Effects of integrated care on the quality of life and social relationships of older adults in South Korea

Effects of integrated care on the quality of life and social relationships of older adults in South Korea | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of integrated care on the quality of life and social relationships of older adults in South Korea Hyun-Ji Lee, Ae Jung Yoo, Hyo Jung Bang, Jae Woo Choi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3820352/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Jul, 2025 Read the published version in BMC Geriatrics → Version 1 posted 13 You are reading this latest preprint version Abstract Objectives: This study examined the effects of integrated care on the subjective quality of life and social relationships of older adults in South Korea. Methods: We combined data from the National Health Insurance Service and a survey of older adults across local governments participating in a pilot project for integrated care. To compare before and after participation in the pilot project, regression analysis was performed using the generalized estimation equations. The dependent variables were subjective quality of life and social relationships comprising the number of people who can help and the number of people met. Results: Older adults’ subjective quality of life significantly improved by 0.35 points, and the number of people who could help them significantly increased by 0.09 people after participation in the pilot project for integrated care. The results were similar when anayzed by sex and age. When analyzed by sex, subjective quality of life increased by 0.36 for men and by 0.34 for women. The number of people who can help increased by 0.13 for men and by 0.07 for women. As a results of analysis according to age, subjective quality of life significantly increased by 0.45 for older adults aged 65-74, by 0.31 for older adults aged 75 and over. The number of poeplle who can help significantly increased by 0.15 for older adults aged 65-74 and by 0.07 for aged 75 and over. The number of people met decreased slightly overall. Discussion: Integrated care in Korea helped older adults feel more satisfied with their lives and alleviated their feelings of isolation by enabling them to live in their own homes and communities rather than in nursing hospitals or facilities. This study is the first to evaluate the achievements of an integrated care conducted in Korea in terms of older adults' quality of life and social relationships, and this can serve as the basis for developing integrated care in the future. integrated care older adults quality of life social relationships Figures Figure 1 Introduction As population aging has become a serious worldwide phenomenon, social and economic problems, such as “the burden of supporting older adults” and “medical expenditure on older adults,” are being actively discussed [ 27 , 38 ]. Accordingly, various efforts are being made for the well-being, enhancing the quality of life, and aging in place (AIP) for older adults in various countries [ 43 , 44 ]. South Korea is a country with one of the fastest aging populations, which is expected to exceed 40% of the national population by 2050 [ 10 ]. In response, the Korean government implemented long-term care insurance (LTCI) in July 2008 to improve the quality of life of older adults and reduce the burden on caregivers [ 21 ]. LTCI provides home- or facility-based care services to adults aged 65 years or older according to criteria such as physical functioning and behavioral and cognitive problems [ 9 , 16 ]. Concurrently, the Korean government implemented customized care services for frail older adults who were unable to receive LTCI services because they did not meet the qualification criteria despite having trouble completing daily activities [ 23 ]. Nevertheless, the LTCI and customized elderly care services remained insufficient to meet the needs of older adults who wanted to live at home. A further limitation was that the application process and qualification criteria were different for each service, such that either the necessary services could not be provided or it was difficult to receive related services because of segmentation of services. In response to these problems, the Korean government announced an integrated care roadmap in December 2018 and promoted a pilot project for integrated care in 2019. These pilot projects have been conducted by 13 of the 229 local governments over the past four years (2019–2022). The integrated care policy in Korea has supplemented the lack of housing, medical, nursing, and welfare services based on LTCI and customized care services for older adults. In addition, the government planned a service delivery system centered on local governments to evaluate the various care needs of older adults and provide appropriate services locally. The purpose of this pilot project was to enable older adults to spend their old age in their own homes rather than entering a nursing hospital or facility, ultimately relieving caregivers’ burden and improving older adults’ quality of life [ 7 , 22 ]. To evaluate the outcomes of integrated care, it is necessary to observe quality of life and social relationships, which are key components for measuring well-being in older adults. Quality of life is the ultimate goal of integrated care and an important factor mentioned as the goal of several policies to support older adults [ 33 , 