Variations in the provision of healthcare services among hospitals have been an important issue o... more Variations in the provision of healthcare services among hospitals have been an important issue of outcomes research on quality of care. This variability in outcomes represents inconsistencies in care, suggesting a considerable room for quality improvement. In the United States, to narrow the variability in the provision of healthcare services for ensuring the quality of care, the National Surgical Quality Improvement Project has allowed comparative assessment of outcomes and developed a set of quality indicators for continuous quality improvement within the Veterans Affairs health system . In a study examining hospital variations, Garnick et al. reported wide variations in 30-day postadmission hospital mortality rates. Hospital rankings by 30-and 180-day mortality rates after admission, however, did not yield markedly different results. Rosenthal et al. [3] also found nearly a three-fold variation across hospitals in both in-hospital and 30-day mortality rates, with substantial variations in discharge practices. In Korea, given the usefulness of mortality as a quality indicator, hospital mortality at discharge has been used for assessing outcomes of hospital practice [4], with 30-day mortality rates after discharge being evaluated in various studies . Lee et al. [7], using administrative data, found large variations in hospital standardized mortality ratios among hospitals with more than 700 beds.
As the proportion of the elderly population increases rapidly, interest in musculoskeletal health... more As the proportion of the elderly population increases rapidly, interest in musculoskeletal health is also emerging. Here, we investigated how antioxidant vitamin intake and musculoskeletal health are related. Adults aged 50 to 80 years with a body mass index (BMI) of 18.5 to 27.0 kg/m 2 were included. Bone mineral density (BMD), lean mass (LM), appendicular skeletal muscle mass index (ASMI) were measured using dual-energy X-ray absorptiometry (DXA), and the grip strength and knee extension using hand dynamometer. Nutrient intakes were measured using a 24-hour recall questionnaire. A total of 153 adults (44 men and 109 women) participated in this study. A partial correlation analysis showed a significant positive relationship between vitamin E and BMD and between vitamin C and LM/ Height. Participants were classified into three groups according to whether their vitamin E and C intake met the recommended intake for Dietary Reference Intakes for Koreans (KDRIs). The prevalence of having low T-score (< -1.0) and low ASMI (< 7.0 for men and < 5.4 for women) was 51.3% and 15.4% in the group with vitamins C and E intakes below KDRIs. After adjusting for sex, smoking status and energy, protein, vitamin D, and calcium intake, the group with vitamins C and E both below the KDRIs displayed a significantly lower BMD at all test sites and LM/Height compared with vitamin C and/or E intake above the KDRIs groups. We conclude that sufficient intake of vitamin E and C is important for maintaining BMD and lean mass in Korean adults over 50 years of age.
Background: The relationship between macronutrients and frailty is unclear. Previous studies have... more Background: The relationship between macronutrients and frailty is unclear. Previous studies have con rmed the relationships between energy and protein intake and physical frailty, while few studies have examined the role of carbohydrate or fat intake in the prevalence of frailty. The aim of this study is to investigate the relationship of energy and macronutrients with physical frailty in the Korean elderly population who had a high proportion of energy intake from carbohydrates. Methods: This study included 954 adults aged 70 to 84 years who have completed the assessment of frailty and 24-h recall upon enrolment in the Korean Frailty and Aging Cohort Study and have no extreme intake under 400 kcal (n = 2). The relationship between energy or macronutrients and frailty was evaluated using multivariate logistic regression models and multivariate nutrient density models. Results: In the subjects with low energy intake (odds ratio [OR] = 2.94, 95% con dence interval [CI] = 1.34-6.45) and total subjects (OR = 2.01, 95% CI = 1.03-3.93), consuming carbohydrates above the acceptable macronutrient distribution range (65% of energy) was related to a higher risk of frailty. Substituting the energy from fat with carbohydrates was related to a higher risk of frailty (1%, OR = 1.05, 95% CI = 1.00-1.09; 5%, OR = 1.26, 95% CI = 1.02-1.56; 10%, OR = 1.59, 95% CI = 1.03-2.43). Conclusions: This study showed that the proportion of energy intake from carbohydrates and fats may be an important nutritional intervention factor for reducing the risk of frailty.
