A First-year Cohort Study based on Health Behaviors of Older Adults in an Urban City: Gender and Age Differences

Ji Yeon Ha; Belong Cho; Misoon Song; Jaeyoung Lim; Ga Hye Kim; Young-soon Jung; Yeon-Hwan Park

doi:10.7475/kjan.2017.29.5.505

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Ha, Cho, Song, Lim, Kim, Jung, and Park: A First-year Cohort Study based on Health Behaviors of Older Adults in an Urban City: Gender and Age Differences

Original Article

Korean J Adult Nurs 2017;29(5):505-516.

Published online: 9 October 2017

DOI: https://doi.org/10.7475/kjan.2017.29.5.505

A First-year Cohort Study based on Health Behaviors of Older Adults in an Urban City: Gender and Age Differences

Ji Yeon Ha, BSN, RN¹, Belong Cho, Ph.D., MD², Misoon Song, Ph.D., RN¹, Jaeyoung Lim, Ph.D., MD³, Ga Hye Kim, MSN, RN¹, Young-soon Jung, Ph.D.⁴, Yeon-Hwan Park, Ph.D., RN^1,

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

²Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Korea

³Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, Korea

⁴Jongno Senior Welfare Center, Seoul, Korea

Corresponding author: Park, Yeon-Hwan College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8846, Fax: +82-2-765-4103, E-mail: hanipyh@snu.ac.kr

- This research was supported by College of Medicine, Seoul National University(No.800-20150098).

Received 28 July 201710 October 2017 Accepted 23 October 2017

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 aim of this study was to identify gender and age differences in health status and health behaviors of community-dwelling older adults in an urban city.

Methods

A convenience sample of 500 older people were recruited. Participants completed eight study instruments by face to face interview. The instruments were the Korea Instrumental Activities of Daily Living (K-IADL), Short Physical Performance Battery (SPPB), Body Mass Index (BMI), Mini Nutritional Assessment-Short Form, Stanford Research Instruments for Chronic Disease, Geriatric Depression Scale Short Form Korea version, EuroQol-5 Dimensions scale (EQ-5D), and the Study of Osteoporotic Fracture Frailty Index.

Results

71.6% were females and mean age of all participants was 74.4 years. Participants were divided into three age groups: 60 to 74 years (n=263, 52.6%), 75 to 84 years (n=207, 41.4%), and ≥85 years (n=30, 6.0%). Significant gender differences were found in educational level, marital status, family type, religion, perceived economic status, K-IADL, SPPB, grip strength, BMI, fatigue, smoking, drinking, communication with physicians and nurses, and EQ-5D. There were significant differences among the three age groups on educational level, marital status, family type, SPPB, grip strength, regular health check-up, communication with physicians and nurses, and frailty.

Conclusion

Gender difference should be taken into consideration more than age when policy and preventive programs for community-dwelling older adults in an urban city is developed.

Keywords: Health behavior, Health status, Gender, Age groups, Aged

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Table 1.

