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

Seieun Oh; Young Ko

doi:10.12799/jkachn.2015.26.2.140

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

Original Article

Journal of Korean Academy of Community Health Nursing 2015; 26(2): 140-149.

Published online: 30 June 2015

DOI: https://doi.org/10.12799/jkachn.2015.26.2.140

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

Seieun Oh¹, Young Ko²

¹Department of Nursing, College of Health Sciences, Dankook University, Cheonan, Korea.

²School of Nursing, Gachon University, Incheon, Korea.

Corresponding author: Ko, Young. School of Nursing, Gachon University, 191 Hambakmoe-ro, Yeonsu-gu, Incheon 406-799, Korea. Tel: +82-32-820-4205, Fax: +82-32-820-4201, youngko@gachon.ac.kr

Received 20 April 2015 Revised 13 June 2015 Accepted 23 June 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Aged, Socioeconomic status, Health status disparities, Sex, Family

Figures and Tables

Table 1

Demographic and Socioeconomic Characteristics of Subjects

Variables	Categories	Men	Women	Total
Variables	Categories	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)

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)

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)

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)

Variables	Having difficulty in ADLs			Depressive symptoms			Self-rated Health as 'poor'
Variables	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

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.

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.

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.

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.

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.

23. Vlachantoni A. Financial inequality and gender in older people. Maturitas. 2012; 72(2):104–107. DOI: 10.1016/j.maturitas.2012.02.015.

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.

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.

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.

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