Education, Elderly Health, and Differential Population Aging in South Korea: A Demographic Approach

Associations between Cardiometabolic Risk Factors and Increased Consumption of Diverse Legumes: A South African Food and Nutrition Security Programme Case Study

The programme aimed to improve selected cardiometabolic risk (CMR) variables using a nutritional intervention among farmers who reported hypertensive disorders as hindrances during agricultural activities. The intervention had two case controls (n = 103) [experimental group-EG (n = 53) and control group-CG (n = 50)] which were tracked and whose blood pressure measurements, dietary intake, blood indices for cholesterol concentration and glucose levels from pre- and post-intervention surveys after the baseline survey (n = 112) were analysed. The interval for data collection was 12 weeks (±120 days) after five legume varieties were consumed between 3 and 5 times a day, and servings were not <125 g per at least three times per week. Sixty-five per cent of farmers were above 60 years old, with mean age ranges of 63.3 (SD ± 6.3) years for women and 67.2 (SD ± 6.7) for men. The post-intervention survey revealed that EG blood results indicated nutrient improvement with p <= 0.05 for blood glucose (p = 0.003) and cholesterol (p = 0.001) as opposed to the CG. A trend analysis revealed that cholesterol (p = 0.033) and systolic blood pressure (SBP); (p = 0.013) were statistically significant when comparing genders for all study phases. Interventions focusing on legumes can improve hypertension and cardiovascular disease and fast-track the achievement of SGDs 3 and 12 through community-based programmes.

Longitudinal changes in shoulder arthroplasty stratified by age groups, types of surgical facilities, and geographical regions in Korea from 2010 to 2020

BACKGROUND

Shoulder arthroplasty (SA), including hemiarthroplasty, reverse and anatomical total SA (TSA), improves quality of life by reducing shoulder pain and restoring function in patients not only with irreparable rotator cuff tears and/or cuff tear arthropathy but also with osteoarthritis posttraumatic arthritis, proximal humeral fractures, etc. Given the rapid developments in artificial joints and improvements in postoperative outcomes, the number of SA surgeries is increasing worldwide. Therefore, we investigated changes in trends over time in Korea.

METHODS

We analyzed the longitudinal changes in the incidence of SA including anatomic and reverse TSA, hemiarthroplasty, and shoulder revision arthroplasty (SRA) by changes in the Korean age profile, surgical facilities, and geographical regions using the Korean Health Insurance Review and Assessment Service database from 2010 to 2020. Data were also collected from the National Health Insurance Service and the Korean Statistical Information Service.

RESULTS

From 2010 to 2020, the TSA rate per 1,000,000 person-years increased from 10.571 to 101.372 (time trend = 1.252; 95% CI 1.233-1.271, P < .001). The shoulder hemiarthroplasty (SH) rate per 1,000,000 person-years decreased from 6.414 to 3.685 (time trend = 0.933; 95% CI 0.907-0.960, P < .001). The SRA rate per 1,000,000 person-years increased from 0.792 to 2.315; the increase was significant (time trend = 1.133; 95% CI 1.101-1.166, P < .001).

DISCUSSION

Overall, TSA and SRA are increasing and SH is decreasing. For both total TSA and SRA, steep increases are evident in the numbers of patients in their 70s and older than 80 years. The SH trend is decreasing regardless of differences in age groups, surgical facilities, and geographical regions. SRA is preferentially performed in Seoul.

Internet use and health status among older adults: The mediating role of social participation

Background

The acceleration of population aging and the arrival of the informatization make more and more older adults use the Internet, and its use is having an impact on their health. However, the relationship between internet use and the health of older adults and the mechanism of the effect of internet use on the health are not very clear.

Methods

Multiple linear regression models to explore the correlation between internet use and health status in the 3,141 individuals aged ≥60 years were used. Propensity score matching (PSM) method was used to test the robustness of the regression results. In addition, sequential recursive models was used to examine the mediating effect of social participation on the relationship between internet use and health status.