General Characteristics of Community-dwelling Older Adults (N=500

Variables	Total	Gender			Age groups
	Total	Male (n=142)	Female (n=358)	x² or t (p)	60~74(n=263)	75~84(n=207)	≥85(n=30)	x² or F (p)
	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t (p)	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or F (p)
Age (year)	74.40±6.39	74.89±6.23	74.20±6.45	1.08 (.279)	65.59±3.46	78.53±2.89	88.03±3.30	730.81 (＜.001
Educational level
Illiteracy	77 (15.4)	8 (5.6)	69 (19.3)	64.33 (＜.001)	22 (8.4)	44 (21.3)	11 (36.7)	34.68^†(＜.001
Elementary school	182 (36.4)	27 (19.0)	155 (43.3)		91 (34.6)	78 (37.7)	13 (43.3)
Junior high school	83 (16.6)	30 (21.1)	53 (14.8)		50 (19.0)	29 (14.0)	4 (13.3)
High school	98 (19.6)	45 (31.7)	53 (14.8)		62 (23.6)	35 (16.9)	1 (3.3)
≥ College	60 (12.0)	32 (22.5)	28 (7.8)		38 (1.44)	21 (10.2)	1 (3.3)
Marital status
Married	215 (43.0)	83 (58.5)	132 (36.9)	66.61^†(＜.001)	133 (50.6)	78 (37.7)	4 (13.3)	34.41^†(＜.001
Widowed	224 (44.8)	26 (18.3)	198 (55.3)		90 (34.2)	110 (53.1)	24 (80.0)
Divorced	31 (6.2)	18 (12.7)	13 (3.6)		22 (8.4)	8 (3.9)	1 (3.3)
Separated	13 (2.6)	5 (3.5)	8 (2.2)		9 (3.4)	4 (1.9)	0 (0.0)
Not married	17 (3.4)	10 (7.0)	7 (2.0)		9 (3.4)	7 (3.4)	1 (3.3)
Family type
Alone	214 (42.8)	56 (39.4)	158 (44.1)	25.89 (＜.001)	95 (36.1)	99 (47.8)	20 (66.7)	14.77 (.005)
Spouse	167 (33.4)	69 (48.6)	98 (27.4)		99 (37.6)	64 (30.9)	4 (13.3)
Others	119 (23.8)	17 (12.0)	102 (28.5)		69 (26.2)	44 (21.3)	6 (20.0)
Religion
Yes	394 (78.8)	91 (64.1)	303 (84.6)	25.71 (＜.001)	394 (77.6)	166 (80.2)	24 (80.0)	0.51 (.777)
No	106 (21.2)	51 (35.9)	55 (15.4)		59 (22.4)	41 (19.8)	6 (20.0)
Perceived economic status
Upper	20 (4.0)	4 (2.8)	16 (4.5)	8.43 (.015)	12 (4.6)	7 (3.4)	1 (3.3)	8.06 (.089)
Middle	225 (45.0)	51 (35.9)	174 (48.6)		127 (48.3)	91 (44.0)	7 (23.3)
Lower	255 (51.0)	87 (61.3)	168 (46.9)		124 (47.1)	109 (52.7)	22 (73.3)
Chronic disease
Yes	431 (86.2)	120 (84.5)	331 (86.9)	0.48 (.489)	221 (84.0)	181 (87.4)	29 (96.7)	4.07 (.131)
No	69 (13.8)	22 (15.5)	47 (13.1)		42 (16.0)	26 (12.6)	1 (3.3)
Number of comorbidity	1.92±1.40	1.82±1.35	1.95±1.41	-0.93 (.354)	1.85±1.39	2.02±1.44	1.77±1.07	1.02 (.362)
Medical service use
Clinic visit	427 (85.4)	118 (83.1)	309 (86.3)	0.84 (.359)	222 (84.4)	180 (87.0)	25 (83.3)	0.71 (.701)
	8.32±21.32	6.82±18.87	8.91±22.02	-0.99 (.323)	9.66±25.22	7.17±16.87	4.43±4.17	1.32 (.269)
Emergency room visit	21 (4.2)	4 (2.8)	17 (15.0)	0.94 (.332)	11 (4.2)	9 (4.3)	1 (3.3)	0.07 (.967)
	0.09±0.72	0.04±0.22	0.11±0.84	-1.64 (.101)	0.14±0.98	0.04±0.20	0.03±0.18	1.07 (.344)
Hospitalization	26 (5.2)	10 (7.0)	16 (4.5)	1.37 (.243)	15 (5.7)	10 (4.8)	1 (3.3)	0.41 (.817)
Number of hosp. (n=26)	1.50±1.79	1.00±0.00	1.81±2.26	-1.13 (.270)	0.11±0.69	0.05±0.21	0.03±0.18	0.95 (.536)
Hospital stay(days)(n=26)	21.89±34.61	15.20±23.89	26.06±40.08	-0.77 (.448)	1.64±11.26	0.60±6.32	0.47±2.56	0.48 (.896)

hosp.=h ospitalizations;

^† Fisher's exact test.

Table 2.

