Korean Journal of Family Medicine

"age"

Original Articles

Preventing depression in older adults with chronic illnesses through the SMART Elderly Program: a quasi-experimental study in Central Thailand: Phongsakorn Toopboochakorn, Nanthawan Nilpayak, Phornphimon Hotarat, Wanida Jaroensuk, Phannathat Tanthanapanyakorn; Received July 24, 2025 Accepted October 30, 2025 Published online January 29, 2026; DOI: https://doi.org/10.4082/kjfm.25.0222 [Epub ahead of print]

Abstract
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Background
Depression frequently affects older adults with chronic illnesses, reducing their quality of life. In Thailand, limited access to mental health services increases the need for preventive interventions. The SMART (Smile, Mindfulness, Attitude, Relax, and Thinking) Elderly Program aimed to assess its effectiveness in preventing depression among older adults.
Methods
Quasi-experimental research design with a repeated-measures approach was used with two groups. The study included 80 older adults diagnosed by a physician with noncommunicable diseases and a depression score of 7 to 12 on the Thai Geriatric Depression Scale (TGDS), indicating risk for depression. Participants were assigned to two groups through multi-stage sampling. The intervention group (n=40) participated in a 6-week SMART Elderly Program, while the control group (n=40) received standard treatment and a handbook for depression prevention. Evaluations took place through in-person interviews at baseline, post-intervention, and at a 3-month follow-up. Data were analyzed using descriptive statistics and repeated measures analysis of variance.
Results
The analysis showed statistically significant differences in knowledge about depression, attitudes toward depression, and TGDS scores between the intervention and control groups at the 3-month follow-up (P<0.001). In the intervention group, these measures also changed significantly from baseline to the 3-month follow-up (P<0.001).
Conclusion
The SMART Elderly Program significantly reduced depressive symptoms in older adults with chronic illnesses. These results support its use in community health practice and inform health policy to improve preventive mental health care for older adults.

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Family preparedness for aging in Indonesia: a cross-sectional survey: Margareth Maya Parulianta Naibaho, Sri Lilestina Nasution, Resti Pujihasvuty, Desy Nuri Fajarningtiyas, Anissa Rizkianti; Received July 29, 2025 Accepted October 29, 2025 Published online January 14, 2026; DOI: https://doi.org/10.4082/kjfm.25.0228 [Epub ahead of print]

Abstract
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Background
Pre-elderly families experience a significant impact on their quality of life as they transition to old age. This study aimed to identify and analyze the preparatory measures taken by families as they enter aging and develop an index to measure their readiness for aging based on physical, economic, and social aspects.
Methods
This study employed a quantitative approach, drawing secondary data from the 2019 Performance Accountability Survey of the Family Planning and Family Development Program. Binary logistic regression was used to examine the bivariate relationships between demographic characteristics and family readiness.
Results
Physical readiness was the most prevalent among pre-elderly families (88.1%), followed by economic (74.0%) and social (50.2%) readiness. Higher readiness was significantly associated with higher education (adjusted odds ratio [AOR], 3.39), urban residence (AOR, 1.39), health insurance ownership (AOR, 1.95), unemployment (AOR, 1.22), and awareness of aging programs (AOR, 1.62), whereas sex, family structure, and number of children were not significantly associated.
Conclusion
To increase physical readiness, families should be encouraged to use health services such as community health centers and perform regular medical check-ups. Additionally, this study suggests government intervention through outreach and guidance on all dimensions of old-age preparation.

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Clinical practice guidelines improve diagnosis and management of childhood obesity: a survey amongst primary care doctors in Klang Valley, Malaysia: Christina Wan Mei Cheong, Ker Yang Chua, Poi Giok Lim; Korean J Fam Med 2026;47(2):155-161. Published online November 18, 2025; DOI: https://doi.org/10.4082/kjfm.25.0002

Abstract
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Background
Childhood obesity is increasing globally. Primary care doctors are well-positioned to identify children with obesity. This study aimed to assess the usage of clinical practice guidelines (CPG) to determine obesity and the knowledge of primary care doctors regarding childhood obesity.
Methods
An online survey was conducted between November 2023 and February 2024 among primary care doctors in Klang Valley, Malaysia. The questions assessed doctors’ knowledge, practices, beliefs, and usage of the CPG in managing childhood obesity.
Results
There were 246 participants during the study period. Among the doctors, 101 (41%) knew the correct definition of “childhood overweight” while 120 (49%) doctors used the CPG. Doctors using the CPG had higher odds of knowing the correct management (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.30–5.41; P=0.006). Doctors using the CPG had higher odds of screening for childhood obesity complications and measuring body mass index (BMI), blood pressure, and pubertal status. Multivariate analysis showed that doctors working in government clinics (OR, 3.56; 95% CI, 2.01–6.32; P<0.001), having postgraduate training (OR, 3.95; 95% CI, 2.08–7.51; P<0.001) and having worked less than 5 years (OR, 4.53; 95% CI, 1.85–11.08; P<0.001) had higher odds of using the CPG. Doctors working in government clinics (OR, 5.93; 95% CI, 1.95–18.05; P=0.002) and used the CPG (OR, 7.26; 95% CI, 2.09–25.27; P=0.002) had higher odds of measuring the BMI.
Conclusion
Knowledge regarding diagnosis and management of childhood obesity among primary care doctors is still lacking. CPG on childhood obesity could be a useful tool for improving the diagnosis, management, and screening of childhood obesity.

Citations

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Family medicine for all stages of life: turning knowledge into actionable care
Joung Sik Son
Korean Journal of Family Medicine.2026; 47(2): 95. CrossRef

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Barriers to treatment-seeking behaviors among pregnant women with depression: a national cross-sectional study in Indonesia: Tri Wurisastuti, Rofingatul Mubasyiroh, Indri Yunita Suryaputri, Hayani Anastasia, Siti Isfandari, Rozana Ika Agustiya, Irmansyah , Aan Kurniawan, Yurika Fauzia Wardhani; Korean J Fam Med 2026;47(2):109-118. Published online May 21, 2025; DOI: https://doi.org/10.4082/kjfm.24.0078

Abstract
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Background
Hormonal and physical changes during pregnancy affect mothers’ mental health. Because depression during pregnancy is closely associated with poor pregnancy outcomes, treatment is important for pregnant women with depression. This study aimed to identify barriers to treatment-seeking behaviors among pregnant women with depression in Indonesia.
Methods
Data from the 2018 Indonesian Basic Health Research were used, which focused on pregnant women aged 15–54 years who exhibited depressive symptoms. The Mini-International Neuropsychiatric Interview was used to assess depression. Logistic regression analysis was conducted to explore the factors affecting treatment-seeking behaviors.
Results
Among the pregnant women in Indonesia, 7.9% experienced depression; however, only 11.4% sought treatment. Higher transportation costs to the clinic were associated with 41% lower odds of seeking treatment (adjusted odds ratio [AOR], 0.59; 95% confidence interval [CI], 0.37–0.95; P=0.029). Women in their second and third trimesters had 48% (AOR, 0.52; 95% CI, 0.28–0.98; P=0.042) and 54% (AOR, 0.46; 95% CI, 0.24–0.89; P=0.022) lower odds of seeking treatment, respectively, than those in their first trimester.
Conclusion
Financial barriers and the challenges of late pregnancy hinder treatment-seeking behaviors for depression in pregnant women. Therefore, there is an urgent need for affordable and accessible mental health care for vulnerable populations.

Citations

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Family medicine for all stages of life: turning knowledge into actionable care
Joung Sik Son
Korean Journal of Family Medicine.2026; 47(2): 95. CrossRef

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96 Download
1 Crossref

Case Report

Quetiapine-induced hypokalemic periodic paralysis in a pregnant woman: a case report: Muhammad Hafiz Mohamed Pauzi, Azidah Abdul Kadir, Syaheedatul Iman Dinsuhaimi, Zainab Mat Yudin, Wan Nazirah Wan Yusuf; Korean J Fam Med 2025;46(2):115-119. Published online March 19, 2025; DOI: https://doi.org/10.4082/kjfm.24.0301

Abstract
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Quetiapine-induced hypokalemic periodic paralysis (QIHPP) is a rare condition. Herein, we present the case of a 31-year-old pregnant Malay woman diagnosed with bipolar II disorder and QIHPP. She presented to the casualty department with a 2-day history of bilateral lower limb weakness and numbness. Her renal function tests showed moderate hypokalemia (2.5 mmol/L), whereas other investigations were normal. Quetiapine was suspected to be the cause, prompting a psychiatric referral to manage her acute condition. Balancing the risks of untreated QIHPP against the potential relapse of bipolar symptoms from quetiapine discontinuation or dosage reduction poses a significant treatment challenge for pregnant women with QIHPP. Finally, we reduced the quetiapine dosage after careful consideration, leading to the normalization of potassium levels and symptom resolution. Therefore, clinicians should be aware of this side effect when initiating or continuing quetiapine treatment in women of childbearing age or pregnant women with psychiatric disorders. It is crucial to monitor serum electrolytes, especially potassium, following quetiapine administration and warn patients about its potential side effects.

Citations

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Novel CACNA1S Mutation c.3491 A>C in Hypokalemic Periodic Paralysis: First Report with Functional Validation
Haiyan Shu, Chen Chen, Jianmei Yang
Journal of Molecular Neuroscience.2026;[Epub] CrossRef

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Original Article

Effect of electronic cigarettes on the change of Fagerstrom Test for Nicotine Dependence scores during 1-year follow-up: Saksorn Meelarp, Pantitra Singkheaw, Thanin Chattrapiban; Korean J Fam Med 2025;46(6):409-417. Published online November 13, 2024; DOI: https://doi.org/10.4082/kjfm.24.0038

Background
The use of e-cigarettes is increasing globally, particularly among young adults. Although several use them to quit smoking, their effects are controversial. The Fagerstrom Test for Nicotine Dependence (FTND) was used to assess nicotine dependence in the smoking cessation process. This study examined changes in FTND scores among young adults using different types of cigarettes over a 1-year period.
Methods
Prospective cohort data were collected from cigarette users at higher education institutions in the lower northern region of Thailand to analyze changes in FTND scores over a 1-year period. E-cigarette users and combined users were compared with conventional cigarette users. A marginal structural model (MSM) with an inverse probability of weighting (IPW) was used to adjust for time-dependent and time-independent confounders.
Results
Of the 133 participants, 58 were e-cigarette users (43.6%), 33 were combined cigarette users (24.8%), and 42 were conventional cigarette users (31.6%). The results revealed that when both time-dependent and time-independent confounders were adjusted using MSM with IPW, e-cigarette users had a 0.20 decrease in the mean FTND score, and combined users had a 0.47 decrease in the mean FTND score compared to conventional cigarette users. However, the difference was not statistically significant.
Conclusion
The use of e-cigarettes or combined cigarettes did not significantly affect nicotine dependence levels in young adults over a 1-year period. Consequently, e-cigarettes should not be recommended to reduce nicotine dependence among young adult cigarette users. Further studies are required to determine whether e-cigarettes affect smoking cessation rates.

Citations

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A year of significant progress for the Korean Journal of Family Medicine
Seung-Won Oh
Korean Journal of Family Medicine.2026; 47(1): 1. CrossRef

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115 Download
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1 Crossref

Review Article

Metformin-Induced Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Narrative Review with a Practical Approach for Screening, Diagnosing, and Managing Vitamin B12 Deficiency: Meriem Yazidi, Elyes Kammoun, Ibtissem Oueslati, Melika Chihaoui; Korean J Fam Med 2024;45(4):189-198. Published online July 18, 2024; DOI: https://doi.org/10.4082/kjfm.24.0090

Abstract
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Metformin is the most widely used antihyperglycemic drug in patients with type 2 diabetes (T2D). Over the past 2 decades, several studies have highlighted a substantial increase in the risk of vitamin B12 deficiency in patients with T2D on metformin therapy. This can lead to several complications and induce or exacerbate peripheral neuropathy. Despite these data, there are no definite guidelines for screening, diagnosing, and treating vitamin B12 deficiency in patients with T2D on metformin therapy. Therefore, in this narrative review, we aimed to suggest a practical diagnostic and therapeutic strategy to address vitamin B12 deficiency in patients with T2D receiving metformin treatment. Clinical evidence supporting an increased risk of vitamin B12 deficiency in patients with T2D on metformin therapy and its risk factors and potential complications are also discussed.

