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The Burden Experience of Family Caregiver of Older Adults with Chronic Illness
Nova Yustisia, Titin Aprilatutini, Tuti Anggriani Utama, Mahmasoni Masdar
Res Community Public Health Nurs. 2023;34(2):85-95.   Published online June 30, 2023
DOI: https://doi.org/10.12799/rcphn.2022.00304
  • 3,797 View
  • 236 Download
  • 1 Citations
AbstractAbstract PDF
Purpose
This study aims to find out further about the burden on families in undertaking caregiving for the elderly with chronic illnesses.
Methods
A qualitative study was developed using in-depth interviews with 12 family caregivers selected by purposive sampling in July 2022. The thematic analysis was then carried out using the Colaizzi method, and N-Vivo 12 Qualitative Data Analysis Software was used to assist with the content analysis.
Results
The result from the experience interview analysis of caregivers participating in this study were 54 codes which were categorized into thirteen categories. Then, they were derived into four themes, as follows: 1) Physical burden of the caregivers for the elderly with chronic illness, 2) Psychological burden of the caregivers for the elderly with chronic illness, 3) Obstacle of caregivers for the elderly with chronic illness, 4) The state of caregivers who perform caregiving for the elderly with chronic illness.
Conclusion
The experience of caregivers in undertaking caregiving for the elderly with chronic disease has many obstacles, such as physical, psychological, and economic burdens. Caregivers often find positive aspects of their experiences while caregiving for the elderly, although their burden also constantly increases. Health facilities should pay serious attention to family caregivers and facilitate programs that can help reduce the burden on family caregivers.

Citations

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  • Relationship between Care Burden and Health Anxiety in the Family Caregivers of the Older Adults with Alzheimer’s Disease
    Mohammad Sadegh Sargolzaei, Daniyal Kohestani, Tahereh Alsadat Khoubbin Khoshnazar, Hossein Asghari Asl
    Ageing International.2024; 49(2): 280.     CrossRef
Factors Related to Long-term Hospital Length of Stay and Opinions on Discharge-related Community-based Medical and Welfare Service on Elderly Patients with Chronic Diseases in Korean Veterans Hospitals
Young Mi Yoon, Jin Hee Park, Moon Sook Hwang
J Korean Acad Community Health Nurs. 2022;33(4):357-371.   Published online December 31, 2022
DOI: https://doi.org/10.12799/jkachn.2022.33.4.357
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  • 58 Download
AbstractAbstract PDF
Purpose
This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. Methods: The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. Results: The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion. These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). Conclusion: In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.
Development of the Self-Care Non-adherence Risk Assessment Scale for Patients with Chronic Illness
Mi Rae Jo, Hee Young Oh
J Korean Acad Community Health Nurs. 2021;32(4):415-429.   Published online December 31, 2021
DOI: https://doi.org/10.12799/jkachn.2021.32.4.415
  • 937 View
  • 49 Download
  • 2 Citations
AbstractAbstract PDF
Purpose
The purpose of this study was to develop the Self-Care Non-adherence Risk Assessment Scale (SCNRAS) for patients with chronic illness in South Korea.
Methods
This study was conducted from April to July, 2020 and utilized a convenience sampling method to recruit 336 patients with chronic illness from three hospitals located in South Korea. The content, factorial structure, item-convergent/discriminant validity, convergent validity, internal consistency reliability, and test-retest reliability of the scale were evaluated. The data were analyzed using exploratory and confirmatory factor analyses, Pearson’s correlation coefficient, Cronbach’s ⍺, and intra-class correlation coefficient.
Results
The exploratory and confirmatory factor analyses yielded six-factors. Convergent validity was demonstrated using measures of defining issues. Internal consistency reliability and test-retest reliability were found to be acceptable, as indicated by a Cronbach’s ⍺ of .65~.81 and an intra-class correlation coefficient of .93~.98. The Self-Care Non-adherence Risk Assessment Scale for patients with chronic illness is a new instrument that comprehensively measures the knowledge, skill, physical function status, access to health care, social support, motivation, and confidence. It comprises 18 items scored on a 5-point Likert scale. The validity and reliability of the scale were verified. Conclusion: The scale developed through this study is expected to screen those who need nursing intervention early by predicting the self-care non-adherence risk group.

