Journal List > J Korean Acad Nurs > v.49(5) > 1136392

Park and Sohng: Effects of a Customized Health Promotion Program on Depression, Cognitive Functioning, and Physical Health of Elderly Women Living Alone in Community: A Cluster Randomized Controlled Trial

Abstract

Purpose

This study aimed to evaluate the effectiveness of a customized health promotion program (CHPP) on depression, cognitive functioning, and physical health of elderly women living alone in the community.

Methods

A randomized comparison of pre-and post-test design was used with 62 participants assigned to either an intervention (n=32 in seven clusters) or a control group (n=30 in seven clusters) in 14 areas of a town. The final sample included 30 intervention participants who completed the CHPP for 10 weeks, and 26 control participants. The intervention group participated in the CHPP weekly; they were provided with instructions about coping with their chronic illnesses, lifestyle modification, risk management, providing emotional support to each other, and floor-seated exercise, which they were encouraged to do three times a week in their homes.

Results

Significant group differences were found in depression (U=48.50, p<.001), cognitive functioning (U=2.50, p<.001), left arm flexibility (U=251.50, p=.023), right arm flexibility (U=225.00, p=.007), static balance (U=237.00, p=.012), and gait ability (U=190.50, p=.004). However, there were no significant differences in bothgrip strength and muscle mass between the two groups.

Conclusion

The findings indicate that CHPP was overall effective at improving depression, cognitive functioning, and physical functioning of elderly women living alone, and could therefore be considered a positive program for community-dwelling elderly women living alone.