Citations

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Interpretable Machine Learning to Predict Metformin-Induced Vitamin B12 Deficiency: Association with Glycemic Control and Neuropathic Symptoms
Yasmine Salhi, Meriem Yazidi, Amine Dhraief, Elyes Kamoun, Melika Chihaoui, Tamim Alsuliman, Layth Sliman
Metabolites.2026; 16(4): 227. CrossRef
Toxicological profile of anti-diabetic drugs and emerging measures to reduce the toxic burden
George J. Dugbartey, Karl K. Alornyo, Christabel O. Dapaa-Addo, Emmanuel K. Kwashie, Yvonne Harley, Bright N. Asiedu
Toxicology Reports.2026; 16: 102247. CrossRef
Correlation between vitamin B12 deficiency and hemoglobin A1c in patients with diabetes mellitus
Yahya Madkhali, Sami G. Almalki
Journal of King Saud University – Science.2025; 37: 3542024. CrossRef
Possibilities of oral form of cyanocobalamin in pharmacological correction of vitamin B12 deficiency developed in patients with type 2 diabetes mellitus during treatment with metformin
I.G. Koroleva, E.V. Shikh, Zh.M. Sizova, V.L. Zakharova
Russian Journal of Preventive Medicine.2025; 28(9): 64. CrossRef
Lifestyle prescriptions for diabetes management in primary care: a narrative review
Hye Jun Lee, Jung-Ha Kim
Ewha Medical Journal.2025; 48(4): e55. CrossRef
Rethinking about Metformin: Promising Potentials
Kyunam Kim
Korean Journal of Family Medicine.2024; 45(5): 258. CrossRef
Prevalence of Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus on Metformin Therapy: A Cross-Sectional Study
Shoaib Asghar, Haider Tanvir, Asad Riaz, Muhammad Hamza Ejaz, Mamuna Akram, Al Muktadir Chowdhury Evan, Salman Shahid
Cureus.2024;[Epub] CrossRef

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Original Articles

Association of body image distortion with smartphone dependency and usage time in adolescents: a cross-sectional Korean Youth Study: Haein Cho, Junhee Park, Dagyeong Lee, Dong Wook Shin; Korean J Fam Med 2025;46(2):98-106. Published online May 22, 2024; DOI: https://doi.org/10.4082/kjfm.23.0159

Background
Adolescent dependency on smartphones is the highest among all age groups. Adolescents can be influenced to evaluate their body image by popular ideals about beautiful bodies via smartphone content, which can cause body image distortion. This study aimed to examine the association between body image distortion and smartphone dependency and the duration of smartphone usage among Korean adolescents.
Methods
This study used data from the 16th Korean Youth Risk Behavior Web-Based Survey (2020), and included 42,981 participants, who were grouped according to self-reported duration of smartphone usage and smartphone dependency, as measured by a questionnaire. Body image distortion is defined as an exaggerated subjective body image compared to the actual body image. Multivariable-adjusted logistic regression was used to determine the odds ratios (ORs) with 95% confidence intervals (CIs) of body image distortion on smartphone dependency and usage time after adjusting for various factors related to body image distortion.
Results
Among the 42,981 participants, both moderate and high levels of smartphone dependency were associated with body image distortion in boys (moderate: adjusted OR [aOR], 1.11; 95% CI, 1.01–1.22; high: aOR, 1.18; 95% CI, 1.05–1.32) and girls (moderate: aOR, 1.14; 95% CI, 1.05–1.23; high: aOR, 1.30; 95% CI, 1.18–1.42) compared to the low-level dependency group. However, no significant association was found between smartphone usage duration and body image distortion.
Conclusion
Our study demonstrated that moderate to high levels of smartphone dependency are associated with body image distortion in adolescents. Therefore, it is necessary to establish strategies for checking and managing adolescents’ smartphone dependence.

Citations

Citations to this article as recorded by

A year of significant progress for the Korean Journal of Family Medicine
Seung-Won Oh
Korean Journal of Family Medicine.2026; 47(1): 1. CrossRef
Excessive smartphone use, smartphone dependency and body image distortion in Korean adolescents
Young Gyu Cho
Korean Journal of Family Medicine.2025; 46(2): 58. CrossRef
Association Between Social Networking Service Use and Body Image Among Elementary School Children in Japan
Asami Baba, Masumi Suzuki, Rikako Yoshitake, Yumiko Inose, Naomi Omi
European Journal of Investigation in Health, Psychology and Education.2025; 15(7): 125. CrossRef
Association Between Sedentary Behavior and Body Image Distortion Among Korean Adolescents Considering Sedentary Purpose
Suin Park, Heesoo Lee, Wanhyung Lee, Mi-Jeong Lee
Children.2025; 13(1): 20. CrossRef
Social Media Use and Body Image Dissatisfaction Among University Students of Health Sciences in Saudi Arabia
Ihdaa J Abdulwahab, Jumana H Khouja, Noha A Alzahrani, Amina Bargawi
Cureus.2024;[Epub] CrossRef

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Effects of the COVID-19 Pandemic on the Medical Use of Elderly Patients with Hypertension: A Nationwide Cohort Study in Korea: Eunbyul Cho, Sujeong Han, Jae-ryun Lee, Hyejin Lee, Bumjo Oh; Korean J Fam Med 2024;45(5):283-289. Published online March 4, 2024; DOI: https://doi.org/10.4082/kjfm.23.0129

Abstract
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Background
The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services, including chronic disease management, for vulnerable groups, such as older individuals with hypertension. This study aimed to evaluate hypertension management in South Korea’s elderly population during the pandemic using treatment consistency indices such as the continuity of care (COC), modified, modified continuity index (MMCI), and most frequent provider continuity (MFPC).
Methods
This study used the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service between 2017 and 2021. The research included a total of 4,097,299 hypertensive patients aged 65 years or older. We defined 2018 and 2019 as the baseline period before the COVID-19 pandemic and 2020 and 2021 as the COVID-19 period and calculated the indices of medical continuity (number of visits, COC, MMCI, and MFPC) on a yearly basis.
Results
The number of visits decreased during the COVID-19 period compared to the baseline period (59.64±52.75 vs. 50.49±50.33, P<0.001). However, COC, MMCI, and MFPC were not decreased in the baseline period compared to the COVID-19 period (0.71±0.21 vs. 0.71±0.22, P<0.001; 0.97±0.05 vs. 0.96±0.05, P<0.001; 0.8±0.17 vs. 0.8±0.17, P<0.001, respectively).
Conclusion
COVID-19 had no significant impact on the continuity of care but affected the frequency of outpatient visits for older patients with hypertension. However, this study highlights the importance of addressing healthcare inequalities, especially in older patients with hypertension, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.

Citations

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Trends of new diagnosis and treatment initiation of hypertension during the COVID-19 pandemic in Korea
Jaeyong Lee, Ari Lee, Moses Song, Jiyen Han, Kyoung Hwa Ha, Hyeok-Hee Lee, Seng Chan You, Hyeon Chang Kim, Hokyou Lee
Hypertension Research.2026;[Epub] CrossRef
Reflecting on progress and challenges: the Korean Journal of Family Medicine in 2024
Seung-Won Oh
Korean Journal of Family Medicine.2025; 46(2): 55. CrossRef
The impact of the COVID-19 Pandemic on hypertension phenotypes (ESH ABPM COVID-19 study)
Aleksandra Ostrowska, Wiktoria Wojciechowska, Marek Rajzer, Thomas Weber, Michael Bursztyn, Alexandre Persu, George Stergiou, Grzegorz Kiełbasa, Marzena Chrostowska, Michaelis Doumas, Gianfranco Parati, Grzegorz Bilo, Guido Grassi, Giuseppe Mancia, Andrze
European Journal of Internal Medicine.2024;[Epub] CrossRef

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3 Crossref

Association between Processed Meat Protein Consumption and Incident Osteoporosis in Adults Aged 50 Years and Older: A Prospective Cohort Study Based on Korean Genome and Epidemiology Study Data (2005–2020): Dohee Lee, Soo Hyoung Lee, Ki Hyun Park, Kunhee Han, Eunjin Jeong; Korean J Fam Med 2024;45(5):268-273. Published online January 24, 2024; DOI: https://doi.org/10.4082/kjfm.23.0183

Abstract
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Background
Osteoporosis is one of the inevitable diseases affecting an aging society, substantially impacting the quality of life of its population. Protein intake has been shown to be beneficial in reducing the incidence of osteoporosis, and the effects of both animal and vegetable proteins have been studied. However, the relationship between processed meat consumption and osteoporosis has not been studied in Korea. Therefore, we aimed to analyze the correlation between processed meat consumption and incident osteoporosis in adults.
Methods
Our analysis included 1,260 adults aged 50 years and older from the Korean Genome and Epidemiology Study (KoGES), recruited between 2005 and 2020. Participants were categorized into two groups according to their processed meat intake, assessed using a semi-quantitative 103-food item food frequency questionnaire. Diagnosis of osteoporosis was based on questionnaire answers. Multiple Cox hazard regression analyses were conducted to examine the association between processed meat intake and incident osteoporosis.
Results
During an average follow-up period of 8.8 years, 230 participants developed osteoporosis. According to the Cox proportional regression models, the hazard ratio (95% confidence interval) of incident osteoporosis in the high intake group was 0.62 (0.41–0.94), compared to the low intake group after adjusting for confounding variables.
Conclusion
These findings reveal that processed meat protein intake is inversely related to the incidence of osteoporosis in adults aged 50 years and older. This in turn suggests that processed meat intake can be proposed as an additional strategy to prevent osteoporosis.

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Review Articles

Global Mapping of Potentially Inappropriate Prescribing for Older Adults in Community Settings: An Umbrella Review: Nafiseh Ghassab-Abdollahi, Haidar Nadrian, Fatemeh Saadati, Fariba ashazadeh, Elnaz Shaseb, Mina Hashemiparast, Hamid Allahverdipour; Korean J Fam Med 2023;44(4):189-204. Published online July 18, 2023; DOI: https://doi.org/10.4082/kjfm.23.0032

Potentially inappropriate prescribing (PIP) is a major public health concern with several undesirable health consequences for older adults. In this overview, we aimed to map and gather information from existing literature to provide a better insight into the prevalence of PIP among community dwellers. Electronic databases were searched from their inception to April 2022. The quality of the included systematic reviews (SRs) was assessed using the assessment of multiple systematic reviews checklist. The degree of overlap within the SRs was also evaluated (2% overlap). All SRs on the prevalence of PIP in older individuals in community settings were included, and a narrative approach was used to synthesize data. Nineteen SRs comprising 548 primary studies met the inclusion criteria, and the average quality of the included SRs was moderate. More than half (50.5%) of the primary studies were conducted in Europe, followed by the United States (22.8%), and Asia (18.9%). Thirty different criteria were used in the primary studies to estimate the prevalence of PIP. The most widely used criteria were those presented in Beers (41.8%) and STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert to Right Treatment) (21.8%) criteria. Benzodiazepines, nonsteroidal anti-inflammatory drugs, and antidepressants were the most frequently reported PIPs. A considerable variation in the prevalence of PIP ranging from 0% to 98% was reported by SRs. However, there is a high degree of uncertainty regarding the extent of PIP in community settings. To identify knowledge-to-action gaps, SR authors should consider the differences in prevalence of PIP according to settings, applied tools, data sources, geographical areas, and specific pathologies. There is also a need for primary and SR studies from low- and middle-income countries regarding the prevalence of PIP.