Citations

Citations to this article as recorded by  
  • Effects of self-care intervention using a mobile instant messenger on hemodialysis patient’s knowledge, self-efficacy, self-care behavior and physiological index
    Yu Kyung Shin, Mi Young Kim
    Journal of Korean Biological Nursing Science.2024; 26(2): 123.     CrossRef
  • Development of a Conceptual Framework for Non-Adherence to Self-Management in Patients with Chronic Obstructive Pulmonary Disease: An Exploratory Study
    Ja Yun Choi, Eui Jeong Ryu, So Young Yun, Sehyun Cho
    Korean Journal of Adult Nursing.2024; 36(2): 126.     CrossRef
Factors Affecting Unmet Healthcare Needs among Adults with Chronic Diseases
Ji-Young Han, Hyeon-Sook Park
J Korean Acad Community Health Nurs. 2021;32(2):131-139.   Published online June 30, 2021
DOI: https://doi.org/10.12799/jkachn.2021.32.2.131
  • 717 View
  • 38 Download
  • 1 Citations
AbstractAbstract PDF
Purpose
In adults with chronic diseases, unmet healthcare needs are likely to increase the risk of worsening the illness and complications. This study was conducted to explore factors affecting unmet healthcare needs among adults with chronic diseases.
Methods
A cross sectional study was performed using the data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES Ⅶ), 2016-2017. The sample of this study consisted of 6,104 adults with chronic diseases. The data were analyzed by Rao-Scott x2 test and logistic regression using complex samples analysis.
Results
The proportion of subjects who experienced unmet healthcare needs was 10.9% of adults with chronic diseases. The factors affecting unmet healthcare needs of adults with chronic diseases were age, gender, employment status, household income, subjective health status, activity limitation, and perceived stress.
Conclusion
The findings of this study suggest that various factors may be associated with their unmet healthcare needs. Finally, the development of strategies to reduce unmet healthcare needs for people with chronic diseases should consider the associated factors presented in the study.

Citations

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  • Association between Perceived Activity Restriction Due to People’s Perception of Aging and Unmet Medical Needs among Middle-Aged and Elderly People: A Population-Based Study
    Jeong-Min Yang, Min-Soo Kim, Ji-Sung Hong, Jae-Hyun Kim
    Medicina.2024; 60(1): 87.     CrossRef
The Effects of Chronic Diseases, Sleep and Serotonin Concentration on Depression among Elderly People Living in the Community
Eun Jeong Nam, Jin Kyoung Park
J Korean Acad Community Health Nurs. 2020;31(4):472-480.   Published online December 31, 2020
DOI: https://doi.org/10.12799/jkachn.2020.31.4.472
  • 810 View
  • 19 Download
  • 2 Citations
AbstractAbstract PDF
Purpose
This study identified the effects of chronic disease number, quality of sleep and, serum serotonin concentration on the elderly’s depression in order to provide basic data for the development of intervention program to effectively prevent and manage depression of the elderly living in the community.
Methods
The study surveyed 207 people aged 65 or older living in the community. The general characteristics of the subjects, the number of chronic diseases, the quality of sleep (PSQI-K), the hematological test (Serotonin) and the depression (K-GDS) were statistically analyzed using SPSS/WIN 23.0.
Results
It was shown that the elderly’s depression differed significantly depending on the number of chronic diseases, the quality of sleep, and serum serotonin concentration, and that the variable that most affected depression was the quality of sleep. Next, the number of chronic diseases and serum serotonin levels were the variables affecting the depression of the elderly. Conclusion: In order to prevent and manage the depression of the elderly in the future, treatment and education for diseases and depression should be provided to the subjects. In particular, nursing interventions are needed to improve the quality of sleep for the elderly. Health care programs should also be provided, such as providing nutritional supplements to provide serotonin and increasing daytime activities.

