The effects of stay-at-home orders and their associated factors in elderly Koreans and Korean-Americans during COVID-19

doi:10.21203/rs.3.rs-2834341/v1

Objective: The coronavirus pandemic has caused several people to feel isolated. Therefore, we conducted a cross-sectional study on 23 Korean and Korean-Americans to determine their general characteristics, loneliness, depression, and cognitive function.

Methods: We investigated the possible relationships between these variables and the duration of staying at home due to coronavirus disease 2019 (COVID-19). Mann–Whitney U and Fisher’s exact tests were used for continuous and categorical variables, respectively. Stepwise multivariate regression analysis was performed to investigate the relationships between the variables.

Results: Depression scores were higher in the Korean participants, and no difference was found in loneliness or cognitive function. The multivariate regression analysis results indicated that the duration of staying at home due to COVID-19 negatively associated with depression scores.

Conclusions: Depression in the elderly Korean population should be assessed and managed using efficient healthcare approaches. Studies with large cohorts are needed to investigate whether a sense of security affects depression in older adults who stay at home to avoid COVID-19.

Korean-American

Korean

elderly

depression

stay-at-home

COVID-19

Since the outbreak of the coronavirus disease in 2019 (COVID-19) and its global spread in 2020, many countries have implemented physical distancing policies to minimize transmission and control the pandemic. While the Korean and United States (US) governments did not enforce city lockdowns, they ordered mandatory closure of public, educational, worship, and welfare facilities [1]. As a result, the utilization of community-based health, education, cultural activity, and welfare services provided to adults over 65 years of age in Korea dropped to below 20% since the outbreak of the pandemic. Thus, COVID-19 has led to an increased prevalence of depressive mood, with an average score of 5.6/10, as estimated using the Korean version of the Geriatric Depression Scale (GDS-K) [2]. In the US, one in every three older adults suffered mental health consequences of lockdown periods; they have been reported to have experienced stress (36%) and loneliness (42.5%) as a result of social distancing [3]

Depressive moods are influenced by the living environment and social structure of an individual. In Korea, many older adults in rural areas live alone compared to their urban counterparts. Furthermore, older adults have a lower income, which contributes to the high prevalence of depressive mood [4]. Personal factors known to affect depression include income, education, socioeconomic status, and social capital. Physical condition, loneliness, and financial problems affect perceived happiness, which in turn influence depression [5]. In the US, typical personal factors that influence depression among older adults include income, education level, solitary living, race, and language [6].

Depression is not only linked to external situations and stimuli but is also associated with subjective factors such as self-rated health (SRH). Depression mediates the effects of SRH on life satisfaction in older adults [7] and decreases with increasing SRH [8]. SRH refers to the perception and rating of the health of an individuals. The World Health Organization (WHO) defines health as a construct encompassing physical, mental, and social health; therefore, SRH in older adults includes both mental and physical health. The major predictors of SRH in older adults are chronic diseases, physical and mental health status, and functional status [7]. Additionally, depression is influenced by social relationships and support, which may affect mental and social health. In particular, factors such as language barriers, racial discrimination, and poor healthcare access could intensify depressive moods among older adults in the US.

Social support refers to resources provided by others. Humans interact with others to satisfy their social needs and obtain social support through such interactions. Therefore, social support may be an important predictor of mental health [9]. Providers of social support include family, friends, and the community. In particular, it has been reported that people with a high perception of family and frequent contact with friends demonstrate low levels of depression [10].

The US is home to many Korean immigrants. Korean-Americans may suffer from high levels of depression due to communication problems caused by language barriers and other environmental factors [11]. Studies have confirmed a high prevalence of depression, mild cognitive impairment, and low utilization of mental health services among elderly Korean-Americans, emphasizing the need for further research on the barriers to mental healthcare utilization among them. Therefore, intervention studies are needed to prevent and manage depression in communities; the studies should be coupled with the development of various chronic disease management systems [12].

