Older Adults In Taiwan Research Articles

Sense of Coherence among Older Adult Residents of Long-Term Care Facilities in Taiwan: A Cross-Sectional Analysis.

BackgroundGrowing evidence shows that sense of coherence (SOC) is related to health promotion. Knowledge of SOC among older adults in Taiwan is limited. The present study aimed to investigate SOC status and its relationship to personal and environmental factors among older adult residents of long-term care facilities (LTCFs) in northeastern Taiwan.MethodsThis cross-sectional study was performed in Yilan, Taiwan. With face-to-face interviews, we obtained data from 104 LTCF residents (aged 65 years and older) using the Chinese version of Antonovsky's short 13-item SOC scale. We also collected the information on personal characteristics, physical and social environmental resources. Multiple linear regression was used to analyze factors potentially influencing SOC.ResultsOf the participants, the mean score (±standard deviation) of SOC was 58.3 (±8.8), while scores on SOC subscales (comprehensibility, manageability, and meaningfulness) were 23.4 ±4.5, 17.9 ±3.8, and 17.0 ±3.2, respectively. Education level, activities of daily living and number of LTCF staff were found to be independently associated with SOC status after adjusting for demographic characteristics, health status, and environmental resources. In addition, interactions between personal and environmental factors had a crucial influence on SOC status.ConclusionsParticipants in this study had relatively low SOC scores compared to their counterparts in Western countries. In addition to personal factors, environmental factors can play a significant role in SOC status among older adult LTCF residents. Comprehensive evaluation of SOC status should consider person-environment interaction effects.

Sex Differences in Smoking Behavior Trajectory Patterns and Related Factors Among Older Adults in Taiwan

Smoking behavior changes over time in old age, and smoking patterns differ by sex and age. However, the sex-stratified smoking trajectories of older adults are not often examined. The purpose of this study was to examine the smoking trajectories of older adults and their associated factors by sex. Data were drawn from a nationally representative longitudinal study of a sample of Taiwanese adults aged 50–66 years ( n = 2097). The samples were followed from 1996 to 2007. Group-based trajectory analysis was performed. Three smoking trajectories were identified in men: non/rare smokers (42.6%), quitting smokers (16.5%), and chronic smokers (40.9%). Among men, quitting smokers were more likely to be lower educated than non/rare smokers. The male chronic smokers were more likely to be older, lower educated, and living in rural areas than the male non/rare smokers. Two smoking trajectories were identified for females: non/rare smokers (95.9%) and smokers (4.1%). Women of mainlander ethnic groups were more likely to be smokers. There are sex differences in the smoking trajectories and related factors among older adults. Tobacco control programs should be sensitive to the sex of the target population.

Leisure time activities trajectories and physical functions among older adults in Taiwan

Leisure time activities trajectories and physical functions among older adults in Taiwan

The Effects of a Diet and Exercise Program for Older Adults With Metabolic Syndrome.

The prevalence of metabolic syndrome is high among older adults in Taiwan. However, few studies have studied the effect of a combined diet and exercise program on managing metabolic syndrome (MetS) in individuals 65 years and older and living in Taiwan's rural areas. This study tests the effectiveness of a diet and exercise program on the MetS biomarkers in older community residents with MetS. This study used a quasiexperimental study design. All participants were 65 years and older and were diagnosed with MetS. The outcome variables included biomarkers (blood pressure, waist circumference, hip circumference, body mass index, blood sugar, cholesterol, and triglycerides) and demographic characteristics. The participants were distributed into a diet-and-exercise group (n = 163) and a nondiet-and-nonexercise group (n = 138). The outcome variables were examined 3 months after the start of the intervention program. The participants in the diet-and-exercise group had lower values than the nondiet-and-nonexercise group for blood pressure, waist circumference, hip circumference, body mass index, blood sugar, cholesterol, and triglyceride (all ps < .001). The diet and exercise program is an effective intervention for treating older individuals with MetS. Clear and concise information concerning the effects of diet and exercise in promoting the health of older residents with MetS is helpful to improve the health of the older adults inTaiwan.

