Development of a senior-specific, citizen-oriented healthcare service system in South Korea based on the Canadian 48/6 model of care

BACKGROUND: In the age of aging, Korea's current medical delivery system threatens to increase the number of medical and caring refugees. This study attempts to develop an integrated senior citizen-oriented healthcare service system in which daily care, professional care, and rehabilitation are organically organized between medical institutions and local communities, thereby meeting the daily life needs of the elderly and inducing well-being, wellness, and well-dying. METHODS: To develop the integrated healthcare system, data collection and analyses were conducted through a systematic review, literature review, benchmarking, focus group interviews, and expert consultation. RESULTS: The senior-specific, citizen-oriented healthcare service system developed in this study is designed to screen patients aged 65 or older within 24 h of being admitted, using the Geriatric Screening for Care-10. If there is reason for concern as a result of the screening, further evaluation is performed through assessment. Doctors and nurses create a care plan and a discharge plan based on the results from the screening and assessment. The nurse further uses the screening to monitor the patient's condition before discharge. Based on the screening results at the time of discharge, a transitional care plan is prepared and provided to elderly patients and/or their families. This process enables a systematic link between medical institutions and community resources, aiming for the continuous management of health issues. It also establishes a multidisciplinary treatment plan that considers patients and their families so that diseases common to the elderly are diagnosed and treated promptly. CONCLUSIONS: The most important issue for the elderly is to be able to live healthily and independently for the rest of their lives through well-being, wellness, and well-dying. The senior-specific, citizen-oriented healthcare service proposed in this study is an integrated medical treatment system for elderly users the implementation of which requires the daily care, professional care, and rehabilitation of elderly members of society to be organically organized according to the role of the patients, their families, and the caregiver.ope

Association of Geriatric Syndromes with Urinary Incontinence according to Sex and Urinary-Incontinence-Related Quality of Life in Older Inpatients: A Cross-Sectional Study of an Acute Care Hospital

BACKGROUND: Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. We investigated the relationship between geriatric syndromes and UI according to gender and UI-related QOL among older inpatients. METHODS: This study was conducted among 444 older inpatients (aged 65 years and older) between October 2016 and July 2017. We examined geriatric syndromes and related factors involving cognitive impairment, delirium, depression, mobility decline, polypharmacy, undernutrition, pain, and fecal incontinence. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations. RESULTS: Geriatric syndromes and related factors were associated with UI. Mobility decline (odds ratio [OR], 4.16; 95% confidence interval [CI], 2.29-7.56), polypharmacy (OR, 3.35; 95% CI, 1.89-5.92), and pain (OR, 6.80; 95% CI, 3.53-13.09) were related to UI in both genders. Especially, delirium (OR, 7.55; 95% CI, 1.61-35.44) and fecal incontinence (OR, 10.15; 95% CI, 2.50-41.17) were associated with UI in men, while cognitive impairment (OR, 4.19; 95% CI, 1.14-15.44) was significantly associated with UI in women. Patients with depression were more likely to have poor UI-related QOL (OR, 8.54; 95% CI, 1.43-51.15). CONCLUSION: UI was associated with different geriatric syndromes and related factors according to gender. Care for patients with depression, related to poor UI-related QOL, should be considered in primary care to improve the UI-related QOL of these individuals.ope