A previous study compared depressive moods among Korean older adults living in Canada (n = 128) and the US (n = 117). The study reported that Korean-Americans experienced a high level of depressive mood, which increased with increase in durations of living abroad, and health concerns [13]. In a similar study that compared the prevalence of depression among elderly immigrants in the US and older adults in Korea, the prevalence of depression was high in both groups. Furthermore, the prevalence of depression was higher among women than among men, but the lifespan of immigrants was not associated with depression [14].

The Korean and US governments have adopted different policies to prevent and control the spread of COVID-19, and the public cultures in the two countries differed based on how people responded to the policies. The Korean government enforced a mandatory 14-day quarantine system based on social distancing policies that hindered the engagement older adults in social activities. By contrast, the US government suspended a government-led social distancing campaign in April 2020 and allowed the public to choose their practices. As a result, older adults in the US likely had fewer restrictions on engaging in social activities. In Korea, strict social distancing policies were effective in controlling COVID-19; however, the incidence of social loneliness, depressive mood, and fear increased as an adverse consequence [15]. Therefore, this study aimed to investigate the depressive mood in older Korean and Korean-American adults caused by staying at home during the COVID-19 pandemic.

This study also examined the effects of the following depressive mood. First, we compared the differences in SRH and happiness between rural Korean and Korean-American older adults. Second, we compared the differences in social support, loneliness, depressive mood, and cognitive function scores between the two groups. Third, we examined the effects of stay-at-home orders and their associated factors in both the groups.

2.1 Study Design and Participants

Older Korean adults aged ≥ 65 years living in the US and rural communities in Korea were enrolled in this study. A total of 11 Korean participants recommended by a social worker at an administration and welfare center in Wonju, were enrolled, along with 12 Korean churchgoers in Delaware, US, who volunteered for the study.

2.2 Study Period

The data were collected from October 1, 2021, to October 30, 2021.

2.3 Measurements

The general characteristics included sex, age, literacy, religion, solitary living, and SRH status. Depression was assessed using the Korean version of the Geriatric Depression Scale (GDS-K). This 30-item tool contains yes-or-no questions [16]. The total possible score for the GDS-K is 30, and a high score indicates greater depressive mood. The Cronbach’s α for this scale was 0.894.

Loneliness was measured using the R-UCLA Loneliness Scale. This 20-item scale is rated on a four-point scale—high scores indicate high levels of loneliness. The Cronbach’s α for this scale was 0.799. Mild cognitive impairment and dementia were screened using the Korean version of the Mini-Mental State Examination (MMSE-K) [17]. The MMSE-K is a standardized Korean version of the MMSE developed by Folstein (2002) [18]. Assessing the mental health state of participants using the MMSE-K took approximately 5–10 min, and the factors assessed included temporal orientation [5], spatial orientation [5], registration [3], attention and calculation [5], recall [5], language [7], and understanding [2]. The Cronbach’s α for this scale was 0.552.

2.4 Data Collection

In Korea, two researchers either visited the homes of participants or conducted interviews with users of a small library to collect the data. In the US, two researchers conducted interviews in the conference room of a church. The interviews lasted approximately 30 min in both countries. To reduce non-sampling errors, the researchers were trained in data collection in advance, and the same researchers collected data from the Korean and Korean-American participants.

2.5 Data Analysis

This study aimed to compare differences in SRH, social support, depressive mood, and happiness between older rural Korean and Korean-American adults. Continuous variables were compared using the Mann–Whitney U test, a non-parametric test, and categorical variables were compared using Fisher’s exact test. Correlations among the major variables according to the time spent at home due to COVID-19 were analyzed using non-parametric Kendall’s tau. Factors associated with differences in depressive mood and staying at home due to COVID-19 between Korean and Korean-American older adults were analyzed using stepwise multiple regression analysis. Statistical analyses were performed using IBM SPSS Statistics for Windows version 25.0.