To examine whether hospital-based healthcare technology is related to 30-day postoperative mortal... more To examine whether hospital-based healthcare technology is related to 30-day postoperative mortality rates after adjusting for hospital volume of cardiovascular surgical procedures.
Purpose This study aimed at examining the ever and recommended screening inequalities of cancers ... more Purpose This study aimed at examining the ever and recommended screening inequalities of cancers (gastric, breast, and cervical) in rural and urban areas including socio-economic disparities, from 2007 to 2012 amongst Koreans. Methodology This cross-sectional population-based study used data from the Korean National Health and Nutrition Examination Survey (KNHANES) of 2007–2012. It included people with no previous cancer diagnosis for gastric, breast, and cervical cancers. Annual Percent Change (APC) was calculated at 95% confidence interval using STATA version 13.0 and MS Excel. Results In the ever cancer screening group, the screening rates and trends had an increased in both urban and rural areas: APC values were 4.6% (95% CI, 1.6 to 7.8) and 5.6% (95% CI, 2.7 to 8.6) for gastric cancers, 3.6% (95% CI, 1.5 to 5.6) and 3.6% (95% CI, -0.3 to 7.7) for breast cancers, and 0.3% (95% CI, -0.4 to 1.2) and 0.7% (95% CI, -1.0 to 1.4) for cervical cancers in urban and rural areas, respecti...
Variations in the provision of healthcare services among hospitals have been an important issue o... more Variations in the provision of healthcare services among hospitals have been an important issue of outcomes research on quality of care. This variability in outcomes represents inconsistencies in care, suggesting a considerable room for quality improvement. In the United States, to narrow the variability in the provision of healthcare services for ensuring the quality of care, the National Surgical Quality Improvement Project has allowed comparative assessment of outcomes and developed a set of quality indicators for continuous quality improvement within the Veterans Affairs health system . In a study examining hospital variations, Garnick et al. reported wide variations in 30-day postadmission hospital mortality rates. Hospital rankings by 30-and 180-day mortality rates after admission, however, did not yield markedly different results. Rosenthal et al. [3] also found nearly a three-fold variation across hospitals in both in-hospital and 30-day mortality rates, with substantial variations in discharge practices. In Korea, given the usefulness of mortality as a quality indicator, hospital mortality at discharge has been used for assessing outcomes of hospital practice [4], with 30-day mortality rates after discharge being evaluated in various studies . Lee et al. [7], using administrative data, found large variations in hospital standardized mortality ratios among hospitals with more than 700 beds.
Dementia affects 46.8 million of the world’s population, and is projected to increase to 131.5 mi... more Dementia affects 46.8 million of the world’s population, and is projected to increase to 131.5 million by 2050 (1). Increasingly, with no available disease-modifying drug or cure for the disease, preventive strategies are being pursued to curb the worldwide epidemic. Accumulating evidence supports the importance of dementia prevention, with seven risk factors (diabetes mellitus, midlife obesity, midlife hypertension, physical inactivity, depression, smoking, and low education) estimated to contribute to 9.6 million cases, equivalent to a third of Alzheimer’s disease worldwide (2). The potential public health impact of prevention is huge as a 20% reduction per decade from 2010 in the prevalence of these risk factors would translate to a 16.3% (1.5 million) reduction in dementia prevalence by 2050.
