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1 : ) % %, % 1,2) % % % 65. 5). 28.7% 52.7% 1). 85.9% 89.2% 83.4%.,,, 1/3 6) 7),. 40.4% 8-15),,,,, 3). :, % % 1.,.,, 4),,,,,,,,,,, 16), 17),, 18). 120
2 .,, 19-22). 85% ) ). 8, (cluster sampling) 25-29) , % 2, ,,,.. 1).,,,,,. 1),,,,, 2),,,. 2) MMSE-K(Minimental Status Examination, 3). Korean Version) ) (orientation), (registration), 121
3 (recall), (attention and calcula tion), (language), (reasoning 3, and judgement) , time orientation, attention, language MMSE 26, 19-25, 18 8) 24,, 23,,.,,. 3) (The Brief MAST) 9) (Mini-Nutritional Assessment) , 6.. 4) Geriatric Depression Scale(GDS)-Short form., 15 6, 6,, 4. 24, ) (ADL-Activities of Daily Living), 17. Katz.,,.,, t- 6) (IADL-Instrumental Activities of Daily Living),,., ADL. t- 7) (Social support network). (social network) (social support),,.,, 122
4 Table 1. Varia ble s Use d in S tudy Variable Content Measurement Dependent Variable Mini-Nutritional Assessment 0-30 points(18 questions) Independent Variable Socio-demographics Mental state Physical state Social support network Dietary pattern Age Sex Education Literacy of Hangul(the Korean alphabet) Self-income per month Self-expenditure per month Marital status Religion Type of residence Number of persons in the household MMSE-K GDS MAST Presence of current illness Number of drugs in current use Presence of stress IADL(Instrumental Activity of Daily Living) Social activity(2 items) Instrumental(3 items) Emotional(3 items) Number of meals Regularity of meal Change of taste Safisfaction in food Persons at meal Unbalanced diet in years 1: male 2: female 1: uneducated 2: educated 1: illiterate 2: literate in 10,000s of won in 10,000s of won 1: married 2: else 1: not believe 2: believe 1: own house 2: lease 1: 3 2: points 0-15 points 0-29 points 1: no 2: yes 1: 2 0: 3 1: no 0: yes sum of 9 item s points(1: independent, 2: partial dependent, 3: total dependent) sum of each item s points(1: supported 0: not supported) 1: 2 2: 3 1: regular 2: irregular 1: non or a little 2: much 1: unsatisfied 2: satisfied 1: alone or spouse 2: family 1: no 2: yes (hierachical multiple regression analysis) ( 0.7 ). 71 1/3, 2/ % 37.2% 88% 123
5 .,, 56.1%. 80.8% % % (Table 2). Table 2. S ociodemographic Characteristics Characteristics Age(years) Sex Education Marrital status Income (10,000won) Expenditure (10,000won) Religion Type of residency Number of persons in the household mean SD male female uneducated elementary junior high high above college married seperated by death second marriage others mean SD mean SD none protestant buddhism catholic others own house lease lease(monthly rent) others Frequency(%) (33.6) 200(66.4) 150(50.8) 113(37.2) 23( 7.6) 5( 1.6) 3( 1.0) 5( 1.6) 169(56.1) 122(40.5) 5( 1.7) 2( 0.6) 3( 1.0) (32.6) 71(23.6) 91(30.2) 36(12.0) 2( 0.7) 3( 1.0) 243(80.8) 38(12.6) 9( 3.0) 6( 2.0) 5( 1.7) 25( 8.3) 75(24.9) 35(11.6) 31(10.3) 58(19.3) 70(23.2) 7( 2.3) 124
6 MMSE-K % %. GDS % 56.5%. MAST 70.1% 6 4.0% (Table 3). 59.1%, 35.5% % %. 21.6%, 75.4% (Table 4). (Table 6) % %. 70.4% 25.2%. 34.9% 60.7%. Table 3. Characteristics of Mental S tate Mental State Frequency(%) Mean SD MMSE-K GDS 5 6 MAST (46.5) 122(40.5) 39(13.0) 105(34.9) 170(56.5) 26( 8.6) 78(25.9) 12( 4.0) 211(70.1) % 15.6%, 14.6%.,, 8.3%, 8.7% 10.3% (Table 5). 80% 69.1%, 69.1%. 51.5% 64.1% Table 4. Chracte ristics of P hys ica l S ta te Physical State Presence of current illness yes unknown no No. of drugs currently use 2 3 Presece of stress yes no Frequency(%) 178(59.1) 8( 2.7) 107(35.5) 8( 2.7) 237(78.7) 56(18.6) 8( 2.7) 65(21.6) 227(75.4) 9(13.0) 125