Results and discussion

We found a significant positive relationship between internet use and health status, and social participation mediated the relationship between internet use and health status. In addition, the effect of internet use on health status was different among older adults in rural and urban areas.

Conclusions

The development and application of internet products adapted to the development of an aging society should be accelerated to meet their needs for continued socialization. The forms and activities of social participation for the elderly groups should be enriched and public service internet usage training seminars should be conducted to improve internet skills.

How working-age population education and health of older people shape the burden of population aging: A comparative study of Macau, Hong Kong, and Singapore

Macau, Hong Kong and Singapore are all facing increasing population aging. Those aged 65 and over make up the old-age population. The working-age population refers to the population aged 15 to 64. Conventionally, the burden of population aging is measured by the Old-Age Dependency Ratio, which is the ratio of the old-age population to the working-age population. As life expectancy rises, depending exclusively on age to calculate the burden of aging hinders the development of effective anti-aging strategies. The working-age population's education and the elderly's health affect the aging burden's support and generator, respectively. Including them in the calculation gives us a fuller view of the burden of aging.

Objective

To compare the population aging burden in Macau, Hong Kong, and Singapore by including working-age population education and elderly health.

Methods

The overall, working-age and old-age population and proportion, as well as the Old-Age Dependency Ratio of Macau, Hong Kong, and Singapore, were collected from the World Bank database. The life expectancy at 65 was extracted from the 2022 World Population Prospect. The tertiary education rate of the working-age population and the self-rated health status of the old-age population were retrieved from governments' statistical reports. We then calculated the Education-Health Adjusted Old-Age Dependency Ratio, a set of four equations showing the support of the working-age population on the old-age population, where OADRh_t and OADRuh_t represent the burden of healthy and unhealthy old-age population on the working-age population with tertiary education; similarly, OADRh_nt and OADRuh_nt indicate the burden placed on the working-age population without tertiary education by healthy and unhealthy old-age population. Lastly, for comparison with the conventional Old-Age Dependency Ratio, we generated the Weighted Education-Health Adjusted Old-Age Dependency Ratio.

Results

Hong Kong has the greatest old-age population proportion and Old-Age Dependency Ratio, yet its growth rates are moderate and stable, ranging from 0 to 4% and 0 to 6%, respectively. Macau and Singapore experienced sharper changes in old-age population proportion and the Old-Age Dependency Ratio, with Macau's Old-Age Dependency Ratio varying between -2.66 and 8.50% and Singapore's ranging from -1.53 to 9.70%. Three cities showed different patterns in four Education-Health Adjusted Old-Age Dependency Ratio indicators. In Macau, the OADRh_nt and OADRuh_nt increased by 0.4 and 6.2, while the OADRh_t and OADRuh_t decreased by 13.5 and 15.3 from 2004 to 2016. In Hong Kong, only the OADRuh_t fell by 9.4, and the other three increased from 2003 to 2015. In Singapore, the OADRh_nt and OADRh_t increased by 3.8 and 1.0, while OADRuh_nt and OADRuh_t decreased by 1.2 and 3.9 from 2007 to 2011. The Weighted Education-Health Adjusted Old-Age Dependency Ratios are all smaller than the conventional Old-Age Dependency Ratio in the three regions, particularly in Singapore. The Weighted Education-Health Adjusted Old-Age Dependency Ratio of Singapore was reduced by 9.5 to 30.5% compared with the conventional Old-Age Dependency Ratio, that of Hong Kong reduced by 6.2 to 22.5%, and that of Macau reduced by 4.4 to 16.1%.

Conclusion

This is the first study to compare the aging burden in Macau, Hong Kong, and Singapore in connection to working-age population education and elderly health. With the new assessment, the burden of population aging in three regions has been reduced, showing that improving the education of the working-age population and maintaining older people's wellbeing can assist authorities to deal with population aging, especially in Macau and Hong Kong.