Background. Sarcopenia is an important factor of functional impairment related to aging. This stu... more Background. Sarcopenia is an important factor of functional impairment related to aging. This study is conducted to investigate the prevalence of sarcopenia and sarcopenic obesity in Korean population. Methods. Representative Korean men (4,486) and women (5,999) aged 20 years or older were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Sarcopenia was classifi ed into Class I defi ned relative skeletal muscle mass loss within 1-2 SD of the gender-specifi c mean for healthy young adults and Class II below 2 SD. Relative skeletal muscle mass was represented by the appendicular skeletal muscle mass adjusted by height and body weight. Sarcopenic obesity was considered present in Class II sarcopenic participants whose waist circumference was more than or equal to 90 cm for men and more than or equal to 85 cm for women, respectively. Results. The prevalence of Class II sarcopenia in the Korean elderly population was 12.4% for men and 0.1% for women by height-adjusted defi nition and 9.7% for men and 11.8% for women by weight-adjusted defi nition. The prevalence of sarcopenic obesity was 7.6% for men and 9.1% for women by weight-adjusted defi nition but nearly zero for men and women by height-adjusted defi nition. The prevalence of sarcopenia increased with age for men but for women only when applied with weight-adjusted defi nition. Conclusions. The prevalence of sarcopenia and sarcopenic obesity differs by gender and defi nition criteria. The heightadjusted defi nition may tend to underestimate the prevalence of sarcopenia and sarcopenic obesity, especially in women.
Background: This study investigated the impact of physical frailty on the development of disabili... more Background: This study investigated the impact of physical frailty on the development of disabilities in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) according to sex among communitydwelling Korean older adults. Methods: We used data of 2,905 older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS) at baseline (2016-2017) and Wave 2 (2018-2019). Fried's physical frailty phenotype was used to identify frailty. Results: After adjustment, frailty showed a higher impact for women than men on developing mobility disability (odds ratio [OR]=14.00, 95% confidence interval [CI]=4.8-40.78 vs. OR=9.89, 95% CI=4.28-22.86) and IADL disability after two years (OR=7.22, 95% CI=2.67-19.56 vs. OR=3.19, 95% CI=1.17-8.70). Pre-frailty led to mobility disability for women and men (OR=2.77, 95% CI=1.93-3.98 vs. OR=2.49, 95% CI=1.66-3.72, respectively), and IADL disability only for women (OR=3.01, 95% CI=1.28-7.09). Among the IADL components, both men and women who were prefrail or frail showed increased disability in 'using transportation'. Among men, pre-frailty was significantly associated with disability in "going out" and "shopping". In women, frailty was significantly associated with disability in "doing laundry, " "performing household chores, " "shopping, " and "managing money". Conclusions: Physical frailty increased disability over 2 years for women more than men. Physical frailty increased disability in outdoor activity-related IADL components in men and household work-related IADL components in women. This study highlights the need for gender-specific policies and preventative programs for frailty, particularly restorative interventions that focus on women who are physically frail.
Background Stroke recognition systems have been developed to reduce time delays, however, a compr... more Background Stroke recognition systems have been developed to reduce time delays, however, a comprehensive triaging score identifying stroke subtypes is needed to guide appropriate management. We aimed to develop a prehospital scoring system for rapid stroke recognition and identify stroke subtype simultaneously. Methods and findings In prospective database of regional emergency and stroke center, Clinical Information, Vital signs, and Initial Labs (CIVIL) of 1,599 patients suspected of acute stroke was analyzed from an automatically-stored electronic health record. Final confirmation was performed with neuroimaging. Using multiple regression analyses, we determined independent predictors of tier 1 (true-stroke or not), tier 2 (hemorrhagic stroke or not), and tier 3 (emergent large vessel occlusion [ELVO] or not). The diagnostic performance of the stepwise CIVIL scoring system was investigated using internal validation. A new scoring system characterized by a stepwise clinical assessment has been developed in three tiers. Tier 1: Seven CIVIL-AS 3 A 2 P items (total score from-7 to +6) were deduced for true stroke as Age (� 60 years); Stroke risks without Seizure or psychiatric disease, extreme Sugar; "any Asymmetry", "not Ambulating"; abnormal blood Pressure at a cutoff point � 1 with diagnostic sensitivity of 82.1%, specificity of 56.4%. Tier 2: Four items for hemorrhagic stroke were identified as the CIVIL-MAPS indicating Mental change, Age below 60 years, high blood Pressure, no Stroke risks with cut-point � 2 (sensitivity 47.5%, specificity 85.4%). Tier 3: For ELVO diagnosis: we applied with CIVIL-GFAST items (Gaze, Face, Arm, Speech) with cut-point � 3 (sensitivity 66.5%, specificity 79.8%). The main limitation of this study is its retrospective nature and require a prospective validation of the CIVIL scoring system.
