Skip to main content

Health-related quality of life in South Korean community-dwelling older adults with multimorbidity: a convergent parallel mixed-methods approach

Quality of Life Research volume 29, pages 721–732 (2020)Cite this article

Abstract

Purpose

Alongside population aging, the rapid increase in the number of older adults with multimorbidity—the existence of two or more chronic conditions—has been noteworthy. However, in South Korea, studies taking a comprehensive approach to the factors associated with health-related quality of life (HRQoL) and disease-related problems experienced by older adults with multimorbidity have been rare. This study examined the associations of several variables with HRQoL and explored disease-related life experiences of community-dwelling older adults with multimorbidity in South Korea.

Methods

A convergent parallel mixed-methods approach was used with survey data from 310 community-dwelling older adults aged over 65 diagnosed with two or more chronic diseases and who regularly received treatment. Qualitative data were collected from 3 focus group interviews with 15 participants. Factors correlated with HRQoL were analyzed using multiple regression, and NVivo Pro 12.0 was used for content analysis.

Results

In the multiple regression analyses, depression had the most significant association with HRQoL. Depression, activities of daily living, instrumental activities of daily living, support from friends, number of medications, and subjective health status explained 41.0% of the variance in HRQoL. Content analysis revealed 5 major health-related themes in the participants’ lives: reduced physical function, anxious mental state, changes in the importance of the social support structure, limitations of disease management, and acceptance and endurance.

Conclusion

Based on the results, community-based programs and health promotion projects that consider psychological states (e.g., depression) are needed to boost the HRQoL of individuals with multimorbidity.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Statistics Korea. (2018). National survey on Korean older persons. Retrieved September 27, 2018, from http://kostat.go.kr/portal/korea/kor_nw/3/index.board?bmode=read&aSeq=370781&pageNo=&rowNum=10&amSeq=&sTarget=&sTxt=.

  2. Gu, J., Chao, J., Chen, W., Xu, H., Zhang, R., He, T., et al. (2018). Multimorbidity and health-related quality of life among the community-dwelling elderly: A longitudinal study. Archives of Gerontology and Geriatrics,74, 133–140.

    PubMed  Google Scholar 

  3. Weale, R. A. (2009). A note on age-related comorbidity. Archives of Gerontology and Geriatrics,49(1), 93–97.

    PubMed  Google Scholar 

  4. Oh, Y. H. (2015). The health status of older Koreans and policy considerations. Health and Welfare Policy Forum,223, 29–39.

    Google Scholar 

  5. Wallace, E., Salisbury, C., Guthrie, B., Lewis, C., Fahey, T., & Smith, S. M. (2015). Managing patients with multimorbidity in primary care. BMJ,350, h176.

    PubMed  Google Scholar 

  6. Marengoni, A., Rizzuto, D., Wang, H. X., Winblad, B., & Fratiglioni, L. (2009). Patterns of chronic multimorbidity in the elderly population. Journal of the American Geriatrics Society,57(2), 225–230.

    PubMed  Google Scholar 

  7. Parker, L., Moran, G. M., Roberts, L. M., Calvert, M., & McCahon, D. (2014). The burden of common chronic disease on health-related quality of life in an elderly community dwelling population in the UK. Family Practice,31(5), 557–563.

    PubMed  Google Scholar 

  8. Min, S. H., & Kim, J. I. (2012). Construction of explanatory model for medication adherence in older people with chronic disease. The Korean Journal of Fundamentals of Nursing,19(4), 463–473.

    Google Scholar 

  9. Nam, S. K., & Shim, O. S. (2011). A study on the influence factors on quality of life of chronic disease elderly. Korean Journal of Gerontological Social Welfare,53, 196–216.

    Google Scholar 

  10. Schipper, H., Clinch, J., & Powell, V. (1990). Definitions and conceptual issues. In B. Spilker (Ed.), Quality of life assessments in clinical trials. New York: Raven Press.

    Google Scholar 

  11. Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life. JAMA,273(1), 59–65.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Borgaonka, M. R., & Irvine, E. J. (2000). Quality of life measurement in gastrointestinal and liver disorder. Gut,47(3), 444–454.

