노인장기요양시설 서비스 질이 우울에 미치는 영향

강성자(Kang Sung Ja) 한국복지실천학회 2017 한국복지실천학회지 Vol.8 No.1

본 연구는 노인장기요양시설에 입소하여 생활·의료·일상생활서비스를 제공받으려는 노인 수요의 증가, 이를 반영하여 노인장기요양시설 공급이 확대되는 시점에서 이용자들을 대상으로 자기효능감의 매개적 역할로 인하여 노인의 우울정도가 개선될 수 있는지를 실증적 연구를 통해 살펴보고자, 서울지역 노인요양시설, 노인전문병원, 노인그룹홈의 노인장기요양시설 등 총 6곳에 입소하여 서비스를 제공받고 있는 이용자 192명을 대상으로 노인장기요양서비스 질에 대한 자기인식요인이 자기효능감의 정도에 따라 우울의 정도가 얼마나 변화하는가에 대하여 4단계의 회귀분석을 이용하여 실증적으로 분석하였다. 분석 결과, 노인장기요양시설에 입소하여 생활하는 노인들이 인식하고 있는 서비스 질 정도가 우울에 미치는 영향에서 자기효능감의 부분매개효과를 갖는 것으로 해석된다. 또한, 입소 노인에게 제공되는 서비스 질은 우울과 자기효능감에 영향을 미친다는 선행연구와 일치함으로 확인할 수 있었음에 따라 개별화된 공간, 친숙한 환경, 안전한 공간, 인간의 존엄성이 유지되는 공간, 자유로운 표현을 할 수 있는 공간, 직원과의 신뢰관계를 유지할수 있는 공간, 노인이 좋아하는 색채 등의 노인시설에 적합한 유니버설디자인 적용 등의 서비스 질을 향상시킬 수 있는 다양한 방안 및 개발이 요구된다고 할 것이다. The purpose of this study was to examine whether elderly people s depression level can be improved by a mediating role of self-efficacy targeting users of the long-term care facilities through empirical research at the point of time that the supply of the long-term care facilities is expanded by reflecting this along with a rise in number of elderly people who try to be offered health care services and several care services by entering the long-term care facilities. Accordingly, the empirical analysis was made on how much the depression level is changed depending on self-efficacy level as for self-awareness factor on quality of the long-term care service by using 4-step regression analysis targeting 192 users who are being offered services by entering 6 long-term care facilities for the elderly care facilities, geriatrics hospital, and elderly group home in Seoul area. As a result of analysis, in the influence upon depression in service quality level that is recognized by elderly people who are living by entering the long-term care facilities, the self-efficacy can be analyzed to have a mediating effect between independent variable(service quality for elderly people who are admitted to the long-term care facilities) and independent variable(depression) owing to a mediating role of self-efficacy, and is analyzed to have a partial mediating effect. In the meantime, it could be confirmed to be consistent with a prior research as saying that the quality of service, which is offered to the admitted elderly, has influence upon depression and self-efficacy. Hence, the operating institutions and employees of the long-term care facilities are expected to be likely to be necessarily changed the facilities and improved environment in order to possibly increase participants satisfaction with the facility environment service.

노인장기요양보험 재가급여 노인의 건강관련 삶의 질 경로분석

김지현,박승미 한국지역사회간호학회 2023 지역사회간호학회지 Vol.34 No.1

Purpose: The purpose of this study is to construct and verify a path model for the factors affecting on quality of life in long-term care insurance in-home service users. Methods: Total 246 participants using long-term care insurance in-home service were recruited from long-term care agencies. Data collection was conducted using a structured questionnaire from March 1st to March 31st 2021. The collected data were analyzed using SPSS 26.0 and AMOS 26.0 programs. Results: The hypothetical path model was suitable for explaining the health-related quality of life in long-term care insurance in-home service users and has an explanatory power of 39.8%. Long-term care grade, depression, perceived health status, social support, age and living arrangement had a significant total effect on the quality of life in long-term care insurance in-home service users. Conclusion: Long-term care insurance in-home service policies need to be expanded, such as screening and relieving depression, strengthening social support, and fostering a positive perception of health to improve the quality of life of the elderly.