The coronavirus disease 2019 (COVID‐19) pandemic has casted a huge impact on global public health... more The coronavirus disease 2019 (COVID‐19) pandemic has casted a huge impact on global public health and the economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attention. To evaluate the impacts of COVID‐19 on older people, it is important to balance the successful pandemic control and active management of secondary consequences. These considerations are particularly salient in the Asian context, with its diversity among countries in terms of sociocultural heritage, healthcare setup and availability of resources. Thus, the Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to the COVID‐19 pandemic and proposed recommendations for older people, which are germane to the Asian context. More innovative services should be developed to address the increasing demands for new appr...
Background: Aging causes both structural and functional changes in the skeletal muscle, and is as... more Background: Aging causes both structural and functional changes in the skeletal muscle, and is associated with changes in body composition form, which results in an increased incidence of cardiovascular death. Handgrip strength (HGS) is a simple, fast, reliable, and cost-effective tool for measuring muscle strength. Objective: We aimed to investigate which index was most suitable for predicting cardiovascular disease (CVD), and suggested the optimal cutoff points based on the handgrip strength index. In addition, we aimed to identify the effects of weak HGS, as determined by applying the optimal cut point on the occurrence of CVD. Method: A total of 8494 older men and women aged over 45 years from the Korean Longitudinal Study of Aging (KLoSA) were included in this study at baseline. We performed general estimating equations (GEE) with independent correlation structure to assess whether handgrip strength is longitudinally related to occurrence of CVDs such as heart disease or stroke reported from 1 st to 6th wave of KLoSA. Results: The relative HGS was strongly associated with CVD in both sexes, and the best fit model was in that in comparison to dominant HGS and absolute HGS. In addition, we calculated the optimal cut point for CVD based on the relative HGS in this study (men: 2.52 and women: 1.55, respectively), and demonstrated that low HGS, as determined by applying relative HGS cut points, was associated with a higher OR for CVD compared to normal HGS; the associations observed were consistent between the sexes. Conclusions: Our findings suggest that HGS has the potential to be a valuable screening tool for cardiovascular risk in clinical settings; this is advantageous in situations where blood sampling is not possible since HGS is easily measured and highly reproducible. It is necessary to pay attention to weak grip strength against body size in the elderly population.
Body weight is a major risk determinant of frailty, but the effect of obesity on frailty is contr... more Body weight is a major risk determinant of frailty, but the effect of obesity on frailty is controversial. The present study aimed to confirm the hypothesis that the risk of frailty is positively associated with obesity (BMI ≥ 30 kg/m2), but the association is mediated by the waist:height ratio (WHtR) in older women and men. A total of 2862 community-dwelling older individuals aged 70–84 years were assessed for frailty using the Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight index. Obesity (BMI ≥ 30 kg/m2) was associated with a higher risk of frailty compared with BMI 18·5–<23 kg/m2 in all the older individuals (OR 1·88; 95 % CI 1·11, 3·17; P = 0·018) and in older women (OR 1·86; 95 % CI 1·01, 3·42; P = 0·047) before adjusting for WHtR but was not associated with BMI after adjusting for WHtR. Additionally, obesity was not significantly associated with the risk of frailty before and after adjusting for WHtR in older men. Mediation analysis reveale...