Citations

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A Prospective Study on Potentially Inappropriate Drug Use and All‐Cause Mortality in Community‐Dwelling Older Adults
Liat Orenstein, Angela Chetrit, Keren Laufer, Rachel Dankner
Journal of the American Geriatrics Society.2025; 73(9): 2828. CrossRef

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Management of Sarcopenia in Primary Care Settings: Chang Won Won; Korean J Fam Med 2023;44(2):71-75. Published online March 20, 2023; DOI: https://doi.org/10.4082/kjfm.22.0224

Abstract
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With aging, loss of skeletal muscle mass and muscle function increases, resulting in an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even death. Sarcopenia, which is derived from the Greek words “sarx” or flesh+“penia” or loss, is defined as a condition characterized by low muscle mass and low muscle strength and performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, specifically, presented strategies for case-finding and assessment to help diagnose “possible sarcopenia” in primary care settings. For case finding, the AWGS 2019 guideline proposed an algorithm that recommends calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire (cut-off ≥4). If this case finding is confirmed, handgrip strength (cutoff <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds) should be performed to diagnose “possible sarcopenia.” If an individual is diagnosed as “possible sarcopenia,” AWGS 2019 recommends that the individual should start lifestyle interventions and related health education for primary healthcare users. Because no medication is available to treat sarcopenia, exercise and nutrition is essential for sarcopenia management. Many guidelines, recommend physical activity, with a focus on progressive resistance (strength) training, as a first-line therapy for the management of sarcopenia. It is essential to educate older adults with sarcopenia on the need to increase protein intake. Many guidelines recommended that older people should consume at least 1.2 g of proteins/kg/d. This minimum threshold can be increased in the presence of catabolic or muscle wasting. Previous studies reported that leucine, a branched-chain amino acid, is essential for protein synthesis in muscle, and a stimulator for skeletal muscle synthesis. A guideline conditionally recommends that diet or nutritional supplements should be combined with exercise intervention for older adults with sarcopenia.

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Reena Prem, K Vaishali, Girish Nandakumar
BMC Musculoskeletal Disorders.2026;[Epub] CrossRef
Sarcopenia considerations when prescribing glucagon-like peptide-1 agonists to older adults
Azwan Aziz Mohamad
Korean Journal of Family Medicine.2026; 47(2): 184. CrossRef
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Marina Demas Rezende Gischewski, Fernanda Lívia Cavalcante Araujo, Aryana Isabelle De Almeida Neves Siqueira, Alina Joana da Silva Wallraf, João Araújo Barros Neto, Nassib Bezerra Bueno Nassib, Juliana Célia de Farias Santos, Fabiana Andréa Moura
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Australian Journal of Primary Health.2025;[Epub] CrossRef
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Journal of the Korean Medical Association.2024; 67(4): 265. CrossRef
Whole Genome Linkage and Association Analyses Identify DLG Associated Protein-1 as a Novel Positional and Biological Candidate Gene for Muscle Strength: The Long Life Family Study
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The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences.2024;[Epub] CrossRef
Predictors of hip fracture in 15 European countries: a longitudinal study of 48,533 geriatric adults using SHARE dataset
M. Azhar Hussain, Rizwan Qaisar, Asima Karim, Firdos Ahmad, Fabio Franzese, Atif Awad, Abeer A. Al-Masri, Mohammed Alsaeed, Shaea A. Alkahtani
Archives of Osteoporosis.2024;[Epub] CrossRef
Open, Active-Controlled Clinical Study to Evaluate the Correlation between Whole Body DEXA and BIA Muscle Measurements
Yong-Chan Ha, Shinjune Kim, Jun-Il Yoo
Journal of Bone Metabolism.2024; 31(3): 219. CrossRef
Doctor and patient perceptions of sarcopenia in community-based primary care clinics: a questionnaire survey
Jungha Park, Daehyun Lee, Jae Young Jang, Jung-Ha Kim, Jae Uk Baek, Myungkwan Jeong, Sungwouk Kim, Moonbae Kyoung, Miji Kim, Chang Won Won
European Geriatric Medicine.2024; 15(6): 1827. CrossRef
Frequency of clinical signs in patients with Cushing's syndrome and mild autonomous cortisol secretion: overlap is common
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Original Articles

Dietary Intake and Nutritional Status in Young and Middle-Aged Adults according to the Meal Frequency from the Korea National Health and Nutritional Survey: Junhee Park, Yohwan Yeo, Jun Hyun Yoo; Korean J Fam Med 2022;43(5):319-326. Published online September 20, 2022; DOI: https://doi.org/10.4082/kjfm.21.0149

Background
Previous studies have shown a close relationship between skipping breakfast and nutritional deficiency. However, the impact of regular eating, including lunch and dinner, has not been studied well. We explored the correlation between regularity and frequency of daily meals and nutritional status.
Methods
We analyzed Korea National Health and Nutrition Examination Surveys between 2016 and 2018. A total of 7,725 adults aged 19–49 years were classified into four groups according to the regularity of meal intake: three-meal regular diet (3MRD), two-meal regular diet, one-meal regular diet, and irregular diet (IRD). Food and nutrient intake was assessed using the 24-hour recall method and estimated by a generalized linear model in complex sample weight variables.
Results
In IRD, there were relatively more females who were not married, lived alone, or reported low levels of education. As subjects ate more meals, more people felt thinner and healthier by themselves. Dietary intake of cereal, vegetables, seaweed, and fiber was directly proportional to the number of regular meals as well as essential components such as water, carbohydrates, protein, fat, and micronutrients. Contrarily, alcohol and beverage consumption was inversely proportional to the number of regular meals. Intake level of legumes, fish, fruits, seasonings, milk, oils, sugars, and cholesterol was consistent regardless of meal frequency.
Conclusion
Our findings suggest that 3MRD showed nutrient adequacy and a healthier profile on body weight, body mass index, waist circumference, blood pressure, serum fasting glucose, total cholesterol, and triglyceride.

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Ariko Umezawa, Noriko Sato, Hiiro Terasaki, Yu Tahara, Shigenobu Shibata
Nutrients.2026; 18(6): 957. CrossRef
Eating patterns in Korean adults, 1998–2018: increased energy contribution of ultra-processed foods in main meals and snacks
Sukyoung Jung, Jee Young Kim, Sohyun Park
European Journal of Nutrition.2024; 63(1): 279. CrossRef
Analysis of dietary behavior and intake related to glycemic control in patients with type 2 diabetes aged 30 years or older in Korea: Utilizing the 8th Korea National Health and Nutrition Examination Survey (2019–2021)
Jin-Ah Seok, Yeon-Kyung Lee
Nutrition Research and Practice.2024; 18(2): 239. CrossRef
Guidelines for nutrition counseling in primary healthcare clinics
Gyeongsil Lee, Seung-Won Oh
Journal of the Korean Medical Association.2024; 67(4): 278. CrossRef
A national cross-sectional study on breakfast skipping-related factors and comparison of nutritional status according to breakfast skipping in older adults based on the 8th Korea National Health and Nutrition Examination Survey (KNHANES, 2020)
Anna Han, Yean Jung Choi
The Journal of nutrition, health and aging.2024; 28(9): 100335. CrossRef
The Association between Personality Factors and Metabolic Parameters among Patients with Non-Alcoholic-Fatty Liver Disease and Type 2 Diabetes Mellitus—A Cross-Sectional Study
Marcin Kosmalski, Rafał Frankowski, Monika Różycka-Kosmalska, Kasper Sipowicz, Tadeusz Pietras, Łukasz Mokros
Journal of Clinical Medicine.2023; 12(13): 4468. CrossRef
Nutrition fact label (NFL) use is related to meeting the requirements for vitamins and minerals not listed on NFLs: Data from the Korea National Health and Nutritional Examination Survey VIII (2019–2021) for the prepandemic and pandemic periods
Jung Min Cho, Niravkumar Joshi
PLOS ONE.2023; 18(12): e0296268. CrossRef
Association between Prediabetes and Meal Patterns Related to Meal Sharing among Korean Young Adults: Eighth Korean National Health and Nutrition Examination Survey, 2019–2020
Saebom Kim, Sehee Kim, Youngmin Kim, Seonmi Seo, Yu Jin Chung, Sam Cheol Kim
Korean Journal of Family Practice.2023; 13(3): 179. CrossRef
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Young Gyu Cho
Korean Journal of Family Medicine.2022; 43(5): 275. CrossRef

8,449 View
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Inappropriate Topical Antibiotics Use in Clean Dermatological Procedures in South Korea in 2018: A Nationwide Population-Based Cross-Sectional Study: Min Soo Park, Ki Duk Kim, Sang Jun Eun; Korean J Fam Med 2022;43(4):231-240. Published online July 19, 2022; DOI: https://doi.org/10.4082/kjfm.21.0139

Background
The use of topical antibiotics (TA) for prophylactic purposes after clean dermatologic procedures (CDP) is generally not recommended, and the prescription of TA needs to be individualized in consideration of each patient’s situation and underlying disease. The aim of this study was to determine the proportion of patients who underwent CDP in outpatient settings and were prescribed TA inappropriately, as well as the factors that may affect the prescription of TA.
Methods
Outpatient visits coded for CDP were selected using claims data from the Health Insurance Review and Assessment Service in 2018. Of these, patients receiving TA prescriptions were classified as having inappropriate TA use, and the proportion was estimated through technical analysis. A logistic regression analysis was used to identify factors influencing inappropriate prescriptions.
Results
Data were analyzed using 423,651 visits, and TA was prescribed for approximately 1.9% of the visits. TA usage was higher among women (2.0%), 0–19 years of age (2.2%), medical aid (2.2%), clinic settings (2.4%), and metropolitan areas (2.0%). TA was prescribed more frequently in urology (8.6%), pediatrics (5.0%), and dermatology (4.2%) than in other specialties.
Conclusion
The prescription rate of TA after CDP was 1.9% using the 1.4 million patient sample from the national health insurance claims data in Korea, which is equally weighted to represent 50 million people. Although the proportion of inappropriate TA prescriptions in Korea is lower than that in other nations, it cannot be overlooked because of the large number of cases. Efforts to improve quality are required to reduce the number of inappropriate prescriptions.

7,523 View
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Review Articles

Preventive Measures against the Development of Dementia in Old Age: Israel Oluwasegun Ayenigbara; Korean J Fam Med 2022;43(3):157-167. Published online May 20, 2022; DOI: https://doi.org/10.4082/kjfm.21.0030

Abstract
PDF

Dementia is a neurological condition characterized by numerous types of central nervous system diseases, which gradually deteriorates an individual’s reasoning, rational thinking, and judgment abilities. As a serious public health concern that currently affects more than 50 million older adults, dementia is one of the most significant causes of incapacity, disability, and dependency among older adults. As new cases are expected to increase exponentially in the next three decades, dementia, which is not a normal feature of healthy aging despite the fact that it generally affects older adults disproportionately, requires enormous management and care efforts due to its associated socioeconomic, psychological, and physical burdens that involve the patient, their caregivers, guardians, family members, and society at large. Presently, there is no cure for dementia; however, this condition could be prevented. This narrative review aimed to provide a broad overview of studies detailing the alternative lifestyle modification-centered preventive measures against dementia. A comprehensive search of key databases to find articles related to this topic revealed that participating in regular physical activities, healthy eating and dieting, avoiding all forms of smoking, avoiding air pollutants, halting or reducing alcohol consumption, exercising the mind and being socially dynamic, getting enough rest and establishing good sleeping habits, infection prevention, stress prevention, avoidance of injuries, preventing the effects of social isolation and lockdowns, continuing education, and depression prevention are protective measures against the development of dementia.

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Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates: Rania Itani, Lama Soubra, Samar Karout, Deema Rahme, Lina Karout, Hani M J Khojah; Korean J Fam Med 2022;43(2):101-108. Published online March 17, 2022; DOI: https://doi.org/10.4082/kjfm.21.0103

Abstract
PDF

Primary dysmenorrhea (PD) is a common, disregarded, underdiagnosed, and inadequately treated complaint of both young and adult females. It is characterized by painful cramps in the lower abdomen, which start shortly before or at the onset of menses and which could last for 3 days. In particular, PD negatively impacts the quality of life (QOL) of young females and is the main reason behind their absenteeism from school or work. It is suggested that increased intrauterine secretion of prostaglandins F2α and E2 are responsible for the pelvic pain associated with this disorder. Its associated symptoms are physical and/or psychological. Its physical symptoms include headache, lethargy, sleep disturbances, tender breasts, various body pains, disturbed appetite, nausea, vomiting, constipation or diarrhea, and increased urination, whereas its psychological symptoms include mood disturbances, such as anxiety, depression, and irritability. While its diagnosis is based on patients’ history, symptoms, and physical examination, its treatment aims to improve the QOL through the administration of nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and/or the use of non-pharmacological aids (e.g., topical heat application and exercise). Patients must be monitored to measure their response to treatment, assess their adherence, observe potential side effects, and perform further investigations, if needed.

