Health) framework as a conceptual model, the data were analyzed through structural equation modeling.
In the analysis, multidimensional disability was constructed using the following three dimensions: psychological/emotional functions (measured by cognitive ability and depression), activity capacity for daily movement, and participation frequency. Health conditions were measured based on the numbers of chronic illnesses diagnosed by a doctor, and the service-related environmental factors included accessibility and infrastructure. Accessibility represents the duration of time required for older adults to reach senior welfare centers and social welfare service centers
infrastructure represents the total number of senior and social welfare service centers per ten thousand older adults in 16 metropolitan cities and provinces (i.e., Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan, Gyeonggi, Gangwon, Chungbuk, Chungnam (including Sejong), Jeonbuk, Jeonnam, Gyeongbuk, Gyeongnam, and Jeju).
Key findings showed that the higher the number of chronic illnesses, the higher the level of multidimensional disability among older adults. In specific, older adults with higher number of chronic illnesses reported to have lower level of psychological and emotional functions, activity capacity for daily movement, and participation frequency. Better accessibility to senior and social welfare service centers had a positive effect on all three dimensions of disability, and better infrastructure was proven to increase the level of activity capacity for daily movement among older adults, even though it had no statistically significant association with participation frequency. Furthermore, the analysis showed that the better the infrastructure the lower the psychological and emotional functions of older adults. Of the service-related environmental factors, infrastructure had moderating effects on the association between chronic illnesses and activity capacity for daily movement, and the association between chronic illnesses and participation frequency. However, accessibility had an insignificant moderating effect on the association between chronic illnesses and all three dimensions of disability.
Based on the findings, theoretical, policy, and practice implications were discussed. The ICF framework is not only a simple health and disability model, but, as it is established based on the biopsychosocial approach and the integration of the medical and social models of disability, it will contribute to a more comprehensive understanding of disability at older ages. The ICF construes disability as a multidimensional concept based on the biopsychosocial perspective and delineates how this multidimensional disability is created in the dynamic interactions among older adults health conditions and their service-related environmental factors. The ICF framework was empirically examined in this study which discovered that it is a well-established tool for explaining the association between health and disability and the mechanisms of disability onset in older age. This finding will contribute to modifying the paradigm of health and disability at older ages and to understanding the concept of multidimensional disability at older ages.
The findings and the ICF framework have important policy and practical implications. Consistent with most previous studies, chronic illnesses negatively affected the three dimensions of disability: psychological and emotional functions, activity capacity, and participation frequency. Thus, development of effective strategies is recommended to prevent or delay the onset of chronic illnesses and to promote health among older adults. Systematic planning is required to ensure an equally distributed infrastructure. Despite the important moderating effects that senior and social welfare service centers have to mitigate the negative influence of chronic illnesses on older adults activity capacity and participation frequency, these centers are not distributed in a balanced way. As a more equal establishment of these centers is planned by the Korean government this year, it is expected that older adults will have equal access to the centers, which will have a positive effect on their health and disabilities. The significant moderating role of infrastructure on older adults chronic illnesses and multidimensional disability has important implications for social work practice. As senior and social welfare centers were found to be key protective factors, these centers should put forth an effort to increase older adults use by developing health programs, informing them of the centers locations and services, and providing convenient transportation services. Lastly, it is recommended that policy makers and practitioners pay attention to the use of the ICF framework. The ICF is not only a conceptual framework but one that also provides practical manuals for professionals in various sectors, including practitioners and policy makers
it will be a useful instrument for assessing the levels of older adults health and disability, and for gathering data and establishing policies for them.
Language
English
URI
https://hdl.handle.net/10371/120469
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