Journal List > J Korean Acad Community Health Nurs > v.26(2) > 1058373

Oh and Ko: Activities of Daily Living, Depression, and Self-rated Health and Related Factors in Korean Elderly: Focused on Socioeconomic Status and Family Support

Abstract

Purpose

This study was conducted to identify activities of daily living, depression and self-rated health and related factors for Korean Elderly.

Methods

Data from the survey for the Korean Longitudinal Study of Aging in 2010 were used. The data were analyzed using frequencies, weighted proportions, and hierarchical multiple logistic regression.

Results

Significant difference was observed in health status induced by socioeconomic status between men and women, but not among age groups. Socioeconomic status was strongly associated with self-rated health among male and female elders. Being unschooled and low net family asset were significantly related with dependency in activities of daily living and depressive symptoms among men. Only low net family asset was significantly related with depressive symptoms among women. Family support provides a slight decrease to the negative relationship between socioeconomic status and health status, especially depressive symptoms.

Conclusion

This study suggests that interventions to reduce health inequalities should target elderly with lower socioeconomic status and with poor family support, using a gender-specific approach.

Figures and Tables

Table 1

Demographic and Socioeconomic Characteristics of Subjects

jkachn-26-140-i001
Variables Categories Men Women Total
n (%) n (%) n (%)
Age (year) 65~74 1,281 (61.3) 1,490 (52.1) 2,771 (56.0)
75~84 673 (32.2) 1,018 (35.6) 1,691 (34.2)
≥85 136 (6.5) 350 (12.2) 486 (9.8)
Education No education 203 (9.7) 967 (33.8) 1,170 (23.7)
≤Elementary school 578 (27.7) 1,159 (40.6) 1,737 (35.1)
Middle school or high school 1,014 (48.5) 660 (23.1) 1,674 (33.8)
≥College 295 (14.1) 71 (2.5) 366 (7.4)
Family net assets (10,000 won) <3,500 349 (16.7) 715 (25.0) 1,064 (21.5)
3,500~9,999 424 (20.3) 660 (23.1) 1,084 (21.9)
10,000~19,999 635 (30.4) 755 (26.4) 1,390 (28.1)
≥20,000 682 (32.6) 727 (25.4) 1,409 (28.5)
Family support Living with supported family 1,151 (55.1) 1,413 (49.5) 2,564 (51.8)
Living with unsupported family 817 (39.1) 837 (29.3) 1,654 (33.4)
Living alone 122 (5.8) 607 (21.2) 729 (14.7)
Number of diagnosed disease 1.0±1.02 1.4±1.12 1.2±1.09
Total 2,090 (100.0) 2,857 (100.0) 4,947 (100.0)

%: weighted.

Table 2

Gender-stratified Prevalence of Having Difficulty in ADLs, Depressive Symptoms and Self-rated Health as 'poor' among Elderly (N=4,947)

