: 1 2 1998 1) 1990 71.3 2000 74.3. 65 1997 6.6% 2000 7%, 2022 14% 1,2). 1960 1960 28.8% 1989 73.1%.. 10-12% 65. 5). 28.7% 52.7% 1). 85.9% 89.2% 83.4%.,,, 1/3 6) 7),. 40.4% 8-15),,,,, 3). :, 1997 21. 1988 65 4.8% 1991 60 37% 1.,.,, 4),,,,,,,,,,, 16), 17),, 18). 120

.,, 19-22). 85% 1 60 1997 7 14 7. 24. 11 23). 8 1937 12 31 60 24). 8,963. 2 (cluster sampling) 25-29). 1. 1 1 2 1 55. 26.., 60 31.6% 2,830 301,,,.. 1).,,,,,. 1),,,,, 2),,,. 2) MMSE-K(Minimental Status Examination, 3). Korean Version) 12 30 4) (orientation), (registration), 121

(recall), (attention and calcula tion), (language), (reasoning 3, and judgement) 6 12 2, 2 30. time orientation, attention, language. 1 3. MMSE 26, 19-25, 18 8) 24,, 23,,.,,. 3) (The Brief MAST) 9) (Mini-Nutritional Assessment) 10 29 6, 6.. 4) Geriatric Depression Scale(GDS)-Short form., 15 6, 6,, 4. 24, 17 23.5 5) (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

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: 4 0-30 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, 2/3. 50.8% 37.2% 88% 123

.,, 56.1%. 80.8% 32. 1 500 8.3%. 27 1 300. 24.9% (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 1 2 3 4 5 6 Frequency(%) 71.2 7.1 101(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) 32.1 49.9 26.6 35.2 98(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

MMSE-K 22.7 4.5 23 46.5% 24 40.5%. GDS 6.9 3.7 5 34.9% 56.5%. MAST 70.1% 6 4.0% (Table 3). 59.1%, 35.5%. 3 78.7% 3 18.6%. 21.6%, 75.4% (Table 4). (Table 6). 3 82.7% 1 11.3%. 70.4% 25.2%. 34.9% 60.7%. Table 3. Characteristics of Mental S tate Mental State Frequency(%) Mean SD MMSE-K 23 24 GDS 5 6 MAST 5 6 140(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) 22.7 4.5 6.9 3.7 2.7 4.2 20.6% 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

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

Table 7. Chra cte ris tics of Die t P a tte rn Diet Pattern Number of meal(per day) 1 2 3 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) 17 3.0% 17 23.5 38.5% 24 50.5%. (Table 8). 24.2 3.3, 23.3 3.4 MNA (p<0.05). 70 70 24.2 3.1, 70 22.9 3.5 (p< 0.01). 22.9 3.4 24.4 3.2 (p< 0.01). 24.0 3.4 23.0 3.3 (p< 0.05). 10 10 23.2 3.3, 10 24.2 3.3 (p< 0.05). 10 10 23.5 3.4, 10 24.3 3.1 (p< 0.05). 23.8 3.0, 23.5 3.5 (p> 0.05). 23.7 3.3 23.1 3.6 (p>0.05)(table 9). MMSE-K 23 MNA 23.4 3.5 24 24.1 3.0 0.05 (p- value 0.08). GDS 6 MNA 22.7 3.2 5 25.5 2.5 (p= 0.0001) MAST 6 MNA 22.8 3.0 5 24.3 3.0 127

Table 8. Mini-nutritiona l As s e ss ment Fre que ncy(%) Age(yrs) -69 70-79 80- 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 (17-23.5) 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) 24.2 3.3 23.3 3.4 24.2 3.1 22.9 3.5 22.9 3.4 24.4 3.2 24.0 3.4 23.0 3.3 23.2 3.3 24.2 3.3 23.5 3.4 24.3 3.1 23.8 3.0 23.5 3.5 23.7 3.3 23.1 3.6 2.01 3.37-3.88 2.54-1.57-2.08 0.68 1.10 <0.05 <0.05 <0.05 <0.05 >0.05 >0.05 128

(Table 10). 24.1 3.2 (p). IADL 9 24.2 3.2 1 22.8 3.5 (p)(table 11).,, 3, IADL. IADL MNA 22.9 3.4, 24.5 3.1,, (p).,,,,, 3 21.5 3.3 3 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) 23.4 3.5 24.1 3.0 25.5 2.5 22.7 3.2 24.3 3.0 22.8 3.0-1.72 7.64 1.60 0.0829 0.0001 0.1317 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) 22.9 3.4 24.5 3.1 21.5 3.3 24.1 3.2 21.6 3.7 24.2 3.0 24.2 3.2 22.8 3.5 3.96-5.22-5.47 3.39 129