Trends of Total Knee Arthroplasty According to Age Structural Changes in Korea from 2011 to 2018

Total Knee Arthroplasty (TKA) is one of the most commonly performed surgeries worldwide since it can improve pain, quality of life, and functional outcome. Due to the expansion of hospitals specialized in joint surgery, the topography of TKA implementation in Korea is changing. This study analyzed longitudinal trends of TKA based on changes in age distribution, sex, hospital, and region based on the Health Insurance Review and Assessment Service (HIRA) of Korea database. Data were collected from the National Health Insurance Service (NHIS), the Korean Statistical Information Service (KOSIS), and the Health Insurance Review and Assessment Service (HIRA) in Korea for the period 2011-2018. Results show the total number of surgeries increased and the number of patients by age decreased in those under the age of 70, while the number of patients over 70 years of age increased. A remarkable increase in women was found, and there was no significant difference between regions. TKA is spreading in a more universal and easily accessible form in Korea and has increased more in other relatively small medical institutions compared to tertiary referral medical centers. Due to the increase of orthopedics' specialized hospitals and clinics, TKA is becoming more prominent in those hospitals.

Risk Factors Associated with Fall Awareness, Falls, and Quality of Life Among Ethnic Minority Older Adults in Upper Northern Thailand

Background

Falls are a major public health issue and one of the leading causes of morbidity and mortality among the older adults in many countries. Falls and their consequences have an impact on people’s quality of life, particularly the older adults. However, there have been very few studies on falls among ethnic minority groups living in rural areas. The aim of this study was to examine factors related to fall awareness, falls, and quality of life among ethnic minority older adults living in northern Thailand.

Methods

A cross-sectional study was conducted among 462 older adults from ethnic minority groups living in rural communities in Phayao and Lamphun provinces of northern Thailand using a multi-stage sampling technique. The data were collected through face-to-face interviews, with structured questionnaires covering health information, fall awareness, and quality of life (WHOQOL-OLD). The factors were determined using simple linear regression and binary logistic regression.

Results

The mean age of the participants was 68.2, Karen (35.5%), Mien (24.2%), indigenous (20.8%), and Hmong (19.5%). In the previous 12 months, 20.6% of elders had experienced a fall, and 4.5% of them had experienced multiple falls. More than half of the elders had moderate fall awareness and quality of life (71.6% and 68.6%, respectively). Univariate analysis revealed that minority group, sociodemographic characteristics, sleep duration, and fear of falling were all found to be associated with fall awareness, falls, and quality of life score (p<0.001). There was a significant relationship among fall awareness, falls, and quality of life score (p<0.001). Compared to those who had not fallen in the previous year, the quality of life of the older adults who had fallen was about 11 points lower.

Conclusion

Several independent variables were discovered to be fall risk factors and quality of life indicators. It is critical to recognize the risk factors to promote fall prevention programs that are appropriate for the older adults among ethnic minorities. Therefore, public health agencies and local government should be aware of the problem and initiate an implementation program and policy to prevent falls and improve the quality of life among ethnic minority older adults.

The Effects of Selective Survival on Black Adults' Cognitive Development

OBJECTIVES

The theory of selective survival suggests that possibly around 70-75 years of age, Blacks may display substantive changes in their pattern of cognitive decline. This study examined the age-graded pattern of cognitive decline within older Blacks by describing a trend that characterizes differences in the change of cognitive decline from ages 51.5 to 95.5, and hypothesized that this age-graded pattern is nonlinear.

METHOD

Utilizing 2 waves of longitudinal data from the Baltimore Study of Black Aging, this study used multilevel modeling to test whether the interaction between age and the 3-year study period (time between waves) had a positive effect on changes in inductive reasoning, declarative memory, working memory, and perceptual speed.

RESULTS

A significant positive interaction between age and wave was found for inductive reasoning, demonstrating an age-grade pattern of change/decline in cognitive pattern for Blacks aged 51.5-95.4. Simple slope probing via the Johnson-Neyman Technique suggested that Black adults ~64 years and younger experienced significant decline in inductive reasoning across study time, whereas for those older than 63.71, the decline was nonsignificant. No significant age-wave interactions were found for declarative memory, working memory, or perceptual speed.