Variations in the provision of healthcare services among hospitals have been an important issue o... more Variations in the provision of healthcare services among hospitals have been an important issue of outcomes research on quality of care. This variability in outcomes represents inconsistencies in care, suggesting a considerable room for quality improvement. In the United States, to narrow the variability in the provision of healthcare services for ensuring the quality of care, the National Surgical Quality Improvement Project has allowed comparative assessment of outcomes and developed a set of quality indicators for continuous quality improvement within the Veterans Affairs health system . In a study examining hospital variations, Garnick et al. reported wide variations in 30-day postadmission hospital mortality rates. Hospital rankings by 30-and 180-day mortality rates after admission, however, did not yield markedly different results. Rosenthal et al. [3] also found nearly a three-fold variation across hospitals in both in-hospital and 30-day mortality rates, with substantial variations in discharge practices. In Korea, given the usefulness of mortality as a quality indicator, hospital mortality at discharge has been used for assessing outcomes of hospital practice [4], with 30-day mortality rates after discharge being evaluated in various studies . Lee et al. [7], using administrative data, found large variations in hospital standardized mortality ratios among hospitals with more than 700 beds.
As the proportion of the elderly population increases rapidly, interest in musculoskeletal health... more As the proportion of the elderly population increases rapidly, interest in musculoskeletal health is also emerging. Here, we investigated how antioxidant vitamin intake and musculoskeletal health are related. Adults aged 50 to 80 years with a body mass index (BMI) of 18.5 to 27.0 kg/m 2 were included. Bone mineral density (BMD), lean mass (LM), appendicular skeletal muscle mass index (ASMI) were measured using dual-energy X-ray absorptiometry (DXA), and the grip strength and knee extension using hand dynamometer. Nutrient intakes were measured using a 24-hour recall questionnaire. A total of 153 adults (44 men and 109 women) participated in this study. A partial correlation analysis showed a significant positive relationship between vitamin E and BMD and between vitamin C and LM/ Height. Participants were classified into three groups according to whether their vitamin E and C intake met the recommended intake for Dietary Reference Intakes for Koreans (KDRIs). The prevalence of having low T-score (< -1.0) and low ASMI (< 7.0 for men and < 5.4 for women) was 51.3% and 15.4% in the group with vitamins C and E intakes below KDRIs. After adjusting for sex, smoking status and energy, protein, vitamin D, and calcium intake, the group with vitamins C and E both below the KDRIs displayed a significantly lower BMD at all test sites and LM/Height compared with vitamin C and/or E intake above the KDRIs groups. We conclude that sufficient intake of vitamin E and C is important for maintaining BMD and lean mass in Korean adults over 50 years of age.
Background: The relationship between macronutrients and frailty is unclear. Previous studies have... more Background: The relationship between macronutrients and frailty is unclear. Previous studies have con rmed the relationships between energy and protein intake and physical frailty, while few studies have examined the role of carbohydrate or fat intake in the prevalence of frailty. The aim of this study is to investigate the relationship of energy and macronutrients with physical frailty in the Korean elderly population who had a high proportion of energy intake from carbohydrates. Methods: This study included 954 adults aged 70 to 84 years who have completed the assessment of frailty and 24-h recall upon enrolment in the Korean Frailty and Aging Cohort Study and have no extreme intake under 400 kcal (n = 2). The relationship between energy or macronutrients and frailty was evaluated using multivariate logistic regression models and multivariate nutrient density models. Results: In the subjects with low energy intake (odds ratio [OR] = 2.94, 95% con dence interval [CI] = 1.34-6.45) and total subjects (OR = 2.01, 95% CI = 1.03-3.93), consuming carbohydrates above the acceptable macronutrient distribution range (65% of energy) was related to a higher risk of frailty. Substituting the energy from fat with carbohydrates was related to a higher risk of frailty (1%, OR = 1.05, 95% CI = 1.00-1.09; 5%, OR = 1.26, 95% CI = 1.02-1.56; 10%, OR = 1.59, 95% CI = 1.03-2.43). Conclusions: This study showed that the proportion of energy intake from carbohydrates and fats may be an important nutritional intervention factor for reducing the risk of frailty.