Spatial Measurement of Mobility Barriers: Improving the Environment of Community-Dwelling Older Adults in Taiwan

Spatial Measurement of Mobility Barriers: Improving the Environment of Community-Dwelling Older Adults in Taiwan

Cognition and social-physiological factors associated with malnutrition in hospitalized older adults in Taiwan.

Malnutrition is prevalent among hospitalized geriatric patients. The aim of this study was to explore the impact of cognitive status and its associated factors on the nutritional status of hospitalized geriatric patients. A descriptive and cross-sectional study design was conducted. Two instruments, the Mini Nutritional Assessment and the Mini-Mental State Examination (MMSE), were administered to 401 geriatric participants. Linear regression was used to examine the contribution of cognitive status and its associated factors to the nutritional status of participants. Participants had a mean age of 85 years, and three quarters (73.6%) were men. Participants earned a mean MMSE score of 19.1 ± 8.0 and a mean Mini Nutritional Assessment score of 20.2 ± 5.2. Two thirds (67.1%) were at risk for malnutrition, and 22.7% experienced malnutrition. One third (33.1%) had mild-to-moderate cognitive impairment, and 32.2% had severe cognitive impairment. The MMSE scores accounted for 21% of the total variability in nutritional status. In addition, the Charlson Comorbidity Index score and care status were also significant predictors of malnutrition and, together with the MMSE scores, accounted for 53% of the variability in the nutritional status of participants in the regression model. Findings indicate that cognitive status, concomitant comorbidities, and care status are significant predictors of malnutrition. The results of this study provide information to help clinicians identify at-risk populations for malnutrition and develop appropriate nutrition programs based on individual needs.

Active Engagement in Social Groups as a Predictor for Mental and Physical Health Among Taiwanese Older Adults: A 4-year Longitudinal Study

The present research evaluated the long-term effects of late-life social participation on health conditions during 1–4 years among older adults in Taiwan. Included in this study were adults older than 65 years who were interviewed in the 1999 fourth-wave Taiwan Longitudinal Study on Aging (TLSA), re-interviewed 1 year later in the Social Environment and Biomarkers of Aging Study, and interviewed 4 years later in the fifth-wave TLSA. Participation in social groups demonstrated a positive effect on decreasing the risk of developing depressive symptoms in older Taiwanese females 4 years later, regardless of the influences of demographic characteristics and previous health conditions. Social participation emerged to benefit later mental health among active older female adults. Active participation in social groups should therefore be strongly recommended for maintaining health in old age.

Disability trajectories and associated disablement process factors among older adults in Taiwan

ObjectivesWe aimed to identify disability trajectories and examine whether the predisposing, intra-individual, and extra-individual factors in the disablement process predicted different disability trajectories among older adults in Taiwan. MethodsData were from the Taiwan Longitudinal Study on Aging (TLSA) Survey in 1996–2007 (n=3186). Disability trajectories for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were identified by using latent class growth curves modeling. Factors including demographics, health conditions, health behaviors, social relations, and use of assistive devices were significantly predicted different disability trajectories of older adults over the following 11 years by applying hierarchical logistic regression. ResultsThree disability trajectories – maintained function, progressive disability, and consistent disability – were identified. Predisposing factors such as younger age, more educational attainment, and better health conditions had protective effects of leading to a later healthier maintained function trajectory. Intra-individual factors such as engaging in leisure time activities (LTAs) were positively related to the maintained function trajectory but negatively related to the consistent disability trajectory; decreasing social networks was common to those on consistent disability trajectory; dissatisfaction with social support was noted in maintained function trajectory group. An extra-individual factor, using assistive devices, was significantly related to maintaining older adults’ disability levels, even for those who started disabled. ConclusionsThe findings suggested that predisposing, intra-individual, and extra-individual factors play different roles in the development of later disability trajectories. More educational attainment, better health conditions, active in LTAs, and using assistive devices might benefit the maintenance of functioning in Taiwanese older adults.

BMI and all-cause mortality among middle-aged and older adults in Taiwan: a population-based cohort study.

