Geriatric Medicine, an Underrecognized Solution of Precision Medicine for Older Adults in Korea

Lim, Jae‐Young

doi:10.4235/agmr.18.0048

Cited by 7 publications

(8 citation statements)

References 9 publications

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“… 4 , 5 ) Therefore, a given society must prepare to serve its aging population in a multifaceted manner, from developing fiscal policies to establishing healthcare models that are specially designed for older multimorbid individuals. 6 ) While many policies have been developed to tackle the aging population, the sustainability and viability of modern welfare systems and government-operated healthcare systems that were originally proposed in Western countries have not been tested at this extreme pace of aging in Korea.…”

Section: Introductionmentioning

confidence: 99%

Geriatrics Fact Sheet in Korea 2021

Baek

Lee

Jang

2021

Ann Geriatr Med Res

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While the global population is aging, South Korea is one of the most rapidly aging societies worldwide. It took 17 years for Korea to transition to an aged society from an aging society, defined as proportions of the population aged 65 years or older of ≥ 14.0% and 7.0%, respectively, while Japan took 24 years for the same transition. 1) More strikingly, Korea is expected to become a super-aged society, defined as a proportion of the population aged 65 years or older of ≥ 20.0%, in 2025. This prominent trend of population aging in Korea has been, to some degree, attributed to rapid economic development that accompanies the fast-growing life expectancy at birth with the establishment of modern healthcare systems after

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Section: Introductionmentioning

confidence: 99%

Geriatrics Fact Sheet in Korea 2021

Baek

Lee

Jang

2021

Ann Geriatr Med Res

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“…In Korean acute hospitals, however, assessments of frailty in inpatients are rarely performed except for a few hospitals with geriatric medicine services [ 29 ]. While measures focusing on older patients such as fall prevention, discharge planning, and social welfare services are available in some hospitals, case-finding and coordination are mostly performed ad hoc , without evaluation of frailty or other geriatric problems [ 29 ]. Consequently, many older, vulnerable patients are currently left with unmet needs in the medical and functional domains.…”

Section: Discussionmentioning

confidence: 99%

“…Since hospital medicine provides global medical care and functional demands of hospitalized patients, adopting the concept of frailty may facilitate the coordination of various patient-centered programs including risk prevention measures for adverse outcomes such as falls, delirium, and bedsores [ 32 ]; translation care planning services involving pharmacists and social workers [ 33 ]; and care planning entailing advance directives and deprescribing [ 34 ]. With hospital medicine in Korea rapidly expanding to address the soaring demand for in-hospital care with population aging, adopting frailty-based care coordination may also alleviate the ever-increasing and unmet geriatric care needs [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Frailty Scale, K-FRAIL questionnaire, and clinical outcomes in an acute hospitalist unit in Korea

Han

Lee

Lim

et al. 2021

Korean J Intern Med

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Background/Aims: Frailty increases the risks of in-hospital adverse events such as delirium, falls, and functional decline in older adults. We assessed the feasibility and clinical relevance of frailty status in Korean older inpatients using the Clinical Frailty Scale (CFS) and Korean version of the Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight scale (K-FRAIL) questionnaires.Methods: Frailty status was measured using the Korean-translated version of the CFS and K-FRAIL questionnaire within 3 days from admission in 144 consecutive patients aged 60 years or older. The correlation between CFS and K-FRAIL score was assessed. The criterion validity of CFS was assessed using receiver operating characteristic analysis. As outcomes, delirium, bedsore, length of stay (LOS), in-hospital mortality, and unplanned 30-day readmission were measured by reviewing medical records. Results: The mean age of the study population was 70.1 years (range, 60 to 91), and 75 (52.1%) were men. By linear regression analysis, CFS and K-FRAIL were positively correlated (B = 0.72, p < 0.001). A CFS cutoff of ≥ 5 maximized sensitivity + specificity to classify frailty using K-FRAIL as a reference (C-index = 0.893). Higher frailty burden by both CFS and K-FRAIL was associated with higher LOS and bedsores. Unplanned readmission and in-hospital mortality were associated with higher CFS score but not with K-FRAIL score, after adjusting for age, gender, polypharmacy, and multimorbidity. Conclusions: Frailty status by CFS was associated with LOS, bedsores, unplanned readmission, and in-hospital mortality. CFS can be used to screen high-risk patients who may benefit from geriatric interventions and discharge planning in acutely hospitalized older adults.