Citations

Citations to this article as recorded by  
  • Effects of Fatigue and Emotional Labor on Sleep Quality among Apartment Security Guards
    Chul-Gyu Kim, Sujeong Jeong, Young Mi Ryu, Seungmi Park, Kyoungmi Moon, Yunjung Kwon, Sun-A Park, Hye Ok Park
    Research in Community and Public Health Nursing.2023; 34: 205.     CrossRef
  • Factors Related to Long-term Hospital Length of Stay and Opinions on Discharge-related Community-based Medical and Welfare Service on Elderly Patients with Chronic Diseases in Korean Veterans Hospitals
    Young Mi Yoon, Jin Hee Park, Moon Sook Hwang
    Journal of Korean Academy of Community Health Nursing.2022; 33(4): 357.     CrossRef
Concept Analysis of Health Literacy for Patients with Cardiovascular Disease using Hybrid Model
Jeong Eun Sim, Seon Young Hwang
J Korean Acad Community Health Nurs. 2019;30(4):494-507.   Published online December 31, 2019
DOI: https://doi.org/10.12799/jkachn.2019.30.4.494
  • 1,801 View
  • 21 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
The purpose of this study is to provide a clear definition of the health literacy for patients with cardiovascular disease by analyzing the dimensions and properties using Hybrid concept analysis.
METHODS
The concept of health literacy of patients with cardiovascular disease was analyzed according to the cyclic process of theoretical phase-field work phase-final analysis phase presented in the Hybrid model. We reviewed 26 literatures and conducted in-depth interviews with 13 patients with cardiovascular disease.
RESULTS
The concept of health literacy in cardiovascular patients is derived from two dimensions and five attributes. Literacy skills, health information search ability and health information utilization skills were derived as attributes in the individual functional dimension, while active communication with the medical team and utilization of health information support resources were derived at the interrelational dimension. It is defined as the individualized and integrated ability of an individual to explore and utilize the various health information needed to make appropriate health decisions during the chronic course after diagnosis of cardiovascular disease, to communicate proactively with medical staffs and to utilize support resources.
CONCLUSION
This study will contribute to the development and related research of health literacy measurement tools that can be used in cardiovascular nursing practice based on the attributes and indicators of health literacy for patients with cardiovascular disease.

Citations

Citations to this article as recorded by  
  • Hypertension literacy: Concept analysis
    Kennedy Diema Konlan, Hyeonkyeong Lee, Eun Kyoung Choi
    Nursing Open.2023; 10(9): 6078.     CrossRef
Factors Influencing Health-related Quality of Life of Young Adults and Elderly with Multimorbiditiy: A Secondary Analysis of the 2013 Korea Health Panel Data
Seun Young Joe, In Sook Lee, Bo Hyun Park
J Korean Acad Community Health Nurs. 2016;27(4):358-369.   Published online December 31, 2016
DOI: https://doi.org/10.12799/jkachn.2016.27.4.358
  • 847 View
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  • 12 Citations
AbstractAbstract PDF
PURPOSE
This study was to identify health-related quality of life of Korean young adults and elderly with multimorbidity and to examine factors influencing their health-related quality of life.
METHODS
Health-related quality of life was measured by the Korean version of the EQ-5D. Using a descriptive study, the study incorporated a secondary analysis of the Korean version of the EQ-5D data from the 8th wave of the Korea Health Panel Survey in 2013. Selected demographic data and the Korean version of the EQ-5D were analyzed using χ²-test, t-test, ANOVA and multiple regression analysis.
RESULTS
Education, drinking, type of health insurance, and number of chronic disease significantly affected the health-related quality of life in the young adults with multimorbidity. Educational level, occupational type, drinking, physical activity, number of chronic disease, unmet healthcare need and the type of multimorbidity significantly affected the health-related quality of life in the elderly with multimorbidity.
CONCLUSION
The factors influencing health-related quality of life were different for young adults versus elderly with multimorbidity. Therefore, there is a need for age-specific health care programs that may improve health-related quality of life of adults with multimorbidity.