MNA (p< 0.01), (Table 12). 23.6 3.6 (p)(table 13). 3 MNA MNA 24.0 24.2 3.2 21.9 3.4 3.2 (< 0.01). 23.3 3.4 24.5 3.0,. 22.4 3.5 (< 2 MNA 0.01). 24.1 3.3 23.1 3.6, 24.2 3.0 23.1 3.4 (< 0.01) (p). 24.0 3.3 3 22.1 3.3 MNA 24.0 3.2 ()(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 23.9 3.3 23.8 3.3 23.8 3.3 23.8 3.3 23.8 3.2 23.9 3.2 23.9 3.2 23.9 3.2 23.6 3.4 23.9 3.3 22.1 3.6 22.1 3.4 21.5 3.3 21.1 3.5 21.9 3.6 21.9 3.6 20.6 3.9 23.4 3.4 2.66 2.76 2.77 3.30 3.88 3.73 3.42 4.49 0.57 0.008 0.006 0.005 0.001 0.000 0.000 0.000 0.000 0.569 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) 23.3 3.4 24.0 3.2 23.1 3.4 24.1 3.3 22.6 3.6 24.0 3.2-1.60-2.57-3.17 0.41 130

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) 24.2 3.2 21.9 3.4 24.1 3.2 22.0 3.5 24.5 3.0 22.4 3.5 23.1 3.6 24.2 3.0 24.0 3.3 22.1 3.3 4.77 5.75-5.16-2.84 3.94,, 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,,,,. 4 3 23.8% (Table 14). MMSE-K, GDS 1 t- 37.9%. 4, IADL,, 7.4%., GDS.,,,,,. 2 1, 131

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 (%) -0.6-0.1** 1.0* 8.3** 7.4-0.6-0.1** 0.9* 0.4 # 0.7** 8.5** 12.2-0.1-0.0 0.6-0.0 0.9** -0.2 # -0.7** 1.8* 2.2** 12.2** 28.3 0.2-0.0 0.3-0.1 1.0** -0.1 # -0.5 1.7** 1.5** 0.1-0.3** 13.0** 37.9 0.4-0.0 1.0* -0.2 0.7** -0.1-0.3 1.4** 1.4** 0.1 # -0.1* 0.9-1.2** -0.4 0.7 # 0.3-1.2** 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

45.1%. program,,,., MMSE-K, GDS,, program,,,,,,,. (Table 15). MMSE-K 23 46.5% 24 40.5%. 1991 Guigoz MMSE-K 24 31.6% 30). 36,37) 17 3.0% 17 23.5 2-23%, 11.3%61) 38.5% 24 50.5% (Table 8).. MMSE-K 36). 5-8%, 39,40) 30-60% 15,31,32).. MMSE-K. folate, vitamine B12 riboflavin 41) 70... 10..,,, 33), 42). GDS 15 34,35)., 43,44) 30,,,. 134

. GDS 5. 34.9% 56.5%.... (ADL). GDS 6 MNA 22.7 3.2 5 25.5. (IADL) 2.5 (p=,,, 0.0001).,, 45).,,,.,,,, 2/3 70.1% MAST. 6 4.0%. MAST.. 59.1%. 85.9%..,, 1 46).,.. 135

. 7.5% 6.7%, 22.2%, 23.7%, 23.8%. 60 1997 7. 14 7 24 11 2 45.1%. (cluster sampling).,.,, Mini Mental Status Exam(MMSE-K), Geria, tric Depression Scale(GDS),, (Brief MAST), (IADL),,.. t-test, multiple regression. 71.2 7.1 101 (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

= 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 72 7.1 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, 1995 2) :. 11(2):155-174, 1989 3),, :. 34(3):189-195, 1993 4) Stuck AE, Siu AL, Wieland GD, et al: Com prehensive geriatric assessment: A meta-analy sis of controlled trials. Lancet 342:1032-1036, 1993 5) 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 44:166 174, 1996 6) 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, 1991 7) Tierney AJ: Undernutrition and elderly hospital patients: a review. J of Adv Nursing 23:228-236, 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 44:166-174, 1996 137

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