The Effect of a Comprehensive Intervention Program on the Functional Status and Bone Density of the Socially-Vulnerable and Frail Elderly

In Sook Lee; Kwang Ok Lee

doi:10.12799/jkachn.2016.27.1.51

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Lee and Lee: The Effect of a Comprehensive Intervention Program on the Functional Status and Bone Density of the Socially-Vulnerable and Frail Elderly

Original Article

J Korean Acad Community Health Nurs 2016;27(1):51-59.

Published online: 12 March 2016

DOI: https://doi.org/10.12799/jkachn.2016.27.1.51

The Effect of a Comprehensive Intervention Program on the Functional Status and Bone Density of the Socially-Vulnerable and Frail Elderly

In Sook Lee¹, Kwang Ok Lee²

¹College of Nursing, Seoul National University, Seoul, Korea

²Department of Nursing, Sangmyung University, Cheonan, Korea

Corresponding author: Lee, Kwang Ok Department of Nursing, Sangmyung University, 31 Sangmyungdae-gil, Dongnam-gu, Cheonan 330-720, Korea. Tel: +82-41-550-5432, Fax: +82-41-550-5545, E-mail: kolee@smu.ac.kr

Received 21 February 2016 Revised 21 March 2016 Accepted 22 March 2016

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

The purpose of this study is to provide a disease management, nutrition education, and group exercise program for three months to the moderately frail elderly whose physical functions have deteriorated, and to investigate its effects in order to develop an intervention program.

Methods

As a quasi-experiment, this study was conducted based on non-equivalence studies designed as a similar experiment. The milk intake group and calcium intake group participated in the disease education, individual nutrition education, and group exercise program for three months, and the control group was visited once in the three months by a nurse who provided disease education, nutrition education, and oral instruction of exercise, and asked them to exercise on their own every day. For the data analysis, x²-test, ANOVA and Scheffé test were used.

Results

After three months of intervention, there was a significant difference in the frailty level (p=.029) and bone density (p=.001) between the groups.

Conclusion

The comprehensive intervention program had an effect on the bone density and the frailty level of the socially-vulnerable and moderately frail elderly, suggesting that the program can be used as a nursing intervention to prevent functional deterioration and damage of the moderately frail elderly.

Keywords: Elderly, Frail, Bone density

References

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Table 1.

Homogeneity of General Characteristics before Intervention

Characteristics	Categories	Cont.	Milk G.	Calcium G.	x² or F	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	x² or F	p
Gender	Male	15 (22.1)	13 (20.6)	14 (21.9)	0.05	.977
Gender	Female	53 (77.9)	50 (79.4)	50 (78.1)
Age (year)		74.09±5.39	73.71±4.28	75.52±5.76	2.15	.120
Academic ability	No	30 (44.1)	33 (52.4)	30 (46.9)	5.82	.667
	Elementary school	21 (30.9)	14 (22.2)	16 (25.0)
	≥Middle school	17 (25.0)	16 (25.4)	18 (28.1)
Depression		6.63±3.47	6.51±3.84	7.19±3.79	0.61	.543
BMI (kg/m²)		24.01±3.27	24.85±3.63	23.71±3.09	1.97	.142
Frailty (range: 0~31)		10.44±3.06	10.40±2.94	10.34±3.24	0.09	.915
BMD (T score)		−2.79±0.85	−2.78±0.65	−2.93±0.70	0.82	.441
Bone density					1.25	.870
Normal	≥-1.5	6 (8.8)	4 (6.3)	3 (4.7)
Osteopenia	−2.5≤T＜-1.5	19 (28.0)	16 (25.4)	16 (25.0)
Osteoporosis	＜-2.5	43 (63.2)	43 (68.3)	45 (70.3)
Total cholesterol		196.66±41.20	197.97±35.74	194.84±39.83	0.10	.903
HDL		47.32±10.60	46.95±9.42	48.73±10.54	0.54	.582
TG		156.34±103.44	4 154.97±74.32	134.84±74.46	1.28	.281
LDL		118.07±40.26	120.02±33.28	119.14±33.82	0.05	.953
Total		68 (100.0)	63 (100.0)	64 (100.0)

Cont.=control group; Milk G.=milk group; Calcium G.=calcium group; BMI=body mass index; BMD=bone mineral density; HDL=high density lipoprotein; TG=tiglyceride; LDL=low density lipoprotein.

