I. Introduction
The number of people over 65 years old in Korea was 6.57 million as of 2015, accounting for 13.2% of the total population
1). It is predicted that the proportion of the elderly population will rapidly increase to 20.8% in 2026 due to an aging society
2).
As the proportion of the elderly population increases, the number of care hospitals, which were 78,461 in 2008, increased to 88,163 in 2015, an average 1.7% increase per year. As a result, the number of healthcare workers in care hospitals in 2015 also increased by 4.7% over the previous year
3).
As the elderly population increases, the number of care hospitals will also increase, and there are many studies on the quality of life of patients in care hospitals, such as studies about the meaning and nature of the change of life of elderly patients admitted to a care hospital
2), and patient satisfaction or reuse according to the motivation for choosing care hospital treatment
4).
Dementia refers to a complex clinical syndrome in which a mature brain is abnormally damaged or destroyed by diseases, not trauma, such that mature cognitive functions and mental functions of intelligence, learning, and language generally decline
5). Questionnaires have been previously used to explore the Western-Korean cooperative treatment of dementia in specialist and clinical studies
6,7).
Although the care hospitals in Korea have Western-Korean cooperative treatments for dementia and these are the only medical institutions that provide cognitive programs through social workers, there is a lack of multidisciplinary studies and data about Western-Korean cooperative treatments on geriatric mental illness patients who have been hospitalized at care hospital. Therefore, it is difficult to provide a basis for the effectiveness of the decision on the policy about the korean medical institution in the care hospitals and the medical specialist of the traditional korean medicine is not applied in the care hospitals.
The purpose of this study is to provide data to guide dementia health policy in Korea and to establish the position of traditional Korean medical specialists within care hospitals through analyzing dementia patients admitted to the Mungyeong municipal care hospital by seriousness, diagnosis, application of Western-Korean cooperative medicine, and the progression of dementia. We analyzed the actual condition of dementia patients in care hospitals and the effect of Western-Korean cooperative medicine on the progression of dementia.
IV. Discussion
In order to protect the health of the elderly, the numbers of whom are rapidly increasing with population aging, countries around the world are developing and operating medical services and insurance systems specialized for the elderly
9). In Korea, too, due to the aging society, the number of care hospitals equipped with professional services and facilities is increasing due to the increases in geriatric diseases and the increases in medical expenses for the elderly.
Patients who are usually hospitalized in care hospitals are those with chronic geriatric diseases, cerebrovascular diseases, and dementia, and also for some elderly, long-term care services are needed because of a decreased ability to perform daily activities of living
10).
Dementia is defined as a disorder of daily and social life due to decreases in various cognitive functions such as memory, language, concentration, performance, and orientation in time and space caused by acquired brain dysfunction. Dementia is not the disease but a syndrome caused by structural damage to the brain or lack of neurotransmitters as a result of various diseases
11).
Research on patients with dementia admitted to a care hospital applying western medicine includes a study by Joo et al.
12), who analyzed a model of internal and external spaces and a medical facility in a care hospital for dementia patients; a study by Bang et al.
13) that analyzed the factors affecting the number of admission days for Alzheimer patients; and a study by Kang et al.
2) that analyzed the changes in the lives of elderly patients in a domestic care hospital, which provides a mixed function of care hospital and geriatric care facilities. In addition, recently, there has been a lot of research about the treatment and quality of life of dementia patients admitted to a care hospital.
According to the current study, dementia patients with Alzheimer disease accounted for 97% of patients admitted to the hospital with dementia. The reason for this is that the primary cause of dementia is degenerative disease and the ages of admission to the hospital were 50% in their 80s, 23% in their 90s, and 19% in their 70s.
According to Lee et al.
8)’s study, the distribution of patients admitted for more than a year to 35 care hospitals between 2008 and 2010 showed a higher proportion of the ultra-high medical care group, high medical care group, and medium medical care group. In contrast, in this study, the impaired cognition group, median, and high medical care group comprised 48%, 26%, and 19%, respectively. This difference seems to be due to being targeted to dementia patients among whom cognitive function and behavioral psychological symptoms mainly occur. In addition, the proportion in the impaired cognition group appears to be high because dementia mainly occurs in memory, locomotion, language disorders, and time and space dysfunction.