Factors Affecting Family Caregivers’ Burden and Depression in Home-based Long-Term Care Service under the Long-Term Care Insurance System

이홍자,김춘미 한국지역사회간호학회 2018 지역사회간호학회지 Vol.29 No.4

Purpose: This study tried to identify changes in family burden after the introduction of the long-term care insurance and to examine the factors influencing subjective and objective caring burden and depression of family caregivers of elders receiving home-based long-term care. Methods: Data were collected from 203 family caregivers of elders from August 1 to 31, 2015 using questionnaires. They were analyzed in descriptive statistics, t test, ANOVA test, and multiple regression analysis. Results: The mean score of depression was 7.24, which suggested mild depression level. The subjective family burden was 2.71 and the objective burden 3.04. The factors affecting depression included subjective burden (t=5.08, p<.001), objective burden (t=2.80, p=.006), time of elderly care per day (t=-3.61, p< .001), caregiving duration (t=3.33, p=.001), age (t=3.13, p=.002), family relationship (t=2.48, p=.014), and economic status (t=1.99, p=.047). Conclusion: The family burden was most important influencing factor on caregiver’s depression. Therefore, services and supports to alleviate caregivers’ burden in the home-based care should be added to long-term care.

Long-term Treatment with Oriental Medicinal Herb Artemisia princeps Alters Neuroplasticity in a Rat Model of Ovarian Hormone Deficiency

김현범,권병재,조현지,김지원,천정우,도문호,박상용,김선여,맹성호,박유경,박지호 한국뇌신경과학회 2015 Experimental Neurobiology Vol.24 No.1

Artemisia princeps (AP) is a flowering perennial used as a traditional medicine and dietary supplement across East Asia. No study has yet assessed its effects on synaptic plasticity in hippocampus and much less in a model of ovarian hormone deficiency. We examined the influence of chronic oral AP ethanol extract treatment in ovariectomized rats on the induction of long-term depression in a representative synapse (CA3-CA1) of the hippocampus. Ovariectomized rats demonstrated lower trabecular mean bone mineral densities than sham, validating the establishment of pathology. Against this background of pathology, AP-treated ovariectomized rats exhibited attenuated long-term depression (LTD) in CA1 relative to water-treated controls as measured by increased field excitatory post-synaptic potentials (fEPSP) activation averages over the post-stimulation period. While pathological significance of long-term depression (LTD) in ovariectomized rats is conflicting, that AP treatment significantly affected its induction offers justification for further study of its influences on plasticity and its related disorders Artemisia princeps (AP) is a flowering perennial used as a traditional medicine and dietary supplement across East Asia. No study has yet assessed its effects on synaptic plasticity in hippocampus and much less in a model of ovarian hormone deficiency. We examined the influence of chronic oral AP ethanol extract treatment in ovariectomized rats on the induction of long-term depression in a representative synapse (CA3-CA1) of the hippocampus. Ovariectomized rats demonstrated lower trabecular mean bone mineral densities than sham, validating the establishment of pathology. Against this background of pathology, AP-treated ovariectomized rats exhibited attenuated long-term depression (LTD) in CA1 relative to water-treated controls as measured by increased field excitatory post-synaptic potentials (fEPSP) activation averages over the post-stimulation period. While pathological significance of long-term depression (LTD) in ovariectomized rats is conflicting, that AP treatment significantly affected its induction offers justification for further study of its influences on plasticity and its related disorders.

Implementation of Memristive Bioelectronics Device for Synapse and Plasticity

주바에르 이브네 만난,김형석 제어로봇시스템학회 2020 제어로봇시스템학회 국내학술대회 논문집 Vol.2020 No.7

This paper represents a memristive bioelectronics device that imitates the bio-realistic behavior and plasticity of biological synapse. Especially, the proposed architecture exhibits synaptic plasticity of synapse (one of the important neurochemical foundations for learning and memory) which is demonstrated via effective and efficient imitation of shortterm plasticity (short-term facilitation (STF), short-term depression (STD)) and long-term plasticity (long-term potentiation (LTP), long-term depression (LTD)). Moreover, the memristive artificial circuit mimics the distinct biorealistic attributes (such as strong stimulation, exponentially decaying conductance trace of synapse, and voltage dependent synaptic responses) of a neuron. The proposed bioelectronics model is designed in SPICE and the bio-realistic functionalities are demonstrated via various simulations.

