Background: This study aimed to develop an instrument for assessing physical functioning among adults aged 50 years or older living in the community. Methods: Based on a review of various national health surveys and cohort studies, a 144-item bank was constructed for assessing physical functioning. Focus group interviews were conducted among adults aged 50 years or older to investigate their level of understanding of 60 selected items, followed by a pretest of the items on a nationally representative sample (n=508). The final 25-item questionnaire was tested on an independent sample (n=259) for validity and reliability based on classical test and item response theories. Predictive validity at the 6-month follow-up was tested in a separate sample (n=263). Results: The newly developed Life Functioning (LF) scale assessed the dimensions of functional limitations, disabilities, and social activities. The scale satisfied a one-dimensionality assumption with good item fit and demonstrated criterion validity, construct validity, high internal consistency (Cronbach’s alpha=0.93), and test-retest reliability (intra-class correlation coefficient=0.84; 95% confidence interval, 0.76–0.89). The LF scale comprised 25 items with a total score ranging from 0 to 100. Higher scores indicated higher levels of functioning. The LF score was significantly associated with the Physical Functioning score at 6 months. Conclusion The LF scale was developed to assess the physical functioning of people in their late midlife or older. Future studies should test the instrument on a national sample and evaluate its application in diverse population subgroups.

Background: This study aimed to develop an instrument for assessing physical functioning among adults aged 50 years or older living in the community. Methods: Based on a review of various national health surveys and cohort studies, a 144-item bank was constructed for assessing physical functioning. Focus group interviews were conducted among adults aged 50 years or older to investigate their level of understanding of 60 selected items, followed by a pretest of the items on a nationally representative sample (n=508). The final 25-item questionnaire was tested on an independent sample (n=259) for validity and reliability based on classical test and item response theories. Predictive validity at the 6-month follow-up was tested in a separate sample (n=263). Results: The newly developed Life Functioning (LF) scale assessed the dimensions of functional limitations, disabilities, and social activities. The scale satisfied a one-dimensionality assumption with good item fit and demonstrated criterion validity, construct validity, high internal consistency (Cronbach’s alpha=0.93), and test-retest reliability (intra-class correlation coefficient=0.84; 95% confidence interval, 0.76–0.89). The LF scale comprised 25 items with a total score ranging from 0 to 100. Higher scores indicated higher levels of functioning. The LF score was significantly associated with the Physical Functioning score at 6 months. Conclusion The LF scale was developed to assess the physical functioning of people in their late midlife or older. Future studies should test the instrument on a national sample and evaluate its application in diverse population subgroups.

Background: This study aimed to develop an instrument for assessing physical functioning among adults aged 50 years or older living in the community. Methods: Based on a review of various national health surveys and cohort studies, a 144-item bank was constructed for assessing physical functioning. Focus group interviews were conducted among adults aged 50 years or older to investigate their level of understanding of 60 selected items, followed by a pretest of the items on a nationally representative sample (n=508). The final 25-item questionnaire was tested on an independent sample (n=259) for validity and reliability based on classical test and item response theories. Predictive validity at the 6-month follow-up was tested in a separate sample (n=263). Results: The newly developed Life Functioning (LF) scale assessed the dimensions of functional limitations, disabilities, and social activities. The scale satisfied a one-dimensionality assumption with good item fit and demonstrated criterion validity, construct validity, high internal consistency (Cronbach’s alpha=0.93), and test-retest reliability (intra-class correlation coefficient=0.84; 95% confidence interval, 0.76–0.89). The LF scale comprised 25 items with a total score ranging from 0 to 100. Higher scores indicated higher levels of functioning. The LF score was significantly associated with the Physical Functioning score at 6 months. Conclusion The LF scale was developed to assess the physical functioning of people in their late midlife or older. Future studies should test the instrument on a national sample and evaluate its application in diverse population subgroups.