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Original Articles

Risk Factors Related to Serious Adverse Drug Reactions Reported through Electronic Submission during Hospitalization in Elderly Patients: Seon-Hye Won, Sang-Yeon Suh, Eunji Yim, Hong-Yup Ahn; Korean J Fam Med 2022;43(2):125-131. Published online March 17, 2022; DOI: https://doi.org/10.4082/kjfm.21.0086

Background
Many studies have assessed the risk factors for adverse drug reactions (ADRs) in elderly patients. However, most of these studies have focused on risk factors for ADRs, not serious ADRs (s-ADRs). s-ADRs are commonly found in hospitalized patients. s-ADRs warrant imminent but thorough investigations, given their critical impact on patient health. Therefore, this retrospective study aimed to assess the associated risk factors for s-ADRs in elderly hospitalized patients.
Methods
In-patients aged >65 years having ADRs during hospitalization at a university hospital in Korea between 2010 and 2012 were included. Medical professionals spontaneously reported ADRs using an electronic submission system at the study hospital. Further, all descriptions of ADRs were characterized and categorized through the screening of electronic medical records. We compared the characteristics of patients having s-ADRs with those of patients not having s-ADRs.
Results
There were 353 cases of ADRs, 67 of which were s-ADRs. Patients taking more than eight concomitant drugs showed the highest odds ratio (OR, 11.99; 95% confidence interval [CI], 3.42–42.03). The ratio of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) was also significantly related to s-ADRs (OR, 2.78; 95% CI, 1.33–5.81). The use of antibiotics (OR, 2.39; 95% CI, 1.13–5.02) and antineoplastics (OR, 4.17; 95% CI, 1.09–15.94) were significant risk factors.
Conclusion
Our findings highlight the importance of polypharmacy. Liver function tests (AST/ALT ratio) must be monitored carefully within high-risk groups for ADRs.

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Cultural Adaption and Psychometric Analysis of Family APGAR Scale in Iranian Older People: Zeinab Karimi, Zahra Taheri-Kharameh, Fatemeh Sharififard; Korean J Fam Med 2022;43(2):141-146. Published online March 17, 2022; DOI: https://doi.org/10.4082/kjfm.21.0028

Abstract
PDF

Background
Family function is a necessary factor that influences older people’s health. The Family APGAR has been widely used to study family functions. However, there has been no Persian version of this instrument to assess family function in older people. The aim of this study was to determine the psychometric properties of the Persian version of the Family APGAR Scale to evaluate the perception of family functions.
Methods
The “forward-backward” procedure was applied to translate the scale from English into Persian. The translated version was checked in terms of validity and reliability, with a sample of 281 older people selected from retirement centers. The factor structure of the scale was also tested using a confirmatory factor analysis. To test reliability, internal consistency and test–retest analyses were performed.
Results
The results of the confirmatory factor analysis indicated a good structural model. Criterion-related validity was strongly supported by the pattern of association between the APGAR Scale and the social support survey. Cronbach’s α of the scale was 0.88 and test–retest reliability ranged from 0.96 to 0.98, indicating a good range of reliability.
Conclusion
The findings of this study suggest that the Iranian version of the Family APGAR is a valid and reliable scale to evaluate family functions in health intervention programs.

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Review Articles

Can Nutritional Supports Beneficial in Other Viral Diseases Be Favorable for COVID-19?: Fatmanur Zehra Zelka, Rümeysa Rabia Kocatürk, Öznur Özge Özcan, Mesut Karahan; Korean J Fam Med 2022;43(1):3-15. Published online January 20, 2022; DOI: https://doi.org/10.4082/kjfm.20.0134

Abstract
PDF

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2), has rapidly spread worldwide, causing many deaths, the number of which continues to increase. Global public health organizations and governments have advised on the adoption of various handwashing and hygiene guidelines, use of masks, and social distancing, along with isolation or lockdown protocols to prevent SARS-COV-2 spread. There are vaccines and drugs that are confirmed but still many human suffer from this disease. Important risk factors for SARS-COV-2 infection are similar to other viral infectious diseases as including influenza, hepatitis B, acquired immunodeficiency syndrome, and other lung infections. These diseases might be related to poor nutritional support, affecting the patient outcomes against COVID-19. In this review, we discuss some of the nutritional therapies currently being investigated for infectious diseases. Studies have shown that nutrition has the potential to prevent and mitigate viral infections. Micronutrients (vitamins A, B6, B12, C, D, and E, B9, and trace elements, such as iron, zinc, copper, selenium, magnesium, and polyphenols) and macronutrients (carbohydrates, prebiotics, probiotics, protein [amino acids], and lipids [fatty acids]) affect the whole body, including the immune system, preventing viral entry and modulating clinical symptoms. This review discusses the importance of nutrition as a strategy to understand food groups and key nutrients that may affect the clinical outcomes of COVID-19 patients during the ongoing pandemic. Scientists believe that the likelihood of another pandemic is imminent. COVID-19 remains important and scientists believe it will continue will in the future. We emphasize the lack of studies on the nutritional impact of COVID-19 in terms of nutrition, even though nutritional interventions has been shown to have many advantages during the treatment of viral infections.

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Malaysia Healthcare Early Response in Combatting COVID-19 Pandemic in 2020: Safiya Amaran, Ahmad Zulfahmi Mohd Kamaruzaman, Nurul Yaqeen Mohd Esa, Zaharah Sulaiman; Korean J Fam Med 2021;42(6):425-437. Published online November 20, 2021; DOI: https://doi.org/10.4082/kjfm.20.0117

Abstract
PDF

The year 2020 saw the emergence of a novel coronavirus—the severe acute respiratory syndrome coronavirus 2— which has led to an unprecedented pandemic that has shaken the entire world. The pandemic has been a new experience for Malaysia, especially during the implementation of large-scale public health and social measures called the Movement Control Order (MCO). This paper seeks to describe the experiences of the Malaysian healthcare system thus far in combatting the pandemic. The Malaysian healthcare system comprises two main arms: public health and medicine. The public health arm focuses on early disease detection, contact tracing, quarantines, the MCO, and risk stratification strategies in the community. The medical arm focuses on the clinical management of coronavirus disease 2019 (COVID-19) patients; it encompasses laboratory services, the devising of clinical setting adjustments, and hospital management for COVID-19 and non-COVID-19 patients. Malaysia experienced intense emotions at the beginning of the pandemic, with great uncertainty regarding the pandemic’s outcome, as the world saw a frighteningly high COVID-19 mortality. As of writing (May 30, 2020), Malaysia has passed the peak of its second wave of infections. The experience thus far has helped in preparing the country’s healthcare system to be vigilant and more prepared for future COVID-19 waves. To date, the pandemic has changed many aspects of Malaysia’s life, and people are still learning to adapt to new norms in their lives.

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Original Articles

Factors that Predict Smoking Cessation among Older Koreans: Based on the Korea National Health and Nutrition Examination Survey 2016–2018: Han Kyul Lim, Yong Soon Park, Jeong Hyeon Kim, Jeong Hyun Kim; Korean J Fam Med 2021;42(5):363-368. Published online September 20, 2021; DOI: https://doi.org/10.4082/kjfm.20.0203

Abstract
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Background
Tobacco smoking is associated with several diseases and deaths in older Koreans. This study aimed to evaluate the factors associated with smoking cessation in older Koreans.
Methods
We selected 579 subjects who started smoking before the age of 65 years from the Korea National Health and Nutrition Examination Survey 2016–2018. We excluded the subjects who quit smoking before the age of 65 years, and then categorized the rest of subjects into those who stopped smoking after the age of 65 years and those who are constant smokers. Multivariable logistic analysis was performed to evaluate the factors related to smoking cessation among older Koreans.
Results
Among the participants, 66.1% were persistent smokers. After multivariable analysis, the factors significantly associated with smoking cessation were as follows: being in the age group of 75–79 years (adjusted odds ratio [aOR], 4.07; 95% confidence interval [CI], 2.12–7.83), being in the age group of 70–74 years (aOR, 3.10; 95% CI, 1.72–5.61), a family history of ischemic heart disease (aOR, 3.36; 95% CI, 1.09–10.35), and having had no cancer screening (aOR, 0.36; 95% CI, 0.18–0.70).
Conclusion
Further efforts to identify the factors related to smoking cessation will help formulate a smoking cessation policy.

Citations

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Current status of health promotion in Korea
Soo Young Kim
Journal of the Korean Medical Association.2022; 65(12): 776. CrossRef

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Association between Consumption of Sugar-Sweetened Beverages and Risk of Cardiovascular Disease in Korean Men: Analysis Based on the Korea National Health and Nutrition Examination Survey 2014–2016: Su-Ok Kim, Eun Mi Bae, Ye-Na Lee, Joung Sik Son; Korean J Fam Med 2021;42(3):212-218. Published online May 20, 2021; DOI: https://doi.org/10.4082/kjfm.20.0114

Abstract
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Background
This study aimed to evaluate the association between the high risk of cardiovascular disease (CVD) and the consumption of sugar-sweetened beverages (SSBs) in Korean men.
Methods
This cross-sectional study analyzed the data of 3,705 men (age 30–64 years) who participated in the 2014–2016 Korea National Health and Nutrition Examination Survey (KNHANES). SSB intake was defined as the sum of the intakes of carbonated beverages and fruit juices. Participants were categorized into study groups depending on their intake of SSBs: ≤2, 3–4, or ≥5 times per week. High CVD risk was defined as a 10-year risk of more than 10%, based on the Framingham Heart Study 10-year CVD Risk Calculator. The association between high CVD risk and SSB intake was evaluated using a multivariable-adjusted logistic regression model.
Results
Korean men who consumed SSBs 3–4 and ≥5 times a week showed a multivariate-adjusted odds ratio of 1.49 (95% confidence interval [CI], 1.05–2.11) and 1.61 (95% CI, 0.97–2.67) for high CVD risk, respectively, compared with those who consumed SSBs ≤2 times per week. Additionally, the risk of CVD increased with the increase in the intake of SSBs (P-trend=0.01). In subgroup analysis, no association was observed between SSB intake and high CVD risk in the group with regular physical activity (P for interaction=0.01).
Conclusion
In Korean men, except those with regular physical activity, SSB intake ≥3 times a week is associated with a high risk for CVD (10-year CVD risk ≥10%).

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Review Article

Diagnosis and Management of Frailty in Primary Health Care: Chang Won Won; Korean J Fam Med 2020;41(4):207-213. Published online July 20, 2020; DOI: https://doi.org/10.4082/kjfm.20.0122

Abstract
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Disability in older adults has become a significant burden, both individually and socially, due to the rapidly aging population in Korea. It is important to manage both frailty and chronic diseases to delay disability. Frailty, which is considered to be a transition phase between healthy status and disability, is defined as a significant decline in functional reserves of multiple organ systems and the resultant extreme vulnerability to stressors, leading to a higher risk of adverse health-related outcomes. The frailty phenotype and frailty index are the most commonly used methods to diagnose frailty. Frailty is related to physical, psychological, cognitive, and social dysfunction, and is sometimes caused by chronic disease. Therefore, primary care providers are ideally situated to incorporate the concept of frailty into their practice, as they are champions in comprehensive care. Although the identification and treatment of frailty is not yet standard practice in primary care, primary care physicians must use the electronic frailty index to identify frailty in all the patients aged ≥65 years in the United Kingdom. In Canada, some insurance companies and governments are using a similar program, which is called the Community Actions and Resources Empowering Seniors model. The clinical practice guidelines of the International Conference of Frailty and Sarcopenia Research, as well as some additional references, will be introduced. Here, we review the current literature on how to diagnose and manage frailty in primary care.