    Google Scholar 

  13. Park, D. S., Ma, S. J., & Choi, K. E. (2010). Current situation of the rural vulnerable class and policy improvement measures: Centered on the elderly living alone and grandparents-grandchildren families. Seoul: Korea Rural Economic Institute.

    Google Scholar 

  14. Chin, W. Y., Choi, E. P. H., Wan, E. Y. F., & Lam, C. L. K. (2015). Health-related quality of life mediates associations between multi-morbidity and depressive symptoms in Chinese primary care patients. Family Practice,33(1), 61–68.

    PubMed  PubMed Central  Google Scholar 

  15. Gunn, J. M., Ayton, D. R., Densley, K., Pallant, J. F., Chondros, P., Herrman, H. E., et al. (2012). The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Social Psychiatry and Psychiatric Epidemiology,47(2), 175–184.

    PubMed  Google Scholar 

  16. Ng, C. L., Luo, N., & Heng, B. H. (2014). Health status profiles in community-dwelling elderly using self-reported health indicators: A latent class analysis. Quality of Life Research,23(10), 2889–2898.

    PubMed  Google Scholar 

  17. Wicke, F. S., Güthlin, C., Mergenthal, K., Gensichen, J., Löffler, C., Bickel, H., et al. (2014). Depressive mood mediates the influence of social support on health-related quality of life in elderly, multimorbid patients. BMC Family Practice,15(1), 62.

    PubMed  PubMed Central  Google Scholar 

  18. Henchoz, Y., Abolhassani, N., Büla, C., Guessous, I., Goy, R., & Santos-Eggimann, B. (2019). Change in quality of life among community-dwelling older adults: Population-based longitudinal study. Quality of Life Research,28(5), 1305–1314.

    PubMed  Google Scholar 

  19. Garvey, J., Connolly, D., Boland, F., & Smith, S. M. (2015). OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: A randomized controlled trial. BMC Family Practice,16, 59.

    PubMed  PubMed Central  Google Scholar 

  20. Markle-Reid, M., Ploeg, J., Fraser, K. D., Fisher, K. A., Bartholomew, A., Griffith, L. E., et al. (2018). Community program improves quality of life and self-management in older adults with diabetes mellitus and comorbidity. The Journal of the American Geriatrics Society,66(2), 263–273.

    PubMed  Google Scholar 

  21. Jung, Y. H. (2014). Distribution and types of multiple chronic condition in Korea. Seoul: Korea Institute for Health and Social Affairs.

    Google Scholar 

  22. Kim, C. H., Lee, M. R., & Yoo, W. S. (2014). Common combinations of chronic diseases in multimorbidity and their effect on healthcare cost in Korea. The Korean Association of Health Economics and Policy,20(4), 81–102.

    Google Scholar 

  23. Kim, J. I. (2013). Levels of health-related quality of life (EQ-5D) and its related factors among vulnerable elders receiving home visiting health care services in some rural areas. Journal of Korean Academy of Community Health Nursing,24(1), 99–109.

    Google Scholar 

  24. Park, B., Ock, M., Lee, H. A., Lee, S., Han, H., Jo, M. W., et al. (2018). Multimorbidity and health-related quality of life in Koreans aged 50 or older using KNHANES 2013–2014. Health and Quality of Life Outcomes,16, 186.

    PubMed  PubMed Central  Google Scholar 

  25. No, J. Y., Kim, S. Y., Kwon, I. S., & Nam, H. S. (2014). Effect of arthritis and comorbid chronic conditions on health-related quality of life in Korean elderly. Journal of the Korea Academia-Industrial Cooperation Society,15(6), 3751–3758.

    Google Scholar 

  26. Jo, S., Lee, I., & Park, B. (2016). Factors influencing health-related quality of life of young adults and elderly with multimorbidity: A secondary analysis of the 2013 Korea Health Panel Data. Journal of Korean Academy Community Health Nursing,27(4), 358–369.

    Google Scholar 

  27. Lee, H. J., Kim, C., & Paik, S. B. (2011). Effects of group intervention program on depression and quality of life in Korean elderly with chronic disease. Korean Journal of Health Promotion,11(4), 217–226.

    Google Scholar 

  28. Creswell, J. W., & Plano Clark, V. L. (2011). Designing and conducting mixed methods research (2nd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  29. Johnson, R. B., & Onwuegbuzie, A. J. (2004). Mixed methods research: A research paradigm whose time has come. Educational Researcher,33(78), 14–26.