7 53.2% 26.9% 6.3% 39.9%. 36.2%. 75.1% 17.3% 12.3%, Table 5. Instrume nta l Activitie s of Da ily Living(IADL) Fre que ncy(%) IADL Independent Partial dependent Total dependent No response Total Using telephone Ability to travel Shopping Cooking Cleaning Doing housework Doing laundry Managing medication Managing money 232(77.1) 248(82.4) 255(84.7) 262(87.0) 266(88.4) 246(81.7) 251(83.4) 267(88.7) 257(85.4) 26( 8.6) 34(11.3) 17( 5.6) 12( 4.0) 12( 4.0) 16( 5.3) 19( 6.3) 19( 6.3) 21( 7.0) 36(12.0) 10( 3.3) 20( 6.6) 19( 6.3) 14( 4.7) 31(10.3) 22( 7.3) 6( 2.0) 12( 4.0) 7(2.3) 9(3.0) 9(3.0) 8(2.7) 9(3.0) 8(2.7) 9(3.0) 9(3.0) 11(3.6) Table 6. S ocia l S upport Ns e twork Fre quency (%) Type of support Items yes no No response Total Emotional Social activity Instrumental Do you have someone listen openly and uncritically to your innermost feelings? Do you have someone who understand and help you to solve worry? Do you have someone with whom you feel happy? Do you have someone with whom going out or traveling? Do you have someone with whom share leisure time activities? Do you have someone who would go hospital with you if you were sick? Do you have someone who would take care of you if you were sick? Do you have someone give you financial support? 155(51.5) 165(54.8) 193(64.1) 208(69.1) 174(57.8) 244(81.1) 247(82.1) 251(83.4) 136(45.2) 126(41.9) 98(32.6) 83(27.5) 117(38.9) 47(15.6) 44(14.6) 40(13.3) 10(3.4) 10(3.4) 10(3.4) 10(3.4) 10(3.4) 10(3.4) 10(3.4) 10(3.4) 126
8 Table 7. Chra cte ris tics of Die t P a tte rn Diet Pattern Number of meal(per day) Regularity of meal regular irregular Change of taste unchanged a little much Satisfaction in food unsatisfied nutral satisfied Persons at meal alone spouse children or grandchildren family Unbalanced diet no neutral yes 8.3% (Table 7). Frequency(%) 1( 0.3) 32(11.0) 249(82.7) 19( 6.3) 212(70.4) 76(25.2) 13( 4.3) 105(34.9) 85(28.5) 97(32.2) 13( 4.3) 19( 6.3) 109(36.2) 3(53.2) 13( 4.3) 52(17.3) 81(26.9) 32(10.6) 120(39.9) 16( 5.3) 226(75.1) 37(12.3) 25( 8.3) 13( 4.3) % % %. (Table 8) , MNA (p<0.05) , (p< 0.01) (p< 0.01) (p< 0.05) , (p< 0.05) , (p< 0.05) , (p> 0.05) (p>0.05)(table 9). MMSE-K 23 MNA (p- value 0.08). GDS 6 MNA (p= ) MAST 6 MNA
9 Table 8. Mini-nutritiona l As s e ss ment Fre que ncy(%) Age(yrs) No response Sex Male Female Malnutrition (<17) 1( 0.8) 4( 3.3) 4(11.8) 0( 0.0) 4( 4.0) 5( 2.5) At risk of malnutrition ( ) 39(32.5) 61(50.0) 16(47.1) 0( 0.0) 29(28.7) 87(43.5) Well-nourished ( 24) 80( 66.7) 57( 46.7) 14( 41.2) 1(100.0) 57( 56.4) 95( 47.5) No response 7( 5.5) 13( 9.6) 4(10.5) ( 0.0) 11(10.9) 13( 6.5) Total 127( 42.2) 135( 44.9) 38( 12.6) 1( 0.3) 101( 33.6) 200( 66.4) Total 9( 0.0) 116(38.5) 152(50.5) 24( 8.0) Table 9. MNA S core According to S ociode mogra phic Cha ra cte ristics Demographics MNA Score(mean SD) t-value p-value Sex male(n=90) female(n=187) Age 70(N=137) >70(N=139) Education uneducated(n=145) educated(n=129) Marital status married(n=155) else(n=122) Income(10,000 won) 10(N=117) >10(N=118) Expenditure(10,000 won) 10 (N=118) >10(N=123) Religion not believe(n=94) believe(n=183) Type of residency own(n=235) lease(n=50) <0.05 <0.05 <0.05 <0.05 >0.05 >
10 (Table 10) (p). IADL (p)(table 11).,, 3, IADL. IADL MNA , ,, (p).,,,,, Table 10. MNA S core According to Mental S tate Mental State MNA Score(mean SD) t-value p-value MMSE-K(N=248) 23 (N=133) 24 (N=115) GDS(N=259) 5 (N= 99) 6 (N=160) MAST(N=85) 5 (N= 73) 6 (N= 12) Table 11. MNA S core According to P hys ica l S ta te Physical State MNA Score(mean SD) t-value p-value Physical illness yes(n=173) no(n=99) Number of drugs in current use 3(N=53) < 3(N=224) Has suffered stress in the past 3 months yes(n=64) no(n=214) IADL independent in all items(n=157) dependent in at least 1 item(n=109)