Table 2.

Differences before and after Intervention (N=195)

Variables	Cont. (n=68)	Milk G. (n=63)	Calcium G. (n=64)	F	p
Variables	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	F	p
Frailty	−1.31±2.67	−2.44±1.95	−2.20±2.97	3.59	.029
BMD	0.25±0.36	0.49±0.46	0.54±0.52	7.69	.001
Total cholesterol	1.44±30.09	9.52±29.58	−1.05±23.02	2.51	.084
HDL	2.46±7.11	4.13±6.85	1.91±6.54	1.82	.166
TG	−11.00±66.13	3.17±80.41	0.11±62.01	0.76	.471
LDL	1.19±29.51	4.76±25.15	−2.98±20.93	1.46	.235
Depression	−1.21±3.23	−1.14±2.80	−1.14±3.64	0.07	.933

Cont.=control group; Milk G.=milk group; Calcium G.=calcium group; BMD=bone mineral density; HDL=high density lipoprotein; TG=triglyceride; LDL=low density lipoprotein.

Table 3.

Frailty and BMD after Intervention

Variables	Group (I)	Group (J)	Mean (I-J)	SD	p
Frailty	Cont.	Calcium G	0.894	.45	.138
	Cont.	Milk G.	1.135	.45	.043
	Milk G.	Calcium G	−0.241	.46	.869
	Milk G.	Cont.	−1.135	.45	.043
	Calcium G	Milk G.	0.241	.46	.869
	Calcium G	Cont.	−0.894	.45	.138
BMD	Cont.	Calcium G	−0.286	.08	.002
	Cont.	Milk G.	−0.235	.08	.012
	Milk G.	Calcium G	−0.050	.08	.820
	Milk G.	Cont.	0.235	.08	.012
	Calcium G	Milk G.	0.050	.08	.820
	Calcium G	Cont.	0.286	.08	.002

BMD=bone mineral density; Cont.=control group; Milk G.=milk group; Calcium G.=calcium group.

Table 4.

Differences of BMD before and after Intervention

Before	Groups	BMD				x²	p
Before	Groups	Normal	Osteopenia	Osteoporosis	Total	x²	p
Normal	Cont.	6 (100.0)	0 (0.0)		6 (100.0)	2.45	.296
	Milk G.	3 (75.0)	1 (25.0)		4 (100.0)
	Cont.	3 (100.0)	0 (0.0)		3 (100.0)
	Total	12 (92.3)	1 (7.7)		13 (100.0)
Osteopenia	Cont.	3 (15.8)	12 (63.2)	4 (21.0)	19 (100.0)	6.17	.187
	Milk G.	8 (50.0)	7 (43.8)	1 (6.3)	16 (100.0)
	Calcium G	5 (31.3)	10 (62.5)	1 (6.2)	16 (100.0)
	Total	16 (31.4)	29 (56.9)	6 (11.8)	51 (100.0)
Osteoporosis	Cont.	0 (0.0)	7 (16.3)	36 (83.7)	43 (100.0)	6.09	.192
	Milk G.	0 (0.0)	15 (34.9)	28 (65.1)	43 (100.0)
	Calcium G	1 (2.2)	10 (22.2)	34 (75.6)	45 (100.0)
	Total	1 (0.8)	32 (24.4)	98 (74.8)	131 (100.0)

BMD=bone mineral density; Cont.=control group; Milk G.=milk group; Calcium G.=calcium group.

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