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Original Articles

Trajectories of Handgrip Strength and Their Associations with Mortality among Older Adults in Korea: Analysis of the Korean Longitudinal Study of Aging: Kyung Hyun Bae, Yong Ho Jo, Dong Ryul Lee, Jungun Lee; Korean J Fam Med 2021;42(1):38-46. Published online May 27, 2020; DOI: https://doi.org/10.4082/kjfm.19.0140

Background
Handgrip strength (HGS) is a good predictor of adverse health outcomes in later life. This prospective study aimed to investigate whether HGS trajectory patterns were associated with all-cause mortality among older adults in Korea.
Methods
This study used the database of the 2006–2016 Korean Longitudinal Study of Aging. Study participants included 3,069 adults aged ≥65 years without a previous history of cancer. The trajectory model was developed to identify different homogeneous trajectory patterns of HGS according to study period. Cox proportional hazards models were then applied to investigate the association between HGS and all-cause mortality.
Results
The survival probability according to HGS during the follow-up period decreased as base HGS weakened. We identified four distinct trajectory groups of HGS among men and three among women. The risk of mortality increased as the HGS of both males and females decreased. Compared with the highest HGS group, the adjusted hazard ratios for all-cause mortality of the lowest, lower-mid, and upper-mid HGS groups among males were 3.46 (95% confidence interval [CI], 2.17–6.69), 2.26 (95% CI, 1.47–3.48), and 1.58 (95% CI, 1.07–2.32). Those of the low and mid HGS groups among females were 2.69 (95% CI, 1.39–5.21) and 1.97 (95% CI, 1.05–3.69).
Conclusion
The faster HGS declined over time, the greater the all-cause mortality risk increased compared with the slowly decreasing or maintained HGS groups among men and women. HGS measurement among older adults will be helpful in assessing their health statuses and pre-assessing disease-associated morbidity.

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Quality of life, grip strength, health indicators, and clinical risk in older adults: A cross-sectional study
Ana Fernandez-Araque, Andrea Giaquinta-Aranda, Veronica Velasco-Gonzalez, María Sainz-Gil, Patricia Romero Marco, Zoraida Verde
Geriatric Nursing.2026; 69: 103910. CrossRef
Effects of a 16-week high-speed resistance training program on physical and cognitive function in community-dwelling independent older adults: a clinical trial
Alexandre Duarte Martins, Nuno Batalha, Orlando Fernandes, Bruno Gonçalves, Rafael Oliveira, Joao Paulo Brito
Sport Sciences for Health.2025; 21(3): 1981. CrossRef
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Hui Chang, Yu Zhao
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Association of absolute and relative hand grip strength with all-cause mortality among middle-aged and old-aged people
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Ji-Young Choi, Young-Mo Yang
Journal of Health, Population and Nutrition.2023;[Epub] CrossRef
Grip Strength Measurement in the Right Hand Better Predicts Mortality Regardless of Dominant Hand
Yun-A Shin, Won-Ho Choi, Jae-Hyun Kim
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Longitudinal association of handgrip strength with all-cause and cardiovascular mortality in older adults using a causal framework
Rubén López-Bueno, Lars Louis Andersen, Joaquín Calatayud, José Casaña, Lee Smith, Louis Jacob, Ai Koyanagi, José Francisco López-Gil, Borja del Pozo Cruz
Experimental Gerontology.2022; 168: 111951. CrossRef
Importance of Handgrip Strength as a Health Indicator in the Elderly
Soo Young Kim
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Grip Strength as a Cardiometabolic Marker
Jungun Lee
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Effect of Increasing Tobacco Prices on Stages of Smoking Cessation: A Korean Nationwide Data Analysis: Jihye Kwon, Hyunji Kim, Hyoeun Kim, Sunmi Yoo, Seung Guk Park; Korean J Fam Med 2021;42(1):17-23. Published online May 19, 2020; DOI: https://doi.org/10.4082/kjfm.19.0135

Abstract
PDF

Background
In 2015, tobacco prices significantly increased in Korea as part of the government’s smoking cessation policy. This study examined the changes in the stages of smoking cessation among Korean male smokers before and after the implementation of the tobacco price policy, and identified the predictors of such changes.
Methods
The study population comprised 3,533 male current smokers (age ≥19 years) who participated in the Korea National Health and Nutrition Survey in 2012, 2013, 2015, and 2016. Current smokers were defined as persons who had smoked ≥100 cigarettes during their lifetime and are continuing to smoke. In accordance with the transtheoretical model, smokers were classified into the precontemplation stage (no plan to quit), contemplation stage, and preparation stage (planning to quit within 6 months). We examined the changes in the smoking cessation stages before and after the implementation of the policy. Multivariate logistic regression analysis was conducted to identify factors related to the likelihood of continuing smoking, after adjustments for potential confounders.
Results
Immediately after the policy implementation, the percentage of smokers in the precontemplation stage decreased from 65.6% to 60.8% (P=0.014). However, this effect was temporary. Significant risk factors for remaining in the precontemplation stage were older age (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.002–1.018; P=0.004), being in the lowest income quartile (OR, 1.226; 95% CI, 1.001–1.502; P=0.049), and manual worker or unemployed status (OR, 1.256; 95% CI, 1.036–1523; P=0.020).
Conclusion
Increasing tobacco prices only temporarily change the stage of smoking cessation among Korean male smokers.

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Seyoung Kim, Jee Hoon Sohn, Seung-sik Hwang
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Understanding the Turning Point of Patients with Diabetes: Syahnaz Mohd Hashim, Idayu Badilla Idris, Shalisah Sharip, Rafidah Bahari, Nasrin Jahan; Korean J Fam Med 2021;42(2):123-131. Published online May 18, 2020; DOI: https://doi.org/10.4082/kjfm.19.0177

Abstract
PDF

Background
The patient’s intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one’s readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care.
Methods
A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany).
Results
Three themes emerged from the analysis. The first theme, “Initial reactions toward diabetes,” described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. “Process of discovery” was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, “Making the right decision,” highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care.
Conclusion
Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one’s ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.

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Enhancing self-care management among women with type 2 diabetes mellitus
Na’eemah Zaini, Idayu Badilla Idris, Norfazilah Ahmad, Syahnaz Mohd Hashim, Nik Nairan Abdullah, Nadia Aqilla Shamsusah
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Kelly Sze Fang Num, Azimatun Noor Aizuddin, Syahnaz Mohd Hashim, Mohd Shahrir Mohamed Said, Gursharan K Singh
PLOS One.2025; 20(10): e0335192. CrossRef
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Clinical Epidemiology and Global Health.2023; 21: 101279. CrossRef

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Fear of Falling and Mortality among Older Adults in Korea: Analysis of the Korean Longitudinal Study of Aging: Ari Lee, Jungun Lee, Gyumin Lee, Dong Ryul Lee; Korean J Fam Med 2020;41(4):243-249. Published online May 12, 2020; DOI: https://doi.org/10.4082/kjfm.18.0128

Abstract
PDF

Background
The fear of falling (FOF) has been reported in a high percentage of elderly people. An excessive FOF is a major concern among the elderly because it can lead to permanent disability. However, the impact of FOF on mortality has been insufficiently studied. The aim of this study was to investigate the impact of FOF on mortality among the elderly in Korea.
Methods
This was a prospective study carried out using the database of the Korean Longitudinal Study of Aging, a nationwide study of community-dwelling adults in Korea. Study participants included 3,421 adults, aged 65 years or older, without either severe cognitive impairment (Korean version of Mini-Mental Status Examination ≥10), or previous history of cancer. We used Cox proportional hazards models to investigate the association between FOF and all-cause mortality.
Results
This study included 1,474 men and 1,947 women. Cox regression showed that participants with FOF had an increased risk of mortality (mild: hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.01−1.54; moderate: HR, 1.59; 95% CI, 1.23−2.05) after adjusting for confounding variables. In a subgroup analysis, FOF was still a significant risk factor of mortality for patients with no previous history of falling after adjusting for other risk factors, as in the full model, except for history of falling (HR, 1.65; 95% CI, 1.27−2.13).
Conclusion
We found that FOF was a significant risk factor for mortality in the elderly in Korea. Further studies on the effects and mechanism of FOF on mortality are needed.

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Development of a scale to measure fear of falling in older adults: a psychometric validation study
Dayeon Lee, Sunghee H Tak
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The Impact of Depression on Cardiovascular Disease: A Nationwide Population-Based Cohort Study in Korean Elderly: Dong Han Park, Jung Jin Cho, Jong Lull Yoon, Mee Young Kim, Young Soo Ju; Korean J Fam Med 2020;41(5):299-305. Published online May 8, 2020; DOI: https://doi.org/10.4082/kjfm.18.0134

Abstract
PDF

Background
Depression is suggested to be associated with cardiovascular disease, including ischemic heart disease and cerebrovascular disease. This study investigated the impact of depression on cardiovascular disease in the elderly population in Korea.
Methods
This retrospective cohort study was performed using the Senior Cohort database released by the Korean National Health Insurance Services from January 1, 2008 to December 31, 2012, or January 1, 2009 to December 31, 2013. The study group constituted participants newly diagnosed with depression, but not cardiovascular disease. The control group constituted participants with no past history of depression or cardiovascular disease, and were not diagnosed with depression during the follow-up period. During the 5-year follow-up period, development of ischemic heart disease or cerebrovascular disease was assessed. Depression and cardiovascular disease were identified using the International Classification of Diseases, 10th revision, Clinical Modification codes. The data was analyzed using Cox proportional hazards model.
Results
The hazard ratio (HR) between depression and ischemic heart disease was 1.38 (95% confidence interval [CI], 1.23 to 1.55) and the HR between depression and cerebrovascular disease was 1.46 (95% CI, 1.32 to 1.62), after adjusting all confounding variables.
Conclusion
Independent of other cardiovascular risk factors, depression increased the risk of ischemic heart disease by 38% and cerebrovascular disease by 46% among older adults in Korea. Since depression may increase the risk of cardiovascular disease, future research should focus on the diagnosis and prevention of cardiovascular disease in people with depression.

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Factors Associated with the Intention to Quit Smoking in Elderly Korean Men: The Korea National Health and Nutrition Examination Survey 2010-2015: Inho Lee, Yong Soon Park, Jeong Hyeon Kim, Seung Hyeok Han; Korean J Fam Med 2020;41(4):237-242. Published online April 24, 2020; DOI: https://doi.org/10.4082/kjfm.18.0124

Abstract
PDF

Background
Tobacco smoking is the most preventable cause of diseases and death in older adults. This study aimed to evaluate the factors associated with the intention to quit smoking in elderly Korean men.
Methods
We investigated 813 male smokers aged 65 years or more from the 5th and 6th Korea National Health and Nutrition Examination Survey 2010–2015. Multiple logistic regression analysis was performed to identify factors related with smoking cessation intention.
Results
Of the respondents, 26.3% had the intention to quit smoking. After adjustment for confounding factors, the intention to quit smoking was significantly associated with a history of ischemic heart disease (adjusted odds ratio, 1.88; 95% confidence interval, 1.02–3.48).
Conclusion
Identifying the factors related to the intention to quit smoking among older adults can help in developing effective smoking cessation strategies for this section of the population.