jkachn-26-140-i002
Variables Having difficulty in ADLs Depressive symptoms Self-rated health as 'poor'
Men Women Men Women Men Women
n (%) n (%) n (%) n (%) n (%) n (%)
Total 107 (5.1) 186 (6.5)* 144 (6.9) 255 (8.9)* 634 (30.3) 1,317 (46.1)**
Age (year)
 65~74 32 (2.5) 39 (2.6) 74 (5.8) 131 (8.8)** 298 (23.3) 567 (38.1)**
 75~84 53 (7.9) 60 (5.9) 52 (7.7) 97 (9.5) 268 (39.8) 531 (52.2)**
 ≥85 22 (16.2) 87 (24.9)* 18 (13.3) 27 (7.7) 68 (50.0) 219 (62.6)**
Education
 No education 21 (10.4) 111 (11.5) 23 (11.3) 98 (10.1) 97 (47.8) 549 (56.7)*
 ≤Elementary school 33 (5.7) 56 (4.8) 54 (9.3) 110 (9.5) 207 (35.8) 549 (47.4)**
 Middle or high school 46 (4.5) 18 (2.7) 55 (5.4) 45 (6.8) 275 (27.1) 206 (31.2)
 ≥College 7 (2.4) 1 (1.4) 13 (4.4) 3 (4.2) 56 (19.0) 13 (18.6)
Family net assets (10,000 won)
 <3,500 25 (7.2) 63 (8.8) 37 (10.6) 93 (13.0) 149 (42.7) 450 (62.9)**
 3,500~9,999 25 (5.9) 41 (6.2) 30 (7.1) 56 (8.5) 144 (34.0) 308 (46.7)**
 10,000~19,999 43 (6.8) 46 (6.1) 45 (7.1) 60 (7.9) 196 (30.9) 310 (41.1)**
 ≥20,000 14 (2.1) 36 (5.0)** 32 (4.7) 46 (6.3) 145 (21.3) 248 (34.1)**
Family support
 Living with supported family 38 (3.3) 80 (5.7)** 53 (4.6) 86 (6.1) 300 (26.0) 560 (39.6)**
 Living with unsupported family 62 (7.6) 68 (8.1) 70 (8.6) 100 (11.9)** 294 (36.0) 438 (52.3)**
 Living alone 7 (5.8) 37 (6.1) 21 (17.4) 69 (11.4) 40 (33.1) 318 (52.4)**

%: weighted; ADLs=activities of daily living; *p<.05, **p<.01 for different between men and women.

Table 3

Age Groups-stratified Prevalence of Having Difficulty in ADLs, Depressive Symptoms and Self-rated Health as 'poor' among Elderly (N=4,947)

jkachn-26-140-i003
Variables Having difficulty in ADLs Depressive symptoms Self-rated Health as 'poor'
65~74 75~84 ≥85 65~74 75~84 ≥85 65~74 75~84 ≥85
n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)
Total 70 (2.5) 113 (6.7) 109 (22.5) 205 (7.4) 150 (8.9) 46 (9.4) 865 (31.2) 799 (47.3) 288 (59.1)
Education
 No education 20 (5.9) 34 (6.4) 79 (26.5) 48 (14.2) 50 (9.4) 22 (7.4) 163 (48.1) 294 (55.2) 189 (63.2)
 ≤Elementary school 22 (2.3) 45 (7.1) 21 (16.2) 85 (8.7) 63 (10.0) 16 (12.3) 377 (38.7) 311 (49.1) 68 (52.3)
 Middle or high school 28 (2.3) 29 (7.0) 6 (14.6) 64 (5.3) 31 (7.5) 5 (12.2) 294 (24.2) 165 (39.7) 22 (53.7)
 ≥College 0 (0.0) 5 (4.6) 3 (18.8) 8 (3.3) 5 (4.6) 3 (18.8) 31 (12.9) 31 (28.2) 8 (50.0)
Family net assets (10,000 won)
 <3,500 22 (4.5) 31 (7.2) 35 (23.3) 67 (13.8) 44 (10.3) 20 (13.3) 240 (49.3) 261 (61.0) 99 (66.0)
 3,500~9,999 12 (2.2) 28 (6.5) 26 (24.3) 36 (6.6) 42 (9.7) 8 (7.5) 169 (31.0) 210 (48.7) 73 (68.2)
 10,000~19,999 30 (3.5) 36 (8.4) 23 (20.4) 66 (7.8) 27 (6.3) 13 (11.5) 256 (30.2) 188 (43.7) 63 (55.8)
 ≥20,000 7 (0.8)** 18 (4.5) 25 (21.6) 36 (4.0)** 37 (9.2) 5 (4.3) 200 (22.5)** 140 (34.8)** 53 (45.3)**
Family support
 Living with SF 24 (1.6) 15 (4.3) 21 (18.3) 82 (5.3) 45 (5.7) 12 (5.0) 395 (25.7) 334 (42.3) 130 (54.4)
 Living with UF 38 (3.9) 50 (9.0) 42 (32.1) 92 (9.5) 63 (11.4) 15 (11.5) 372 (38.4) 280 (50.5) 81 (61.4)
 Living alone 8 (3.0)** 48 (6.1)* 46 (19.2)** 31 (11.7)** 41 (11.8)** 19 (16.4)** 98 (36.8)** 185 (53.3)** 76 (65.5)

%: weighted; ADLs=activities of daily living; SF=supported family; UF=unsupported family; *p<.05, **p<.01 for different among age group.