Objectives: Bisphosphonate is associated with a decreased risk of vertebral fractures due to osteoporosis. However, there are limited studies on how poor compliance with bisphosphonate affects the risk of vertebral fractures in a nationwide cohort. We aim to evaluate whether adherence to bisphosphonate affects the risk of fracture in osteoporosis patients. Methods: We used the data of the Korean National Health Insurance Service Senior Cohort. A total of 33,315 (medication possession ratio [MPR]: 50) osteoporosis patients were matched using the propensity score matching method: those who received low-dose bisphosphonate and those who received highdose bisphosphonate. Twenty-two confounding variables, including age, socioeconomic status, medications prescribed, and underlying diseases that may affect the risk of fracture were adjusted for propensity score matching. The risk of vertebral fracture was assessed by Cox proportional hazards regression. Results: Patients with a higher MPR showed a decreased vertebral fracture risk than those with a lower MPR (MPR 50 ¼ hazard ratio [HR] 0.909; 95% confidence interval [CI] 0.877e0.942 P < 0.001; MPR 70 ¼ HR: 0.874, 95% CI: 0.838e0.913, P < 0.001; MPR 90 ¼ HR: 0.822, 95% CI: 0.780e0.866, P < 0.001). MPR was associated with a decreased vertebral fracture risk in both groups with or without history of fracture. In the subgroup analysis, MPR was associated with a decreased vertebral fracture risk in women, in all ages, with or without T2DM, and with or without hypertension. Conclusions Higher MPR is associated with a lower vertebral fracture risk.

Background: This study investigated the differences in the risk of potentially avoidable hospitalization (PAH) among eligible long-term care insurance (LTCI) beneficiaries with dementia for LTCI services in Korea. Nested case-control study was conducted using the National Health Insurance Service–Senior claim database. Methods: Cases of individuals who had a PAH incident diagnosis and controls were selected by incidence density sampling and matched to cases based on age, sex, and difficulty of daily living among dementia patients. We conducted incidence density sampling three times by PAH type. Results: Our main results were presented by conditional logistic regression analysis for the matched case–control studies. Out of the 7,352 eligible LTCI beneficiary patients, there were 1,231 cases (16.7%) in overall PAH, 132 cases (19.0%) in acute PAH and 1,114 cases (16.7%) in chronic PAH categories. In terms of individual risk of overall and chronic PAH, the odds ratios of those who did not receive any services were 1.336 time higher (95% confidence interval [CI], 1.159–1.540) and 1.280 time higher (95% CI, 1.103–1.485) compared to those who received home care, respectively. For risk of acute PAH, the odds ratios of those who did receive institutional care were 2.046 time higher (95% CI, 1.170–3.578) compared to those who received home care. Conclusion This study identified the differences in risk of PAH incidents according to the type of LTCI service in the elderly population in Korea. Therefore, it will require substantial effort and strategy from health policy makers to improve care quality.

BACKGROUND: This study is to investigate the association between the distribution of multimorbidity and length of stay and medical expenses among inpatients in a municipal hospital to achieve an integrated care setting. METHODS: We used the exploratory factor analysis and the generalized estimating equation model to analyze the data from patients living in the northeast region of Seoul, who were hospitalized from January 2017 to December 2017 in a municipal hospital. RESULTS: As a result of the factor analysis, seven types of multiple chronic diseases were classified. Among the elderly patients admitted to municipal hospitals, the burden of medical expenses was mainly influenced by the length of stay (B=310,719, p-value<0.0001), not the type of disease (all not significant). Length of stay were mainly due to psychiatric illness (factor 1: B=4.323, p-value<0.0001) related to the brain and metabolic diseases (factor 2: B=2.364, p-value=0.003). CONCLUSION This study showed that the medical expenses of the elderly patients were largely due to prolonged hospitalization, not multimorbidity. Therefore, it is necessary to develop an integrated care paradigm strategy cope with the multimorbidity of the elderly in the community and to alleviate the socio-economic burden.

