S-Space Graduate School of Public Health (보건대학원) Dept. of Public Health (보건학과) Theses (Ph.D. / Sc.D._보건학과)
The Trajectories and Risk Factors of Health Status in the Elderly
노인의 건강 변화 양상과 위험요인 연구
- 보건대학원 보건학과
- Issue Date
- 서울대학교 보건대학원
- Health trajectories; Risk factors; Life course approach; Group-based trajectory model; Self-rated health; Depressive symptoms; Pain; All-cause mortality; Trajectory analysis; Survival analysis
- 학위논문 (박사)-- 서울대학교 보건대학원 보건학과, 2017. 8. 조성일.
- Introduction: Population aging has become a global problem, especially, the rapid aging of South Korea is unrivaled, resulting in a dim forecast of becoming the second oldest country in the world in 2050. Therefore, identifying the health status and the associated risk factors of the elderly is very important in order to reduce the national burden. The objectives of the present study were to investigate the association between self-rated health and socioeconomic positions in life course, examine the changes in the trajectories of depressive symptoms and identify the risk factors that influence these aforementioned changes according to gender, determine changing patterns in the pain trajectories and demonstrate the causes of these changes according to gender, and finally, determine the long-term effect of depressive symptoms on all-cause mortality in the Korean elderly.
Methods: First, 1,000 older adults were randomly allocated, and they conducted a face-to-face interview using a self-developed questionnaire. Self-rated health status, socioeconomic variables throughout life course, and demographic variables were included in the analysis. Secondly, 3,667 individuals (1,566 men and 2,101 women) aged 60 years and above were selected from a subsample of subjects who participated in the Korean Longitudinal Study of Ageing between 2006 and 2012. Thirdly, 2,820 individuals (1,171 men and 1,649 women) aged 60 years and above were included from a subsample of subjects who participated in the Korean Longitudinal Study of Ageing between 2006 and 2014. Lastly, 5,501 individuals (2,359 men and 3,142 women) aged 60 years and above were included from a subsample of subjects who participated in the Korean Longitudinal Study of Ageing between 2006 and 2014. A group-based trajectory model was utilized to determine the appropriate number of groups and also to observe changes in health outcomes for chapter II to IV. Following the trajectory analysis, a multinomial regression analysis was performed to examine health outcomes and related risk factors that influenced the membership of the different trajectory groups. Kaplan-Meier analysis and Cox Proportional Hazard regression analysis with and without time-varying covariates were conducted to determine the association between depressive symptoms and all-cause mortality.
Results: First of all, the elderly men who experienced skipping meals during their childhood and those with chronic disease conditions were more likely to be in the lower health trajectory, and the likelihood of being in the lower health trajectory among elderly women were increased by experiences of skipping meals, lower house income, housekeeping labor, and chronic disease conditions. Secondly, chronic diseases, self-rated health, and somatic pain were associated with depressive symptoms in both genders and statistically significant differences were found in terms of employment in older men and social participation in older women. Thirdly, lack of physical activity, chronic disease, and depressive symptoms were risk factors for having more pain sites in both genders. The longest job demanding manual work, experience of injuries, and married status were associated with pain in men but not in women
household income, in contrast, was a risk factor of pain only in women. Finally, depressive symptoms had a negative effect on all-cause mortality, and men had a higher risk of mortality than women. The protective effect of social participation has been confirmed in both genders.
Conclusions: The health status in later life is the cumulative result of the various experiences undergone during the life course, and initial values of health status should be measured and monitored. In addition, maintenance of physical health is also beneficial in maintaining mental health. Also, employment policies that reflect the physical and mental conditions of the elderly and social welfare policies that allow the formation of social network among the elderly are crucial in improving the elderlys mental health status. Moreover, most of elderly men and women suffered from persistent pain suggesting the need for improved intervention before pain becomes chronic. Modifying the risk factors, as well as early treatment of pain among those with risk factors should be considered. Greater efforts are necessary for monitoring and investigation of pain among the older population in order to reduce the socioeconomic burden associated with pain. Lastly, spatial and policy environment should be created for the elderly to participate in society to reduce the risk of mortality associate with depressive symptoms.