11 MNA (p< 0.01), (Table 12) (p)(table 13). 3 MNA MNA (< 0.01) , (< 2 MNA 0.01) , (< 0.01) (p) MNA ()(Table 14). Table 12. MNA S core According to IADL IADL MNA Score(mean SD) Independent Dependent t-value p-value Using telephone Ability to travel Shopping Cooking Cleaning Doing housework Doing laundry Managing medication Managing money Table 13. MNA S core According to S ocia l S upport Social support Nunber of supported items MNA Score(mean SD) t-value p-value Emotional(3 items) Social activity(2 items) Instrumental(3 items) 3(N=166) 3(N=108) 2(N=129) 2(N=145) 3(N= 83) 3(N=191)
12 Table 14. MNA S core According to Diet P a tte rn Diet Pattern MNA Score(mean SD) t-value p-value Regularity of meal regular(n=200) irregular(n=70) Change of taste unchanged(n=180) changed(n=90) Satisfaction in food satisfied(n=118) unsatisfied(n=152) Persons at meal alone with a spouse(n=157) with family(n=113) Unbalanced diet no(n=212) yes(n=58) ,, 12.2%. 2 MNA,,, Adj-R 2 7.5% 7.5%. 3 2.,, IADL, 6.7%,. IADL,, 28.3%. 3,, IADL,,, 22.2%. MMSE-K GDS, MAST,, 23.7%, 3,,,, % (Table 14). MMSE-K, GDS 1 t- 37.9%. 4, IADL,, 7.4%., GDS.,,,,,. 2 1, 131
13 Table 16. Hierarchia l Re gres s ion Mode l for Nutritional S ta tus Variables Model 1 Model 2 Model 3 Model 4 Whole model Demographics sex age education Social support network social activity instrumental Physical state IADL current illness no. of drugs stress Mental state MMSE-K GDS Diet pattern no. of meals regularity change satisfaction persons at meal have unbalanced diet F-value Adj-R 2 (%) ** 1.0* 8.3** ** 0.9* 0.4 # 0.7** 8.5** ** -0.2 # -0.7** 1.8* 2.2** 12.2** ** -0.1 # ** 1.5** ** 13.0** * ** ** 1.4** 0.1 # -0.1* ** # ** 10.9** 45.1 # : p<0.1, *: p<0.05, **:p Sex : 1; male 2; female Age : years Education : 1; uneducated 2; educated Social activity : sum of 2 item s points (1; supported, 0; not supported) Instrumental : sum of 2 item s points (1; supported, 0; not supported) IADL : sum of 9 item s points (1; independent, 2; partial dependent, 3; total dependent) Current illness : 1; no 2; yes Number of drugs : 1; <3 0; 3 Stress : 1; no 0; yes MMSE-K : 1-30 points GDS : 1-15 points Number of meals : 1; 2 2; 3 Regularity (of meals) : 1; regular 2; irregular Taste : 1; unchanged, or a little changed 2; much changed Satisfaction (in food) : 1; unsatisfied 2; satisfied Persons at meal : 1; alone or with a spouse 2; with family Unbalanced diet : 1; no 2; yes 133
14 45.1%. program,,,., MMSE-K, GDS,, program,,,,,,,. (Table 15). MMSE-K % % Guigoz MMSE-K % 30). 36,37) % %, 11.3%61) 38.5% % (Table 8).. MMSE-K 36). 5-8%, 39,40) 30-60% 15,31,32).. MMSE-K. folate, vitamine B12 riboflavin 41) ,,, 33), 42). GDS 15 34,35)., 43,44) 30,,,. 134
15 . GDS % 56.5%.... (ADL). GDS 6 MNA (IADL) 2.5 (p=,,, ).,, 45).,,,.,,,, 2/3 70.1% MAST %. MAST %. 85.9%..,, 1 46).,.. 135
16 . 7.5% 6.7%, 22.2%, 23.7%, 23.8% %. (cluster sampling).,.,, Mini Mental Status Exam(MMSE-K), Geria, tric Depression Scale(GDS),, (Brief MAST), (IADL),,.. t-test, multiple regression (33.6%), 200 (66.4%). 41.5%. t-test,,,,,,, MMSE-K., GDS,,,,,,,,,,, IADL,,,,,,, 3,, (p<0.05).,,,, 7.47%, 25.3%,, 6.7%, 23.8%,. 22.2%. 45.1%,,,,,,,,..,,,.. 136