References

1. Statistics Korea. 2017 Statistics of the aged [Internet]. Daejeon: Statistics Korea;c2018. [cited 2018 Sep 5]. Available from:. http://kosis.kr/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ZTITLE&parmTabId=M_01_01#SelectStatsBoxDiv.
2. Kim YS. The study of the impact of the family type on the health promoting behavior and physical and mental health of elderly people. Health and Social Welfare Review. 2014; 34(3):400–429. https://doi.org/10.15709/hswr.2014.34.3.400.
3. Statistics Korea. Survey of living conditions and welfare needs of Korean older persons [Internet]. Daejeon: Statistics Korea;c2018. [cited 2018 Sep 5]. Available from:. http://kosis.kr/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ZTITLE&parmTabId=M_01_01&parentId=D.1;D3.2;117_11771.3;117_11771_003.4;117_11771_003_117_11771_003_06.5;#SelectStatsBoxDiv.
4. Kim CG, Park S. Gender difference in risk factors for depression in community-dwelling elders. Journal of Korean Academy of Nursing. 2012; 42(1):136–147. https://doi.org/10.4040/jkan.2012.42.1.136.
crossref
5. Lee HK, Lee KH. The relations among body mass index, depression and cognitive function of elderly residents in S public health center. Journal of the Korean Data Analysis Society. 2014; 16(3):1583–1597.
6. Cheoi YH, Sin KL, Kim OS, Ko SH, Gong US, Kim KH, et al. Aging and health. 5th ed. Seoul: Hyunmoonsa;2014. p. 1–452.
7. Jang IY, Jung HW, Lee CK, Yu SS, Lee YS, Lee E. Comparisons of predictive values of sarcopenia with different muscle mass indices in Korean rural older adults: A longitudinal analysis of the aging study of Pyeongchang rural area. Clinical Interventions in Aging. 2018; 13:91–99. https://doi.org/10.2147/CIA.S155619.
crossref
8. Korea Centers for Disease Control & Prevention. Korea health statistics 2016: Korea national health and nutrition examination survey (KNHANES VII-1). Sejong: Ministry of Health and Welfare;2017.
9. Pastorino CA, Dickey T. Health promotion for the elderly: Issues and program planning. Orthopaedic Nursing. 1990; 9(6):36–42. https://doi.org/10.1097/00006416-199011000-00007.
crossref
10. Kim YS, Ha WY. A study of the effect of participation in productive leisure activities on the suicide ideation and physical and mental health of elderly living alone. Health and Social Welfare Review. 2015; 35(4):344–374. https://doi.org/10.15709/hswr.2015.35.4.344.
11. Choi MJ, Sohng KY. The effects of floor-seated exercise program on physical fitness, depression, and sleep in older adults: A cluster randomized controlled trial. International Journal of Gerontology. 2018; 12(2):116–121. https://doi.org/10.1016/j.ijge.2017.06.003.
crossref
12. Cho SH, Kim HS. A study on depression of low-income elderly people who live alone - focusing on the moderating effect of social support -. Crisisonomy. 2015; 11(11):55–71. https://doi.org/10.14251/krcem.2015.11.11.55.
crossref
13. Kim SH, Kim HS. The meta analysis of the effects of self-esteem and depression programs of the elderly. Journal of Social Science. 2014; 40(3):77–97. https://doi.org/10.15820/khjss.2014.40.3.004.
14. Park YR, Yoo YG. The effects of a health management program on health-promoting lifestyle and depression in older adults living at home. The Korean Journal of Rehabilitation Nursing. 2013; 16(1):71–78. https://doi.org/10.7587/kjrehn.2013.71.
crossref
15. Kim YS, Kim GC, Lee JW, Kim CT, Oh MJ, Kwak YS. The effects of Qi-gong exercise and elastic band exercise on fitness, ADL and depression in elderly women. Journal of Korea Society for Wellness. 2013; 8(4):293–302.
16. Killip S, Mahfoud Z, Pearce K. What is an intracluster correlation coefficient? Crucial concepts for primary care researchers. Annals of Family Medicine. 2004; 2(3):204–208. https://doi.org/10.1370/afm.141.
crossref
17. Kwak YS, Um SY, Kapasi ZF. The effects of regular exercise on cognitive function and blood lipid in woman patient with senile dementia. Korean Society of Life Science. Korean Society of Life Science Symposium. Proceedings of the 43th International Symposium of Korean Society of Life Science; 2004 Oct 8; Dong-Eui University, Busan, Korea. Busan: Korean Society of Life Science;2004. p. 117.
18. Kee BS. A preliminary study for the standardization of Geriatric Depression Scale Short Form-Korea version. Journal of the Korean Neuropsychiatric Association. 1996; 35(2):298–307.
19. Kwon YC, Park JH. Korean Version of Mini-Mental State Examination (MMSE-K). Part Ⅰ: Development of the test for the elderly. Journal of the Korean Neuropsychiatric Association. 1989; 28(1):125–135.
20. Kim HG. The effects of home visit healthcare using a complex program on community-dwelling frail elders' strength, frailty, and depression. Journal of Korean Academy of Community Health Nursing. 2015; 26(4):405–414. https://doi.org/10.12799/jkachn.2015.26.4.405.
crossref
21. Lee HS, Park SW. Assessment of gait as a diagnostic tool for patients with dementia. Journal of the Korean Society of Physical Medicine. 2017; 12(2):129–136. https://doi.org/10.13066/kspm.2017.12.2.129.
crossref
22. Schein C, Gagnon AJ, Chan L, Morin I, Grondines J. The association between specific nurse case management interventions and elder health. Journal of the American Geriatrics Society. 2005; 53(4):597–602. https://doi.org/10.1111/j.1532-5415.2005.53206.x.
crossref
23. Kim KM, Kim HY. The systemic contemplation of sadness mediation program applied to internal senior citizens. Journal of Digital Convergence. 2015; 13(12):391–400. https://doi.org/10.14400/JDC.2015.13.12.391.
crossref
24. Lee SE, Kim BH. Predictors of depression in community dwelling older women living alone. Journal of Korean Gerontological Nursing. 2016; 18(1):1–11. https://doi.org/10.17079/jkgn.2016.18.1.1.
crossref
25. Sun JJ, Oh SH. The development and effects of the integrated dementia prevention program for life in the elderly women living alone. Journal of Convergence for Information Technology. 2017; 7(3):55–64. https://doi.org/10.22156/CS4SMB.2017.7.3.055.
crossref
26. Kim KY, Lee EJ. Effects of cognition improvement programs on normal elderly in Korea: A systematic review and meta-analysis. Journal of the Korea Gerontological Society. 2017; 37(2):431–444.
27. Kim YA, Sung YJ, Yang YA. The effects of the cognition improvement activities of the elderly in the welfare center on hand dexterity, cognition, instrumental activity of daily living and depression. The Journal of Occupational Therapy for the Aged and Dementia. 2018; 12(2):29–35. https://doi.org/10.34263/jsotad.2018.12.2.29.
crossref
28. Park KS, Jeong HY, So SY, Park YH, Yang HJ, Jung KR, et al. The effects of the activity program for preventing dementia against depression, cognitive function, and quality of life for the elderly. Journal of Oriental Neuropsychiatry. 2013; 24(4):353–362. https://doi.org/10.7231/jon.2013.24.4.353.
crossref
29. Jeong SY, Kim HC, Kim HJ, Park R. Effects of healing yoga training for old women on physical ability and stress levels. Journal of the Korea Convergence Society. 2016; 7(3):1–14. https://doi.org/10.15207/JKCS.2016.7.3.001.
crossref
30. Jung HS, Choi EH. A qualitative research on the characterization of visiting healthcare in public health centers - identification of characteristics, service process and recipient change -. Korean Journal of Health Education and Promotion. 2017; 34(5):107–119. https://doi.org/10.14367/kjhep.2017.34.5.107.
crossref