Health Status of Community-dwelling Older Adults (N=500)

Variables	Total	Gender			Age groups
	Total	Male (n=142)	Female (n=358)	x² or t (p)	60~74(n=263)	75~84(n=207)	≥85(n=30)	x² or F (p)
	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t (p)	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or F (p)
Physical health
K-IADL	10.42±1.43	10.48±1.25	10.39±1.50	0.60 (.549)	10.38±1.35	10.40±1.37	10.87±2.24	1.58 (.207)
Independent	417 (83.4)	111 (78.2)	306 (85.5)	3.92 (.048)	223 (84.8)	171 (82.6)	23 (76.7)	1.44 (.486)
Dependent	83 (16.6)	31 (21.8)	52 (14.5)		40 (15.2)	36 (17.4)	7 (23.3)
SPPB	10.49±1.92	10.78±1.76	10.37±1.96	2.29 (.023)	10.90±1.60	10.18±1.98	8.93±2.73	20.24 (＜.001)
BMI (kg/m²)	24.67±3.59	23.85±3.30	25.00±3.66	-3.25 (＜.001)	24.89±3.68	24.54±3.54	23.66±3.00	1.81 (.166)
Under weight	14 (2.8)	10 (7.0)	8 (2.2)1	12.34 (.006)	8 (3.0)	9 (4.3)	1 (3.3)	6.13 (.409)
Normal	274 (54.8)	19 (13.4)	32 (8.9)		26 (9.9)	21 (10.1)	4 (13.3)
Overweight	177 (35.4)	22 (15.5)	64 (17.9)		46 (17.5)	32 (15.5)	8 (26.7)
Obesity	35 (7.0)	91 (64.1)	254 (70.9)		183 (69.6)	145 (70.0)	17 (56.7)
Grip strength
Left hand	21.85±7.92	29.81±7.71	18.69±5.391	15.72 (＜.001)	22.87±8.24	21.14±7.22	17.90±8.26	6.89 (＜.001)
Right hand	22.90±8.29	30.61±8.97	19.84±5.591	13.32 (＜.001)	24.18±8.39	21.95±7.90	18.27±8.05	9.48 (＜.001)
MNA-SF	12.32±1.96	12.31±2.07	12.33±1.91	-0.09 (.930)	12.40±1.99	12.28±1.90	11.90±2.06	0.97 (.380)
Normal	380 (76.0)	8 (5.6)	9 (2.5)	3.16 (.206)	10 (3.8)	5 (2.4)	2 (6.7)	3.99 (.407)
At risk of malnutrition	103 (20.6)	27 (19.0)	76 (21.2)		50 (19.0)	44 (21.3)	9 (30.0)
Malnourished	17 (3.4)	107 (75.4)	273 (76.3)		203 (77.2)	158 (76.3)	19 (63.3)
Mental health
Self-rated health	1.96±0.77	1.92±0.77	1.98±0.77	-0.81 (.417)	1.95±0.76	1.98±0.78	1.90±0.84	0.18 (.832)
Very good	159 (31.8)	48 (33.8)	111 (31.0)	0.69 (.709)	83 (31.6)	64 (30.9)	12 (40.0)	1.92 (.751)
Fair	202 (40.4)	58 (40.8)	144 (40.2)		110 (41.8)	83 (40.1)	9 (30.0)
Poor	139 (27.8)	36 (25.4)	103 (28.8)		70 (26.6)	60 (29.0)	9 (30.0)
Fatigue	4.67±2.95	4.25±2.83	4.84±2.99	-1.99 (.047)	4.65±2.91	4.77±2.88	4.20±3.73	0.50 (.606)
Stress	3.71±3.01	3.61±2.77	3.75±3.11	-0.48 (.633)	3.77±2.94	3.70±3.09	3.23±3.17	0.43 (.650)
Depression (GDSSF-K)	4.96±4.26	5.38±4.36	4.79±4.21	1.40 (.163)	4.76±4.33	5.09±4.11	5.73±4.69	0.87 (.419)
Normal	313 (62.6)	85 (59.9)	228 (63.7)	1.76 (.416)	170 (64.6)	125 (60.4)	18 (60.0)	3.99 (.407)
Major depression	96 (19.2)	26 (18.3)	70 (19.6)		47 (17.9)	45 (21.7)	4 (13.3)
Severe depression	91 (18.2)	31 (21.8)	60 (16.8)		46 (17.5)	37 (17.9)	8 (26.7)

K-IADL=Korea instrumental activities of daily living; SPPB=short physical performance battery; BMI=body mass index; MNA-SF=mini nutritional assessment-short form; GDSSF-K=geriatric depression scale short form Korean version.

Table 3.