17 = Abstract = Factors Related to Nutritional Status of Elderly in a Korean Rural Commuity Hang Suk Cho, M.D., Byoung Hoon Oh, M.D.* Hyun Soo Kim, M.D.*, Kyung Won Kim** Ji Young Park***, Hye Ree Lee, M.D. and Gye Joon Yoo, M.D.* Department of Family Medicine, Department of Psychiatry, Yonsei University College of Medicine* Department of Nutrition, Seoul Women s University** Department of Social Welfare, Ewha Women s University *** College of Medicine Background : Nutrition is closely related to morbidity and mortality, and active intervention is known to be effective in their prevention. This study evaluates the factors related to nutritional status of elderly, to be used as a basic reference for effective prevention program. Methods : The cross-sectional study evaluates the nutritional status of community-living elderly, aged 60 and older, in a Korean rural community. The subject were selected from a two stage cluster sampling. Questionnaire contained demographics, the Mini-Nutritional Assessment(MNA), Mini-Mental Status Exam-Korean(MMSE-K), Geriatric Depression Scale(GDS), IADL, Social support network, and dietary patterns. T-test and hierarchical regression models were constructed to explore the factors related to nutritional status. Results : Mean age was with 101 male subjects and 200 female subject. The MNA score revealed 41.5% of subjects who were at risk of malnutrition. The mean MNA score showed significant differences in terms of following factors: gender, age, education, marital status, income, expenditures, MMSE-K, GDS, social support, instrumental support, regularity of meal, changes in taste, satisfaction in food, unbalanced dietary habit, number of family members sharing the meal, IADL, presence of disease, number of medications(p<0.05). Multiple regression analysis revealed that demographic characteristics explained 7.5% of nutritional status, social support network 6.7%, mental disease 25.3%, dietary pattern 23.8%, and physical disease 22.2% correspondingly. Whole model explained 45.1% of nutritional status. The significant variables were the number of medications, presence of stress, unbalanced dietary habit, regularity of meal, instrumental support, depression, cognition, and satisfaction in food(p<0.05). Conclusion : Mental and physical state, dietary pattern, social support network, demographic characteristics were related to nutritional status. Key Words : Mini-Nutritional Assessment, Social support network, Functional assessment, Depression, Cognitive function REFERENCES 1) :. 20(1):75-89, ) :. 11(2): , ),, :. 34(3): , ) Stuck AE, Siu AL, Wieland GD, et al: Com prehensive geriatric assessment: A meta-analy sis of controlled trials. Lancet 342: , ) Antonelli Incalzi R, Landi F, Cipriani L, et al Nutritional assessement: A primary component of multidimentional Geriatric assessment in acute care setting. J of Am Geriatr Soc 44: , ) Leheman AB, Bassey EJ, Morgan K, Dallosso HM: Normal values for weight, skeletal size and body mass indices in 890 men and women aged over 65years. Clinical Nutrition 10:18-22, ) Tierney AJ: Undernutrition and elderly hospital patients: a review. J of Adv Nursing 23: , 19965) Antonelli Incalzi R, Landi F Cipriani L. et.al: Nutritional assessement: A primary component of multidimentional Geria tric assessment in acute care setting. J of Am Geriatr Soc 44: ,
18 8) Frisoni GB, Franzoni S, Rozzini R, et al: A nutritional index predicting motality in the nursing home. J Am Geriatr Soc 42: ) Sullivan DH, Patch GA, Walls RC, et al: Impac of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients. Am J Clin Nutr 51: , ) Sullivan DH, Walls RC, Lipschitz DA: Proteinenergy malnutrition and the risk of mortality within 1 year of hospital discharge in a selec population of geriatric rehabilitation patients. Am J Clin Nutr 53: , ) Potter J, Klipstein K, Reilly J, et al: The nutr tional status and clinical course of acute admis sion to geriatric unit. Age and Ageing 24: , ) Henderson C: Nutrition and