The present study investigates the relationship between BMI and all-cause mortality among middle-aged and older adults with or without pre-existing diseases. A population-based cohort study. The Taiwan Longitudinal Study on Aging is a nationwide prospective cohort study comprising a representative random sample of middle-aged and older adults. The study period was 1996-2007. We followed 4145 middle-aged and older adults, totalling 42,353 person-years. Overweight and mildly obese participants showed a 16% and 30% decrease in the risk of death, respectively, compared with those of normal weight after adjusting for potential covariates (e.g. demographic characteristics, health behaviour, co-morbidities and physical function). Underweight adults showed a 1.36-fold increased adjusted hazard ratio of death compared with normal-weight adults. Adults with a BMI of 27.0-28.0 kg/m(2) showed a significantly lower adjusted hazard ratio of all-cause mortality rate compared with adults who had normal BMI values when they had coexisting hypertension or diabetes (adjusted hazard ratio = 0.50; 95% CI 0.30, 0.81 for hypertension and adjusted hazard ratio=0.41; 95% CI 0.18, 0.89 for diabetes). The study demonstrates that underweight people have a higher risk of death, and overweight and mildly obese people have a lower risk of death, compared with people of normal weight among middle-aged and older adults. An optimal BMI may be based on the individual, who exhibits pre-existing diseases or not.

Spatial measurement of mobility barriers: improving the environment of community-dwelling older adults in Taiwan.

Mobility barriers can impede physical activity, increase the fear of falling, and pose a threat to the ability of older adults to live independently. This study investigated outdoor mobility barriers within a nonretirement public housing community located in Tainan, Taiwan. Site observations and interviews with older adult residents determined that parked motor scooters, potted plants, the rubber tiles of play areas, and a set of steps were the most important barriers. In addition, the space syntax parameters of control value and mean depth were effectively able to quantitatively measure improvements in walkability resulting from the hypothesized removal of these four barriers. These measures of improved walkability can be included in a cost-benefit analysis of spatial improvement factors to help policymakers address the mobility and accessibility needs of older adults.

Social welfare utilization and needs of older adults in Taiwan: Survey research

BackgroundThe demand for long-term care for older adults has escalated sharply. A good policy dedicated to the welfare of older adults has improved their quality of life. The purpose of this study was to explore the social welfare utilization and needs of older adults and compare their differences among age groups, genders, and functional dependency levels. MethodsThree hundred eighty-four stratified, random-sampled Taiwanese community-dwelling older adults were recruited for this survey research. Participants rated their utilization of and needs for the 30 social welfare services provided by the government on a Likert-type scale. ResultsThe most widely used and needed social welfare services by the older adults were senior monetary stipend and a subsidy for the national health insurance premium. Young-old, male, and functionally independent older adults had more knowledge of the social welfare services than their counterparts. ConclusionsWhile designing a comprehensive social welfare system, differing needs of different age groups, genders, and functional dependency levels should be taken into consideration.

A retrospective study to assess the epidemiological and economic burden of pneumococcal diseases in adults aged 50 years and older in Taiwan

Objective:Invasive pneumococcal disease (IPD) and pneumococcal pneumonia cause substantial morbidity and mortality worldwide. This retrospective study was conducted to estimate the disease burden from pneumococcal disease in older adults in Taiwan from a health insurer’s perspective.Methods:Data for the years 2002–2009 from patients aged ≥50 years with insurance records indicating pneumococcal meningitis, pneumococcal bacteremia, or hospitalized or outpatient pneumonia were obtained from the National Health Insurance Research Database in Taiwan. Admission data for inpatients, visit data for outpatients, and associated costs were extracted from the database to estimate the incidence, case fatality rates, and direct and indirect costs of pneumococcal disease episodes. These data were applied to the estimated population of Taiwan in 2010 to provide an estimated disease burden for a single year from the payer perspective.Results:The average incidence per 100,000 person years was 2.4 for IPD, 278.8 for hospitalized pneumococcal pneumonia, and 1376.4 for outpatient pneumococcal pneumonia. The average case fatality rate was 12.3% for IPD and 10.0% for hospitalized pneumonia. Hospitalized pneumonia accounted for over 90% of direct medical costs. The incidence of hospitalized pneumococcal pneumonia per 100,000 person years was 84.4 for adults of 50–64 years, 313.1 for adults of 65–74 years, 820.3 for adults of 75–84 years, and 1650.9 for adults of 85+ year of age. In 2010, it was estimated there were over 113,000 episodes of pneumococcal disease, causing almost 2000 deaths, with direct medical costs of more than NT$3.4 billion annually.Conclusions:Pneumococcal disease is a significant cause of mortality and excess healthcare expense among the elderly in Taiwan. Disease burden in older adults increases with advancing age.