Citations

Citations to this article as recorded by  
  • Factors associated with quality of life in patients with benign prostatic hyperplasia, 2009–2016
    Sewon Park, Kyu-Sung Lee, Mankyu Choi, Munjae Lee
    Medicine.2022; 101(36): e30091.     CrossRef
  • Analysis of multiple chronic disease characteristics in South Koreans by age groups using association rules analysis
    Eul Hee Roh
    Health Informatics Journal.2022; 28(1): 146045822110702.     CrossRef
  • Experience and response to a randomised controlled trial of extended-release injectable buprenorphine versus sublingual tablet buprenorphine and oral liquid methadone for opioid use disorder: protocol for a mixed-methods evaluation
    Natalie Lowry, Fiona Cowden, Edward Day, Eilish Gilvarry, Stacey Johnstone, Robbie Murray, Mike Kelleher, Luke Mitcheson, John Marsden
    BMJ Open.2022; 12(10): e067194.     CrossRef
  • Factors Affecting Health-Related Quality of Life in Multimorbidity
    Eunmi Lee, Sunkyung Cha, Geun Myun Kim
    Healthcare.2021; 9(3): 334.     CrossRef
  • Effects of Living Alone and Sedentary Behavior on Quality of Life in Patients With Multimorbidities: A Secondary Analysis of Cross-Sectional Survey Data Obtained From the National Community Database
    Young Eun AHN, Chin Kang KOH
    Journal of Nursing Research.2021; 29(5): e173.     CrossRef
  • Effects of healthcare interventions on psychosocial factors of patients with multimorbidity: A systematic review and meta-analysis
    Hyun-Ju Lee, Misoon Lee, Jae-Hyun Ha, Yeongsuk Lee, Jungmi Yun
    Archives of Gerontology and Geriatrics.2020; 91: 104241.     CrossRef
  • Analysis of the Types and Affecting Factors of Older People's Health-related Quality of Life, Using Latent Class Analysis
    Sun-Hee Jang, Dong-Moon Yeum
    Journal of Korean Academy of Community Health Nursing.2020; 31(2): 212.     CrossRef
  • Quality of Life in Older Adults with Benign Prostatic Hyperplasia
    Sewon Park, Jeong-min Ryu, Munjae Lee
    Healthcare.2020; 8(2): 158.     CrossRef
  • Health-related quality of life in South Korean community-dwelling older adults with multimorbidity: a convergent parallel mixed-methods approach
    Hyun-Ju Lee, Jungmi Yun
    Quality of Life Research.2020; 29(3): 721.     CrossRef
  • Latent Class Analysis for Health-Related Quality of Life in the Middle-Aged Male in South Korea
    Youngsuk Cho, Dong Moon Yeum
    Journal of Korean Academy of Nursing.2019; 49(1): 104.     CrossRef
  • Femoral Intertrochanteric Fractures of the Patients in the Emergency Department due to Minor Falls: Special Consideration in the Middle-old to Oldest-old Patients
    Jung Min Jang, Han Sung Choi, Jong Seok Lee, Ki Young Jeong, Hoon Pyo Hong, Seok Hoon Ko
    Annals of Geriatric Medicine and Research.2019; 23(3): 125.     CrossRef
  • Quality of Life of Patients with Post-Stroke Speech-Language Disorders
    Yun Kyung Hwang, Yunji Hwang, Soo Ryon Kim
    Audiology and Speech Research.2018; 14(4): 292.     CrossRef
The Effects of the Designated Doctor System on Health Care Utilization of Medical Aid Beneficiaries with Chronic Diseases
Min Jung Kim, Young Ha Cho, Nam Hee Park
J Korean Acad Community Health Nurs. 2015;26(3):278-291.   Published online September 30, 2015
DOI: https://doi.org/10.12799/jkachn.2015.26.3.278
  • 885 View
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  • 1 Citations
AbstractAbstract PDF
PURPOSE
This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences.
METHODS
Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program.
RESULTS
There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution.
CONCLUSION
These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