Health Behaviors of Community-dwelling Older Adults (N=500)

Variables		Total	Gender			Age groups
		Total	Male (n=142)	Female (n=358)	x² or t (p)	60~74(n=263)	75~84(n=207)	≥85(n=30)	x² or F (p)
		n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t (p)	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or F (p)
Smoking
Smoking status
Never		381 (76.2)	40 (28.2)	341 (95.3)	252.45 (＜.001)	195 (74.1)	163 (78.7)	23 (76.7)	6.08 (.193)
Former		90 (18.0)	78 (54.9)	12 (3.4)		47 (17.9)	36 (17.4)	7 (23.3)
Current		29 (5.8)	24 (16.9)	5 (1.4)		21 (8.0)	8 (3.9)	0 (0.0)
Amount of CD (n=29)		12.26±6.90	12.02±6.90	13.40±7.60	-0.40 (.692)	13.29±7.00	9.56±6.28	0 (0.0)	1.73 (.200)
Drinking
Drinking status
Never		289 (57.8)	31 (21.8)	258 (72.1)	106.53 (＜.001)	151 (57.4)	117 (56.5)	21 (70.0)	7.49 (.112)
Former		85 (17.0)	41 (28.9)	44 (12.3)		39 (14.8)	39 (18.8)	7 (23.3)
Current		126 (25.2)	70 (49.3)	56 (15.6)		73 (27.8)	51 (24.6)	2 (6.7)
Frequency of DM (n=126)		8.38±8.96	5.24±8.38	0.87±3.66	3.34 (.001)	8.67±8.93	7.78±8.86	13.00±16.97	0.41 (.662)
Exercise
Yes		415 (83.0)	120 (84.5)	295 (82.4)	0.32 (.572)	415 (83.0)	415 (83.0)	415 (83.0)	3.14 (.208)
No		85 (17.0)	22 (15.5)	63 (17.6)		85 (17.0)	85 (17.0)	85 (17.0)
Sleeping
Average SHD		6.11±1.63	6.28±1.60	6.04±1.64	1.52 (.130)	6.18±1.61	5.99±1.67	6.23±1.52	0.94 (.395)
Quite enough		176 (35.2)	56 (39.4)	120 (33.5)	5.17 (.160)	93 (35.4)	69 (33.3)	14 (46.7)	4.48 (.611)
Enough		152 (30.4)	36 (25.4)	116 (32.4)		85 (32.3)	61 (29.5)	6 (20.0)
Not enough		118 (23.6)	30 (21.1)	88 (24.6)		61 (23.2)	50 (24.2)	7 (23.3)
Not quite enough		54 (10.8)	20 (14.1)	34 (9.5)		24 (9.1)	27 (13.0)	3 (10.0)
Sleep disturbance		3.54±3.06	3.44±3.17	3.58±3.01	-0.49 (.628)	3.57±3.09	3.62±3.00	2.70±3.09	1.23 (.294)
Regular health check-up
Yes		392 (78.4)	107 (75.4)	285 (79.6)	1.09 (.297)	224 (85.2)	152 (73.4)	16 (53.3)	21.27 (＜.001)
No		108 (21.6)	35 (24.6)	73 (20.4)		39 (14.8)	55 (26.6)	14 (46.7)
Vaccination	Influenza
	Yes	414 (82.8)	117 (82.4)	297 (83.0)	0.02 (.880)	210 (79.8)	181 (87.4)	23 (76.7)	5.53 (.063)
	No	86 (17.2)	25 (17.6)	61 (17.0)		53 (20.2)	26 (12.6)	7 (23.3)
	Pneumococcus
	Yes	314 (62.8)	89 (62.7)	225 (62.8)	0.00 (.971)	159 (60.5)	138 (66.7)	17 (56.7)	2.43 (.297)
	No	186 (37.2)	53 (37.3)	133 (37.2)		104 (39.5)	69 (33.3)	13 (43.3)
	Tetanus
	Yes	30 (6.0)	12 (8.5)	18 (5.0)	2.11 (.146)	17 (6.5)	9 (4.3)	4 (13.3)	3.96 (.138)
	No	470 (94.0)	130 (91.5)	340 (95.0)		246 (93.5)	198 (95.7)	26 (86.7)
Communication with physicians and nurses		0.78±0.69	0.88±0.74	0.74±0.66	2.15 (.032)	0.87±0.72	0.69±0.63	0.59±0.68	4.99 (.007)

CD= cigarette per day; DM=drinking per month; SHD=sleep hours per day.

Table 4.