To examine whether hospital-based healthcare technology is related to 30-day postoperative mortal... more To examine whether hospital-based healthcare technology is related to 30-day postoperative mortality rates after adjusting for hospital volume of cardiovascular surgical procedures.
Purpose This study aimed at examining the ever and recommended screening inequalities of cancers ... more Purpose This study aimed at examining the ever and recommended screening inequalities of cancers (gastric, breast, and cervical) in rural and urban areas including socio-economic disparities, from 2007 to 2012 amongst Koreans. Methodology This cross-sectional population-based study used data from the Korean National Health and Nutrition Examination Survey (KNHANES) of 2007–2012. It included people with no previous cancer diagnosis for gastric, breast, and cervical cancers. Annual Percent Change (APC) was calculated at 95% confidence interval using STATA version 13.0 and MS Excel. Results In the ever cancer screening group, the screening rates and trends had an increased in both urban and rural areas: APC values were 4.6% (95% CI, 1.6 to 7.8) and 5.6% (95% CI, 2.7 to 8.6) for gastric cancers, 3.6% (95% CI, 1.5 to 5.6) and 3.6% (95% CI, -0.3 to 7.7) for breast cancers, and 0.3% (95% CI, -0.4 to 1.2) and 0.7% (95% CI, -1.0 to 1.4) for cervical cancers in urban and rural areas, respecti...
Variations in the provision of healthcare services among hospitals have been an important issue o... more Variations in the provision of healthcare services among hospitals have been an important issue of outcomes research on quality of care. This variability in outcomes represents inconsistencies in care, suggesting a considerable room for quality improvement. In the United States, to narrow the variability in the provision of healthcare services for ensuring the quality of care, the National Surgical Quality Improvement Project has allowed comparative assessment of outcomes and developed a set of quality indicators for continuous quality improvement within the Veterans Affairs health system . In a study examining hospital variations, Garnick et al. reported wide variations in 30-day postadmission hospital mortality rates. Hospital rankings by 30-and 180-day mortality rates after admission, however, did not yield markedly different results. Rosenthal et al. [3] also found nearly a three-fold variation across hospitals in both in-hospital and 30-day mortality rates, with substantial variations in discharge practices. In Korea, given the usefulness of mortality as a quality indicator, hospital mortality at discharge has been used for assessing outcomes of hospital practice [4], with 30-day mortality rates after discharge being evaluated in various studies . Lee et al. [7], using administrative data, found large variations in hospital standardized mortality ratios among hospitals with more than 700 beds.
Dementia affects 46.8 million of the world’s population, and is projected to increase to 131.5 mi... more Dementia affects 46.8 million of the world’s population, and is projected to increase to 131.5 million by 2050 (1). Increasingly, with no available disease-modifying drug or cure for the disease, preventive strategies are being pursued to curb the worldwide epidemic. Accumulating evidence supports the importance of dementia prevention, with seven risk factors (diabetes mellitus, midlife obesity, midlife hypertension, physical inactivity, depression, smoking, and low education) estimated to contribute to 9.6 million cases, equivalent to a third of Alzheimer’s disease worldwide (2). The potential public health impact of prevention is huge as a 20% reduction per decade from 2010 in the prevalence of these risk factors would translate to a 16.3% (1.5 million) reduction in dementia prevalence by 2050.