Table 4

Adjusted Odds Ratios (95% confidence intervals) of Having difficulty in ADLs, Depressive Symptoms and Self-rated Health as 'poor' among Men (N=2,090)

jkachn-26-140-i004
Variables Having difficulty in ADLs Depressive symptoms Self-rated Health as 'poor'
Model I Model II % Model I Model II % Model I Model II %
Adj. OR (95% CI) Adj. OR (95% CI) Adj. OR (95% CI) Adj. OR (95% CI) Adj. OR (95% CI) Adj. OR (95% CI)
Education
 ≥College 1.00 1.00 1.00 1.00 1.00 1.00
 Middle or high school 1.85 (0.80~4.29) 1.86 (0.80~4.35) 1.12 (0.60~2.09) 1.13 (0.60~2.12) 1.60 (1.12~2.29)* 1.60 (1.11~2.29)* 0.0
 ≤Elementary school 1.83 (0.77~4.37) 1.82 (0.76~4.36) 1.85 (0.98~3.51) 1.85 (0.97~3.52) 2.17 (1.49~3.17)** 2.12 (1.45~3.11)** 4.3
 No education 2.97 (1.18~7.51)* 2.68 (1.05~6.84)* 14.7 2.10 (1.00~4.38)* 2.00 (0.95~4.21) 9.1 3.28 (2.09~5.16)** 3.13 (1.99~4.94)** 0.0
Family net assets (10,000 won)
 ≥20,000 1.00 1.00 1.00 1.00 1.00 1.00
 10,000~19,999 3.20 (1.68~6.11)** 3.16 (1.65~6.05)** 1.8 1.39 (0.86~2.24) 1.30 (0.80~2.10) 1.57 (1.19~2.08)** 1.58 (1.19~2.10)** -1.8
 3,500~9,999 2.26 (1.11~4.58)* 2.25 (1.10~4.59)* -1.6 1.23 (0.72~2.09) 1.42 (0.66~1.96) 1.55 (1.14~2.11)** 1.57 (1.15~2.14)** -3.6
 <3,500 2.72 (1.34~5.53)** 2.49 (1.21~5.12)* 13.4 1.96 (1.18~3.28)* 1.57 (0.92~2.67) 40.6 2.43 (1.77~3.34)** 2.42 (1.75~3.34)** 0.7
Family support
 Living with supported family 1.00 1.00 1.00
 Living with unsupported family 2.29 (1.47~3.57)** 1.83 (1.25~2.66)** 1.53 (1.23~1.90)**
 Living alone 1.29 (0.55~3.04) 3.68 (2.09~6.51)** 0.93 (0.59~1.47)

ADLs=activities of daily living; ; Adj. ORs=adjusted odds ratios; Model I: Adjusted for age, educational level, family net assets, and number of diagnosed disease; Model II: Adjusted for age, educational level, family net assets, number of diagnosed disease and family support; %: Changes in adj. ORs were calculated by [ (adj. OR before controls - adj. OR after controls)/ (adj. OR before controls -1)×100] after adjusting the family support.; *p<.05, **p<.01.

