South Korea will become a super-aged society by 2025, with >20% of its population being aged ≥65 years. In addition, since the baby boomer cohort transitioned into the elderly age-group 4 years ago, the number of people aged ≥75 years is expected to increase dramatically in the next few years.This means that the number of elderly people needing long-term care will increase as the number of frail elderly individuals increases. The longterm care insurance (LTCI) system was introduced in Korea 15 years ago. However, as resources for long-term care services in the community continued to remain insufficient, the number of patients institutionalized or admitted to geriatric hospitals increased making integrated community care more important. Consequently, a community-integrated care policy was implemented in 2018. However, primary care physicians in Korea are still largely unaware of the meaning and importance of long-term and community-integrated care in geriatric healthcare. This is due to the separation of healthcare and social care from the time LTCI was introduced. To achieve healthy aging, primary healthcare professionals must recognize and actively participate in long-term integrated care. Now is the time to dramatically increase the participation of primary care physicians in home-visit care. They must ensure proper completion of medical statement forms for long-term and integrated care and act as dedicated physicians for residents of nursing facilities.

South Korea will become a super-aged society by 2025, with >20% of its population being aged ≥65 years. In addition, since the baby boomer cohort transitioned into the elderly age-group 4 years ago, the number of people aged ≥75 years is expected to increase dramatically in the next few years.This means that the number of elderly people needing long-term care will increase as the number of frail elderly individuals increases. The longterm care insurance (LTCI) system was introduced in Korea 15 years ago. However, as resources for long-term care services in the community continued to remain insufficient, the number of patients institutionalized or admitted to geriatric hospitals increased making integrated community care more important. Consequently, a community-integrated care policy was implemented in 2018. However, primary care physicians in Korea are still largely unaware of the meaning and importance of long-term and community-integrated care in geriatric healthcare. This is due to the separation of healthcare and social care from the time LTCI was introduced. To achieve healthy aging, primary healthcare professionals must recognize and actively participate in long-term integrated care. Now is the time to dramatically increase the participation of primary care physicians in home-visit care. They must ensure proper completion of medical statement forms for long-term and integrated care and act as dedicated physicians for residents of nursing facilities.

South Korea will become a super-aged society by 2025, with >20% of its population being aged ≥65 years. In addition, since the baby boomer cohort transitioned into the elderly age-group 4 years ago, the number of people aged ≥75 years is expected to increase dramatically in the next few years.This means that the number of elderly people needing long-term care will increase as the number of frail elderly individuals increases. The longterm care insurance (LTCI) system was introduced in Korea 15 years ago. However, as resources for long-term care services in the community continued to remain insufficient, the number of patients institutionalized or admitted to geriatric hospitals increased making integrated community care more important. Consequently, a community-integrated care policy was implemented in 2018. However, primary care physicians in Korea are still largely unaware of the meaning and importance of long-term and community-integrated care in geriatric healthcare. This is due to the separation of healthcare and social care from the time LTCI was introduced. To achieve healthy aging, primary healthcare professionals must recognize and actively participate in long-term integrated care. Now is the time to dramatically increase the participation of primary care physicians in home-visit care. They must ensure proper completion of medical statement forms for long-term and integrated care and act as dedicated physicians for residents of nursing facilities.

The Korean healthcare system is ill-equipped to manage geriatric diseases, even though we are on the verge of becoming a super-aged society.Current Concepts: In Korea’s delivery of healthcare system, which is centered on subspecialty care from primary to tertiary care, older adults with multiple chronic diseases are forced to receive fragmented care from multiple doctors. In medical education and residency programs, even the most fundamental concepts of geriatrics are misunderstood, and geriatricians receive inadequate training. Consequently, along with the rapidly growing elderly population, elderly patients with complex health problems, frailty, and dysfunction are deprived of the opportunity to achieve healthy aging by taking multiple medications and suffering from geriatric syndromes caused by fragmented medical care.Discussion and Conclusion: Establishing a system for training geriatricians and strengthening geriatric education is necessary to ensure existing specialists can assign them the role of primary care geriatricians. Additionally, person-centered, integrated geriatric care that requires appropriate management of various complex diseases, as well as maintenance of function and frailty prevention, will be possible by establishing a geriatric healthcare system that ranges from frailty prevention, polypharmacy management, and home visits in primary healthcare to multidisciplinary geriatric care and transitional care in tertiary healthcare. Implementing this strategy as early as possible will help older adults age well and reduce the caregiving burden in later life. This could also ease concerns regarding physician shortages induced by the rapidly growing elderly population.

South Korea will become a super-aged society by 2025, with >20% of its population being aged ≥65 years. In addition, since the baby boomer cohort transitioned into the elderly age-group 4 years ago, the number of people aged ≥75 years is expected to increase dramatically in the next few years.This means that the number of elderly people needing long-term care will increase as the number of frail elderly individuals increases. The longterm care insurance (LTCI) system was introduced in Korea 15 years ago. However, as resources for long-term care services in the community continued to remain insufficient, the number of patients institutionalized or admitted to geriatric hospitals increased making integrated community care more important. Consequently, a community-integrated care policy was implemented in 2018. However, primary care physicians in Korea are still largely unaware of the meaning and importance of long-term and community-integrated care in geriatric healthcare. This is due to the separation of healthcare and social care from the time LTCI was introduced. To achieve healthy aging, primary healthcare professionals must recognize and actively participate in long-term integrated care. Now is the time to dramatically increase the participation of primary care physicians in home-visit care. They must ensure proper completion of medical statement forms for long-term and integrated care and act as dedicated physicians for residents of nursing facilities.