Background. Sarcopenia is an important factor of functional impairment related to aging. This stu... more Background. Sarcopenia is an important factor of functional impairment related to aging. This study is conducted to investigate the prevalence of sarcopenia and sarcopenic obesity in Korean population. Methods. Representative Korean men (4,486) and women (5,999) aged 20 years or older were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Sarcopenia was classifi ed into Class I defi ned relative skeletal muscle mass loss within 1-2 SD of the gender-specifi c mean for healthy young adults and Class II below 2 SD. Relative skeletal muscle mass was represented by the appendicular skeletal muscle mass adjusted by height and body weight. Sarcopenic obesity was considered present in Class II sarcopenic participants whose waist circumference was more than or equal to 90 cm for men and more than or equal to 85 cm for women, respectively. Results. The prevalence of Class II sarcopenia in the Korean elderly population was 12.4% for men and 0.1% for women by height-adjusted defi nition and 9.7% for men and 11.8% for women by weight-adjusted defi nition. The prevalence of sarcopenic obesity was 7.6% for men and 9.1% for women by weight-adjusted defi nition but nearly zero for men and women by height-adjusted defi nition. The prevalence of sarcopenia increased with age for men but for women only when applied with weight-adjusted defi nition. Conclusions. The prevalence of sarcopenia and sarcopenic obesity differs by gender and defi nition criteria. The heightadjusted defi nition may tend to underestimate the prevalence of sarcopenia and sarcopenic obesity, especially in women.
Background: This study investigated the impact of physical frailty on the development of disabili... more Background: This study investigated the impact of physical frailty on the development of disabilities in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) according to sex among communitydwelling Korean older adults. Methods: We used data of 2,905 older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS) at baseline (2016-2017) and Wave 2 (2018-2019). Fried's physical frailty phenotype was used to identify frailty. Results: After adjustment, frailty showed a higher impact for women than men on developing mobility disability (odds ratio [OR]=14.00, 95% confidence interval [CI]=4.8-40.78 vs. OR=9.89, 95% CI=4.28-22.86) and IADL disability after two years (OR=7.22, 95% CI=2.67-19.56 vs. OR=3.19, 95% CI=1.17-8.70). Pre-frailty led to mobility disability for women and men (OR=2.77, 95% CI=1.93-3.98 vs. OR=2.49, 95% CI=1.66-3.72, respectively), and IADL disability only for women (OR=3.01, 95% CI=1.28-7.09). Among the IADL components, both men and women who were prefrail or frail showed increased disability in 'using transportation'. Among men, pre-frailty was significantly associated with disability in "going out" and "shopping". In women, frailty was significantly associated with disability in "doing laundry, " "performing household chores, " "shopping, " and "managing money". Conclusions: Physical frailty increased disability over 2 years for women more than men. Physical frailty increased disability in outdoor activity-related IADL components in men and household work-related IADL components in women. This study highlights the need for gender-specific policies and preventative programs for frailty, particularly restorative interventions that focus on women who are physically frail.
Background Stroke recognition systems have been developed to reduce time delays, however, a compr... more Background Stroke recognition systems have been developed to reduce time delays, however, a comprehensive triaging score identifying stroke subtypes is needed to guide appropriate management. We aimed to develop a prehospital scoring system for rapid stroke recognition and identify stroke subtype simultaneously. Methods and findings In prospective database of regional emergency and stroke center, Clinical Information, Vital signs, and Initial Labs (CIVIL) of 1,599 patients suspected of acute stroke was analyzed from an automatically-stored electronic health record. Final confirmation was performed with neuroimaging. Using multiple regression analyses, we determined independent predictors of tier 1 (true-stroke or not), tier 2 (hemorrhagic stroke or not), and tier 3 (emergent large vessel occlusion [ELVO] or not). The diagnostic performance of the stepwise CIVIL scoring system was investigated using internal validation. A new scoring system characterized by a stepwise clinical assessment has been developed in three tiers. Tier 1: Seven CIVIL-AS 3 A 2 P items (total score from-7 to +6) were deduced for true stroke as Age (� 60 years); Stroke risks without Seizure or psychiatric disease, extreme Sugar; "any Asymmetry", "not Ambulating"; abnormal blood Pressure at a cutoff point � 1 with diagnostic sensitivity of 82.1%, specificity of 56.4%. Tier 2: Four items for hemorrhagic stroke were identified as the CIVIL-MAPS indicating Mental change, Age below 60 years, high blood Pressure, no Stroke risks with cut-point � 2 (sensitivity 47.5%, specificity 85.4%). Tier 3: For ELVO diagnosis: we applied with CIVIL-GFAST items (Gaze, Face, Arm, Speech) with cut-point � 3 (sensitivity 66.5%, specificity 79.8%). The main limitation of this study is its retrospective nature and require a prospective validation of the CIVIL scoring system.