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“…Although Korea is experiencing an extreme pace of population aging, the concept of geriatric medicine is rarely taught in medical schools. 29) Thirdly, specialized or fragmented care for older multimorbid patients might contribute to the occurrence of prescribing cascades that often involve PIMs. 30) While our retrospective, descriptive study cannot address the contributions of these factors that may affect PIM and ACB in older patients with multimorbidities, our findings underscore the need for further research on the current nationwide status of medication usage in older adults.…”

Section: Discussionmentioning

confidence: 99%

Anticholinergic Cognitive Burden as a Predictive Factor for In-hospital Mortality in Older Patients in Korea

Lee¹,

Jung²,

Jang³

et al. 2020

Ann Geriatr Med Res

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With the increasing prevalence of chronic disease with aging, many older adults are treated concurrently for two or more diseases, a condition commonly referred to as a state of multimorbidity. 1,2) A recent report indicated that the prevalence of multimorbidity in Korea is up to 73%, 3) predominantly due to common diseases such as hypertension, osteoarthritis, and hyperlipidemia. Since medical management for these conditions requires medications for specific diseases, older adults with multimorbidity are likely to take multiple medications simultaneously. Consequently, polypharmacy, a geriatric condition defined as taking multiple medications (usually five or more per day) is a frequently encountered clinical condition in medical care for older adults. 4,5) Medical care for older patients, especially those with polypharmacy, should consider factors such as prescribing cascade, drugdrug interactions, drug-disease interactions, and potentially inappropriate medications (PIMs) for older adults. 6-9) Among these factors, the presence of PIMs is reportedly associated with increased adverse outcomes, including delirium, falls, functional decline, and mortality. Therefore, guidelines have recommended to reduce the use of or to replace PIMs with safer alternatives. 8-10) Moreover, the concept of deprescribing, an individualized therapeutic strategy that considers the risks and benefits of medications according to patient functional and comorbid status, has emerged with efforts to minimize adverse outcomes with polypharmacy. 11) Background: With the increasing prevalence of chronic disease due to aging, many older adults experience multimorbidity and polypharmacy. Medications with anticholinergic properties are particularly associated with adverse cognitive outcomes, including functional decline and mortality. We assessed the clinical impact of anticholinergic cognitive burden (ACB) on clinical outcomes of older patients acutely admitted to a single, hospitalist-operated medical unit of a tertiary hospital in Korea. Methods: This retrospective study reviewed electronic medical records of 318 patients aged 65 years or older admitted to the hospitalist-operated medical unit through the emergency department of Seoul National University Hospital. The analyzed clinical outcomes were the length of hospital stay, in-hospital mortality, unplanned intensive care unit admission, and unexpected readmission within 30 days. Results: The clinical outcomes did not differ between patients who took five or more drugs and those who did not. Patients with an ACB score of 3 or higher had a higher in-hospital mortality rate and longer hospital stay than those who did not. After adjusting for confounding factors, an ACB score of 3 or higher was an independent predictive factor for in-hospital mortality (odds ratio=3.09; 95% confidence interval, 1.18-8.06). Conclusion: ACB rather than the number of medications was associated with in-hospital mortality in acutely ill older patients. Further analytic and interventional studies are required to as...

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Geriatric Medicine, an Underrecognized Solution of Precision Medicine for Older Adults in Korea

Cited by 7 publications

References 9 publications

Geriatrics Fact Sheet in Korea 2021

Geriatrics Fact Sheet in Korea 2021

Clinical Frailty Scale, K-FRAIL questionnaire, and clinical outcomes in an acute hospitalist unit in Korea

Anticholinergic Cognitive Burden as a Predictive Factor for In-hospital Mortality in Older Patients in Korea

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