Factors Affecting the Quality of Life in Low-Income Older Adults with Sarcopenia: A Cross-Sectional Study

Factors Affecting the Quality of Life in Low-Income Older Adults with Sarcopenia: A Cross-Sectional Study

 

Ju-Hee Nho, and Eun Jin Kim

 

J Korean Acad Nurs. 2023 Feb;53(1):1-11. English.
Published online Feb 28, 2023.  https://doi.org/10.4040/jkan.22126

Factors Affecting the Quality of Life in Low-Income Older Adults with Sarcopenia: A Cross-Sectional Study

https://www.jkan.or.kr/search.php?where=aview&id=10.4040/jkan.22126&code=0006JKAN&vmode=FULL

---

 

Abstract

 

Purpose
This study aimed to identify the factors influencing quality of life (QoL) of low-income older adults (LOAs) with sarcopenia.

Methods
A convenience sample of 125 older adults was recruited from Jeonbuk Province, South Korea. Data were collected using a self-report questionnaire that included nutritional status, the Depression Anxiety Stress Scale-21, and the World Health Organization Quality of Life Instrument Older Adults Module. Additionally, grip strength and appendicular skeletal muscle mass, were evaluated, along with the short physical performance battery.

Results
Sarcopenia and severe sarcopenia were observed in 43.2% and 56.8% of participants, respectively. Using multiple regression analysis, depression (β = -.40, p < .001), nutritional status (β = .24, p = .003), and anxiety (β = -.15, p = .042) were identified as factors affecting the QoL of the older adults in low income groups with sarcopenia, the explanatory power of these variables was 44%.

Conclusion
The results of this study can be used to develop a nursing intervention program and establish policies to improve depression, anxiety, and nutritional status to enhance QoL of LOAs with sarcopenia.

Keywords:Anxiety; Depression; Nutritional Status; Sarcopenia; Quality of Life

---

검색했더니 맨앞에 나와있던 논문인데 주제자체가 어렵지 않아서 선택하였다. 제목만 보면 근감소증이 있는 저소득 노인의 삶의 질에 영향을 미치는 것들이 뭐가 있을까인데, 읽어보지 않아도 짐작되는 것들이 있긴 하다. 그것들을 얼마나 논리적으로 접근가능한가, 통계적으로 의미가 있는지를 확인하는 것이 논문의 역할일 것이다.

 

 

---

Introduction

 

한국에서 노인의 비율을 지속적으로 증가하고 있다. 근감소증은 나이가 들면서 진행되며, 신체의 생리적변화로 인한 악력과 근육량이 감소되기 때문에 나타나는데,  이것은 당뇨, 암, 고관절 골절과 같은 다른 질병과 밀접하게 관련된 주요 노인병문제가 되고 있다. 그러므로 근감소증는 노인의 삶의 질과 생존율에 영향을 미치고 의료, 장기요양 비용을 증가시킨다. 따라서 노인의 근감소증은 더 많은 주의가 필요하며 신중하게 평가되어야 한다.

 

목적 

1. 근감소가 있는 저소득 노인의 일반적 특성, 영양상태, 우울, 불안, 스트레스, 삶의 질을 확인한다.

2. 근감소가 있는 저소득 노인의 일반적 특성에 따른 영양상태, 우울, 불안, 스트레스, 삶의 질의 차이를 확인한다.

3. 근감소가 있는 저소득 노인의  영양상태, 우울, 불안, 스트레스, 삶의 질의 상관관계를 분석한다.

4. 근감소가 있는 저소득 노인의 삶의 질에 영향을 미치는 요인을 확인한다.

 

 

 

Participants

Inclusion criteria

 1) 65세이상

 2) 근감소증 기준에 충족되는 사람

 3) 악력, ASM(Appendicular Skeletal muscle mass) 나 근력운동 가능한자

 4) 한글 이해 가능한자

 

Exclusion criteria

 1) 치매나 인지장애

 2) 거동불가능

 

총 125명이 연구에 참여하였다.

 

 

Data collection

 자가보고식 설문지

  악력, ASM 측정

 

 

 

Measurement

1.General Characteristics

나이, 성별, 1인가구 여부,  교육, 종교, 주관적 건강상태, 신체적 문제, 질병, 근감소정도

 

2. Sarcopenia

Asian Working Group for Sarcopenia(AWGS)

 

Handgrip strength(HGS)

- The cutoff values for HGS were < 28 kg and < 18 kg for male and female, respectively.

 

Short physical performance battery(SPPB)

- The cutoff scores for SPPB were ≤ 9 points for both male and female.

 

ASM(appendicular skeletal muscle mass)

- The cut-off values for ASM were < 7.0 kg/m2 for male and < 5.7 kg/m2 for female.

 

3. Nutritional status

17-item nutiritional survey

 -protein/fruit/milk food intake, eating behavior, age, household type, pocket money, education, age, and related diseases.