Table 5

Adjusted Odds Ratios (95% confidence intervals) of Having difficulty in ADLs, Depressive Symptoms and Self-rated Health as 'poor' among Women (N=2,857)

jkachn-26-140-i005
Variables Having difficulty in ADLs Depressive symptoms Self-rated Health as 'poor'
Model I
Adj. OR (95% CI)
Model II
Adj. OR (95% CI)
% Model I
Adj. OR (95% CI)
Model II
Adj. OR (95% CI)
% Model I
Adj. OR (95% CI)
Model II
Adj. OR (95% CI)
%
Education
 ≥College 1.00 1.00 1.00 1.00 1.00 1.00
 Middle or high school 1.92 (0.19~18.98) 1.75 (0.20~17.38) 1.47 (0.41~5.31) 1.45 (0.40~5.25) 1.38 (0.72~2.68) 1.35 (0.70~2.62)
 ≤Elementary school 2.34 (0.24~22.59) 2.13 (0.22~20.52) 1.89 (0.53~6.75) 1.79 (0.50~6.40) 2.18 (1.36~4.19)* 2.08 (1.09~4.00)* 8.5
 No education 3.63 (0.37~35.10) 3.23 (0.33~31.27) 2.10 (0.58~7.58) 1.94 (0.54~7.04) 2.71 (1.39~5.26)** 2.59 (1.33~5.02)** 7.0
Family net assets (10,000 won)
 ≥20,000 1.00 1.00 1.00 1.00 1.00 1.00
 10,000~19,999 1.29 (0.80~2.07) 1.34 (0.83~2.17) 1.22 (0.81~1.83) 1.24 (0.82~1.87) 1.33 (1.06~1.68)** 1.36 (1.08~1.72)* -9.1
 3,500~9,999 1.05 (0.64~1.73) 1.14 (0.69~1.88) 1.20 (0.79~1.83) 1.19 (0.78~1.81) 1.43 (1.12~1.81)** 1.44 (1.13~1.84)* -2.3
 <3,500 1.29 (0.81~2.04) 1.52 (0.94~2.46) 1.86 (1.26~2.74)** 1.71 (1.15~2.55)** 17.4 2.58 (2.03~3.27)** 2.63 (2.06~3.36)** -3.2
Family support 1.00 1.00 1.00
 Living with supported family 1.45 (1.01~2.08)* 1.83 (1.34~2.49)** 1.43 (1.19~1.73)**
 Living with unsupported family 0.64 (0.41~1.01) 1.60 (1.12~2.28)** 1.01 (0.81~1.26)
 Living alone

ADLs=activities of daily living; ; Adj. ORs=adjusted odds ratios; Model I: Adjusted for age, educational level, family net assets, and number of diagnosed disease; Model II: Adjusted for age, educational level, family net assets, number of diagnosed disease and family support; %: Changes in adj. ORs were calculated by [ (adj. OR before controls - adj. OR after controls)/ (adj. OR before controls -1)×100] after adjusting the family support.; *p<.05, **p<.01.