    Google Scholar 

  30. Morse, J. M., & Niehaus, L. (2009). Mixed method design: Principles and procedures. New York: Left Coast Press.

    Google Scholar 

  31. Creswell, J. W. (2014). A concise introduction to mixed methods research. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  32. Stewart, D. W., & Shamdasani, P. M. (2014). Focus groups. Theory and practice. London: Sage Publications.

    Google Scholar 

  33. The International Consensus Group for the Development of an International Physical Activity Questionnaire. (2011). International Physical Activity Questionnaire(IPAQ) Korean version of short form. Retrieved May 13, 2018, from https://sites.google.com/site/theipaq/questionnaire_links.

  34. Oh, J. Y., Yang, Y. J., Kim, B. S., & Kang, J. H. (2007). Validity and reliability of Korean version of International Physical Activity Questionnaire (IPAQ) short form. Journal of the Korean Academy of Family Medicine,28(7), 532–541.

    Google Scholar 

  35. Won, C. W., Yang, K. Y., Rho, Y. G., Kim, S. Y., Lee, E., Yoon, J. L., et al. (2002). The development of Korean Activities of Living(K-ADL) and Korean Instrumental Activities of Living(K-IADL) Scale. Journal of the Korean Geriatrics Society,6(2), 107–120.

    Google Scholar 

  36. Katz, S. (1983). Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. Journal of American Geriatric Association,31, 721–727.

    CAS  Google Scholar 

  37. Lawton, M. D., & Brody, E. (1963). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist,9, 179–186.

    Google Scholar 

  38. Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist,5(2), 165–173.

    Google Scholar 

  39. Kee, B. S. (1996). A preliminary study for the standardization of the Geriatric Depression Scale short form-Korea version. Journal of the Korean Neuropsychiatric Association,35(2), 298–307.

    Google Scholar 

  40. Shin, J. S., & Lee, Y. B. (1999). The effects of social supports on psychosocial well-being of the unemployed. Korean Journal of Social Welfare,37, 241–269.

    Google Scholar 

  41. Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment,52(1), 30–41.

    Google Scholar 

  42. Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Research in Nursing,62(1), 107–115.

    Google Scholar 

  43. Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today,24(2), 105–112.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage Publications.

    Google Scholar 

  45. Bayliss, E. A., Ellis, J. L., & Steiner, J. F. (2007). Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities. The Annals of Family Medicine,5(5), 395–402.

    PubMed  Google Scholar 

  46. Nam, K. M., & Park, H. J. (2010). The influence of participation in religious and social activities of the elderly on their life satisfaction-Focusing on depression and death anxiety. Journal of Welfare for the Aged,49, 405–428.

    Google Scholar 

  47. Heo, C. M., & Ahn, S. H. (2014). Relationship among subjective health, psychological well-being, and successful aging of elderly participating in physical activity. Journal of Korean Society for the Study of Physical Education,53(6), 357–369.

    Google Scholar 

  48. Rodrigues, L. R., Tavares, D. S., Dias, F. A., Pegorari, M. S., Marchiori, G. F., & Tavares, D. M. (2017). Quality of life of elderly people of the community and associated factors. Journal of Nursing,11(Suppl. 3), 1430–1438.

    Google Scholar 

Download references

Funding

This research was funded by the National Research Foundation of Korea (NRF-20180408844).

Author information

Affiliations

  1. College of Nursing, Catholic University of Pusan, Busan, South Korea

    Hyun-Ju Lee

  2. Graduate School, College of Nursing, Pusan National University, Yangsan, South Korea

    Jungmi Yun

Authors
  1. Hyun-Ju Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jungmi Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jungmi Yun.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional board (C university (Approval No. CUPIRB-2018-015)) and the Declaration of Helsinki.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, HJ., Yun, J. Health-related quality of life in South Korean community-dwelling older adults with multimorbidity: a convergent parallel mixed-methods approach. Qual Life Res 29, 721–732 (2020). https://doi.org/10.1007/s11136-019-02360-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-019-02360-0

Keywords

  • Aged
  • Chronic disease
  • Health
  • Multimorbidity
  • Quality of life