Figure 1.
Flow of participants through the trial.
jkan-49-515f1.tif
Table 1.
Customized Health Promotion Program
Session Strategies Component Contents Time (min)
1 Introduction Program introduction 20
Introducing oneself
Keeping a neighbor
Floor-seated exercise introduction 40
2 Coping assistance Health education Management of chronic disease (Diabetes mellitus, Hypertension) 20
Medication compliance
Healthy lifestyle
Physical comfort promotion Exercise Floor-seated exercise 40
3 Risk management Health education Fall-prevention 20
Physical comfort promotion Exercise Floor-seated exercise 40
4 Risk management Health education Preparing for the heat wave 20
Physical comfort promotion Exercise Floor-seated exercise 40
5 Risk management Health education Food poisoning prevention 20
Physical comfort promotion Exercise Floor-seated exercise 40
6 Coping assistance Health counseling
Self-care facilitation Cognitive function stimulation practice Drawing liberalization 20
Physical comfort promotion Exercise Floor-seated exercise 40
7 Coping assistance Health counseling
Self-care facilitation Cognitive function stimulation practice Mandarin coloring 20
Physical comfort promotion Exercise Floor-seated exercise 40
8 Coping assistance Health counseling
Self-care facilitation Cognitive function stimulation practice Puzzle matching 20
Physical comfort promotion Exercise Floor-seated exercise 40
9 Coping assistance Health counseling
Self-care facilitation Cognitive function stimulation practice Hand-knitting 20
Physical comfort promotion Exercise Floor-seated exercise 40
10 Physical comfort promotion Exercise Floor-seated exercise 40
Self-care facilitation Discussion Making a positive self image 20
Sharing health improvement practice at home and empowering
Finish Election of health leader
Closing
Table 2.
Homogeneity Test for General Characteristics and Variables (N=56)
Characteristics/Variables Con. (n=26) Exp. (n=30) χ2 or U p
M±SD or n (%) Shapiro–Wilk statistic (p) M±SD or n (%) Shapiro-Wilk statistic (p)
Age (yr) 78.5±4.02 77.2±4.70 360.00 .552
Education 3.42 .489
 Illiteracy 8 (30.8) 14 (46.7)
 Elementary school 13 (50.0) 9 (30.0)
 ≥Middle school 5 (19.2) 7 (23.3)
Religion 2.42 .657
 Yes 19 (73.1) 19 (63.3)
 No 7 (26.9) 11 (36.7)
Alcohol drinking 0.09 .763
 Yes 2 (7.7) 3 (10.0)
 No 24 (92.3) 27 (90.0)
Smoking 2.74 .097
 Yes 0 (0.0) 3 (10.0)
 No 26 (100.0) 27 (90.0)
Perceived health status 3.75 .441
 Healthy 3 (11.5) 6 (20.0)
 Moderate 9 (34.6) 6 (20.0)
 Not healthy 14 (53.9) 18 (60.0)
GDSSF-K 10.31±2.62 10.73±2.03 386.00 .947
.84 (.001) .92 (.034)
MMSE-K 22.92±1.09 22.67±2.06 330.00 .486
.92 (.074) .92 (.036)
Muscle mass (%) 18.67±2.01 19.74±5.44 357.50 .742
.27 (<.001) .51 (<.001)
G.S.
 Left (kg) 17.49±3.91 16.37±4.80 347.00 .480
.96 (.501) .94 (.105)
 Right (kg) 18.31±5.28 16.59±4.79 352.50 .538
.81 (<.001) .94 (.111)
A.F.
 Left (cm) 22.15±11.00 22.75±12.66 371.50 .761
.96 (.581) .92 (.032)
 Right (cm) 18.75±9.00 20.07±13.10 364.50 .675
.93 (.121) .85 (.001)
S.B. (sec) 6.96±7.04 7.46±7.94 380.00 .870
.66 (<.001) .70 (<.001)
G.A. (sec) 5.98±0.84 6.03±1.60 331.50 .336
.92 (.074) .87 (.002)