DISCUSSION

Findings suggest a selective survival effect for inductive reasoning ability among Blacks. With decline evident so early, common cognitive intervention programs targeting adults 65+ may come too late for Blacks, signifying the importance and urgency for early health interventions and public policy designed to promote cognitive reserve.

Does Educational Attainment Affect Residents' Health?

Based on the data of the Chinese General Social Survey 2015 (CGSS2015), this article conducts an empirical analysis on the relationship between education and health status of Chinese residents by using the structural equation model (SEM), the propensity score matching (PSM) method, and generalized ordered logit (Gologit) model. Our study found that education promotes both the subjective and objective health of residents, and the finding holds true after considering the selection bias. In addition to having a direct role, education could promote health through improved mental health, economic status, and healthy behaviors. The finding is consistent with the explanations in existing research of “efficiency-improving effect”, “mental health effect”, and “budget relaxation effect”. Further research on the mechanism of education affecting health through structural equation modeling finds that mental health plays a more important role than healthy behaviors and economic status. In terms of the differences of various groups, education has stronger effect on vulnerable groups with fewer social resources, which shows that education helps reduce health inequality. The conclusion has important policy significance.

Falls among community-dwelling older adults in Ethiopia; A preliminary cross-sectional study

Background

Falls among older adults is a common precipitating factor for unintentional injuries and represent a major health problem associated with increased morbidity, mortality, and health care cost in low-and-middle-income countries. The burden of fall in this population is well established in high-income countries and scant attention is given to this precipitating factor in low-and-middle-income countries, including Ethiopia. Therefore, this study aimed to estimate the prevalence and factors associated with fall among community-dwelling older adults in Ethiopia.

Methods

A community-based cross-sectional study was conducted among community-dwelling older adults of Gondar. Multi-stage random sampling technique was used across administrative areas. Six hundred and five households were selected proportionally using systematic random sampling technique. Physical measurement and face to face interview method were employed using a structured questionnaire for data collection. Data were analyzed descriptively and through uni- and multivariate logistic regression model.

Results

One hundred and seventy (n = 170, 28.4%; 95% CI 24.7–32.1) community-dwelling older adults reported having experienced fall in the past 12 months. Sex (OR = 1.91, 95% CI: 1.24–2.95), low educational status (OR = 2.37, 95% CI: 1.19–4.74), uncomfortable home environment (OR = 2.02, 95% CI: 1.34, 3.04), having diagnosed medical condition (OR = 4.659, 95% CI: 1.20–18.02), and use of medication (OR = 5.57, 95% CI: 1.19–26.21) were significantly associated risk factors of self-reported fall in the past 12 months. Most outdoor falls are associated with females and participants aged below 66 years.

Conclusion

In conclusion, more than 1/4th of the community-dwelling older adults experienced at least one episode of fall and about 60% of them reported recurrent falls. Identifying risk group and risk factors that could be modified so as to prevent falls in older adults deserves attention. Outdoor falls are usually attributable to modifiable environmental aspects and improvements in outdoor environment needed.

Cognitive performance norms from the Korean genome and epidemiology study (KoGES)

BACKGROUND

While normative data on neuropsychological performance provide baseline metrics for the assessment and diagnosis of mild cognitive impairment and dementia, a lack of comparative normative data in non-Caucasian populations makes it difficult to conduct similar evaluations and studies in individuals from diverse backgrounds. The current paper aims to provide normative data on a range of cognitive measures in a Korean general population sample and investigate various demographic and health variables associated with cognitive performance in this representative population.

METHOD(S)

The study population was 1,528 stroke and dementia-free individuals who participated in the Korean Genome and Epidemiology study (KoGES) (mean age 60.43 ± 7.30, 52.42% female). All participants underwent a comprehensive neuropsychological test battery that included verbal and visual memory, language, attention, and executive function measures. A health examination and a questionnaire-based interview were also administered.