Citations

Citations to this article as recorded by  
  • A Two-step Clustering Approach for Measuring Socioeconomic Factors Associated with Cardiovascular Health among Older Adults in South Korea
    Chi-Young Lee
    Korean Journal of Adult Nursing.2020; 32(6): 551.     CrossRef
An Exploratory Study of Factors associated with the Health Behavior of Working Elderly with Chronic Diseases
Dong Ok Kim, Soon Nyung Yun
J Korean Acad Community Health Nurs. 2012;23(4):395-404.   Published online December 31, 2012
DOI: https://doi.org/10.12799/jkachn.2012.23.4.395
  • 499 View
  • 1 Download
  • 2 Citations
AbstractAbstract PDF
PURPOSE
This study aimed to identify the health behaviors of working elderly Koreans aged 65 over and examined the socio-demographic and disease-related factors by health behaviors.
METHODS
This study used data obtained from the 2nd basic survey of the 2008 Korean Longitudinal Study of Ageing. We selected 381 working elderly having one or more of the diseases hypertension, diabetes, heart disease or cerebrovascular disease.
RESULTS
78.9% out of the subjects have hypertension, 31.2% have diabetes, 12.3% have heart disease, and 6.3% have cerebrovascular disease. Compared to the health behaviors of the general elderly, the rate of the practice of regular exercise among the subjects was lower, but the smoking and drinking rate were higher. The significant variables associated with health behavior practice rates were gender, type of work, subjective health status and chronic diseases.
CONCLUSION
The type of work of the elderly with chronic diseases was significantly associated with health behaviors. Consequently, this study found that continuous care programs for the working elderly with chronic diseases should be developed and provided as an occupational health service when the jobs are offered to them.

Citations

Citations to this article as recorded by  
  • The Relationship between Health Belief and Exercise Compliance among Elderly Adults at Senior Centers
    Kyung Im Lee, Young Eun
    Journal of Korean Academy of Community Health Nursing.2015; 26(2): 79.     CrossRef
  • The Effect of Health Behavior, Resilience, and Recognition of Well-dying on the Depression of Elderly with Chronic Disease
    Jeong-Hyeon Kong, Hyeon-Hwa Hong, Eun-Young Jung
    Journal of the Korea Academia-Industrial cooperation Society.2015; 16(10): 7146.     CrossRef
Change in Healthcare Utilization by Disease Severity after Case Management for Medicaid
Seung Joo Lim
J Korean Acad Community Health Nurs. 2010;21(3):321-332.   Published online September 30, 2010
DOI: https://doi.org/10.12799/jkachn.2010.21.3.321
  • 684 View
  • 2 Download
  • 4 Citations
AbstractAbstract PDF
PURPOSE
This study examined change in healthcare utilization by disease severity after case management (CM) for Medicaid.
METHODS
Data were extracted from survey data on "Healthcare utilization and health status of Medicaid beneficiaries" conducted in 2007 and 2008 by the Ministry for Health, Welfare and Family Affairs. This study was designed to compare change in healthcare utilization between the CM group and the non-CM group. The subjects were 528 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006.
RESULTS
In beneficiaries having fewer than 3 among the 11 notified diseases, the CM group showed a significantly larger decrease in outpatient day, outpatient expense, medication day, and medication expense than the non-CM group. In beneficiaries having 3 or more among the 11 notified diseases, however, there was no significant difference in healthcare utilization between the CM group and the non-CM group.
CONCLUSION
CM worked effectively on Medicaid beneficiaries outpatient healthcare utilization for mild diseases. However, its effects on hospitalization, which is a major cause increasing the total expense, were not observed. Therefore, a future study is needed to develope strategies to reduce hospitalization and care for Medicaid beneficiaries with severe diseases.