Physical Self-Concept, Possible Selves, and Well-Being Among Older Adults in Taiwan

Possible selves is an important self-related construct for older adults' health behaviors and well-being. This study examines the relationships among older adults' current physical self-concept, possible selves, and physical activity participation, and it examines the mediating effect of possible selves on the relationships between physical self-concept and well-being. One hundred and sixty-three community-dwelling older adults (M age = 70.91, SD = 6.39) in Taiwan completed the survey packet assessing physical self concept, possible selves, health-related qualities of life, and life satisfaction. Bivariate correlation analyses showed that older adults' possible selves were positively related to physical self-concept and moderate physical activity participation. In addition, the link between older adults' physical self-concept and psychological well-being was mediated partially by possible selves. The results show the significance of using the construct of possible selves to examine and promote older adults' physical activity/exercise behaviors and psychological well-being.

Parents who need children's care: Exploring the association between intergenerational relations and subjective economic strain among older adults in Taiwan

Parents who need children's care: Exploring the association between intergenerational relations and subjective economic strain among older adults in Taiwan

Psychological and socioeconomic health of community‐dwelling older adults

Different dimensions of health are intertwined. The purposes of this study were: (1) to investigate the psychological and socioeconomic health status of community-dwelling older adults in Taiwan, and (2) to compare the psychological and socioeconomic health differences among people of different age groups, gender, marital status, and exercise habits. Using stratified random sampling, 384 Taiwanese community-dwelling older adults were recruited for this survey research. Based on the Health Model of Older Adults, seven constructs were measured: (1) psychological health: sleep quality, emotional health, cognitive functioning, and health promotion behaviors; (2) socioeconomic health: social engagement, social support, and financial status. Results showed that most participants were in a good state of psychological and socioeconomic health, except that 38.02% of them suffered from sleep disruptions, and the majority of them were not involved in any social group, nor engaged in any volunteer work. Young-old older adults had better psychological and socioeconomic health than middle-old and old-old older adults. Male older adults had better psychological health than female older adults; however, they had less social engagement and social support than female older adults. Married older adults and exercisers performed better in most of the psychological and socioeconomic health indicators than single/widowed older adults and non-exercisers.

Risk factors associated with adverse drug events among older adults in emergency department

BackgroundLittle is known about the emergency department (ED) visits from drug-related injury among older adults in Taiwan. This study seeks to identify risk factors associated with adverse drug events (ADEs) leading to ED visits. MethodsWe prospectively conducted a case–control study of patients 65years and older presenting to the ED. ED visits between March 1, 2009 and Feb 28, 2010 identified by investigators for suspected ADEs were further assessed by using the Naranjo Adverse Drug Reaction probability scale. For each patient with an ADE, a control was selected and time-matched from the ED population of the study hospital. The association between the risk of adverse drug events and triage, age, gender, serum alanine transaminase (ALT), serum creatinine, number of medications, and Charlson Comorbidity Index scores were analyzed using logistic regression. ResultsOf 20,628 visits, 295 ADEs were physician-documented in older adults. Independent risk factors for ADEs included number of medications (adjusted odds ratio [OR]=4.1; 95% confidence interval [CI] 2.4–6.9 for 3–7 drugs; adjusted OR=6.4; 95% CI 3.7–11.0 for 8 or more drugs) and increased concentration of serum creatinine (adjusted OR=1.5; 95% CI 1.1–2.2). Diuretics, analgesics, cardiovascular agents, anti-diabetic agents and anticoagulants were the medications most commonly associated with an ADE leading to ED visits. ConclusionsThis study suggests that prevention efforts should be focused on older patients with renal insufficiency and polypharmacy who are using high risk medications such as anticoagulants, diuretics, cardiovascular agents, analgesics, and anti-diabetic agents.

Do Interviewer and Physician Health Ratings Predict Mortality?