The MMSE was developed by Folstein et al. in 1975 and is designed to measure various cognitive functions in 5 to 15 minutes. In Korea, there are the MMSE-K and K-MMSE. The K-MMSE used in this study is useful for evaluating and detecting cognitive impairment in Alzheimer dementia patients and vascular dementia patients as shown in Kang et al.
14).
It is also possible to observe changes in cognitive function through repeated measures. The GDS is an overall degenerative scoring system that can be used to evaluate the degree of cognitive impairment during aging and dementia, and it can show changes in the patient’s level of function over time
15).
In this study, on the K-MMSE, 52% had 0–9 scores, 44% 10–19 scores, and 4% 20–30 scores. For the GDS, it was 27% had GDS6, 26% had GDS5, and GDS3 and GDS4 were both at 16%. The percentage with severe and moderate dementia, which is at a stage that is no longer capable of thinking or reasoning, was high at 53% with GDS 5 and 6, which is moderate dementia with diminished memory and poor judgment, and 14% at GDS7, which is severe dementia. This suggests that moderate dementia predominated in this study.
As a result of comparing the changes of K-MMSE and GDS every 6 months for dementia inpatients, 83% of the patients were maintained, 16% of the patients were getting worse, and 1% were getting better. Therefore, overall the degree of progression of symptoms was not large
16).
When considering the fact that 39% of patients with Alzheimer disease will have to use a care hospital within a year after diagnosis due to symptomatic deterioration, the rate of progression of dementia was somewhat lower in inpatients in this study with moderate to severe Alzheimer disease who received Western-Korean cooperative treatment.
The most common diseases treated by Korean medical consultants at this hospital were 370 cases of other spinal diseases, followed by 245 cases of cerebrovascular disease, 229 cases of arthropathy, 152 cases of hemiplegia, and 119 cases of knee arthropathy.
Although there is no established acupuncture treatment for dementia, patients who have been hospitalized for long periods with dementia generally prefer the traditional Korean medicine treatment for paralysis and musculoskeletal diseases. In addition, the number of patients treated by extracts or herbal medicine was rather small, although they are widely used as a prescription related to diseases such as pain, digestive diseases, and cold damage. This suggests that, in the case of Korean herbal insurance extracts, these are not allowed to be prescribed within the same diagnosis, so that a simple prescription cannot be written for dementia.
Currently, the insurance fee for acupuncture in long-term inpatient care hospitals is estimated to be calculated every day for the first 3 months. Long-term inpatients for more than 6 months, such as patients with dementia admitted to the hospital, are allowed traditional Korean medicine treatment only twice a week, so it is difficult to actively treat them with traditional Korean medicine
17).
Western medicine is applied to diagnosis-related-groups payment, and a certain amount of the insurance fee is calculated for long-term patients hospitalized over 4 months. Thus, in traditional Korean medicine, due to these factors, inpatients who have a longer stay are treated with a lower frequency and quality of medical services. As a result, the role that Korean medical specialists play is limited by the institutional limit compared to western medical specialists, and the position of the Korean medical specialist in care hospital is bound to become narrow. Eventually, inpatients who are admitted for long periods to care hospitals are not able to receive Korean medical treatment.
This study examined the distribution according to the classification system of dementia patients at care hospital, the distribution of dementia patients by severity according to the simplified test, the progression of their dementia over a year, and the traditional Korean treatment of dementia patients.
In an aging society, geriatric mental illness is a major part of health care, and the percentage of geriatric patients with dementia in care hospitals is rising. In addition, since the medical expenses of dementia patients are rising year by year, the medical expenses burden has increased, and cost-effective patient care is needed.
However, this study is limited to one hospital that was surveyed and it is difficult to generalize its findings to other hospitals. However, in the current study, it can be meaningful that there is no analysis of the progress of dementia inpatients in a care hospital for one year. In addition, this study shows the institutional problems that may occur in Western-Korean cooperative treatment of inpatients with dementia in care hospitals. Based on this, it seems that institutional systems should be reorganized, so that the Korean medical specialists should be able to provide more active traditional Korean medicine to long-term hospitalized patients such as geriatric dementia patients.