Earticle

Background & objectives: Cognitive function decline is a main factor influencing the overall life of the elderly and places a burden of society. The aime of this study was to investigate the risk factors of cognitive function decline of elderly living alone and living with a spouse. Methods: This study used the Korean Longitudinal Study of Ageing from 2014 to 2018. 243 older adults who lived alone and 1,155 lived with a spouse with the Korean version of Mini Mental State Examination scores in normal range at the time of 2014 were included in the analysis. Logistic regression analysis was conducted to determine the difference of risk factors affecting cognitive function decline between in elderly living alone and elderly living with a spouse. Results: Cognitive function decline incidence rate of elderly living alone was 30.5% and the elderly living with a spouse showed 23.0%. According to the results of logistic regression analysis, the risk factors of cognitive function decline in the elderly living alone was age and residential area, while in the elderly living with a spouse were age, education level, social networks, and depression. Conclusions: The factors that affect the cognitive function decline of the elderly living alone and the elderly living with a spouse were different. Accordingly, other measures to prevent cognitive decline are necessary.

Purpose: This descriptive research study aimed to identify the factors that influence depression according to household type (elderly who live with a spouse, adult children, or alone). Methods: A total of 9,790 older adults were selected and analyzed using the 2020 National Older Koreans data. A Rao-Scott chi-square test was conducted to evaluate the differences in the individual, health-behavior, and mental-health factors according to family structure. A complex samples logistic regression was used to analyze the factors that influence depression according to family structure. Results: Depression according to family structure was in the order of older adults who live alone, with adult children, or a spouse (p <.001). Total income, number of chronic diseases, hospitalization, exercise, and suicide ideation were identified as depressive factors for older adults who live with adult children. Employment, subjective health status, number of chronic diseases, hospital visitation, hospitalization, drinking, suicide ideation, economic status satisfaction, and cultural life satisfaction were depressive factors for older adults who live with a spouse. Employment, subjective health status, hospitalization, drinking, suicide ideation, and cultural life satisfaction were depressive factors (p <.05) for older adults who live alone. Conclusion: It is necessary to detect depression early and operate a mental health program considering the family structure of older adults.

연구목적: 본 연구의 목적은 장기복무 제대군인 배우자의 스트레스가 고립감을 매개로 부부갈등에 미치 는 영향에서 거주 지역 규모에 따른 경로의 차이를 확인하는 것이다. 연구방법: 자료 분석은 SPSS 24.0 프로 그램을 활용하였고, 인구사회학적 특징 및 주요 변수 실태를 파악하여 기술 통계로 제시하였다. 매개모형 검 증을 위해 PROCESS Macro 프로그램(ver.2.16.3)을 사용하여 대도시 및 중소·군소 도시 거주 집단으로 각각 구분하고 매개경로를 비교하였다. 분석대상은 복무기간 10년 이상의 남자 장기복무 제대군인의 여성 배우자 중 부부 동거 중인 144명이다. 연구결과: 연구결과는 다음과 같다. 첫째, 장기복무 제대군인 배우자의 스트 레스는 거주 지역 규모에 따른 차이를 보이지 않았다. 둘째, 장기복무 제대군인 부부갈등 수준은 전국 가정 폭력 실태조사(2019)에 비해 매우 높았으나, 거주 지역 규모에 따른 차이는 보이지 않았다. 셋째, 대도시에 거주하는 제대군인 배우자의 스트레스는 고립감에 영향을 미치나, 고립감의 매개효과는 유의미하지 않았다. 넷째, 중소도시에 거주하는 제대군인 배우자의 스트레스는 고립감을 매개로 하여 부부갈등에 유의미한 영향 을 미치는 것으로 나타났다. 결론: 본 연구결과를 토대로 제대군인 배우자의 스트레스 감소를 위한 개별 사 례관리, 부부간 긍정적 의사소통을 향상시키는 가족치료 프로그램 도입, 지방에 거주하는 제대군인 배우자 의 고립감 해소 및 정서 안정을 위한 지역사회 친화 프로그램을 제언하였다. 향후 군사회복지 연구에 제대 군인 가정과 관련한 연구로 범위의 확장이 필요하다.

Objectives: The purpose of this study is to verify the relation between the stress of a veteran spouse and marital conflict as well as the mediating effect of the perceived isolation with difference in size of living areas. Method: The SPSS 24.0 program was used to analyze the demographic characteristics and main variables of the study subjects. The PROCESS Macro program(ver.2.16.3) was also used to test the mediating effect of the perceived isolation with difference in size of living areas. A total of 144 middle-aged women living with husbands who serviced in the army for more 10 years and discharged was analyzed. Among the middle-aged women, 73 people (51.8%) live in large cities and 68 people (48.2%) live in small and middle-sized cities. Results: First, in the group of spouses living in the large cities, stress of spouses affects the perceived isolation but does not affect marital conflict through the perceived isolation so that the mediating effect is insignificant. Second, in the group of spouses living in the small and middle-sized cities, the stress of spouses affects marital conflict through the perceived isolation so that the mediating effect is significant. Therefore, it is confirmed that the mediating effects are different from the large and small-sized cities. Conclusions: Based on the results, the study suggested to expand the support system for veteran spouse to ease the perceived isolation of the spouses living in small-sized cities, prepare long-term policy measures to relieve veteran spouse stress, and introduce the TSL program to increase positive communication between veteran and spouses.