41 , 44 ]. Social relationships are also an important factor for successful aging. Connections with society, including friends and family, contribute to older adults’ happiness and life satisfaction. In addition, it not only improves individual emotional well-being but is also prevent cognitive deterioration [ 15 ], and reduce rates of readmission to hospital [ 40 ]. It is, therefore, a necessary factor to measure when assessing the performance of integrated care aimed at healthy aging in the community [ 24 ]. To the best of our knowledge, no study has been conducted that has observed the effects of integrated care in Korea in terms of quality of life and social relationships. Overseas, there have been studies that have observed the effects of the integrated care model conducted in the Netherlands in various aspects, including quality of life, were observed; however, the observation period was only three months, which was too short to observe changes in the participants [ 19 ]. This study is meaningful because it includes all different participation periods for each person and observes more participants for a long period of 3 years. And this study aimed to evaluate the effect of integrated care by observing changes in the quality of life and social relationships of the older adults who participated in the integrated care pilot project implemented in Korea. METHODS Data and study sample In this study, we combined National Health Insurance Service (NHIS) data and a survey conducted by local governments that participated in the pilot project for integrated care. In Korea, the entire population subscribes to the National Health Insurance (NHI), and the NHIS holds all claims data for medical services in the NHI and LTCI as a single insurer. The data included information on birth, death, residence, disability, and income [ 6 ]. The data comprised the results of a survey conducted before and after the pilot project to measure changes in the older adults who participated in the pilot project. The survey period was from August 2019 to August 2022, and the survey was conducted at the time of registration and at the end of the pilot project. It comprised questions that measured individual perceptions, such as subjective quality of life and social relationships, which could not be observed in the NHIS data. In addition, personal information, dates of registration and termination of the pilot project, and the type of service used during the pilot project were included. Among the 28,669 individuals who participated in the pilot project over four years (2019–2022), 3,047 who participated in the project more than once and were entered in duplicate were excluded, leaving only the most recent registration standard data. We also excluded individuals with incorrect residence registration numbers in the promotion performance data (n = 18), individuals under the age of 65 (n = 1,101), older adults who did not fill in the project selection or termination dates (n = 69), and integrated care services that were not linked or those that were canceled (n = 1,889). Additionally, those who were not linked to the NHIS data (n = 39) and those who did not agree to the use of their personal information (n = 72) were excluded from the analysis. Among the 22,343 study participants, 12,510 without pre–post-survey data for observation were excluded, and the final study comprised 9, 924 participants (Fig. 1 ). Interventions Although there are differences in details depending on the local government, the pilot project for integrated care provided meal support such as lunch box delivery, housework support, house repair, movement assistance when going out. Additionally, the pilot project provided LTCI services (Home-visit care, Home-visit nursing, Home-visit bath, day or night care, short-term care, etc.) for eligible, and home-based primary care (HBPC) for homebound older patients discharged from the hospital so they could remain at home. The HBPC services was usually provided counseling or education on arrangement of medications and healthy lifestyle. And in some cases, a team consisting of nurses, physical therapists, etc. provided injections for pain, exercise therapy and rehabilitation [ 8 ]. Measurements We measured “subjective quality of life” and “social relationships”, which consisted of “the number of people who can help” and “number of people met”. The measurement method and definition of each indicator were as follows, and all variables were measured as a continuous variable. Subjective quality of life refers to “the degree of satisfaction with one’s life over the past week” and responses consist of a score between 0 (very low) and 10 (very high) [ 28 ]. Social relationships among older adults were measured using two indicators: “the number of people who can help” and “the number of people met”. “the number of people who can help” refers to the number of people who can help when there is a problem in daily life, measured by the number of friends or relatives excluding immediate family members [ 29 ]. “The number of people met” indicates the number of people an older adult has met in the past week. It was measured focusing on the number of friends and relatives that older adults met with except for immediate family members [ 3 , 14 ]. Potentially confounding factors included sex, age, region of residence, medical security, household income, Charlson Comorbidity Score (CCI), disability, living alone. The household