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Factors Associated with Quit Intentions among Adult Smokers in South Korea: Findings from the 2020 ITC Korea Survey
Minjung Han, Donghee Seo, Yeol Kim, Hong Gwan Seo, Sung-il Cho, Sungkyu Lee, Sujin Lim, Susan C. Kaai, Anne C. K. Quah, Mi Yan, Steve S. Xu, Geoffrey T. Fong
International Journal of Environmental Research and Public Health.2022; 19(17): 10839. CrossRef
Factors that Predict Smoking Cessation among Older Koreans: Based on the Korea National Health and Nutrition Examination Survey 2016–2018
Han Kyul Lim, Yong Soon Park, Jeong Hyeon Kim, Jeong Hyun Kim
Korean Journal of Family Medicine.2021; 42(5): 363. CrossRef

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Association between Falls and Nutritional Status of Community-Dwelling Elderly People in Korea: Ah-Ra Jo, Mi-Jeong Park, Byung-Gue Lee, Young-Gyun Seo, Hong-Ji Song, Yu-Jin Paek, Kyung-Hee Park, Hye-Mi Noh; Korean J Fam Med 2020;41(2):111-118. Published online March 19, 2020; DOI: https://doi.org/10.4082/kjfm.18.0112

Abstract
PDF

Background
Malnutrition is a well-known risk factor of falls, although studies examining the association between nutritional status and falls are rare. We aimed to investigate the association between nutritional status and falls according to gender among Korean older adults.
Methods
The study included 10,675 participants (4,605 men and 6,070 women) aged 65 years and older and used data from the 2011 Survey of Living Conditions and Welfare Needs of Korean Older Persons. Nutritional status of the participants was assessed using the Nutritional Screening Initiative checklist, and the participants were categorized into the following groups: “good,” “moderate nutritional risk,” and “high nutritional risk.” Odds ratios (OR) of fall risk in the above groups based on gender were evaluated using multivariate logistic regression analyses.
Results
Fallers in both genders showed significant association with older age, lower household income, inadequate exercise, and poor nutritional status compared with non-fallers. Considering the good nutritional status group as the reference group, the high nutritional risk group showed a higher risk of falls in men (OR, 1.59; 95% confidence interval [CI], 1.26–1.99); both moderate and high nutritional risk groups showed a higher risk of falls after adjusting for confounding factors in women (OR, 1.39; 95% CI, 1.19–1.62 and OR, 1.90; 95% CI, 1.61–2.24, respectively).
Conclusion
The risk of falls was associated with poor nutritional status, and statistical significance of the association between nutritional status and falls was stronger in women than in men.

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Review Articles

Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management: Amir Mari, Mahmud Mahamid, Hana Amara, Fadi Abu Baker, Afif Yaccob; Korean J Fam Med 2020;41(3):139-145. Published online February 17, 2020; DOI: https://doi.org/10.4082/kjfm.18.0182

Abstract
PDF

Chronic constipation (CC) is a common disorder in the elderly population globally and is associated with comorbidities and negative implications on the quality of life. Constipation prevalence varies in different studies, primarily owing to the nonuniformity of the diagnostic criteria. However, 15%–30% of individuals aged >60 years are diagnosed with CC. Primary care physicians are the main healthcare providers that manage constipation in elderly patients in parallel with increased population aging and increased prevalence of constipation. Physical inactivity, polypharmacy, chronic medical conditions, rectal hyposensitivity, and defecatory disorders all play a role in the pathogenesis of CC in elderly patients. Detailed anamnesis, particularly history related to chronic medication use, with digital rectal examination may assist in identifying constipation causes. Additionally, blood tests and colonoscopy may identify organic causes of CC. Physiologic tests (i.e., anorectal manometry, colonic transit time with radiopaque markers, and defecography) can evaluate the physiologic function of the colon, rectum, and anus. However, generally, there are several causes of constipation in older patients, and an individualized approach is recommended. Treatment of chronic idiopathic constipation is empiric, based on the stepwise approach. Lifestyle advice, adjustment of chronic medications, and prescription of laxatives are the first steps of management. Several laxatives are available, and the treatment is evolving in the last decade. Biofeedback is an effective therapy especially for defecatory disorders. This review aimed to summarize the most updated knowledge for primary care physicians in the approach and management of CC in elderly patients.

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Eosinophilic Esophagitis in Adults: A Concise Overview of an Evolving Disease: Amir Mari, Emmanouela Tsoukali, Afif Yaccob; Korean J Fam Med 2020;41(2):75-83. Published online February 17, 2020; DOI: https://doi.org/10.4082/kjfm.18.0162

Abstract
PDF

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that encompasses esophageal symptoms along with eosinophilic infiltration of the esophageal epithelium. EoE is an evolving disease that has been a subject of interest to many researchers since the first studies recognized this condition as a new and distinct clinicopathological entity 25 years ago. Clinical presentation in adult patients may include dysphagia, food impaction, vomiting, and reflux symptoms. The diagnosis of EoE is based on the combination of clinical history suggestive of esophageal dysfunction, endoscopic features indicative of the disease, and histology revealing eosinophilic infiltration of the esophageal epithelium that persists after a trial of proton pump inhibitor therapy along with the exclusion of other disorders that may be associated with esophageal tissue eosinophilia. The interplay between EoE and gastroesophageal reflux disease (GERD) is complex, and differentiating these two conditions continues to be difficult and challenging in clinical practice. The mainstay treatment includes dietary modification, topical steroids, and/or endoscopic dilation. The primary care physician (PCP) plays an important role in improving patient care and quality of life by ensuring early referral and participating in management and follow-up. This article provides an overview of the current knowledge base regarding the disease including epidemiology, genetics, pathogenesis, common clinical presentations, the interplay between EoE and GERD, diagnostic approaches, and therapeutic options available to the PCP.

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Original Articles

Association between Serum-Ferritin Levels and Sleep Duration, Stress, Depression, and Suicidal Ideation in Older Koreans: Fifth Korea National Health and Nutrition Examination Survey 2010–2012: Kyung Mi Kim, Hye Rim Hwang, Yun Jin Kim, Jeong Gyu Lee, Yu Hyeon Yi, Young Jin Tak, Seung Hun Lee, Sung In Chung; Korean J Fam Med 2019;40(6):380-387. Published online November 20, 2019; DOI: https://doi.org/10.4082/kjfm.18.0097

Abstract
PDF

Background
Serum-ferritin levels may be associated with psychiatric symptoms among the elderly; however, this association has not been extensively studied. The aim of this study was to evaluate the association between serumferritin levels and mental health issues in older Koreans.
Methods
This cross-sectional study included large-scale national data from the Korea National Health and Nutrition Examination Survey 2010–2012. In total, 1,802 older Koreans (≥65 years old) were included. The assessed psychiatric symptoms included short sleep duration, stress, depressed mood, and suicidal ideation. Any association between serum-ferritin levels and mental health issues according to sex was examined using logistic regression analysis.
Results
The prevalence of short sleep duration, stress, depressed mood, and suicidal ideation was 50.9%, 21.7%, 18.2%, and 22.5%, respectively. In men, suicidal ideation decreased with increased serum-ferritin levels after multivariate adjustment for sociodemographic and lifestyle factors and comorbidities. The odds ratios (OR) and 95% confidence interval (CI) of suicidal ideation by quartiles of serum-ferritin level were 1 (reference), 1.132 (95% CI, 0.569–2.252), 0.453 (95% CI, 0.217–0.945), and 0.608 (95% CI, 0.295–1.253), respectively, (P for trend=0.039). In women, no trend was observed. However, compared to the lowest quartile, short sleep duration (<7 h) and stress perception were significantly decreased in the third quartile, with odds ratios of 0.601 (95% CI, 0.461–0.888), and 0.606 (95% CI, 0.386–0.952), respectively.
Conclusion
Moderate serum-ferritin levels were associated with decreased risk for suicide ideation in men, and were associated with decreased short sleep duration and stress perception in women.

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Usefulness of Carbohydrate Antigen 19-9 Test in Healthy People and Necessity of Medical Follow-up in Individuals with Elevated Carbohydrate Antigen 19-9 Level: Sang Pyo Lee, In-Kyung Sung, Jeong Hwan Kim, Sun-Young Lee, Hyung Seok Park, Chan Sup Shim; Korean J Fam Med 2019;40(5):314-322. Published online April 8, 2019; DOI: https://doi.org/10.4082/kjfm.18.0057

Background
Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker whose level is elevated in many types of cancers and other benign conditions. CA 19-9 levels are frequently found to be elevated in individuals during general health examinations. This study aimed to investigate the clinical characteristics of such individuals and to determine the need for medical follow-up.
Methods
We investigated individuals who underwent a health inspection, including a serum CA 19-9 test, at our center. Their CA 19-9 levels, age, sex, body mass index (BMI), and personal and past histories were investigated. Additionally, subgroup analyses were performed for those who underwent follow-up study for the elevated CA 19-9 levels.
Results
Of 58,498 subjects, 581 (1.0%) had elevated CA 19-9 levels. Multivariate analyses revealed that older age, female sex, lower BMI, and diabetes were independent predisposing factors for elevated CA 19-9 level. A subgroup analysis revealed that the causative conditions were identified in 129 of 351 subjects (36.8%). Among them, the causative conditions in 31 subjects (8.8%, including four cases of cancer and 15 of benign tumors) were not detected at the initial check-up and were found during the follow-up period.
Conclusion
The use of CA 19-9 as a marker for cancer in healthy individuals is inappropriate. However, medical follow-up in individuals with elevated CA 19-9 levels may be useful because some causative diseases may be detected during follow-up.

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Shao-Cheng Lyu, Jing Wang, Mengxiu Huang, Han-Xuan Wang, Lin Zhou, Qiang He, Ren Lang
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Carbohydrate antigen 19-9 as a novel prognostic biomarker in distal cholangiocarcinoma
Tao Jiang, Shao-Cheng Lyu, Lin Zhou, Jing Wang, Han Li, Qiang He, Ren Lang
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Unintentional Injuries among the Elderly in Rural Areas and Their Related Behaviors: Forouzan Rezapur-Shahkolai, Nasrin Sayfian, Babak Moeini, Ghodratollah Roshanaei; Korean J Fam Med 2019;40(2):80-86. Published online February 28, 2019; DOI: https://doi.org/10.4082/kjfm.17.0124

Abstract
PDF

Background
Although the role of unintentional injuries as a cause of death in adults is known, there is limited knowledge about such adults’ behaviors. This study aims to investigate the frequency of and factors affecting unintentional injuries among the elderly living in rural areas and their related behaviors.
Methods
A cross-sectional study was carried out in the rural areas of Hamadan County, Iran, in 2016. The sample consists of randomly selected 445 adults aged 60–75 years. Data collection was conducted through face-to-face interviews, using questionnaires.
Results
One hundred and forty-three participants (34.7%) experienced 166 injury occurrences. The injuries occurred more in females than in males. There were more mild and severe injuries (48.2% and 31.3%, respectively) than moderate ones (20.5%). The most frequent mechanism of injuries was accidental falls (64.5%). There was a significant relationship between using aid devices and injuries (P=0.001). Among the most applied injury preventive measures as reported by the elderly, crossing streets safely and the use of proper lighting at night had the highest percentages (81.5% and 69.7%, respectively). However, the use of protective handles and plastic flooring in bathrooms in order to prevent slipping had the lowest percentages (less than 1.0%).
Conclusion
The injuries among the elderly in this study were important health concerns. Injury-related factors should be considered in the development of injury prevention programs.