2.6 Ethical Statement

All components of this survey were approved by the Institutional Review Board (IRB) of Yonsei University, Korea (IRB document number: 1041849-202204-SB-078-01).

3.1 Socio-demographic comparison

Socio-demographic characteristics of the participants are presented in Table 1. All the 11 Korean participants were women, while 11 of the 12 Korean-American participants were women. The mean ages of the Korean and Korean-American participants were 78.09 years and 69.1 years, respectively. The mean duration of residence in the community was 24.64 years in Korea and 30.5 years in the US. In Korea, 36.36% of the participants lived alone, while none of the Korean-Americans lived alone. In terms of religion, 54.55% of the Korean participants followed a religion, whereas all the Korean-American participants followed Christianity. Regarding subjective economic status, 54.55% of the Korean participants and 83.33% of the Korean-American participants considered themselves in the lower class, respectively. The source of income was work (36.36%) or pension/retirement funds (45.45%) among Korean participants and work (41.67%) or pension/retirement funds (33.33%) among Korean Americans.

Table 1. Sociodemographic characteristics of Korean and Korean-American participants.

Variables	Frequency (%)
Variables	Korea (n=11)	US (n=12)
Sex
Male	0 (0.00%)	1 (8.33%)
Female	11 (100.0%)	11 (91.67%)
Mean age (M±SD)	78.09±7.23	69.1±5.38
Solitary living
Yes	4 (36.36%)	0 (0.00%)
No	7 (63.64%)	12 (100.00%)
Literacy
Yes	8 (72.73%)	12 (100.00%)
No	3 (27.27%)	0 (0.00%)
Religion
Yes	6 (54.55%)	12 (100.00%)
No	5 (45.45%)	0 (0.00%)
Subjective economic status
High	0 (0.00%)	0 (0.00%)
Middle	6 (54.55%)	2 (16.67%)
Low	5 (45.45%)	10 (83.33%)
Source of income
Work	4 (36.36%)	5 (41.67%)
Pension, retirement fund	5 (45.45%)	4 (33.33%)
Help of child (or children)	1 (9.09%)	2 (16.67%)
Other	1 (9.09%)	1 (8.33%)
Time spent at home due to COVID-19 (hours) (M±SD)	12.92±12.45	4.80±3.89

3.2 Comparison of loneliness, depressive mood, and cognitive function

Differences in loneliness, depressive mood, and cognitive function scores were compared between the two populations. Depressive mood was higher in Korea (p = 0.004), but no differences were found in loneliness or cognitive function between the two groups (Table 2).

Table 2. Comparison of loneliness, depressive mood, and cognitive function in Korean and Korean-American older adults.

	Frequency (%)		p value
	Korea (n=11)	US (n=12)	p value
Loneliness (R-UCLA Loneliness Scale)	39.09 (11.41%)	38.33 (8.34%)	0.317
Depressive mood (GDS-K)	15.73 (5.12%)	8.50 (5.68%)	0.004**
Cognitive function (MMSE-K)	27.36 (2.11%)	27.25 (2.41%)	0.894

Note: GDS-K, Korean version of Geriatric Depression Scale; R-ULS; MMSE-K, Korean version of the Mini-Mental State Examination. * p < 0.05 ** p < 0.01 *** p < 0.001

3.3 Factors associated with time spent at home due to COVID-19

3.3.1 Korea

Correlation analysis was performed to examine the association between the time spent at home and major study variables among older adults in Korea. The results confirmed a significant negative correlation between the time spent at home and depressive mood among older Korean adults (r = −0.500, p < 0.05). Furthermore, life satisfaction had a significant negative correlation with depressive mood (r =−0.732, p < 0.05).

Table 3. Correlation between time spent at home and major study variables among older Korean adults.