As both the number of elderly people and the component ratio of the elderly living alone rise dramatically, long?term care has become one of the major problems that aged society faces. And with increase of double income households and weakened family ties, the elderly of Korea and Japan are hard to expect their adult children's care. Sometimes they may suffer from acute illness or chronic disease, and they easily become casualties of accidents such as falling down. Furthermore some of them became victims of suicides or dying?alone or starved?death. So policies and measures for preventing crisis and dealing with risks and emergencies of elderly people are urgent tasks to be solved. Long?term Care Insurance should cover services for mitigating risk of elderly people, and assistance care services for daily life of the elderly such as meal, bath, clothing and going?out should be provided. Both Korea and Japan have abundant practical experiences in this area. Korea executes various government-driven security programs such as Elderly Care Service program and Japan depends on silver industrial services based on heath related services of medical facilities. But nowadays U?care service system for the elderly living alone, utilizing ubiquitous IT equipments, was developed. Social work for the elderly consistently emphasizes the challenges, problems, crises, and losses experienced by individual elderly who want to live in community settings, even though they live alone without any assistance from their families. Crisis management of Korea gives an accent to governmental efforts, including both central and local government, and tries to utilize ubiquitous IT techniques to reduce financial burden. On the other hand in Japan, non?profit industries such as gas company developed equipments for managing crisis of the older people as industrial goods. And social services for crisis management for the elderly tend to combine with health services on community level.

Objectives: This study aimed to investigate factors associated with depression among elderly living alone and those living with a spouse in an urban area. Methods: This study was a community-based, cross-sectional study that included 384 elderly aged 60 years or older. The subjects completed a questionnaire that covered sociodemographic characteristics and chronic medical illnesses. The Korean version of the Short Form of the Geriatric Depression Scale, the Korean version of the Quality of Life-Alzheimer’s Disease (KQOL-AD), and the Korean Mini Mental State Examination in the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease assessment packet were also performed. Results: The participants were divided into two groups: 137 elderly individuals living alone and 247 elderly individuals living with a spouse. Heart disease (odds ratio [OR]=13.099, 95% confidence interval [CI]=1.892-90.697, p=0.009) was identified as a risk factor for depression, while the religion (OR=0.137, 95% CI=0.028-0.668, p=0.014) was found to be a protective factor against depression among elderly individuals living alone. Higher scores on the KQOL-AD scale were found to be protective factors against depression for both elderly individuals living alone (OR=0.742, 95% CI=0.636-0.867, p<0.001) and those living with a spouse (OR=0.664, 95% CI=0.573-0.771, p<0.001). Conclusions: Among elderly living alone in an urban area, heart disease, religion, and the quality of life appear to have an impact on depression. To reduce the risk of depression in the elderly, it is necessary to properly manage heart disease, encourage religious participation, and enhance the quality of life.

Objectives：This study aimed to investigate the spouse effects on depression in community-dwelling elderly Korean population. We examined the gender difference in the influence of living arrangement on depression. We also sought to clarify the role of cognitive function in the influence of living arrangement on depression. Methods：This study was a community-based, cross-sectional study that included 395 elderly subjects aged 60 years or more. Subjects completed the questionnaire including sociodemographic characteristics and chronic medical illness. Korean version of Short Form of the Geriatric Depression Scale(SGDS-K) and Korean MMSE in the Korean version of the CERAD(Consortium to Establish a Registry for Alzheimer’s Disease) assessment packet(MMSE-KC) were also evaluated. Depression was identified as SGDS-K score of 8 and above. Results：The mean score on SGDS-K was 5.9(SD=4.52), and the mean score on MMSE-KC was 23.3(SD=4.67) in all samples. The prevalence of depression was 35.4%. In univariate analyses, the elderly living alone had a higher risk of depression than those living with a spouse(Odds ratio, OR=2.32, 95% Confidence Interval, CI=1.51-3.58, p＜0.001). After adjusting for sociodemographic characteristics and chronic illness state, this association was attenuated(OR= 1.80, 95% CI=1.01-3.21, p=0.048). But, after further adjusting for MMSE-KC scores, the association was further attenuated and it remained statistically insignificant. In the full adjusted model, more number of elderly females living alone had depression than those living with a spouse with marginal statistical significance(OR=2.03, 95% CI=1.00-4.13, p=0.051). Conclusion：These findings suggest that cognitive function is a possible confounding factor in the influence of living arrangement on depression. Living alone is likely to be a significant risk factor for depression among community-dwelling elderly females.