References

1. Ministry of Health and Welfare. Report No.: 11-1352000-000285-13. The 3rd national health plan (2011-2020). 2011. Seoul: Ministry of Health and Welfare;2011. 07.
2. Lee SM. A study on health status by social class and the influence of social support among Korean elderly. J Korea Gerontol Soc. 2002; 22(3):135–157.
3. Woo H, Yoon I. Differences in the health status of the Korean elderly by socio-demographic factors. Health Soc Sci. 2001; 9:67–106.
4. Huisman M, Kunst AE, Mackenbach JP. Socioeconomic inequalities in morbidity among the elderly; A European overview. Soc Sci Med. 2003; 57(5):861–873.
crossref
5. Kang E. Educational attainment and subjective unhealthiness-an exploration of the mediators. Korean J Health Econ Policy. 2008; 14(1):51–74.
6. Kim HR. The relationship of socioeconomic position and health behaviors with morbidity in Seoul, Korea. Health Soc Welf Rev. 2005; 25(2):3–35.
7. Kim YS. Equity in health status and health care utilization by income: Analyzing different populations in old adults. Health Soc Sci. 2012; 31:55–81.
8. Grundy E, Holt G. The socioeconomic status of older adults: How should we measure it in studies of health inequalities. J Epidemiol Community Health. 2001; 55:895–904. DOI: 10.1136/jech.55.12.895.
crossref
9. Park K. The future of inequality in old age. Korean J Sociol. 2001; 35(6):141–168.
10. Flasherud JH, Winslow BJ. Conceptualizing vulnerable populations health-related research. Nurs Res. 1998; 47(2):69–78.
11. Jeon GS, Jang SN, Rhee SJ. The impact of socioeconomic factors on the gender difference of disability and subjective health among elderly Koreans. J Prev Med Public Health. 2009; 42(3):199–207.
12. Huisman M, Kunst AE, Andersen O, Bopp M, Borgan JK, Borrell C, et al. Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Community Health. 2004; 58:468–475. DOI: 10.1136/jech.2003.010496.
crossref
13. Kim J. Equity in health levels and health care utilization of elderly people in Korea. Soc Sci Res Rev. 2011; 27(2):65–87.
14. Kim J, Won S. The impact of late-life poverty on self-rated health: A mediated moderation model of health behaviors and social support. J Korean Gerontol Soc. 2011; 31(3):463–478.
15. Kim D, Yoo B, Min J. Analysis of factors affecting health inequalities among Korean elderly. Korean J Soc Welf Stud. 2011; 42(3):267–290.
16. World Health Organization. Strategy for integrating gender analysis and actions into the work of WHO [Internet]. Geneva: World Health Organization;2009. cited 2015 April 1. Available from: http://whqlibdoc.who.int/publications/2009/9789241597708_eng_Text.pdf.
17. Lynch JW, Kaplan GA. Socioeconomic position. In : Berkman LF, Kawachi I, editors. Social Epidemiology. New York, NY: Oxford University Press;2000. p. 13–25.
18. van Oort FV, van Lenthe FJ, Mackenbach JP. Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in the Netherlands. J Epidemiol Community Health. 2005; 59(3):214–220. DOI: 10.1136/jech.2003.016493.
crossref
19. Park JH, Lim S, Lim J, Kim K, Han M, Yoon IY, et al. An overview of the Korean longitudinal study on health and aging. Psychiatry Investig. 2007; 4(2):84–95.
20. Back JH, Lee Y. Gender difference in the association between socioeconomic status (SES) and depressive symptoms in older adults. Arch Gerontol Geriatr. 2011; 52(3):e140–e144.
21. Won CW, Yang KY, Rho YG, Kim SY, Lee EJ, Yoon JL, et al. The development of Korean activities of daily living (K-ADL) and Korean instrumental activities of daily living (K-IADL) scale. J Korean Geriatr Soc. 2002; 6(2):107–120.
22. Boey KW. Cross-validation of a short form of the CES-D in chinese elderly. Int J Geriatr Psychiatry. 1999; 14(8):608–617.
crossref
23. Vlachantoni A. Financial inequality and gender in older people. Maturitas. 2012; 72(2):104–107. DOI: 10.1016/j.maturitas.2012.02.015.
crossref
24. Deeg DJ, Portrait F, Lindeboom M. Health profiles and profile-specific health expectancies of older women and men: The netherlands. J Women Aging. 2002; 14(1-2):27–46. DOI: 10.1300/J074v14n01_03.
crossref
25. Davidson PM, Digiacomo M, McGrath SJ. The feminization of aging: How will this impact on health outcomes and services? Health Care Women Int. 2011; 32(12):1031–1045. DOI: 10.1080/07399332.2011.610539.
crossref
26. Kim J, Song Y, Paek E. Education and self-rated health: The links through labor-market status and economic status. Korean J Sociol. 2013; 47(2):211–239.
27. Jang SN. Life course approach on health disparities in older adults. J Korean Geriatr Soc. 2013; 17(3):111–117. DOI: 10.4235/jkgs.2013.17.3.111.
crossref
28. Oh YH, Bae HO, Kim YS. A study on physical and mental function affecting self-perceived health of older persons in Korea. J Korean Gerontol Soc. 2006; 26(3):461–476.
TOOLS
ORCID iDs

Young Ko
https://orcid.org/http://orcid.org/0000-0003-2708-8543

Similar articles