일상생활능력이 건강만족도에 미치는 영향과 우울증의 매개역할에 관한 연구: 3개월 이상 요양시설 입원 노인을 대상으로

손용진 경인행정학회 2018 한국정책연구 Vol.18 No.4

This study investigated the effect of the ADL(Activities of Daily Living) on the health life satisfaction and the mediating role of depression between the ADL and health life satisfaction using the 2017 Elderly Living Conditions Survey. A sample of 132 individuals 65 or older was adopted, and they all have experienced in staying in long-term care hospitals for a duration of three months or more. It was hypothesized that the level of depression mediates the relation of the ADL with the health life satisfaction. The study results were as follows. First, the ADL did not have a direct effect on the health life satisfaction. Second, the ADL was a significant predictor of depression. Third, the depression acted as the complete mediation factor for predicting the health life satisfaction when both the ADL and depression was entered in the final model. That is, when the ADL was more limited, the depression was higher. In turn, the higher depression led to have the lower likelihood of the health life satisfaction. Therefore, although the ADL did not show a direct effect on the health life satisfaction, the ADL had an indirect effect with depression on the health life satisfaction. This result suggested that depression should be considered as a mediating factor for the ADL in case of modeling the relationship between the ADL and the health life satisfaction. For the maintenance of better mental health for the residents of long-term care facilities, the implementation of depression-alleviating program was suggested. 본 연구는 2017년도 노인실태조사 자료를 중심으로 노인의 일상생활능력이 건강만족도에 미치는 영향을 분석하였으며, 두 변수 간 관련성에 있어 우울증의 매개효과가 존재하는지를 분석하였다. 분석을 위해, 3개월 이상 요양원에 입소 혹은 요양병원에 입원한 경험이 있는 65세 이상 132명의 노인들을 대상으로 표본을 구성하였다. 연구결과는 다음과 같다. 첫째, ADL은 건강만족도에 직접적인 영향력이 없었다. 둘째, ADL은 우울증에 유의한 예측변인이었다. 셋째, ADL과 우울증 변수를 투입한 모델에서 우울증이 ADL과 건강만족도와의 관계를 유의하게 완전 매개하였다. 즉, ADL이 제한적일수록 우울증이 높았고, 우울증이 높을수록 건강만족도는 낮아지는 것으로 나타났다. 이러한 결과는, 요양시설 이용경험이 있는 노인에 있어서 ADL이 직접적으로 건강만족도에 영향을 주기보다는 우울증이 수반될 경우 건강만족도에 유의한 영향을 나타낸다는 것이다. 본 연구의 함의는 장기요양시설에 거주경험이 있는 대상자의 ADL과 건강만족도의 관계를 규명하고자 할 경우, 우울증 수준을 고려하여 모델에 설정하여야 한다는 점이다. 장기요양시설에서 입소자들의 정신 건강유지를 위해 우울증 완화 프로그램 등의 필요성에 대해 언급하였다.