Purpose: The purpose of this study was to identify how women who were adult children of alcoholics and spouses of alcoholics had grown up in difficult situations and found the meaning of life. Methods: This study used a life history research method and data were collected from three participants who are adult children of alcoholics and spouses of alcoholics. In-depth interviews with each participant were conducted three times from September to October 2020. Results: In this study, ‘realm of life’ includes taking care of the family like a young hero, difficulty in express one’s feelings and desire, facing the problems of the family at stake. ‘Turning point’ meeting a role model overcoming addiction problems, sharing one’s story in the Therapeutic Community, self-awareness to live independently not as a victim. ‘Adaptation’ includes recognizing and expressing one’s thoughts and feelings, trying to separate from the family psychologically and spatially, reinterpretation of one’s life and discovery of the meaning of life. Conclusion: Their meaning of life was to love and respect themselves, make responsible choices in their circumstances, break the inheritance of addiction and had a healthy family life. Therefore, it is necessary to provide an existential meaning therapy program that helps them find the meaning of life and recover to their original self.

목적 알코올 의존증 남편을 둔 여성 배우자로 살아감에 관한 본질적 의미를 파악하여 이들에게 필요한 전문적 개입의 실천적 방안마련을 위한 기초자료를 제시하고자 본 연구를 시행하였다. 방법 질적 연구방법 중 하나인 생애사적 연구 방법을 이용하였다. 연구 참여자는 알코올 의존증 남편을 둔 52세 여성 배우자 1인이다. 주제 중심적 생애사 자료 수집 방법으로 심층면담을 시도하였고 참여자 면담 시 연구 참여 동의서를 받았다. 자료의 분석은Mandelbaum이 제시한 생애사 분석 틀인 삶의 차원, 삶의 전환점, 적응 차원에 따라 참여자의 생애사를 분석하고 생애사 문장을구성하였다. 결과 자료의 분석결과 삶의 영역은 ‘아버지의 술 문제로 불안정한 어린 시절’, ‘울타리가 되어주지 않는 부모를 원망함’, ‘어머니의자리를 자신이 채움’, ‘하고 싶은 일을 참고 살아 옴’, ‘부모를 바라보며 자신은 다른 부모가 되리라 다짐함’, ‘남편의 술 문제로 고통스러운 결혼생활’로 나타났다. 또한 삶의 전환점 영역은 ‘엄마의 부재가 사회로부터 버림받은 느낌을 줌’, ‘동기들과 동떨어진 삶의 방향’, ‘다시 삶을 붙들어 준 신앙’, ‘남편의 눈물에서 변화의 가능성을 발견함’, ‘나를 개방하며 삶의 태도가 바뀜’으로 나타났다. 마지막으로 적응 영역은 ‘자기 가치를 회복하고 표현하는 삶을 살게 됨’, ‘서로를 이해하며 건강한 가족이 되는 길로 한 걸음 나아감’, ‘감사의제목들을 발견하고 내적 성장을 이루어 감’으로 나타났다. 결론 본 연구에서 시도한 알코올 의존증 남편을 둔 여성 배우자가 경험하는 생애에 대한 분석을 통해 이들이 경험해 온 삶의 궤적에는자기 자신에 대한 부정적 내재화, 우울감 및 공허함이 내재되어 있음을 확인할 수 있었다. 이러한 결과를 통해 알코올 의존자 가정의여성 배우자가 경험하는 다양한 어려움에 대한 심도 깊은 이해를 제공하였으며 알코올 의존자와 그 배우자 및 가족의 회복과 건강가정 유지를 위한 전문적 개입의 실천적 방안 마련을 위한 기초자료를 제시하였다고 보여진다.

Objectives This study was conducted to understand the essence of what it is like to live as a wife of an alcoholic and to provide baseline data to help develop protocols for professional interventions. Methods Life history research, an example of a qualitative study method, was utilized. The study participant was a 52-year-old female spouse of an alcoholic. In-depth interviews were conducted to gather data on her life history. Consent was acquired prior to the initiation of the interview. Data analysis were assessed based on the life history research frame presented by Mandelbaum, which included life dimensions, turning point, and adaptations. Life history sentences were constructed. Results Analysis were identified, the realms of life were ‘an unstable childhood due to father's alcohol problem’, ‘resented her parents for not being a fence’, ‘filled mother’s place herself’, ‘lived by enduring what I want’, ‘vowed to herself that will be a better parent than parent’, and ‘painful marriage life due to her husband's drinking problem’. Life turning points included ‘felt deserted due to her mother’s absence by society’, ‘a way of life apart from classmates’, ‘faith that sustains life’, ‘found possibilities of change in her husband’s tears’, ‘changed in the attitude towards life by opening myself’. Adaptations were ‘living a life that restores self-worth and expressed’, ‘one step better to be a healthy family in which understandings each other’, ‘discovered gratitude and achieved internal growth’. Conclusions An analysis of the life of a female spouse of an alcoholic revealed that the trajectory of their lives included negative self-internalization, depression, and emptiness. This study provided a detailed understanding of the various difficulties that occur to the female spouse in a family with alcoholic and went further to provide baseline data to help develop protocols for professional interventions to restore and protect a healthy family for the alcoholic and spouse.