OBJECTIVES: This study aimed to evaluate the association between dental implants and cognitive function in community-dwelling older adults. METHODS: Data were collected from the baseline survey (2016–2017) of the Korean Frailty and Aging Cohort Study. The study sample comprised 1115 community-dwelling people aged 70 years to 84 years who had 0-19 natural teeth. Dental implants and natural teeth were identified by panoramic radiography, while the cognitive function was assessed by the Korean version of the Mini-Mental State Examination (MMSE-KC). The association between dental implants and cognitive function was analyzed by multiple linear regression. Sensitivity analysis was performed to test for potential bias. RESULTS: The mean number of natural teeth in the study population was 9.50 (standard deviation [SD], 6.42), and the mean MMSE-KC score was 24.93 (SD, 3.55). In the simple univariate analysis, tooth replacement, age, sex, smoking status, alcohol consumption, body mass index, osteoporosis, number of natural teeth, periodontitis, chewing discomfort, tooth-brushing frequency, education level, monthly household income, participation in economic activity, living alone, and marital status had a significant impact on the association. After adjusting for confounders, the association between dental implants and cognitive function remained significant (B, 0.85; standard error, 0.40; p<0.05). Age, body mass index, periodontitis, tooth-brushing frequency, and education level were also significantly associated with cognitive function. The results of the sensitivity analyses were consistent with those of the primary analysis. CONCLUSIONS Dental implants were associated with cognitive function in older adults living in the community. Dental implants as tooth replacements may play a role in preserving cognitive function.

BACKGROUND: Potentially avoidable hospitalizations (PAH) contribute to an increased post-discharge mortality. METHODS: To investigate the between-hospital variation and the relationship between all predictors and mortality after discharge among older adults with PAH, we studied 15,186 older patients with PAH in 2,200 hospitals included in the National Health Insurance Service-Senior claims database from 2002 to 2013. Multivariable multilevel logistic regression analyses were performed to analyze the variance at between-hospital for mortality after accounting for differences in patient characteristics. RESULTS: The between-hospital variation in mortality that could be attributed to hospital practice variations were 37.6% at 1-week to 13.9% at 12-month post-discharge, after adjustment for individual patient characteristics and hospital-level factors. Hospital-level factors significantly explained mortality at 3 weeks after discharge. Clinics, compared with general hospitals, demonstrated a 2.75 times higher likelihood of deaths at 3-week post-discharge (p<0.001). Compared with private hospitals, public hospitals exhibited 1.61 times higher odds of 3-week mortality (p=0.01). CONCLUSION: This study demonstrates considerable between-hospital variations in PAH-related mortality that could be attributed to hospital practices. Monitoring of hospitals to identify practice variations would be warranted to improve the survival of older patients with PAH.
Adult ; Hospitalization ; Hospitals, General ; Hospitals, Private ; Hospitals, Public ; Humans ; Logistic Models ; Mortality ; National Health Programs

OBJECTIVES: This study aimed to evaluate the association between dental implants and cognitive function in community-dwelling older adults. METHODS: Data were collected from the baseline survey (2016–2017) of the Korean Frailty and Aging Cohort Study. The study sample comprised 1115 community-dwelling people aged 70 years to 84 years who had 0-19 natural teeth. Dental implants and natural teeth were identified by panoramic radiography, while the cognitive function was assessed by the Korean version of the Mini-Mental State Examination (MMSE-KC). The association between dental implants and cognitive function was analyzed by multiple linear regression. Sensitivity analysis was performed to test for potential bias. RESULTS: The mean number of natural teeth in the study population was 9.50 (standard deviation [SD], 6.42), and the mean MMSE-KC score was 24.93 (SD, 3.55). In the simple univariate analysis, tooth replacement, age, sex, smoking status, alcohol consumption, body mass index, osteoporosis, number of natural teeth, periodontitis, chewing discomfort, tooth-brushing frequency, education level, monthly household income, participation in economic activity, living alone, and marital status had a significant impact on the association. After adjusting for confounders, the association between dental implants and cognitive function remained significant (B, 0.85; standard error, 0.40; p<0.05). Age, body mass index, periodontitis, tooth-brushing frequency, and education level were also significantly associated with cognitive function. The results of the sensitivity analyses were consistent with those of the primary analysis. CONCLUSIONS: Dental implants were associated with cognitive function in older adults living in the community. Dental implants as tooth replacements may play a role in preserving cognitive function.
Adult ; Aging ; Alcohol Drinking ; Bias (Epidemiology) ; Body Mass Index ; Cognition ; Cognitive Reserve ; Cohort Studies ; Dental Implants ; Education ; Family Characteristics ; Humans ; Korea ; Linear Models ; Marital Status ; Mastication ; Osteoporosis ; Periodontitis ; Prostheses and Implants ; Radiography, Panoramic ; Smoke ; Smoking ; Surveys and Questionnaires ; Tooth