Cont.=Control group; Exp.=Experimental group; M=Mean; SD=Standard deviation; G.A.=Gait ability; GDSSF-K=Geriatric depression scale short form-Korean version; G.S.=Grip strength; MMSE–K=Mini-mental state examination-Korean version; S.B.=Static balance.

Mann-Whitney U test.

Table 3.
Differences in Dependent Variables between Groups (N=56)
Variables Cont. (n=26) Exp. (n=30) After intervention between groups difference M±SD U†† (p)
Pre - Post difference M±SD W (p) Pre - Post difference M±SD W (p)
GDSSF-K 0.54±1.30 -1.92 (.054) -5.80±2.17 -4.79 (<.001) 5.92±0.66 48.50 (<.001)
MMSE-K 0.19±1.13 -0.88 (.379) 5.30±2.18 -4.79 (<.001) -4.85±0.34 2.50 (<.001)
Muscle mass (%) -5.66±28.08 -0.94 (.347) -1.16±4.97 -1.77 (.076) -0.03±0.69 363.00 (.813)
G.S.
 Left (kg) -0.12±3.44 -0.32 (.747) 0.43±4.43 -0.08 (.931) 0.58±1.31 369.50 (.736)
 Right (kg) -0.56±4.28 -0.32 (.747) -0.21±4.22 -0.41 (.681) 1.37±1.12 346.50 (.474)
A.F.
 Left (cm) -0.38±4.08 -0.73 (.465) -7.27±4.59 -4.70 (<.001) 6.29±2.63 251.50 (.023)
 Right (cm) 1.82±6.22 -1.20 (.229) -5.74±6.07 -4.26 (<.001) 6.23±2.38 225.00 (.007)
S.B. (sec) 0.13±6.15 -0.77 (.439) 3.42±10.13 -1.98 (.047) -3.79±2.80 237.00 (.012)
G.A. (sec) -0.06±1.33 -0.87 (.381) -1.31±1.83 -3.47 (.001) 1.20±0.33 190.50 (.004)

Cont.=Control group; Exp.=Experimental group; M=Mean; SD=Standard deviation; A.F.=Arm flexibility; G.A.=Gait ability; GDSSF-K=Geriatric depression scale short form-Korean version; G.S.=Grip strength; MMSE-K=Mini-mental state examination-Korean version; S.B.=Static balance.

Wilcoxon’s signed rank test;

†† Mann-Whitney U test.

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