Health promotion behaviors and quality of life among community-dwelling elderly in Korea: A cross-sectional survey

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Abstract

As individuals live longer, health promotion behaviors become even more important, particularly with regard to maintaining functional independence and improving quality of life (QoL). The purpose of this study was to explore the relationship between health promotion behaviors and QoL in Korean elderly living in the community.

This study was a descriptive-correlational study to explore the relationship between health promotion behaviors and QoL among the community-dwelling elderly in Korea. A convenience sample of 2000 community residents who were over 65 years old and cognitively intact were selected from 32 senior centers and 242 public health centers in Korea. A total of 1920 were included in the analyses, following the exclusion of 80 incomplete questionnaires and subject refusals. Participants who consented to participate in the study were interviewed by trained interviewers with a structured questionnaire. The results of the study showed that there were statistically significant differences in QoL of the elderly related to exercise participation, alcohol abstinence and blood pressure (BP) check-up (p<.05). Multiple regression analysis revealed that perceived health status, number of chronic illnesses, activities of daily living, BP checkup, exercise, and gender were statistically significant predictors of QoL. R2 for this whole regression model was .412, indicating that approximately 41.2% of the variance in QoL was accounted for by the linear combination of these variables. Nurses should enhance the QoL in elderly persons by facilitating health promotion behaviors through formal nursing interventions which will maintain and increase a healthy and active life.

Introduction

With the aging of the world population, more than one-quarter of the world's population will be over the age of 60 by the year 2100 (WHO, 2004). As in most other countries, the proportion of elderly people is increasing every year in Korea due to decreased birth rates and increased longevity. The proportion of those 65 years and older in Korea was approximately 8.3% in 2003, and is expected to rise 15% in 2019 (Korea Ministry of Health and Welfare, 2003). The average life expectancy is predicted to increase from 75.9 years in 2000 to 80.7 in 2020.

As individuals live longer, health promotion behaviors become even more important, particularly with regard to maintaining function and independence and improving quality of life (QoL; Goldberg and Chavin, 1997; Leveille et al., 1999; Sims et al., 2000). Issues in health promotion for older persons are related to their independence in every day life, high cognitive and physical function, and active engagement with life. US Department of Health and Human Services (2000) on health promotion and aging highlighted regular exercise, smoking cessation, avoiding excessive alcohol use, nutrition, and having age-appropriate immunization. These behaviors are encouraged with the intention of reducing the potential years of life lost in premature mortality and ensuring better quality of remaining life (Bloom, 2001). There is considerable evidence that health-promoting behaviors of older adults offer the potential for improving health status and QoL as well as reducing the cost of health care (Higgins, 1988; Mayer et al., 1994; Heidrich, 1998; Beattie et al., 2003).

QoL is considered to be the key goal for health promotion in older people. The WHO Quality of Life Group (1998, p. 1570) defined QoL as “an individual's perceptions of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns”. Most researchers consider QoL to be a multidimensional concept encompassing health, functional status, social, as well as other aspects of an individual life (Raphael et al., 1995; Bowling et al., 2002; Osborne et al., 2003). Knowledge about the factors that influence QoL in old age is of major importance as population aging becomes a reality world-wide, yet empirically knowledge about QoL in this population is limited (Huppert et al., 2000; Mowad, 2004). According to theorists, a health-promoting lifestyle contributes to a positive QoL because the individual who engages in a health-promoting lifestyle will remain healthy and functional without the burden of disease and disability (Walker et al., 1988; Green and Kreuter, 1991). Previous research has supported a positive relationship between health promotion behaviors and QoL. McDaniel (1987) found a positive correlation between health-promoting lifestyle and QoL in elderly over 60 years old. A positive relationship was also found in 117 male retirees (Gall et al., 1997), and 135 older veterans aged 65–85 years (Mowad, 2004).

Since the National Health Promotion Act was enacted in 1995 (Korea Ministry of Health & Welfare, 1995), there has been a growing need for developing community-focused health promotion programs that are directed toward the elderly population in Korea. Since there are only a few health promotion programs for Korean elderly, little is known about the degree of health promotion behaviors of elderly and how these behaviors eventually contribute to the QoL. Several researchers have called attention to the lack of empirical data focused on health promotion behaviors and QoL to develop effective strategies at a national level to improve the elderly's QoL (Skevington, 2002; Nilsson et al., 2004). Especially, culturally sensitive guidelines are becoming more important because of the rapid growth of the older population and the growing awareness of the importance of cultural differences.

Therefore, this study examined the degree of health promotion behaviors and the relationship between health promotion behaviors and QoL in the Korean elderly who live in the community. This study will elucidate the health promotion behaviors that Korean elderly engage in, how they evaluate their QoL, and whether their QoL varies by the degree of health promotion behaviors. This investigation of the relationship between health promotion behaviors and QoL will help nurses to develop evidence-based health promotion strategies in the community to facilitate healthy and active life for the elderly population. Ultimately, this will help these individuals achieve their highest level of health and QoL.

Section snippets

Design

This study was a descriptive-correlational study to explore the relationship between health promotion behaviors and QoL among the community-dwelling elderly in Korea.

Sample and procedures

The sample included 2000 community residents who were over 65 years old, cognitively intact, and who had a score of 24 or more on a Korea version of the Mini Mental State Exam (K-MMSE). Participants were conveniently selected from 32 senior centers and 242 public health centers nation-wide. Subjects who consented to participate in

Socio-demographic characteristics of the participants

The majority of the participants was female (70.2%), 65–74 years old (56.7%), with no schooling (47.8%), and widowed (53.8%). There were approximately two times as many women as men in the entire sample. The mean age was 73.77 years old (SD=6.26) with a range of 65–99. Examining the living arrangement of the elderly, 42.9% of the elderly lived with their family, followed by alone (32.8%), and with spouse (21.7%) (Table 2).

Perceived health status, chronic illnesses and physical functioning

On average, these participants had 3.57 chronic illnesses. Arthritis

Discussion

The two goals of Healthy People 2010 focus on increasing the quality and years of healthy life for each individual and eliminating health disparities (Resnick, 2003). Caring for older people in the community can be a challenging task for public health nurses. This study explored the relationship between health promotion behaviors and QoL among community-dwelling elderly in Korea. The goals of health promotion behaviors are to maintain function and independence, and improve QoL (Leveille et al.,

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