Despite the serious biases that characterize self-rated health, researchers rely heavily on these ratings to predict mortality. Using newly collected survey data, we examine whether simple ratings of participants' health provided by interviewers and physicians can markedly improve mortality prediction. We use data from a prospective cohort study based on a nationally representative sample of older adults in Taiwan. We estimate proportional-hazard models of all-cause mortality between the 2006 interview and 30 June 2011 (mean 4.7 years' follow-up). Interviewer ratings were more strongly associated with mortality than physician or self-ratings, even after controlling for a wide range of covariates. Neither respondent nor physician ratings substantially improve mortality prediction in models that include interviewer ratings. The predictive power of interviewer ratings likely arises in part from interviewers' incorporation of information about the respondents' physical and mental health into their assessments. The findings of this study support the routine inclusion of a simple question at the end of face-to-face interviews, comparable to self-rated health, asking interviewers to provide an assessment of respondents' overall health. The costs of such an undertaking are minimal and the potential gains substantial for demographic and health researchers. Future work should explore the strength of the link between interviewer ratings and mortality in other countries and in surveys that collect less detailed information on respondent health, functioning, and well-being.

Volunteer Transitions and Physical and Psychological Health Among Older Adults in Taiwan

This study examines the relationship between transitions in volunteering activity and physical and psychological health outcomes among older adults in Taiwan. We used 3 waves of a longitudinal survey from Taiwan (1999, 2003, and 2007) including 1,847 older adults aged 58-74. We categorized volunteer activity over time into 5 categories and used generalized estimating equations to examine the relationship between volunteer transition group membership and health outcomes. Approximately, 3% of older volunteers kept volunteering and 7% stopped or started their volunteering over time. Engaging in any volunteering, including continuous volunteering, discrete volunteering, active-to-inactive volunteering, and inactive-to-active volunteering, was significantly associated with better self-rated health and higher life satisfaction when compared with the nonvolunteering group. Only those in the continuous volunteer group and those who shifted from inactive-to-active volunteering showed a positive association with better physical function and less depression, compared with the nonvolunteering group. The results suggest that the positive relationship between volunteering and health may decline when older adults discontinue or withdraw from volunteering. More research is needed to explore the mechanism behind older people's desistance from, persistence in, and resumption of volunteer engagement.

Eight Forms of Moving Meditation for Preventing Falls in Community-Dwelling Middle-Aged and Older Adults

Background: In numerous countries worldwide, fall prevention among older adults is a major public health issue. For older adults, regular participation in moderate physical activity or exercise lowers the risks of falls. However, scant information is available regarding the prevention strategies that the most at-risk groups may undertake. The purpose of this study is to examine the effects of a fall prevention strategy, eight forms of moving meditation (EFMM), on community-dwelling middle-aged and older adults in Taiwan. Methods: This was a quasi-experimental study; 84 participants were recruited from Taipei in Taiwan. For 12 weeks, participants in the experimental group performed 30-min EFMM 3 times per week. The measurements included a Functional Reach Test (FRT), Timed Get-up-and-Go Test (TGUG), and a One-Leg Stance Test (OLST) with eyes both opened and closed. All were conducted at the baseline and 12 weeks after intervention. Results: The participants who performed EFMM showed a significant and positive performance on FRT, TGUG, and OLST with eyes opened and eyes closed compared to those in the control group. Conclusion: The results suggest that EFMM is an effective strategy for enhancing balance and functional mobility and preventing falls among community-dwelling middle-aged and older adults.

Grip strength measurement in older adults in Taiwan: A comparison of three testing positions

The purpose of this study was to explore the effects of three commonly used positions on grip strength measurement in older people. A total of 249 (113 women, 136 men) older participants, 72.8 ± 6.5 years old, participated in this study. Grip strength (kg) was measured in three positions: (i) the standard posture (sitting, elbow flexed 90°) suggested by the American Society of Hand Therapists; (ii) standing, elbow flexed 90°; and (3) standing, elbow fully extended. One-way repeated measures analysis of variance showed that grip strength was significantly greater in the standing position with the elbow fully extended than in the other two positions. The grip strengths obtained from the three positions were not all comparable in our community-dwelling older adults. Clinicians and researchers need to be cautious when choosing testing position for assessing and interpreting grip strength results obtained from these positions.