Citations

Citations to this article as recorded by  
  • The Effect of Case Management Services for High-risk Medicaid Beneficiaries
    Young Jin Ahn, Yun-Kyoung Choi
    Journal of the Korea Academia-Industrial cooperation Society.2015; 16(8): 5430.     CrossRef
  • Comparing the Needs of Case Management between Medical Aid Beneficiaries with Simple and Multiple Chronic Diseases
    Yang Heui Ahn, Yeonok Suh, Ok Kyung Ham, Hee Kyung Kim
    The Korean Journal of Rehabilitation Nursing.2015; 18(2): 98.     CrossRef
  • Case Management for Medical Aid Beneficiaries in Korea: Findings from Case-control Study
    Hee-Sun Shin, Jin-Joo Oh
    Asian Nursing Research.2014; 8(4): 274.     CrossRef
  • Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea
    Yang Heui Ahn, Ok Kyung Ham, Soo Hyun Kim, Chang Gi Park
    Journal of Korean Academy of Nursing.2012; 42(7): 928.     CrossRef
Coping with Experiences in Multiple Chronic Diseases in the Rural Elderly
Eun Ok Joung, Sung Bok Kwon, Ok Hee Ahn
J Korean Acad Community Health Nurs. 2007;18(1):32-41.   Published online March 31, 2007
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AbstractAbstract PDF
PURPOSE
The purpose of this study was to describe how the rural elderly cope with experiences in multiple chronic diseases.
METHOD
Data were collected through participant observation and in-depth interview using ethnography. The participants were 9 women and 2 men who aged over 65, were living in rural community, and had experienced two or more chronic diseases.
RESULTS
According to the results of this study, those who had experienced multiple chronic diseases went through the stages of 'recognizing of revealed symptoms', 'discovering of disease', 'overcoming', 'neglecting', 'discovering another disease', 'being frustrated' and 'living with suffering'.
CONCLUSION
The results of this study are expected to be utilized as basic materials to develop a nursing intervention program for effective management of chronic diseases.
A Chronic Disease Self-management Program for the Elderly in Korea
Hye Ra Yoo, Jee Won Park
J Korean Acad Community Health Nurs. 2005;16(4):404-414.   Published online December 31, 2005
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AbstractAbstract PDF
OBJECTIVES
The present study proposed to evaluate 1st-month and 3rd-month health status, depression, self-efficacy and medical expenses of a community-based health promotive self-management program for old Koreans.
METHOD
Participants in the CDSMP were selected from elders in a community health center through convenient sampling. The program included a 3-hour session per week for 14 weeks. Outcomes of evaluation in the 1st month and the 3rd month included modified Self-rated Health Status Scale, Center for Epidemiologic Studies Short Depression Scale, Self-Efficacy for Managing Chronic Disease 6-item Scale, and 1-item Medical Expenses Scale.
RESULTS
Self-rate health scores increased significantly just after the intervention (16.22), in the 1st month (17.57) and in the 3rd month (19.04) (chi2=32.06, p=.000); Depression scores (reversed) also increased significantly just after the intervention (6.04), in the 1st month (7.75) and in the 3rd month (8.39) (chi2=29.92, p=.000); Self-efficacy score increased significantly just after intervention (12.87) but it decreased in the 1st month (12.73) and in the 3rd month (12.04). But all of the three scores were still higher than those before the intervention (8.65) (chi2=32.42, p=.000): Medical expense score decreased at the end of the intervention (1.57) but the cost score increased in the 1st month (2.48) and in the 3rd month (2.39) (chi2=7.81, p=.050).
CONCLUSION
CDSMP is effective in increasing self-rate health and self-efficacy and in decreasing depression in the Korean elderly. However, no significant effect of the program was observed in decreasing the medical cost of the Korean elderly.

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