	Time spent at home	Social support	Life satisfaction	Depressive mood (GDS-K)	Loneliness (R-ULS)	Cognitive function (MMSE-K)
Time spent at home	1	−0.024	0.317	−0.600*	−0.215	−0.279
Social support		1	0.016	−0.032	−0.419	0.134
Life satisfaction			1	−0.732**	0.000	0.067
Depressive mood (GDS-K)				1	0.112	−0.104
Loneliness (R-ULS)					1	0.505
Cognitive function (MMSE-K)						1

Note: GDS-K, Korean version of Geriatric Depression Scale; R-ULS; MMSE-K, Korean version of the Mini-Mental State Examination. * p < 0.05 ** p < 0.01 *** p < 0.001

3.3.2 United States

The results of the correlation analysis showed that none of the study variables were significantly correlated with the time spent at home by Korean-Americans. However, social support had a significant positive correlation with life satisfaction (r = 0.427, p < 0.05) and significant negative correlation with loneliness (r = −0.520, p < 0.05). Furthermore, life satisfaction had a significant negative correlation with depressive mood (r = −0.500, p< 0.05) and loneliness (r = −0.512, p < 0.05). Depressive mood significantly and positively correlated with loneliness (r = −0.531, p < 0.05).

Table 4. Correlation between time spent at home and major study variables among Korean-American older adults.

	Time spent at home	Social support	Life satisfaction	Depressive mood (GDS-K)	Loneliness (R-ULS)	Cognitive function (MMSE-K)
Time spent at home	1	0.359	0.460	−0.372	−0.423	−0.336
Social support		1	0.427*	−0.240	−0.520*	−0.134
Life satisfaction			1	−0.500*	−0.512*	0.131
Depressive mood (GDS-K)				1	0.531*	−0.050
Loneliness (R-ULS)					1	0.348
Cognitive function (MMSE-K)						1

Note: GDS-K, Korean version of Geriatric Depression Scale; R-ULS; MMSE-K, Korean version of the Mini-Mental State Examination. * p < 0.05 ** p < 0.01 *** p < 0.001

3.4 Multiple regression

Multiple regression analysis was performed to identify the predictors of depressive mood among Korean and Korean-American older adults (Table 5). The depressive mood score was significantly higher (8.565) among Korean older adults than among Korean American older adults (b = 8.565, p = 0.002). Furthermore, depressive mood scores were significantly lower (6.925) among older adults living alone than among those who lived with their families (b = −6.925, p = 0.025). Moreover, depressive mood scores significantly decreased by −0.236 with a 1-h increase in time spent at home (b = −0.236, p = 0.027).

Table 5. Multiple regression analysis to identify predictors of depressive mood in Korean and Korean-American older adults.

Variables	B	t	95% CI	p value
Country	8.565	3.677	[3.689, 13.441]	0.002***
Solitary living	−6.925	−2.440	[−12.865, −0.985]	0.025***
Time spent at home	−0.236	2.402	[0.442, −0.030]	0.027***
Integer	11.439	6.497

Note: B,beta; t, t-test; CI, confidence interval

This study was conducted on adults aged ≥ 65 years during the COVID-19 pandemic in 2021. All the 11 Korean participants were women, while 11 of the 12 Korean-American participants were women. This predominantly female study sample is presumably due to the possibility that men tend to avoid social activities more than women and that women tend to be more involved in religious or leisure activities [19]. Of the Korean participants, 36.36% were older adults living alone, whereas all the Korean-American participants had spouses. Our results for Korean participants are similar to previous findings that older adults living alone have poor SRH [20,21] and high depressive mood [22]. In addition, 45.45% of the Korean participants did not follow a religion, which is probably related to the higher depressive mood among Korean participants, whereas all Korean-American participants followed a religion and had lower depressive mood [23,24].

Economic activity influences SRH and life satisfaction [25]; thus, we compared this variable between the two groups. Consequently, we found that 36.36% of Korean and 41.67% of Korean-American participants worked to make a living, while 45.45% of Korean and 33.33% of Korean-American participants lived off pension or retirement funds, indicating that older Korean adults received more social security services than did Korean-Americans. These results reveal that the life satisfaction of older adults is attained not only by meeting their individual-level needs but also by meeting their social needs. Furthermore, this suggests that the life satisfaction of older adults can affect their social support. Social support and life satisfaction were correlated, although their causality could not be determined, supporting previous findings [26].