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“A Familiar but Unsafe Shelter” – Older Adults’ Experience of Fall-Related Injuries at Home: A Phenomenological Study
Ok-Hee Cho, Sanghyun Bae, Jeongeun Yoon
Journal of Community Health Nursing.2026; 43(2): 81. CrossRef
Prevalence and Risk Factors of Unintentional In-Home Injuries in Older Adults
Ok-Hee Cho, Hyekyung Kim
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Factors Affecting Home Injuries in Older Adults: An Analysis Using Binary Logistic Regression
Mehdi Abbasian, Homayoun Sadeghi‐bazargani, Hossein Matlabi, Naser Havaei, Mina Hashemiparast, Hamid Allahverdipour
Health Science Reports.2025;[Epub] CrossRef
The Effectiveness of the Safety and Home Injury Prevention for Seniors: A Study Protocol for a Randomized Controlled Trial
Ok-Hee Cho, Hyekyung Kim, Kyung-Hye Hwang
Healthcare.2025; 13(21): 2695. CrossRef

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Mild Anemia and Risk for All-Cause, Cardiovascular and Cancer Deaths in Apparently Healthy Elderly Koreans: Sil Vi Han, Minseon Park, Young-Min Kwon, Hyung-Jin Yoon, Yoosoo Chang, Ho Kim, Youn-Hee Lim, Su Gyeong Kim, Ahryoung Ko; Korean J Fam Med 2019;40(3):151-158. Published online January 17, 2019; DOI: https://doi.org/10.4082/kjfm.17.0089

Abstract
PDF

Background
Being common, mild anemia is sometimes considered a mere consequence of aging; however, aging alone is unlikely to lead to anemia. Therefore, this study aimed to investigate the association between mild anemia and total mortality and cause-specific mortality in apparently healthy elderly subjects.
Methods
A retrospective cohort study was conducted on 10,114 apparently healthy elderly individuals who underwent cancer screening and routine medical check-ups at one Health Promotion Center between May 1995 and December 2007. We defined mild anemia as a hemoglobin concentration between 10.0 g/dL and 11.9 g/dL in women and between 10.0 g/dL and 12.9 g/dL in men. We assessed the relationship between the overall, cardiovascular (CV), and cancer mortality and mild anemia using Cox proportional hazard models.
Results
Mild anemia was present in 143 men (3.1%) and 246 women (6.1%). During an average follow-up of 7.6 years, 495 deaths occurred, including 121 CV and 225 cancer deaths. After adjustments, mild anemia was associated with a 128% increase in the risk of all-cause mortality hazard ratio (HR, 2.28; 95% confidence interval [CI], 1.54– 3.37) in men and cancer-related mortality (HR, 2.25; 95% CI, 1.22–4.13), particularly lung cancer (HR, 2.70; 95% CI, 1.03–7.08) in men, but not in women. In the subgroup analyses based on smoking status, obesity, and age, the associations were more prominent in never or former smoker groups and the older group.
Conclusion
The present study shows that overall and cancer-related mortality was associated with mild anemia in elderly men. Future prospective studies are needed to consolidate our findings.

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Case Reports

Mammary Paget’s Disease of the Nipple: Relatively Common but Still Unknown to Many: Poh Siang Ooi, Nani Draman, Siti Suhaila Mohd Yusoff, Wan Zainira Wan Zain, Dharmendra Ganasagaran, Hui Heng Chua; Korean J Fam Med 2019;40(4):269-272. Published online November 29, 2018; DOI: https://doi.org/10.4082/kjfm.17.0143

Abstract
PDF

Mammary Paget’s disease is clinically defined as skin inflammation of the nipple area and is an adenocarcinoma of the epidermis of the nipple. The pathogenesis of mammary Paget’s disease is relatively unknown; nonetheless, there are two popular theories that support the underlying carcinoma and de novo carcinogenesis. For the attending medical practitioner, mammary Paget’s disease poses a diagnostic and therapeutic dilemma, especially in the absence of a clinically palpable breast mass. We report a rare case of a 48-year-old Malay woman who presented at Hospital Universiti Sains Malaysia, Kelantan, Malaysia with the symptom of skin erosion on the left nipple and unresponsiveness to multiple topical treatments. A full evaluation and assessment of the patient were conducted, and mammary Paget’s disease was diagnosed.

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Mammary Paget’s disease in a young woman: A rare occurrence
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Gastro Oesophageal Reflux Disease Shadowing Anxiety Disorder Causing Prolonged Exposure to Proton Pump Inhibitor: Nur Sharharni Mohd Tahir, Rosnani Zakaria, Nani Draman; Korean J Fam Med 2019;40(5):348-350. Published online November 27, 2018; DOI: https://doi.org/10.4082/kjfm.18.0001

Abstract
PDF

Anxiety disorders are the most prevalent psychiatric disorders in the general population. The relationship between dyspepsia and particularly gastroesophageal reflux disease (GERD) and psychiatric comorbidity such as anxiety is poorly defined. However, GERD was noted to be strongly associated and often coincident in onset with generalized anxiety disorder in the community. In this paper, we report the case of an adult man who presented with severe weight loss and underlying GERD, and was later found to have an anxiety disorder as the cause of both.

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121 Download

Original Articles

The Association between Family Mealtime and Depression in Elderly Koreans: Yunhwa Kang, Soyeon Kang, Kyung Jung Kim, Hyunyoung Ko, Jinyoung Shin, Yun-Mi Song; Korean J Fam Med 2018;39(6):340-346. Published online October 31, 2018; DOI: https://doi.org/10.4082/kjfm.17.0060

Abstract
PDF

Background
Several studies have revealed the frequency of family mealtimes to be inversely associated with depressive symptoms in adolescents. However, there have been few studies in older populations. This cross-sectional study investigated the association between family mealtime frequency and depressive symptoms in elderly Koreans.
Methods
This study analyzed 4,959 elderly men and women (aged 65 years or older) who participated in the Korea National Health and Nutrition Examination Survey. Self-administered questionnaires were used to assess depressive status, family mealtime frequency, and covariates. Multiple logistic regression analysis was performed to evaluate the association using the eating alone group as a reference.
Results
After adjusting for all covariates, participants who had family meals 3 times a day had fewer depressive symptoms than the eating alone group; adjusted odds ratios (ORs) (95% confidence intervals [CIs]) were 0.72 (0.58– 0.89) for point depressiveness/anxiety and 0.73 (0.56–0.94) for depressiveness lasting for at least 2 weeks. In suicidal ideation, the OR (95% CI) of eating with family twice a day was significant after full adjusting for covariates at 0.67 (0.50–0.88).
Conclusion
Family mealtimes were closely associated with depressive symptoms in elderly Koreans, which suggests that maintaining intrafamilial bonding is important for mental health in an older population.

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Ji-Myung Kim, EunJung Lee
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Factors Associated with Dry Eye Symptoms in Elderly Koreans: the Fifth Korea National Health and Nutrition Examination Survey 2010–2012: Kyong In Kim, Yong Soon Park, Ryoung Hee Kim, Jeong Hyeon Kim; Korean J Fam Med 2019;40(1):22-30. Published online October 29, 2018; DOI: https://doi.org/10.4082/kjfm.17.0058

Abstract
PDF

Background
Dry eye disease is an aging-related ophthalmic disease that not only affects the daily activities but also causes deterioration in the quality of life. This study aimed to evaluate the factors associated with dry eye symptoms in elderly Koreans.
Methods
We investigated 4,185 subjects (men=1,787 and women=2,398) aged ≥65 years from the fifth Korea National Health and Nutrition Examination Survey 2010−2012. Data were analyzed using multiple logistic regressions to identify the relationships between dry eye symptoms and other factors.
Results
The prevalence of dry eye symptoms was 17.9%. After adjustment for confounding factors, dry eye symptoms were significantly associated with female sex (adjusted odds ratio [aOR], 1.806; 95% confidence interval [CI], 1.410−2.313), a history of cataract (aOR, 1.683; 95% CI, 1.255−2.255), suicidal ideation (aOR, 1.414; 95% CI, 1.070−1.870), hypercholesterolemia (aOR, 1.289; 95% CI, 1.025−1.621), age ≥80 years (aOR, 0.538; 95% CI, 0.337−0.859), and sleep duration ≥9 h/d (aOR, 0.524; 95% CI, 0.330−0.834).
Conclusion
Among elderly Koreans, female sex, a history of cataract, suicidal ideation, and hypercholesterolemia may be the risk factors for dry eye symptoms, whereas sleep duration ≥9 h/d can be a protective factor against dry eye symptoms.

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American Journal of Ophthalmology.2025; 279: 451. CrossRef
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Case Report

Acquired Hemophilia in a Patient Presenting with Swollen Left Limb: George Wong Pah Kiam; Korean J Fam Med 2019;40(2):129-132. Published online July 13, 2018; DOI: https://doi.org/10.4082/kjfm.17.0126

Abstract
PDF

Acquired hemophilia is a rare, potentially life-threatening disease that usually remains under-recognized especially in a primary setting; thus, diagnosing this disease is very challenging. Given its prevalence in elderly patients, awareness and diagnosis of this condition in the aging population (particularly those with unexplained bleeding or prolonged activated partial thromboplastin time) should be improved and better managed by the clinicians. Early diagnosis and prompt treatment are usually effective in preventing the adverse outcomes of this disease. In this report, we discuss a case of an elderly patient with acquired hemophilia who initially presented with swelling of his lower left limb. The diagnosis of acquired hemophilia was made a month after the appearance of symptoms. Early diagnosis with proper treatment could have been provided to this patient, if the initial assessment had been thoroughly conducted.

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Orthopedic manifestations of acquired hemophilia: a case report on uncontrolled bleeding and progressive swelling post-phlebotomy- should fasciotomy be considered?
Parham Talebian, Mohammad Soleimani, Mahsa Mottahedi, Elham Nazar, Parmida Shahbazi
BMC Musculoskeletal Disorders.2025;[Epub] CrossRef
Assessment of Lebanese healthcare professionals’ awareness on acquired haemophilia: a cross-sectional study
Ali Taher, Layal Al Mahmasani, Abdallah Aadra, Patricia Yazbeck, Georges Abi Saad, Fadi Nasr, Rita Habib, Amal Chalfoun, Fadi Haddad
Hematology.2021; 26(1): 83. CrossRef

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2 Web of Science
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Original Articles

Association of High-Risk Drinking with Metabolic Syndrome and Its Components in Elderly Korean Men: The Korean National Health and Nutrition Examination Survey 2010–2012: Ji-Hyun Kim, Jeong-Im Ha, Jae-Min Park, Ji Sun Lee, Ah-Leum Ahn, Eun-Jung Oh, Jae-Kyung Choi, Hyuk-Jung Kweon, Dong-Yung Cho; Korean J Fam Med 2018;39(4):233-238. Published online July 6, 2018; DOI: https://doi.org/10.4082/kjfm.17.0024

Abstract
PDF

Background
Previous studies have examined the association between alcohol consumption and metabolic syndrome (MetS) in adults, but studies in the elderly are lacking. We examined the relationship between high-risk alcohol consumption and MetS in elderly Korean men using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire from the 2010–2012 Korean National Health and Nutrition Examination Survey.
Methods
Among 25,534 subjects, 2,807 were men >60 years of age; after exclusions, we included 2,088 men in the final analysis. We categorized the study participants into three groups according to AUDIT score: low risk (0–7), intermediate risk (8–14), and high risk (≥15 points).
Results
Among the study population, 17.0% of the men were high-risk drinkers, who had the highest mean waist circumference, systolic and diastolic blood pressure (BP), fasting plasma glucose (FPG), and triglyceride (TG) levels. The overall prevalence of MetS was 41.9% in the elderly men, and it was significantly higher in the group with high (48.3%) versus low (31.9%) AUDIT scores. The prevalence of MetS components (elevated BP, high FPG, high TG, and low high-density lipoprotein cholesterol) was associated with a high AUDIT score. The odds ratios (95% confidence interval) of the high-risk group for MetS, elevated BP, and high TG were 1.40 (1.03–1.89), 1.82 (1.28– 2.60), and 1.77 (1.30–2.41) after adjustment for confounding variables.
Conclusion
AUDIT score was correlated with most MetS components in elderly Korean men.