노인장기요양보험 재가급여유형이 노인의 우울감에 미치는 영향

김효심 ( Kim Hyo Sim ),신규철 ( Shin Gyu Cheol ) 한국장기요양학회 2020 장기요양연구 Vol.8 No.2

본 연구는 노인장기요양 재가급여유형이 노인의 우울에 미치는 영향을 확인하고 합리적 장기요양서비스 이용모형을 위한 근거자료를 제시하기 위한 것이다. 주요 연구결과는 다음과 같다. 첫째, 주간보호서비스를 중심으로 이용하는 노인 일수록 방문요양 중심 이용노인 보다 우울감이 낮았다. 둘째, 학력이 낮을수록, 동거가족수가 적을수록, 주택 자가소유가 아닐수록, 경제상태가 좋지 않을수록 노인의 우울감이 높았다. 또한, 건강상태가 나쁠수록, 만성질환이 있을수록 우울감이 높았다. 요양서비스는 이용기간이 길수록 높았다. 셋째, 방문요양서비스와 주간보호서비스 중심 이용 노인의 우울에 미치는 영향 요인에 따른 차이를 분석한 결과, 사회적 지지의 경우 방문요양서비스 이용 노인들에 있어서 유의미한 영향을 미치지 않는 반면, 주간보호서비스 이용 노인들에게는 통계적으로 유의미한 영향을 미치고 있었다. 즉, 주간보호서비스 이용 노인들에 대한 사회적지지 수준은 정신건강에 중요한 요인으로 영향을 미치는 반면에 방문요양 이용 노인들에게는 영향을 미치지 않았다. 따라서 재가급여 이용노인의 우울 감소를 위하여 방문요양급여와 주간보호서비스간의 연계와 통합적인 서비스를 위한 노력이 필요하다. This study presents references that the utilized rate of long-term care services reasonably and identifies that having an effect on depression of elderly by long-term care insurance. With regards to this prior research, the included results are as follows. First of all, the elderly who use the day care service mainly showed lower depression than those who visited care centers. Second of all, depression was higher with lower educational background, the number of family members, non-owned house and the economic condition. Not only that, the depression was higher as the state of health worsened, the more chronic disease. According to the period of use of the home-care service, moreover, depression was higher as the use of home-care service was longer. Third of all, the factors affecting the depression of the elderly who use home-care services and day care services are the social support did not have a significant effect on the elderly who use the visiting care services, but it had a statistically significant effect on the elderly who use the day care services. In other words, the level of social support for the elderly who use day care services is an import factor for mental health, but does not affect the elderly who use visiting home-care. As a result, the implements for reducing depression of elderly people using long-term care re-supply benefits were discussed.

장기요양기관 이용 노인의 인지기능과 죽음불안이 우울에 미치는 영향

최지혜(Ji Hye Choi),공성숙(Seong Sook Kong) 한국자료분석학회 2020 Journal of the Korean Data Analysis Society Vol.22 No.2

본 연구는 노인요양시설, 주간보호센터, 방문요양센터를 이용하는 노인들의 인지기능 및 죽음불안이 우울에 미치는 영향을 파악하기 위한 서술적 상관관계 연구이다. 연구대상은 충남 D시에 소재하는 장기요양기관을 이용하는 노인 142명을 대상으로 2017년 7월부터 11월까지 개별 면담을 통해 자료를 수집하였다. 연구결과, 우울은 평균 7.06점으로 대상자의 63.4%가 경증 이상의 우울을 보였고, 주간보호센터와 방문요양센터 노인보다 요양시설 노인의 우울이 더 높았다. 요양시설의 환경이 노인의 삶에 대한 통제력과 의사결정권 상실, 사회적 고립감을 유발할 수 있으므로, 사회적 상호작용 증진과 가족 유대감 및 소통을 향상시키는 우울 중재에 초점을 두어야 한다. 죽음불안은 35.23점으로 중간 이상의 높은 점수를 보였고 우울의 유의한 영향요인으로 나타났으므로, 대상자의 우울을 낮추기 위해서는 타인과의 안정적인 애착관계를 형성하고 인생의 의미를 찾아 생산적으로 죽음을 준비하도록 돕는 등 죽음불안에 대한 중재가 중요하다. 인지기능은 19점 이하의 치매환자를 제외하였기 때문에 평균 22.8점으로 비교적 높은 점수를 보였으며, 치매의심 집단이 정상집단보다 우울이 높았으므로 치매의심 집단의 우울이 악화되지 않도록 중재해야 한다. 그밖에 경제상태와 장기요양서비스 만족감도 우울의 유의한 영향요인으로 나타났으므로, 저소득층 노인에 관심을 기울여야 한다. The purpose of this study was to identify the relationships among cognitive function, death anxiety, and depression in the elderly using long-term care facilities. Subjects were 142 elderly persons using long-term care facilities, such as nursing home, day care centers or visiting care centers, located in D city in South Choongcheong Province. Data were collected from July to November 2017. 63.4% of participants showed more than mild depression, and elderly using nursing home were more depressed than the elderly using day and visiting care centers. Death anxiety showed more than moderate level, and was significantly associated with depression. Therefore, intervention for the depression should focus on reducing death anxiety by helping the elderly establish the secure attachment, find the meaning of life, and acknowledge one’s death to prepare for death productively. Preventive intervention for depression is needed for the elderly who have mild cognitive impairment, because their depression was higher than the depression of normal cognitive function group. Especially, elderly of low economic status should be considered for the long-term care service, based on the results of the economic status as a significant predictor of depression.