This study showed that depressive mood decreased with increase in time spent at home among both Korean and Korean-American participants. In contrast, some US studies have shown that depressive mood increases with increase in time spent at home due to the COVID-19 pandemic. At the time of this study, owing to the progression of the pandemic outbreak, the US government had implemented social distancing and stay-at-home orders. Consequently, many individuals developed mental health problems, such as depression, generalized anxiety disorder, acute stress, and insomnia. However, our results are inconsistent with those of other large-scale studies. In Korea, the study data were collected in late 2021. Owing to the COVID-19 wave during that time, the government had ordered for senior centers to be closed. Hence, older adults in rural communities had no place for leisure, which could have contributed to the elevated levels of depressive moods.

This study has several limitations. First, only 11 Koreans and 12 Korean-Americans participated; these small sample sizes did not meet the requirement of the central limit theorem. Our study period was amid a COVID-19 wave, which hindered adequate sample recruitment. We faced time and cost limitations while performing surveys in the two countries. Subsequent studies should recruit a large sample size from both countries. Second, various external factors such as government policies against COVID-19 and regional sentiment in the two countries are speculated to have influenced the study results. This could have led to a non-sampling error due to COVID-19. Third, education level, economic status, family, and living arrangements differed between the Korean-American and Korean older adults. These differences in general characteristics could have led to differences in depressive moods, happiness, and cognitive function. Therefore, future studies should recruit homogeneous populations to obtain more meaningful results.

In our comparison of stay-at-home measures and levels of depressive mood among older adults in rural communities in Korea and the eastern US, the percentage of good SRH was higher among Korean-Americans than among Koreans. Although loneliness and depressive mood were more prevalent among older Korean adults, cognitive functions remained similar between the two groups. In terms of happiness, 66.87% of Korean-American older adults stated that they were happy, a higher percentage than that of Korean older adults (18.18%). Regarding the predictors of depressive mood in Koreans and Korean-Americans, the former group had a significantly higher depressive mood score (8.565) than that of the latter; those living alone had significantly lower depressive mood scores than that of those living with their family. In addition, depressive mood significantly declined with a 1-h increase in the time spent at home.

Based on these results, we present the following recommendations for promoting social and mental health among older adults in our study regions: First, Korean-American older adults established communities and social relationships based on religious facilities, such as churches and Catholic charges; however, only half of the Korean older adults followed a religion, and they had no car. Hence, the activities of Korean older adults were limited to regions that were accessible by foot, indicating that community-based facilities, such as small libraries, could promote social activities. From this perspective, small community-based facilities other than senior centers, such as libraries, could be helpful. Elderly regional social environments should be fostered so that older adults can voluntarily gather in their community to satisfy their need for a sense of belonging.

Second, considering that all Korean-American participants in this study owned cars and had their daily lives centered around religious organizations, church-based social relationships should be promoted by developing and implementing church-based social-prescription programs to reduce depression and increase happiness. In Korea, social-prescription activities and programs that boost self-esteem are needed for rural-dwelling older adults. The cultures and characteristics of rural regions should be considered during times that require social distancing practices, and individualized outreach programs should be developed considering the high percentage of older adults living alone and older adult classes.

Third, in contrast to the system in the United Kingdom, social prescription programs are not covered by health insurances in Korea and the US but are merely run by volunteers or as a form of social service. Hence, until these programs are institutionalized, they must be hosted by self-governing organizations or funded by colleges or churches; programs linked to corporate social contribution programs should also be developed.

