Go Un Lee

Cognitive decline is an increasingly important public health issue among older adults, particularly those residing in medically underserved areas with limited access to healthcare services. This study aimed to examine the associations of presbycusis, loneliness, frailty, and depression with cognitive function and to identify factors independently associated with cognitive function among community-dwelling older adults residing in medically underserved areas. A cross-sectional survey was conducted among 149 community-dwelling older adults aged 65 years or older residing in medically underserved areas of South Korea. Standardized questionnaires were administered to assess presbycusis, loneliness, frailty, depression, and cognitive function. Data were analyzed using Pearson correlation coefficients and stepwise multiple linear regression to identify factors independently associated with cognitive function. Cognitive function was significantly and negatively correlated with presbycusis ( r = −.32, P < .001), loneliness ( r = −.20, P = .001), frailty ( r = −.40, P < .001), and depression ( r = −.43, P < .001). In the multiple regression analysis, completion of middle school or higher ( β = .47, P < .001), age 65 to 74 years ( β = .29, P < .001), completion of elementary school ( β = .25, P < .001), absence of back pain ( β = .16, P = .010), lower depression scores ( β  = −.14, P = .027), and absence of stroke ( β = .13, P = .024) were independently associated with cognitive function. The final stepwise regression model was statistically significant ( F = 29.88, P < .001) and explained 53.9% of the variance in cognitive function. Educational attainment, age, depression, stroke, and back pain were independently associated with cognitive function among community-dwelling older adults residing in medically underserved areas. These findings support the importance of community-based strategies that consider educational, physical, and psychological factors to promote cognitive health in this population. However, because of the cross-sectional design, causal relationships could not be established. Future longitudinal studies are warranted to confirm these associations and further clarify the mechanisms underlying these associations among older adults living in medically underserved areas.

Background: Tuberculosis (TB) remains a major public health challenge in South Korea which has one of the highest TB incidence rates among the Organisation for Economic Co-operation and Development (OECD) countries. Effective self-care, including medication adherence and regular hospital visits, is crucial for successful TB treatment and the prevention of drug resistance. TB self-care in South Korea is influenced by cultural, social, and systemic factors. This study aimed to systematically review and conduct a meta-analysis of factors influencing self-care among Korean patients with TB, providing evidence-based insights for developing effective self-care promotion programs. Methods: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on quantitative studies published since 2000 involving Korean patients with TB. Twenty studies were included in the final analysis, and 44 factors related to self-care were categorized into sociodemographic, TB-related, psychological, environmental, and educational characteristics. Effect sizes were calculated using Comprehensive Meta-Analysis (CMA) 4.0, with the assessment of heterogeneity and publication bias. Results: The meta-analysis ranked the effect sizes of the different characteristic categories as follows: environmental > educational > psychological. Among the individual factors, social support had the greatest influence on self-care, followed by quality of life, self-efficacy, nonfamily support, family support, and perceived health benefits. These findings underscore the critical role of sustained social support from the community, medical staff, and family in enhancing self-care among TB patients. Conclusion: Effective self-care strategies for patients with TB should focus on interventions that strengthen the environmental, educational, and psychological aspects. These findings suggest that similar approaches can be applied in other countries facing comparable healthcare challenges. This study acknowledges limitations including potential publication bias and the exclusion of older studies and non-Korean patient studies, highlighting the need for further research across diverse settings and populations.

Lee GU, et al. J Korean Acad Community Health Nurs. 2022 Dec;33(4):456-464. https://doi.org/10.12799/jkachn.2022.33.4.456

Hwang WJ, et al. Pediatr Infect Vaccine. 2019 Apr;26(1):32-41. https://doi.org/10.14776/piv.2019.26.e4