This study aimed to reveal the status of physical fitness (PF) levels and determine whether hand grip strength (HGS) could be used to estimate other PF parameters in older adults from large population data. A total of 46,269 participants aged ≥ 65 years who participated in the 2019 National Fitness Award Project in South Korea were included in the analysis. Of the participants, 6.8% had the highest level of overall physical fitness, while 48.9% had the lowest level. The proportion of overall PF levels differed significantly according to age groups. Significant associations between HGS and other PF parameters (30-s chair stand test, 2-min or 6-min walk test, sit-and-reach test, 3-m backwards walk test, and Figure-of-8 walk test) were noted and the group with low HGS (< 28 kg for men and < 18 kg for women) had significantly higher odds of having the lowest level of overall PF (odds ratio: 5.232 in men and 6.351 in women), after adjusting for age and body mass index. HGS could estimate muscular strength and endurance, aerobic fitness, flexibility, balance skills, and coordination skills, as well as overall PF level in older adults, and could be used as a substitute test for their PF level in limited situations.

Background: Polypharmacy should be minimized in end-of-life care. Therefore, this study aimed to provide a basis for establishing guidelines for drug use in end-of-life care. Methods: This retrospective study involved the medical record review of 45 of the 74 patients who were hospitalized and died at one tertiary hospital palliative care center between January 1 and December 31, 2021. Here comfort care was defined as that provided 14 days prior to death. We analyzed the types and numbers of prescribed drugs used by patients, including palliative care essential drugs and pain control drugs, and examined the prescribed drugs based on their efficacy categorization. Results: According to drug efficacy classification, opioid analgesics, anti-ulcer drugs, and psychoactive drugs were most commonly used. The median number of drugs used was 8.8 (standard deviation, ±3.9) with 86.7% (n=39) of patients belonging to the polypharmacy group using 5 or more drugs. Among the narcotic analgesics used for pain control, morphine (53.3%) and oxycodone (46.7%) were the most frequently used, preferably through the intravenous route. Conclusion:Our study identified the current use of opioid analgesics and other palliative care drugs and confirmed that polypharmacy occurred in the majority of end-of-life care patients. Follow-up studies are needed to establish guidelines for comfort care drug use.

Purpose: Despite its well-known clinical importance, physician empathy (PE) has been variably defined and its concepts among cultures are yet to be studied. This study aimed to develop a conceptual framework of PE and explore influencing factors on physicians’ empathetic behavior in the Korean clinical context.Methods: Forty-two faculty members and 67 residents participated in the two-round Delphi survey to arrive at a consensus regarding the conceptual framework of PE in 2019. To explore individual and external factors affecting physicians’ empathetic behavior, a Likert scale questionnaire based on an initial free-text response was administered to the same participants.Results: The conceptual framework of PE among Korean doctors consisted of basic communication skills and attitudes, cognitively understanding of patients’ thoughts and emotions, and communicating the doctors’ understandings to patients. Individual attributes and system- and patient-factors were revealed as influencing factors for PE in real practice. The former included communication ability, self-awareness and management, humanism, clinical competence, and good personality traits. Excessive workload, time constraints, aggressive attitudes, and negative preconceptions towards doctors were perceived as inhibiting or hindering empathy in patient care.Conclusion: PE in the Korean clinical context comprised behavioral and cognitive components. Individual attributes, as well as external factors including system- and patient-factors were identified to affect PE in clinical settings. Further studies are needed to enhance the conceptual clarity of PE and identify how to promote doctors’ empathetic practice even in less favorable healthcare environments.

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Background: Prognosis prediction is a challenge for clinicians caring for patients with cancer in end-of-life. Although previous studies have shown several biological parameters to be prognostic factors, it remains unclear which factors can predict the exact prognosis. Additionally, blood tests for patients with terminal cancer are limited, it is practically difficult to utilize usual parameters as prognostic factors. Therefore, a universal, readily available, and the cost-effective clinical parameter is needed to predict the survival times of patients with cancer in end-of-life regardless of age, sex, or cancer type.Methods: We analyzed the medical records of 280 patients admitted to the palliative care unit at Korea University Guro Hospital from July 2019 to June 2021. After analysis of survival time according to patients’ clinical parameters, Kaplan-Meier survival curves using Serum Creatinine (Scr) levels (cut-off: 1.2 mg/dL) were plotted and compared using the log-rank test. Finally, using stepwise selection, multivariable Cox proportional hazard model was used to identify significant prognostic factors.Results: Patients with high Scr (≥1.2 mg/dL) had shorter median survival than those with normal levels (12 days vs 23 days). Multivariate Cox proportional hazard model identified male (HR=1.47; P=0.019), stomach cancer (HR=1.88; P=0.020), poor performance status (HR=1.56; P=0.004), leukocytosis (HR=1.81; P<0.001), high AST (HR=1.57; P=0.004), and high Scr (HR=1.54; P=0.022) as significantly associated with shorter survival time.Conclusions: High Scr was significantly associated with poor survival in patients with cancer near end-of-life. This readily available and simple clinical parameter might be helpful in predicting prognosis in palliative care settings.