웹 검색량 기반 주가 변동 예측을 위한 변화하는 주식 관계 모델링

학위논문(석사) -- 서울대학교대학원 : 공과대학 협동과정 인공지능전공, 2023. 2. 강유.Given historical stock prices and web search volumes of selected keywords, how can we accurately predict stock price predictions? Stock price movement prediction is an attractive task for its applicability in real-world investments. Even a slight improvement in performance can lead to enormous profit. However, the task is extremely challenging due to the inherently volatile and random nature of the stock market. To overcome such difficulties, many researchers have tried to utilize relationships between stocks to make predictions. Despite the effort, previous works have failed to incorporate the dynamic characteristic of stock relationships as they heavily relied on predefined concepts to find stock correlations. However, correlations between stocks change over time and are not dependent on a single criterion. In this paper, we propose GFS (Graph-based Framework using changing relations for Stock price movement prediction), a novel framework for stock price movement prediction using web search volumes to capture the changing relations between stocks. GFS combines relationship information from stationary connections based on predefined concepts with variable connects made from the correlations of each stocks web search volumes collected using tickers. In addition, from the fact that stock prices are affected by global trends, we collect web search volumes of 5 keywords that best represent a common denominator of the target stocks. Experimental results on a 1-year dataset of semiconductor stocks listed in the U.S. stock market show that our model achieves higher accuracy than its baselines.과거 주가와 관련 키워드 웹 검색량이 주어졌을 때 주가의 변동을 어떻게 정확하게 예측할 수 있을까? 주가 예측은 많은 각광을 받고 있으며 약간의 성능 개선으로도 실제 투자에서 많은 이익을 얻을 수 있기에 매우 매력적인 주제이다. 주가의 움직임을 예측한다는 것은 비록 간단해보이지만 주가의 본질적인 변동성으로 인해 매우 어렵다. 이를 극복하기 위한 방안으로 많은 방법들이 주식 간 상관관계 정보를 활용하기 위해 시도해 왔다. 그러나 이전 연구들은 사전에 정의된 정보를 기반으로 고정된 관계만을 사용하거나 과거 가격만을 사용하여 계속해서 변화하는 주식들간의 관계를 예측에 활용하는데 실패하였다. 본 논문에서는 주식 관계의 동적 변화를 사용해 주가의 변동을 예측하는 방법인 GFS (Graph-based Framework using changing relations for Stock price prediction)를 제안한다. GFS는 사전에 정의된 정보를 활용한 그래프와 함께 웹 검색량으로부터 주식들간의 상관관계를 계산하여 매번 새로운 그래프를 생성하여 사용한다. 또한, GFS 는 뉴스로부터 글로벌 산업 트렌드를 나타내는 키워드를 추출하여 얻은 웹 검색량의 특성을 효과적으로 추출하여 글로벌 산업 트렌드 벡터를 생성한다. 두 그래프와 글로벌 산업 트렌드 벡터는 모두 GFS가 정확한 주가 변동을 예측 하는 것에 상당 부분 기여하며, 실험 결과를 통해 GFS가 주가 변동 예측 분야에서 최고 수준의 정확도를 제공함을 확인할 수 있다I. Introduction 1 II. Related Work 7 2.1 Individual Stock Price Prediction 7 2.2 Correlated Stock Price Prediction 8 III. Proposed Method 9 3.1 Overview 9 3.2 Attentive Feature Extraction 12 3.3 Utilization of Stationary and Trend Graphs 14 3.4 Keyword-based global trend extraction 15 3.5 Stock Price Movement Prediction 15 IV. Experiment 17 4.1 Experiment Settings 17 4.2 Classification Performance 18 4.3 Ablation Study 18 V. Conclusion 21 References 22 Abstract in Korean 24석

Applicability of the 48/6 Model of Care as a Health Screening Tool, and its Association with Mobility in Community-Dwelling Older Adults

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults. METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA. RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = -10.567, P < 0.001), dysphagia (β = -9.610, P = 0.021), and pain (β = -7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age. CONCLUSION: The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.ope

Development of the Korean framework for senior-friendly hospitals: a Delphi study

BACKGROUND: Aging is an inevitable part of life. One can maintain well-being and wellness even after discharge and/or transition if his or her functional decline is minimized, sudden decline is prevented, and functioning is promoted during hospitalization. Caring appropriately for elderly patients requires the systematic application of Senior-Friendly Hospital principles to all operating systems, including medical centres' organization and environment, as well as patient treatment processes. The Senior-Friendly Hospital framework is valid and important for patient safety and quality improvement. This study aimed to make recommendations regarding the development of the Korean Framework for Senior-Friendly Hospitals for older patients' care management, patient safety interventions, and health promotion, via a Delphi survey. METHODS: Two rounds of Delphi surveying were conducted with 15 participants who had at least 3 years' experience in accreditation surveying and medical accreditation standards, survey methods, and accreditation investigator education. In each round, we calculated statistics describing each standard's validity and feasibility. RESULTS: The Korean Framework for Senior-Friendly Hospitals included 4 Chapters, 11 categories, and 67 standards through consensus of the Senior-Friendly Hospitals task force and experts' peer review. After the two rounds of Delphi surveying, validity evaluation led to no changes in standards of the Senior-Friendly Hospitals; however, the number of standards showing adequate validity decreased from 67 to 58. Regarding feasibility, no changes were necessary in the standards; however, the number of categories showing adequate feasibility decreased from 11 to 8 and from 67 to 30, respectively. The excluded categories were 3.2, 4.2, and 4.3 (service, transportation, and signage and identification). The highest feasibility values were given to standards 2.1.1, 4.1.4, and 4.1.6. The highest feasibility score was given to standard 2.4.2. CONCLUSIONS: The Korean Framework for Senior-Friendly Hospitals needs to include 4 Chapters, 8 categories, and 30 standards. The Accreditation Program for Healthcare Organizations should include Senior-Friendly Hospitals -relevant standards considering Korea's medical environment.ope