Background: Prediabetes is a metabolic state between normoglycemia and diabetes and is known to carry a higher risk of developing overt diabetes and cardiovascular disease (CVD). The relative and absolute risks of all-cause mortality, CVD, coronary heart disease, and stroke in prediabetes patients, as well as in diabetic patients, is higher than that in patients with normoglycemia. Carotid intima-media thickness (cIMT) is a method used to stratify CVD risk. In this study, we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) correlates with cIMT in prediabetes patients. Methods: From January 1, 2016, to February 20, 2021, 581 adults their 30s–70s who underwent carotid ultrasonography as part of a comprehensive medical examination at the Dongtan Sacred Heart Hospital were enrolled. Statistical analysis using SPSS presented t-test and chi-square test significance levels into a group with normal cIMT (nIMT; cIMT <1 mm) and a group with thick cIMT (tIMT; cIMT ≥1 mm). Binary logistic regression analysis was performed to confirm the correlation between NLR and cIMT. Results: In prediabetic adults, age, hemoglobin A1c (HbA1c), systolic blood pressure, and NLR were significantly higher in the tIMT group than in the nIMT group. In the regression analysis, NLR, age, and HbA1c were significantly correlated with cIMT. Conclusion NLR was significantly higher in the tIMT group than in the nIMT group; therefore, NLR may be used to assess CVD risk in prediabetes patients.

Background: Korea’s rapidly aging population has experienced a sharp rise in the prevalence of dementia. Patients with Alzheimer’s disease (AD), which is estimated to be about three-quarters of all patients with dementia, tend to have higher mortality rates compared with patients without Alzheimer’s disease. In this study, a survival analysis of patients with AD was conducted in order to provide knowledge to those who provide medical care to these patients. Methods: Data on individuals over 65 years old in 2004 were extracted from the Korean National Health Insurance Services’ Senior Cohort database (2002–2013). The subjects were 209,254 patients, including 2,695 who were first diagnosed with AD (the AD group) and 206,559 that had not been diagnosed with the disease (non-AD group). To investigate the independent effect of AD on survival, the Cox proportional-hazards model, hazard ratios (confidence interval of 95%), and the Kaplan-Meier method were used. Results: Mean survival time in the AD group was 5.3±3.3 years, which was about 2.5 years shorter than that in the non-AD group (7.8±2.4 years). The mortality rate in the AD group (66.3%) was higher than that in the non-AD group (26.3%). The adjusted hazard ratio in the AD group was 2.5 and, therefore, it was found that the AD group had a 2.5-fold higher risk of death than the non-AD group. Conclusion Overall, AD has a large, independent impact on survival. Survival time was shorter, and the mortality rate and risk were generally higher in the AD group, compared with the non-AD group.

Background: Depression is suggested to be associated with cardiovascular disease, including ischemic heart disease and cerebrovascular disease. This study investigated the impact of depression on cardiovascular disease in the elderly population in Korea. Methods: This retrospective cohort study was performed using the Senior Cohort database released by the Korean National Health Insurance Services from January 1, 2008 to December 31, 2012, or January 1, 2009 to December 31, 2013. The study group constituted participants newly diagnosed with depression, but not cardiovascular disease. The control group constituted participants with no past history of depression or cardiovascular disease, and were not diagnosed with depression during the follow-up period. During the 5-year follow-up period, development of ischemic heart disease or cerebrovascular disease was assessed. Depression and cardiovascular disease were identified using the International Classification of Diseases, 10th revision, Clinical Modification codes. The data was analyzed using Cox proportional hazards model. Results: The hazard ratio (HR) between depression and ischemic heart disease was 1.38 (95% confidence interval [CI], 1.23 to 1.55) and the HR between depression and cerebrovascular disease was 1.46 (95% CI, 1.32 to 1.62), after adjusting all confounding variables. Conclusion Independent of other cardiovascular risk factors, depression increased the risk of ischemic heart disease by 38% and cerebrovascular disease by 46% among older adults in Korea. Since depression may increase the risk of cardiovascular disease, future research should focus on the diagnosis and prevention of cardiovascular disease in people with depression.

Activities of Daily Living ; Adult ; Cohort Studies ; Follow-Up Studies ; Gait ; Geriatric Assessment ; Humans ; Insurance, Long-Term Care ; Long-Term Care ; Mass Screening ; National Health Programs

BACKGROUND: This study aimed to evaluate the association between baseline results of the Timed Up and Go (TUG) test and subsequent functional dependency occurrence. METHODS: From the National Health Insurance Service-Senior Cohort database, we identified 39,519 people who participated in the National Screening Program for Transitional Ages at the age of 66 during 2007–2008. Impaired mobility was defined as taking 10 seconds or longer to perform the TUG test. Functional dependency occurrence was defined as the initiation of receiving national Long-Term Care Insurance services—home care or admission to long-term care facilities. Cox proportional hazard regression models were used to assess the hazard ratios (HRs) for dependency occurrence according to baseline TUG test results. RESULTS: The mean follow-up period was 5.7 years. Occurrence rates of dependency were 2.0 and 3.4 cases per 1,000 person-years in the normal and impaired TUG groups, respectively. Impaired mobility was associated with a higher risk of functional dependency occurrence (adjusted HR [aHR], 1.65; 95% confidence interval [CI], 1.40–1.95; P < 0.001). Additionally, in the subgroup analysis for the participants with intact baseline activities of daily living, impaired mobility was associated with a higher risk of dependency occurrence (aHR, 1.65; 95% CI, 1.33–2.04; P < 0.001). CONCLUSION The TUG test might be a useful predictive marker of subsequent functional dependency occurrence. Intervention to prevent functional dependency may be helpful for older adults with impairment on the TUG test.