A Study of the relationship between Chronic Pain and Quality of Life for Elderly in Long-term Care Service - Focused on the Mediating Effect of Depression -

Yu-me No,Jeoung-nam Yang 한국융합학회 2018 한국융합학회논문지 Vol.9 No.4

본 연구는 장기요양 재가서비스 이용 노인의 만성통증이 삶의 질에 미치는 영향에서 우울의 매개효과를 검증하는 데 목적을 두었다. 이를 위해 장기요양 재가서비스를 이용하고 있는 노인 204을 대상으로 조사를 실시하였다. 본 연구의 주요 분석결과는 변수간의 상관관계에서 만성통증과 우울은 정적관계, 만성통증과 삶의 질과의 관계에서는 부적 상관관계 로 분석되었다. 또한, 만성통증과 우울이 삶의 질에 미치는 영향에 있어서 우울은 완전한 매개효과를 보이는 것으로 검증되 었다. 이 결과를 통해 장기요양 재가서비스를 이용하는 노인의 다양한 융합적인 정신건강서비스를 위한 프로그램 개발 필요성에 대해 논의하였다. In this study, the effect of chronic pain on the lives of elderly people in long-term care service was analyzed based on the mediated effect of depression. The research data was sampled from elderly people in long-term care services, 204 people participated. From mediated regression analysis, depression was the most relevant factor on the quality of life, followed by chronic pain. With chronic pain and depression as independent variables and quality of life as a dependent variable, depression was proved to have had a fully mediated effect on quality of life. The result of this study suggested that convergence of various support systems should be implemented for the elderly in long-term care services.

Long-Term Depression of Intrinsic Excitability Accompanied by Synaptic Depression in Cerebellar Purkinje Cells

Shim, Hyun Geun,Jang, Dong Cheol,Lee, Jaegeon,Chung, Geehoon,Lee, Sukchan,Kim, Yong Gyu,Jeon, Da Eun,Kim, Sang Jeong Society for Neuroscience 2017 The Journal of neuroscience Vol.37 No.23

<P>Long-term depression (LTD) at the parallel fiber (PF)-to-cerebellar Purkinje cell (PC) synapse is implicated in the output of PCs, the sole output of the cerebellar cortex. In addition to synaptic plasticity, intrinsic excitability is also one of the components that determines PC output. Although long-term potentiation of intrinsic excitability (LTP-IE) has been suggested, it has yet to be investigated how PF-PC LTD modifies intrinsic excitability of PCs. Here, we show that pairing of the PF and climbing fiber (CF) for PF-PC LTD induction evokes LTD-IE in cerebellar PCs from male C57BL/6 mice. Interestingly, this intrinsic plasticity showed different kinetics from synaptic plasticity, but both forms of plasticity share Ca2+ signaling and protein kinase C pathway as their underlying mechanism. Although small-conductance Ca2+-activated K+ channels play important roles in LTP-IE, no direct implication has been found. After PF-PC LTD induction, neither the temporal summation of dendritic EPSP nor the power of spike frequency adaptation is changed, indicating that cerebellar LTD executes the information processing in a quantitative way without quality changes of synaptic integration and generation of output signals. Our results suggest that LTD-IE may have a synergistic effect with synaptic depression on the total net output of neurons by amplifying the modification of PF synaptic transmission.</P>