Senior Friendly Hospital: A New Paradigm for the Hospital-based

Senior friendly hospital, which is a new paradigm of elderly medical service, is a future-oriented elderly medical management system that can improve the quality of life, health and safety by offering a safe medical treatment system to optimize the participation for self-oriented health management and to respect individuals’ decision making, when it comes to therapeutic intervention. Seeing some cases of a few advanced countries which has already implemented senior friendly hospital system, not only is it an evidence-based medical system, which focuses on applying the general system and culture of the acute phase hospital, but also it has experienced the physical environmental change. Its therapeutic excellence for the elderly has been demonstrated by emphasizing the strengthening of ability through education and training of participating employees. Therefore, in order to establish the senior friendly hospital voluntarily, and recognize the significance of elderly medical service in the medical institution in Korea, active consideration of introducing the senior friendly hospital accreditation system under the support of Ministry of Health and Welfare is necessary, as in the case of Taiwan.ope

Association of High-Risk Drinking with Metabolic Syndrome and Its Components in Elderly Korean Men: The Korean National Health and Nutrition Examination Survey 2010–2012

Background: Previous studies have examined the association between alcohol consumption and metabolic syndrome (MetS) in adults, but studies in the elderly are lacking. We examined the relationship between high-risk alcohol consumption and MetS in elderly Korean men using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire from the 2010-2012 Korean National Health and Nutrition Examination Survey. METHODS: Among 25,534 subjects, 2,807 were men &gt;60 years of age; after exclusions, we included 2,088 men in the final analysis. We categorized the study participants into three groups according to AUDIT score: low risk (0-7), intermediate risk (8-14), and high risk (≥15 points). RESULTS: Among the study population, 17.0% of the men were high-risk drinkers, who had the highest mean waist circumference, systolic and diastolic blood pressure (BP), fasting plasma glucose (FPG), and triglyceride (TG) levels. The overall prevalence of MetS was 41.9% in the elderly men, and it was significantly higher in the group with high (48.3%) versus low (31.9%) AUDIT scores. The prevalence of MetS components (elevated BP, high FPG, high TG, and low high-density lipoprotein cholesterol) was associated with a high AUDIT score. The odds ratios (95% confidence interval) of the high-risk group for MetS, elevated BP, and high TG were 1.40 (1.03-1.89), 1.82 (1.28- 2.60), and 1.77 (1.30-2.41) after adjustment for confounding variables. CONCLUSION: AUDIT score was correlated with most MetS components in elderly Korean men.ope

Longitudinal Observation of Muscle Mass over 10 Years According to Serum Calcium Levels and Calcium Intake among Korean Adults Aged 50 and Older: The Korean Genome and Epidemiology Study

The aim of this study was to investigate the longitudinal change in muscle mass over 10 years according to serum calcium levels and calcium intake. A total of 1497 men and 1845 women aged 50 years and older were included. Significant muscle loss (SML) was defined as a 5% or greater loss from baseline, while time-dependent development of SML was assessed according to quartiles for corrected calcium level and daily calcium intake using Cox regression models. The incidence of SML was 6.7 and 7.7 per 100-person-years among men and women, respectively. Groups with the lowest corrected calcium levels had more prominent SML than those with higher calcium levels, regardless of sex. The relationship between SML and calcium intake was significant only among women. The hazard ratio for SML per 1 mmol/L increase in corrected calcium level was 0.236 and 0.237 for men and women, respectively. In conclusion, low serum calcium levels may predict SML among adults aged ≥ 50 years, while low calcium intake may be a predictor for muscle loss among women. Therefore, encouraging dietary calcium intake among middle-aged and older adults for preservation of muscle mass should be considered.ope

Calcium Supplementation, Risk of Cardiovascular Diseases, and Mortality: A Real-World Study of the Korean National Health Insurance Service Data

Few studies have investigated the effects of calcium supplementation on cardiovascular outcomes in individuals with low calcium intake in real-world settings. This study examined the association between calcium supplementation and cardiovascular outcomes in the Korean population in a real-world setting. This large retrospective cohort study included patients aged ≥45 years first prescribed calcium supplements in 2010. Age- and sex-matched controls were recruited among those who had no prescription for calcium supplements. Longitudinal data were collected on 31 December 2018. Kaplan-Meier estimation and Cox proportional hazard regression analysis were performed. The cumulative incidence of acute myocardial infarction, ischemic stroke, and death was significantly higher in the calcium supplementation group than in the control group (p &lt; 0.05 by log-rank test). The calcium supplementation group had a significantly higher risk of myocardial infarction, ischemic stroke, and death than the control group. Compared to the control group, the hazard ratios (95% confidence intervals) of the incidence of myocardial infarction, stroke, and death in the supplementation group were 1.14 (1.03-1.27), 1.12 (1.05-1.20), and 1.40 (1.32-1.50), respectively, after adjusting for confounding variables. Considering the associated cardiovascular risk, calcium supplementation for osteoporosis treatment should be administered cautiously.ope

Lifestage Sex-Specific Genetic Effects on Metabolic Disorders in an Adult Population in Korea: The Korean Genome and Epidemiology Study

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