The coronavirus disease 2019 (COVID‐19) pandemic has casted a huge impact on global public health... more The coronavirus disease 2019 (COVID‐19) pandemic has casted a huge impact on global public health and the economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attention. To evaluate the impacts of COVID‐19 on older people, it is important to balance the successful pandemic control and active management of secondary consequences. These considerations are particularly salient in the Asian context, with its diversity among countries in terms of sociocultural heritage, healthcare setup and availability of resources. Thus, the Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to the COVID‐19 pandemic and proposed recommendations for older people, which are germane to the Asian context. More innovative services should be developed to address the increasing demands for new appr...
Background: Aging causes both structural and functional changes in the skeletal muscle, and is as... more Background: Aging causes both structural and functional changes in the skeletal muscle, and is associated with changes in body composition form, which results in an increased incidence of cardiovascular death. Handgrip strength (HGS) is a simple, fast, reliable, and cost-effective tool for measuring muscle strength. Objective: We aimed to investigate which index was most suitable for predicting cardiovascular disease (CVD), and suggested the optimal cutoff points based on the handgrip strength index. In addition, we aimed to identify the effects of weak HGS, as determined by applying the optimal cut point on the occurrence of CVD. Method: A total of 8494 older men and women aged over 45 years from the Korean Longitudinal Study of Aging (KLoSA) were included in this study at baseline. We performed general estimating equations (GEE) with independent correlation structure to assess whether handgrip strength is longitudinally related to occurrence of CVDs such as heart disease or stroke reported from 1 st to 6th wave of KLoSA. Results: The relative HGS was strongly associated with CVD in both sexes, and the best fit model was in that in comparison to dominant HGS and absolute HGS. In addition, we calculated the optimal cut point for CVD based on the relative HGS in this study (men: 2.52 and women: 1.55, respectively), and demonstrated that low HGS, as determined by applying relative HGS cut points, was associated with a higher OR for CVD compared to normal HGS; the associations observed were consistent between the sexes. Conclusions: Our findings suggest that HGS has the potential to be a valuable screening tool for cardiovascular risk in clinical settings; this is advantageous in situations where blood sampling is not possible since HGS is easily measured and highly reproducible. It is necessary to pay attention to weak grip strength against body size in the elderly population.
Body weight is a major risk determinant of frailty, but the effect of obesity on frailty is contr... more Body weight is a major risk determinant of frailty, but the effect of obesity on frailty is controversial. The present study aimed to confirm the hypothesis that the risk of frailty is positively associated with obesity (BMI ≥ 30 kg/m2), but the association is mediated by the waist:height ratio (WHtR) in older women and men. A total of 2862 community-dwelling older individuals aged 70–84 years were assessed for frailty using the Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight index. Obesity (BMI ≥ 30 kg/m2) was associated with a higher risk of frailty compared with BMI 18·5–<23 kg/m2 in all the older individuals (OR 1·88; 95 % CI 1·11, 3·17; P = 0·018) and in older women (OR 1·86; 95 % CI 1·01, 3·42; P = 0·047) before adjusting for WHtR but was not associated with BMI after adjusting for WHtR. Additionally, obesity was not significantly associated with the risk of frailty before and after adjusting for WHtR in older men. Mediation analysis reveale...
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