RESULTS

The majority of cognitive test results were associated with age, education, and gender. In general, higher education and younger age was associated with better cognitive performance. Explained variance increased modestly in models that included measures of general health and depressive symptoms.

CONCLUSION

Normative data of cognitive performance in a community based Korean population are presented. These norms provide reference values in a non-Caucasian middle to older aged sample.

Health and Long-Term Care Systems for Older People in the Republic of Korea: Policy Challenges and Lessons

The Republic of Korea is experiencing a rapidly aging population with increased life expectancy and lowered fertility. National health insurance has provided universal access to health care for all since 1989, and mandatory long-term care insurance (LTCI) was introduced in 2008, in which everybody who contributes to health insurance simultaneously contributes to LTCI. Although health services and long-term care are universally accessible, health differentials remain across socioeconomic groups. LTCI covers about 7% of older people through eligibility assessment and provides benefits for institutional and home-based care and cash benefits in exceptional cases. Long-term care (LTC) benefit eligibility has been criticized for being excessively reliant on physical functionality, and recently eligibility has been extended to people with dementia. Despite the oversupply of LTC providers, quality of care has been a concern and calls for more investment in the quality evaluation system and training of care workers. There continues to be overreliance on inpatient care and unmet health care needs among LTC users as a result of weak gatekeeping by primary care and a lack of effective coordination between health care and LTC.

Mushroom Consumption and Incident Dementia in Elderly Japanese: The Ohsaki Cohort 2006 Study

BACKGROUND

Both in vivo and in vitro studies have indicated that edible mushrooms may have preventive effects against cognitive impairment. However, few cohort studies have yet examined the relationship between mushroom consumption and incident dementia.

OBJECTIVE

We examined the relationship between mushroom consumption and incident dementia in a population of elderly Japanese subjects.

DESIGN

Prospective cohort study.

SETTING

Ohsaki Cohort 2006 Study.

PARTICIPANTS

13,230 individuals aged ≥65 years living in Ohsaki City, northeastern Japan.

MEASUREMENTS

Daily mushroom consumption, other lifestyle factors, and dementia incidence.

RESULTS

The 5.7 years incidence of dementia was 8.7%. In comparison with participants who consumed mushrooms <1 time/wk, the multi-adjusted HRs (95% CI) for incident dementia among those did so 1-2 times/week and ≥3 times/week were 0.95 (0.81, 1.10) and 0.81 (0.69, 0.95), respectively (P-trend <.01). The inverse association persisted after excluding participants whose dementia event occurred in the first 2 years of follow-up and whose baseline cognitive function was lower. The inverse association did not differ statistically in terms of vegetable consumption (P-interaction = .10).

CONCLUSIONS

This cohort study suggests that frequent mushroom consumption is significantly associated with a lower risk of incident dementia, even after adjustment for possible confounding factors.

The impact of education and health heterogeneity on Generational Support Ratios: a cross-national comparison between Mexico and Korea

Policy makers are concerned about the socio-economic consequences of population ageing. Policies often rely on estimations of support ratios based solely on the population age structure. We estimate Generational Support Ratios (GSRs) considering health heterogeneity of the population age 60+ and education heterogeneity of their offspring. We explore the effect of a public policy that changes the education of a targeted sub-group of women when they are young on their health once they become older, taking into account changes in demographic processes (i.e.marriage, fertility, offspring's education). We used the model presented by Kyeet al.for the Korean context and examine the Mexican context. Our paper has three objectives. First, by applying this framework to the Mexican context we aim to find that improvements in women's education may mitigate the negative consequences of population ageing directly and indirectly through subsequent demographic behaviours that altogether affect GSRs. Second, by making a cross-national comparison between Korea and Mexico, we aim to quantify how policies of educational expansion have different impacts in contexts in which the population age 60+ have universal access to health care compared to contexts in which access to health care is selective. Third, by comparing cross-nationally we aim to show how differences in family processes across countries alter the pathways through which improvements in education affect GSRs.