Health-related Quality of Life and Frailty of Community-dwelling Older Adults (N=500)

Variables		Total	Gender			Age groups
	Categories	Total	Male (n=142)	Female (n=358)	x² or t (p)	60~74(n=263)	75~84(n=207)	≥85(n=30)	χ² or F (p)
	Categories	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	x² or t (p)	n (%) or M± SD	n (%) or M± SD	n (%) or M± SD	χ² or F (p)
EQ-5D domain	Mobility	1.19±0.39	1.12±0.33	1.21±0.41		1.16±0.37	1.22±0.42	1.17±0.38
	No problem (1)	407 (81.4)	125 (88.0)	282 (78.8)	5.76 (.016)	221 (84.0)	161 (77.8)	25 (83.3)	3.07 (.215)
	Some problems (2)	93 (18.6)	17 (12.0)	76 (21.2)		42 (16.0)	46 (22.2)	5 (16.7)
	Bedridden (3)	0 (0.0)	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)	0 (0.0)
	Self-care	1.03±0.19	1.03±0.17	1.03±0.20		1.02±0.17	1.05±0.21	1.00±0.00
	No problem (1)	485 (97.0)	138 (97.2)	347 (96.9)	0.48^†(＞.999)	)258 (98.1)	197 (95.2)	30 (100.0)	6.45^†(.161)
	Some problems (2)	14 (2.8)	4 (2.8)	10 (2.8)		4 (1.5)	10 (4.8)	0 (0.0)
	Unable (3)	1 (0.2)	1 (0.2)	1 (0.3)		1 (0.4)	0 (0.0)	0 (0.0)
	Usual activity	1.09±0.28	1.06±0.23	1.10±0.30		1.08±0.27	1.11±0.31	1.03±0.18
	No problem (1)	457 (91.4)	134 (94.4)	323 (90.2)	2.22 (.159)	243 (92.4)	185 (89.4)	29 (96.7)	2.47 (.290)
	Some problems (2)	43 (8.6)	8 (5.6)	35 (9.8)		20 (7.6)	22 (10.6)	1 (3.3)
	Unable (3)	0 (0.0)	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)	0 (0.0)
	Pain/discomfort	1.52±0.59	1.37±0.51	1.57±0.61		1.50±0.58	1.58±0.61	1.27±0.52
	No (1)	267 (53.4)	91 (64.1)	176 (49.2)	11.76 (.003)	144 (54.8)	100 (48.3)	23 (76.7)	9.44 (.051)
	Moderate (2)	208 (41.6)	49 (34.5)	159 (44.4)		108 (41.1)	94 (45.4)	6 (20.0)
	Extreme (3)	25 (5.0)	2 (1.4)	23 (6.4)		11 (4.2)	13 (6.3)	1 (3.3)
	Anxiety/depression	1.29±0.53	1.28±0.53	1.30±0.53		1.28±0.51	1.29±0.55	1.37±0.61
	No (1)	374 (74.8)	109 (76.8)	265 (74.0)	0.72 (.696)	196 (74.5)	157 (75.8)	21 (70.0)	2.97 (.564)
	Moderate (2)	107 (21.4)	27 (19.0)	80 (22.3)		60 (22.8)	40 (19.3)	7 (23.3)
	Extreme (3)	19 (3.8)	6 (4.2)	13 (3.6)		7 (2.7)	10 (4.8)	2 (6.7)
EQ-5D Index (quality weighted score)		0.88±0.10	0.90±0.08	0.88±0.10	2.88 (.004)	0.89±0.09	0.87±0.10	0.89±0.09	1.82 (.163)
Frailty		0.51±0.64	0.48±0.60	0.53±0.65-	-0.73 (.465)	0.43±0.58	0.59±0.70	0.63±0.61	4.31 (.014)
	Robust	281 (56.2)	82 (57.7)	199 (55.6)	0.62 (.735)	161 (61.2)	107 (51.7)	13 (43.3)	9.97 (.041)
	Pre-frail	184 (36.8)	52 (36.6)	132 (36.9)		90 (34.2)	79 (38.2)	15 (50.0)
	Frail	35 (7.0)	8 (5.6)	27 (7.5)		12 (4.6)	21 (10.1)	2 (6.7)

^† Fisher's exact test; EQ-5D=EuroQol-5 Dimensions scale.

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