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Sex-Specific Energy Intakes and Physical Activity Levels According to the Presence of Metabolic Syndrome in Korean Elderly People: Korean National Health and Nutrition Examination Survey 2016–2018
Won-Sang Jung, Hun-Young Park, Sung-Woo Kim, Kiwon Lim
International Journal of Environmental Research and Public Health.2020; 17(15): 5416. CrossRef
Cardiovascular effects of alcohol: A double-edged sword / how to remain at the nadir point of the J-Curve?
Theodora A. Manolis, Antonis A. Manolis, Antonis S. Manolis
Alcohol.2019; 76: 117. CrossRef
High-Risk Drinking in the Elderly
Seung-Won Oh
Korean Journal of Family Medicine.2018; 39(4): 209. CrossRef

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Relationship between Marital Status and Metabolic Syndrome in Korean Middle-Aged Women: The Sixth Korea National Health and Nutrition Examination Survey (2013–2014): Young-Ah Jung, Li-Ly Kang, Ha-Nui Kim, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park; Korean J Fam Med 2018;39(5):307-312. Published online July 6, 2018; DOI: https://doi.org/10.4082/kjfm.17.0020

Abstract
PDF

Background
This study aimed to investigate the relationship between marital status and the incidence of metabolic syndrome in Korean middle-aged women.
Methods
Based on data from the sixth Korea National Health and Nutrition Examination Survey (2013–2014), 3,225 women aged 40–69 years were subjected to the analysis. Marital status was categorized as married, unmarried, separated, widowed, or divorced. The odds ratios (ORs) for metabolic syndrome were calculated based on marital status. After adjustment for age, income level, education level, alcohol intake, smoking status, leisure physical activity, menopause status, daily calories, and fat intake, changes in the OR for metabolic syndrome based on marital status were examined by multivariate logistic regression analysis.
Results
The OR for metabolic syndrome in the widowed group to the married group was 4.818 (95% confidence interval [CI], 3.861–6.002; P<0.001) and that after adjustment of age, economic level, education level, alcohol intake, smoking status, physical activity, menopause status, total daily calories, and fat intake was 2.141 (CI, 1.432–3.199; P<0.001), both of which were statistically significant. The OR for metabolic syndrome in the unmarried group to the married group was 0.246 (CI, 0.141–0.431; P<0.001) after adjustment of all components. On the contrary, the ORs of the separated group and the divorced group to the married group were not significant.
Conclusion
In comparison with the married middle-aged group, the widowed middle-aged group tended to have a higher risk of metabolic syndrome, which is speculated to be related to socioeconomic factors and health behavior.

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The Association between Social Support and Happiness among Elderly in Iran: Babak Moeini, Majid Barati, Maryam Farhadian, Milad Heydari Ara; Korean J Fam Med 2018;39(4):260-265. Published online July 4, 2018; DOI: https://doi.org/10.4082/kjfm.17.0121

Abstract
PDF

Background
Elderly people’s life is affected by multiple factors including social support, which is of the utmost importance. This study aimed to explore the association between social support and happiness as well as the impact of types of social support on happiness among elders.
Methods
This descriptive and analytical study was carried out on 411 elderly men and women referred to the retirement, cultural, and rehabilitation centers in Hamadan, west of Iran. Participants were selected by a multi-stage random sampling method. The research instrument included a questionnaire consisting of three parts: demographic information, the Oxford Argyle Happiness Inventory, and a Questionnaire derived from Social Support Theory. The questionnaire was completed through a self-report study. The collected data were analyzed using Pearson correlation coefficients, multiple linear regression, independent t-tests, and one-way analysis of variance in IBM SPSS Software ver. 22.0.
Results
The mean for happiness was reported as 41.17±15.2. The values given for social support were 29.40±11.95 and for its dimensions were 7.53±3.89 and 13.70±4.90 for informational support and emotional support, respectively. Moreover, the mean value for appraisal support was 3.48±2.37 and was 4.70±2.56 for instrumental support. Multiple linear regression analysis revealed that social support and demographic variables could account for approximately 25% (R2 =0.25) of changes in the variable of happiness.
Conclusion
High social support could increase happiness among elders. The quality and quantity of social support can be taken into account as proper determinants and predictors of happiness among elders.

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Effects of Age at First Childbirth and Other Factors on Central Obesity in Postmenopausal Women: The 2013–2015 Korean National Health and Nutrition Examination Survey: Wang Jin Lee, Jung Won Yoon, Joo Ha Lee, Byoung Gyu Kwag, Shin Hae Chang, Yu Jin Choi; Korean J Fam Med 2018;39(3):155-160. Published online May 18, 2018; DOI: https://doi.org/10.4082/kjfm.2018.39.3.155

Abstract
PDF

Background
Waist circumference is one of the key components of metabolic syndrome. Recent studies demonstrated that the reproductive profile was associated with metabolic syndrome in postmenopausal women. This study focused on the association between central obesity and age at first childbirth. It also considered other factors associated with central obesity in postmenopausal women.
Methods
This study was based on the 2013–2015 Korean National Health and Nutrition Examination Survey and involved 3,143 naturally postmenopausal women. These women were divided into three groups according to their age at first childbirth: 19 years or younger (n=252), 20–29 years (n=2,695), and 30 years or older (n=196). Multivariate analysis using logistic regression was performed to evaluate the effects of various reproductive factors, including other confounding factors.
Results
During adjustment for confounding factors, in the early age at first childbirth group, odds ratios (95% confidence intervals) for central obesity decreased. In the final model, younger age at first childbirth was not significantly related to central obesity (waist circumference more than 85 cm) in naturally postmenopausal women after adjusting for other confounding factors.
Conclusion
Younger age at first childbirth was not significantly associated with central obesity after adjustment for confounding factors.

Citations

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The Mediating Role of Body Mass Index in the Association Between Age at First Childbirth and Lung Function Among Chinese Postmenopausal Women
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Brief Communication

Adequacy of Protein Intake among Korean Elderly: An Analysis of the 2013–2014 Korea National Health and Nutrition Examination Survey Data: Hyun Ah Park; Korean J Fam Med 2018;39(2):130-134. Published online March 22, 2018; DOI: https://doi.org/10.4082/kjfm.2018.39.2.130

Abstract
PDF

Background

Protein intake in South Korea is generally considered to be adequate; however, there is concern that it may be inadequate among the elderly. This study evaluated the adequacy of protein intake, the source of protein, and the distribution of protein intake in daily meals in the Korean elderly population.

Methods

Data were obtained from 1,484 men and 2,028 women aged 60 years or older who had participated in the nutrition survey of the 2013–2014 Korea National Health and Nutrition Examination Survey. One-day (24-hour) recall data were used to estimate the daily protein intake.

Results

The mean protein intake was 65.3±1.0 g/d (13.1%±0.1% of energy) and 49.7±0.7 g/d (12.6%±0.1% of energy) for men and women, respectively. The protein intake was less than the estimated average requirement in 30.8%±1.4% of men and 42.6%±1.3% of women, and 47.9%±1.6% and 60.1%±1.4%, respectively, consumed less than the recommended daily allowance. The protein intake was relatively evenly distributed among meals; however, the absolute amount of protein consumption per meal was very low. Only one-third of the protein intake came from animal sources.

Conclusion

The quantity and quality of protein intake were inadequate in the elderly Korean population.

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Original Article

Association between Female Urinary Incontinence and Geriatric Health Problems: Results from Korean Longitudinal Study of Ageing (2006): Kyungjin Sohn, Chang Ki Lee, Jinyoung Shin, Jungkwon Lee; Korean J Fam Med 2018;39(1):10-14. Published online January 23, 2018; DOI: https://doi.org/10.4082/kjfm.2018.39.1.10

Abstract
PDF

Background

Urinary incontinence (UI) is highly prevalent in the aging population. UI is one of the most common geriatric syndromes and affects overall health, quality of life, and economical burden in patients. The aims of this study were to investigate the characteristics of patients with UI and to assess its association with other geriatric health problems.

Methods

We used data from the Korean Longitudinal Study of Ageing obtained in 2006. Among the 10,254 individuals aged 45 years and older, we analyzed data from 2,418 women aged 65 years and older. Data were obtained using questionnaires for UI, comorbidities, and lifestyle factors.

Results

Among the 2,418 women aged 65 years and older, 506 (20.9%) had UI. Cerebrovascular disease (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.26 to 3.23), arthritis (OR, 1.44; 95% CI, 1.18 to 1.77), and fear of falling (OR, 1.62; 95% CI, 1.18 to 2.22) were significantly associated with UI, while chronic lung disease, psychiatric disease, difficulty in daily living due to visual and hearing problems, and experiencing a fall in the last 2 years were not associated with UI.

Conclusion

Cerebrovascular disease, arthritis, and especially fear of falls were significantly associated with UI in elderly Korean women.

Citations

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Case Report

A Brief Psychotic Episode with Depressive Symptoms in Silent Right Frontal Lobe Infarct: Salziyan Badrin, Noraini Mohamad, Nor Akma Yunus, Maryam Mohd Zulkifli; Korean J Fam Med 2017;38(6):380-382. Published online November 14, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.6.380

Abstract
PDF

Psychiatric symptoms may be related to a silent cerebral infarct, a phenomenon that has been described previously in literature. Acute psychosis or other neuropsychiatric symptoms including depression may present in stroke patients and patients with lesions either within the prefrontal or occipital cortices, or in subcortical areas such as the basal ganglia, thalamus, mid-brain, and brainstem. Psychosis in clinical stroke or in silent cerebral infarction is uncommon and not well documented in the literature. Neurological deficits are the most common presentation in stroke, and nearly a third of patients that suffer a stroke may experience psychological disorders such as depression and anxiety, related to physical disability. The present case report describes an elderly female patient who presented with hallucinations and depressive symptoms, and was discovered to have a recent right frontal brain infarction, without other significant neurological deficits.

Citations

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Original Article

Association of Coffee Consumption with Sarcopenia in Korean Elderly Men: Analysis Using the Korea National Health and Nutrition Examination Survey, 2008–2011: Hyewon Chung, Ji Hyun Moon, Ju Il Kim, Mi Hee Kong, Jung Sik Huh, Hyeon Ju Kim; Korean J Fam Med 2017;38(3):141-147. Published online May 23, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.3.141

Abstract
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Background

Sarcopenia is an age-related loss of muscle mass and strength. Coffee has antioxidant and anti-inflammatory properties that have been shown to be inversely related to the mechanism of sarcopenia. While there have been some studies on the effect of coffee on sarcopenia in animals, studies on the topic in humans are rare. Therefore, we investigated this relationship in elderly Korean men.

Methods

The cross-sectional data were derived from the 2008–2011 Korea National Health and Nutrition Examination Survey. After applying the exclusion criteria, the study sample consisted of 1,781 men who were at least 60 years of age. Study participants were identified as having sarcopenia if their appendicular skeletal muscle mass divided by height squared was less than two standard deviations below the gender-specific mean of this value for young adults. Daily coffee consumption amounts were categorized as <1 cup, 1 cup, 2 cups, and ≥3 cups.

Results

Compared to the group of individuals who drank less than one cup of coffee a day, people who consumed at least 3 cups (adjusted odds ratio, 0.43; 95% confidence interval, 0.20 to 0.94) showed significantly decreased sarcopenia; however, the decrease was not significant when the daily coffee consumption was 1 or 2 cups. In multivariate logistic regression models, significant associations were observed between sarcopenia and coffee consumption (P for trend=0.039).

Conclusion

The results of this study suggest that consuming at least 3 cups of coffee per day was associated with a lower prevalence of sarcopenia in elderly Korean elderly men.

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Case Report

A Diagnosis to Consider in an Adult Patient with Facial Features and Intellectual Disability: Williams Syndrome: Özlem Akgün Doğan, Pelin Özlem Şimşek Kiper, Gülen Eda Utine, Mehmet Alikaşifoğlu, Koray Boduroğlu; Korean J Fam Med 2017;38(2):102-105. Published online March 22, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.2.102

Abstract
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Williams syndrome (OMIM #194050) is a rare, well-recognized, multisystemic genetic condition affecting approximately 1/7,500 individuals. There are no marked regional differences in the incidence of Williams syndrome. The syndrome is caused by a hemizygous deletion of approximately 28 genes, including ELN on chromosome 7q11.2. Prenatal-onset growth retardation, distinct facial appearance, cardiovascular abnormalities, and unique hypersocial behavior are among the most common clinical features. Here, we report the case of a patient referred to us with distinct facial features and intellectual disability, who was diagnosed with Williams syndrome at the age of 37 years. Our aim is to increase awareness regarding the diagnostic features and complications of this recognizable syndrome among adult health care providers. Williams syndrome is usually diagnosed during infancy or childhood, but in the absence of classical findings, such as cardiovascular anomalies, hypercalcemia, and cognitive impairment, the diagnosis could be delayed. Due to the multisystemic and progressive nature of the syndrome, accurate diagnosis is critical for appropriate care and screening for the associated morbidities that may affect the patient's health and well-being.

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