Authors contributions statement

Conceptualization, HKN., EWN. SBK and HL.; methodology, HKN.; software, HKN.; validation, HKN.; formal analysis, HKN., EWN. and HL.; investigation, HKN., JAL, HK and BZ.; resources, EWN.; data curation, HKN., HL. and BZ.; writing—original draft preparation, HKN., EWN. and HL.; writing—review and editing, BZ. and HSO.; visualization, HKN.; supervision, EWN.; project administration, EWN.; and funding acquisition, HL. All the authors have read and agreed to the published version of the manuscript.

Acknowledgments

We express our gratitude to everyone working to overcome aging society in South Korea and USA and throughout the world.

Funding statement

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2021R1C1C2005464).

Conflict of interest statement

The authors report no conflicts of interest with this paper’s study.

Data availability

Data will be made available on request.

Kang, Y.J. Mortality rate of infection with COVID-19 in Korea from the perspective of underlying disease. Disaster Med Public Health Prep. 2020, 14, 384–386. DOI:10.1017/dmp.2020.60.
Seong, K.; Kim, S.J.; Moon, J.H. Effects of life changes due to COVID-19 on depression in the elderly. Soc Work Pract Res. 2021, 6, 99–129.
Emerson, K.G. Coping with being cooped up: social distancing during COVID-19 among 60+ in the United States. Rev Panam Salud Publica. 2020, 44, e81. DOI:10.26633/RPSP.2020.81.
Geu‐Rum, S.; Hye‐Yeon, J.; Eun‐Woo, N. Effects of a Social Prescribing Program on the Depressive Status of Elderly People in a Rural Area of Gangwon‐Do; Korean Public Health Association, 45(4), 2019; pp. 77–87.
Kim, S.J.; Noh, J.S.; Noh, H.W.; Jang, K.J.; Chung, Y.K.; Lee, Y., ... & Son, S.J. The effects of stressors on subjective well-being in the elderly. J Korean Geriatr Psychiatry. 2015, 17–23.
Hooker, K.; Phibbs, S.; Irvin, V.L.; Mendez-Luck, C.A.; Doan, L.N.; Li, T.; Turner, S.; Choun, S.; Choun, S. Depression among older adults in the United States by disaggregated race and ethnicity. Gerontologist. 2019, 59, 886–891. DOI:10.1093/geront/gny159.
Lee, Y.H.; Choi, K.S.; Kang, I.O.; Kim, H.J. Determinants of self-rated health among the Korean elderly living in the community. J Korea Gerontol Soc. 1998, 18, 110–124.
Watson, D.; Pennebaker, J.W. Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev. 1989, 96, 234–254. DOI:10.1037/0033-295x.96.2.234.
Tengku Mohd, T.A.M.T.; Yunus, R.M.; Hairi, F.; Hairi, N.N.; Choo, W.Y. Social support and depression among community dwelling older adults in Asia: a systematic review. BMJ Open. 2019, 9, e026667. DOI:10.1136/bmjopen-2018-026667.
Potts, M.K. Social support and depression among older adults living alone: the importance of friends within and outside of a retirement community. Soc Work. 1997, 42, 348–362. DOI:10.1093/sw/42.4.348.
Park, N.S.; Jang, Y.; Chiriboga, D.A. Willingness to use mental health counseling and antidepressants in older Korean Americans: the role of beliefs and stigma about depression. Ethn Health. 2018, 23, 97–110. DOI:10.1080/13557858.2016.1246429.
Kim, M.T.; Kim, K.B.; Han, H.R.; Huh, B.; Nguyen, T.; Lee, H.B. Prevalence and predictors of depression in Korean American elderly: findings from the Memory and Aging Study of Koreans (MASK). Am J Geriatr Psychiatry. 2015, 23, 671–683. DOI:10.1016/j.jagp.2014.11.003.