-Scores were classified as follows: 0~11, 12~16, and 17~23 for high, moderate, and low risk of malnutrition, respectively.

 

4. Depression, anxiety, and stress

Depression Anxiety Stress Scale (DASS-21)

-The cut-off scores for depression, anxiety, and stress were ≥ 10 points, ≥ 8 points, and ≥ 15 points, respectively.

 

5. Quality of Life

Korean version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD)

 

 

 

 

Results

 

1. Participants' general characteristics

 

Table 1. General Characteristcs of Participants(N=125)

 

2. Participants' nutritional status, depression, anxiety, stress and QoL

Table 2. Nutritional Status, Depression, Anxiety, Stress, and Quality of Life(N=125) ; AUT=Autonomy;DAD=Death and dying;INT=Intimacy; PPF=Past,Present, and Future;SAB=Sensory abilities;SOP=Social participation

 

3. Nutritional status, depression, anxiety, stress, and QoL according to general characteristics

Table 3. Nutritional Status, Depression, Anxiety, Stress, and Quality of Life according to General Characteristics(N=125)

 

 

4. Correlation of variables

Table 4. Correlation among Nutritional Status, Depression, Anxiety, and Quality of Life(N=125)

 

 

5. Factors influencing the QoL of vulnerable older adults with sarcopenia

Table 5. Factors Affecting the Quality of Life(N=125)

Model 1 showed that the general characteristics explained 18.0% of the variance in QoL in LOAs with sarcopenia. In Model 2, nutritional status (β = .34, p < .001) significantly influenced QoL, and explanatory power increased from 9.0% to 27.0%. In Model 3, depression (β = -.40, p < .001) and anxiety (β = -.15, p = .042) significantly influenced QoL, and the explanatory power increased from 17.0% to 44.0%. The total explanatory power of QoL of LOAs with sarcopenia was 44.0% in the hierarchical regression model (F = 11.88, p < .001). In this study, a low depression score (β = -.40, p < .001), high nutritional status score (β = .24, p = .003), and low anxiety score (β = -.15, p = .042) influenced the QoL of LOAswith sarcopenia (Table 5).

 

 

 

Discussion

1.  The QoL of LOAs with sarcopenia was significantly lower than that of healthy older adults. The QoL of LOAs with sarcopenia in this study was low, possibly due to low income, lack of surrounding resources, and lack of support systems.

-이것이 핵심

 

2. The variables that significantly affected the QoL of LOAs with sarcopenia were sex, religion, subjective health status, and physical discomfort. Therefore, national and policy efforts are needed to improve QoL in LOAs.

-> 어떤 정책을 할 수 있을까?

 

3.The variables affecting depression were subjective health status and physical discomfort, and depression was negatively correlated with QoL. 

Since sarcopenia in older adults is significantly associated with an increased risk of depression, to improve the QoL of the older adults with sarcopenia it is necessary to develop a social support system using small groups of the older adults living alone and a specific program for the management of older adults with depression.

 

4.The nutritional status of older adults was poor.

 It is recommended that older adults consume more than 1.2 g/day of protein per 1 kg of body weight, which is higher than the daily recommended amount (0.9 g for the general public in Korea). 

Adequate nutritional support is recommended at an early stage to improve bodily function, thereby preventing the progression of sarcopenia in older adults.

Nutritional interventions tailored to LOAs increase nutrient intake and reduce malnutrition in all older adults.

Therefore, there is a need for public awareness of the importance of adequate daily protein intake and implementation of guidelines on daily protein intake in the older adult population in Korea.

Therefore, to improve the QoL of LOAs or alleviate the lack of social support, special evaluation and focus are needed to understand nutritional status and depression simultaneously.

 

5.The variables affecting the anxiety of the participants were one-person households, subjective health status, and physical discomfort.

To improve the QoL of older adults living alone, active nursing intervention activities that can reduce anxiety in both public and private spaces, such as social welfare centers and senior citizen centers, should be prioritized.

 

--

 discuss 의 초반에 언급했던 lack of surrounding resources, lack of social support system 을 채워주는 special 한 program 이나 intervention 필요하다고 언급하고 있다. 

그에 따른 구체적인 중재방법은 제시할 수 없는 것인가. 후속주자가 받아서 그에 따른 중재연구를 해봄직 한 것인가.

 

이 논문은 depression, nutritional status, anxiety 가 QoL 에 영향을 미치는 것을 확인했다는 것에 의의가 있는 것 같다.

근감소가 있는 저소득노인의 삶의 질을 개선하기 위해서 우울과 불안을 감소하고, 영양상태 개선을 위한 전략이 필요하다라는 것.

 

 

Conclusion

In this study, depression, nutritional status, and anxiety were factors influencing QoL in LOAs with sarcopenia. This finding provides practical and useful evidence that nursing interventions, including strategies to reduce depression, improve nutritional status, and reduce anxiety, can potentially improve QoL in LOAs with sarcopenia.