malnutrition in the elderly nursing home patient. Clin Geriatr Med 4: , ) Terpenning MS, Bradly SF: Why ageing leads to increased susceptibility to infection. Geriatrics 46:77-80, ) Antonelli Incalzi R, Gemma A, Capparella O, e al: Predicting motality and length of stay o geriatric patients in acute care general hospital J of gerontology 47:M35-39, ) Constans T, Bacq Y, Brechot JF, et al: Protein energy malnutrition in elderly medical patient. J Am Geriatr Soc 40: , ) Goodison SM: Assessment of nutritional status. Professional nurse 11: , ) Roebothan BV, Chandra RK: Relationship be tween nutritional status and immune function o elderly people. Age and Ageing 24:49-53, ) Robinson G, Goldstein M, Levine GM: Impac of nutritional status on DRG length of stay. J o Parenteral and Enteral Nutrition 11:49-51, ) Rubenstein LZ, Josephson KR, Darryl Wieland G, et al: Effectiveness of a geriatric evaluation unit. NEJM 311(26): , ) Applegate WB, Miller ST, Graney MJ, et al: A randomized, controlled trial of a geriatric as sessment unit in a community rehabilitation hospital. NEJM 322(22): , ) Hendriksen C, Lund E, Stromgard E: Conse quences of asswssent and intervention among elderly people: a three year randomised control led trial. British medical journal 289: , ) Thomas DR, Brahan R, Haywood BP: Inpatien community-based geriatric assessment reduces subsequent mortality. J Am Geriatr Soc 41: , ) Posner BM, Fanelli MT, Krankenfels MM, et al Position of the american dietetic association: Nutrition, ageing, and the continuum of health care. J Am Diet Assoc 87: , ) Bianchetti A, Rozzini R, Carabellese C, et al Nutritional intake, socioeconomic conditions, and health status in a large elderly population J Am Geriatr Soc 38: , ) :. 9(1): 13-17, ), :. 22: , ), :. 19: ),, :. 28:59-72, ), :. 21:12-22, ) Guigoz Y., Vellas BJ, Garry PJ: Mini Nutritio nal Assessment: A practical assessment tool for grading the nutritional state of elderly patients Facts and Research in Gerontology(Supplement on nutrition and aging), p15-59, New York, NY Springer Publishing Co., ) Cederhorlm C, Hellerstorm K: Nutritional status in recently hospitalized and free-living elderly subjects. Gerontology 6:50, ) Rudman D, Feller AG: Protein-calorie under nutrition in the nursing home. J Am Geriatr Soc 37: , ) Mc Lennan WJ: Subnutrition in the elderly. Br Med J 183:1189, ) Davis MA, Randall E, Forthofer RN, et al Living arrangements and dietary patterns of 138
19 older adults in the United States. J Gerontology 40:434, ) Krondi ML, Milbank JE, Gibbs D: The nutritio nal status of the elderly. Age and aging 11: ), : Mini-Mental State Examination. 29: , ), : Mini-Mental State Examination(MMSE-K). 28: , ),, :. 30: , ) Rogers PJ, Lloyd HM: Nutrition and menta performance. Proceedings of the nutrition so ciety 53: , ) Rue LA, Koehler KM, Wayne SJ, et al: Nutri tional status and cognitive functioning in a normally aging sample: a 6-y reassessment. Am J Clin Nutr 65:20-29, ) Goodwin JS, Goodwin JM, Garry PJ: Associa tion between nutritional status and cognitive functioning in a healthy elderly population. JAMA 249: , ) Rozzini R, Bianchetti A, Carabellese C, et al Depression, life events and somatic symptoms. Gerontologist 28:229, ) Sheikh JI, Yesavage JA: Geriatric depression scale: recent evidence and development of a shorter version. Clin Gerontol 5: , ) Yesavage JA, Brink TL, Rose TL, et al: De velopment and validation of geriatric depression rating scale: a preliminary report. J Psych Res 17:27, ) Young EA: Nutrition, ageing and the aged. Med Clin North Am 67:95, ), :. 12:65-78,
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