Kim, W.; Kang, S.Y.; Kim, I. Depression among Korean immigrant elders living in Canada and the United States: A comparative study. J Gerontol Soc Work. 2015, 58, 86–103. DOI:10.1080/01634372.2014.919977.
Sin, M.K.; Choe, M.A.; Kim, J.; Chae, Y.R.; Jeon, M.Y. Depressive symptoms in community-dwelling elderly Korean immigrants and elderly Koreans: cross-cultural comparison. Res Gerontol Nurs. 2010, 3, 262–269. DOI:10.3928/19404921-20100108-01.
Lee, H.S.; Dean, D.; Baxter, T.; Griffith, T.; Park, S. Deterioration of mental health despite successful control of the COVID-19 pandemic in South Korea. Psychiatry Res. 2021, 295, 113570. DOI:10.1016/j.psychres.2020.113570.
Cho, M.J.; Bae, J.N.; Suh, G.H.; Hahm, B.J.; Kim, J.K.; Lee, D.W.; Kang, M.H. Validation of Geriatric Depression Scale, Korean version (GDS) in the assessment of DSM-III-R major depression. Journal of Korean Neuropsychiatric Association, 1999; pp. 48–63.
Ahn, S.H.; Choi, J.H.; Im, C.S.; Kim, T.S.; Kim, J.L. A comparison of the Severe Cognitive Impairment Rating Scale with the Mini-Mental State Examination and Delirium Rating Scale-Revised-98 for delirium: a cross-sectional study. Psychosomatics. 2017, 58, 643–651. DOI:10.1016/j.psym.2017.08.002.
Cockrell, J.R.; Folstein, M.F. Mini-Mental State Examination. Princ Pract Geriatr Psychiatry. 2002, 140–141.
Levasseur, M.; Richard, L.; Gauvin, L.; Raymond, E. Inventory and analysis of definitions of social participation found in the aging literature: proposed taxonomy of social activities. Soc Sci Med. 2010, 71, 2141–2149. DOI:10.1016/j.socscimed.2010.09.041.
Byun, M.; Kim, E.; Ahn, H. Factors contributing to poor self-rated health in older adults with lower income. In Healthcare (Vol. 9, No. 11, p. 1515); MDPI, 2021.
Ko, H.; Park, Y.H.; Cho, B.; Lim, K.C.; Chang, S.J.; Yi, Y.M.; Noh, E.Y.; Ryu, S.I.; Ryu, S.I. Gender differences in health status, quality of life, and community service needs of older adults living alone. Arch Gerontol Geriatr. 2019, 83, 239–245. DOI:10.1016/j.archger.2019.05.009.
You, K.S.; Lee, H.O.; Fitzpatrick, J.J.; Kim, S.; Marui, E.; Lee, J.S.; Cook, P. Spirituality, depression, living alone, and perceived health among Korean older adults in the community. Arch Psychiatr Nurs. 2009, 23, 309–322. DOI:10.1016/j.apnu.2008.07.003.
Moon, Y.S.; Kim, D.H. Association between religiosity/spirituality and quality of life or depression among living‐alone elderly in a South Korean city. Asia Pac Psychiatry. 2013, 5, 293–300. DOI:10.1111/appy.12025.
Park, J.; Roh, S.; Yeo, Y. Religiosity, Social Support, and Life Satisfaction Among Elderly Korean Immigrants. Gerontologist. 2012, 52, 641–649. DOI:10.1093/geront/gnr103.
Park, H.; Hwangbo, Y.; Nam, Y. The effect of employment and occupational factors on late-life depression in Korea. J Occup Environ Med. 2018, 60, e492–e497. DOI:10.1097/JOM.0000000000001403.
Seo, S.; Cho, M.; Kim, Y.; Ahn, J. The relationships among satisfaction with food-related life, depression, isolation, social support, and overall satisfaction of life in elderly South Koreans. J Korean Diet Assoc. 2013, 19, 159–172. DOI:10.14373/JKDA.2013.19.2.159..

No competing interests reported.

The effects of stay-at-home orders and their associated factors in elderly Koreans and Korean-Americans during COVID-19

Status:

Version 1

Abstract

1 Introduction

2 Methods

3 RESULTS

4 DISCUSSION

5 CONCLUSION

Declarations

References

Additional Declarations

Status:

Version 1