income was categorized into five levels: Q1 (< 20th percentile, lowest), Q2 (21th–40th percentile), Q3 (41th–60th percentile), Q4 (61th–80th percentile), or Q5 (81th–100th percentile, highest). The CCI is the summation of weighted scores assigned to many major health conditions [ 4 ]. The CCI is the summation of weighted scores assigned to many major health conditions and was calculated utilizing records for one year before first utilization date of participation in the pilot project. Statistical analysis Data on the demographic and health characteristics of participants were collected. To observe the changes before and after participation in the pilot project, the average and standard deviation of the pre- and post-measurement results were calculated. Regression analysis was performed using the generalized estimation equations considering the characteristics of repeated measurement data. Regression results are comparative analysis of the results of repeated measurements before and after project participation for the same subject, and were analyzed by adjusting potential confounding variables. Additionally, we performed the same analysis by sex and age. Age was divided into young-old (65–75 years old) and old-old (75 years or older) [ 18 , 26 ]. The survey subjects were those who participated in the pilot project and who agreed to participate in the survey and signed the informed consent to participate form. This study was approved by the Institutional Review Board of the NHIS (approval number: 2022-HR-03-024). RESULTS The older adults who participated in the pilot project were observed for an average of 217.6 days (SD: 241.8). Table 1 shows the general characteristics of older adults who participated in the pilot project. Of the participants, 72.6% were women and 27.4% were men. Regarding age distribution, 8.2% were 65–70 years old, 16.2% were 70–74 years old, 28.6% were 75–79 years old, and 47.0% were 80 years old or older. Regarding the region where they lived, 78.2% of the older adults lived in rural areas, followed by 21.6% and 0.2% who lived in urban and metropolitan cities, respectively. The proportion of older adults covered by medical aid was 31.8% while 68.2% were covered by the NHI. Older adults with high household income comprised 27.2% of the participants and those with low household income comprised 31.8%. As a result of determining the CCI score, older adults with CCI scores of 1 or higher comprised 90.3% of the participants. Older adults with disability and living alone comprised 32.1% and 62.5%, respectively. Table 2 shows the changes in subjective quality of life, number of people who can help, and the number of people met before and after the older adults participated in the pilot project. Subjective quality of life significantly increased by 0.35 (95% CI 0.31, 0.39) after participation in the pilot project. The number of people who can help significantly increased by 0.09 (95% CI 0.05, 0.12) from 1.11 before participation to 1.20 after participation. On the other hand, the number of people met significantly significantly decreased by 0.20 people (95% CI -0.28, -0.13) from an average of 2.39 before participating in the pilot project to 2.19 after participating. Table 3 shows the results for changes in subjective quality of life, the number of people who can help, and the number of people met before and after the older adults participated in the pilot project by sex and age. When analyzed by sex, subjective quality of life of men significantly increased by 0.36 (95% CI 0.29, 0.43), and score of women increased by 0.34 (95% CI 0.30, 0.39). The number of people who can help increased significantly increased by 0.13 for men (95% CI 0.06, 0.19) and by 0.07 (95% CI 0.04, 0.11) for women. The number of people met significantly decreased by 0.15 (95% CI -0.32, -0.03) for men, and by 0.22 (95% CI -0.31, -0.13) for women. According to the results of the analysis by age, the scores for subjective quality of life significantly increased by 0.45 (95% CI 0.37, 0.53) for older adults aged 65–74. Meanwhile, the scores for older adults aged 75 and over significantly increased by 0.31 (95% CI 0.27, 0.36). The number of people who can help significantly increased by 0.15 (95% CI 0.06, 0.20) for older adults aged 65–74 and by 0.07 (95% CI 0.04, 0.10) for aged 75 and over. The number of people met significantly decreased by 0.30 (95% CI -0.49, -0.16) for older adults aged 65-74, and by 0.17 (95% CI -0.25, 0.09). DISCUSSION This study aimed to evaluate the changes in the subjective quality of life and social relationships of older adults who participated in a pilot project for integrated care. In our study, the subjective quality of life and social relationship aspects of older adults demonstrated a significant improvement after participation in the pilot project compared with before participation. A study by Looman et al (2014) reported that integrated care for older adults had a positive effect on the quality of life in the short term (three months) [ 19 ]. Our results confirmed that integrated care was effective in improving subjective quality of life in older adults over the longer term as data were obtained from observations over a longer period of time. A study by Aroogh et al. (2020) also reported that participation in community-based activities, interpersonal interactions, and care services increase the quality of life of older adults [ 1 ]. As indicated by the analysis by sex, the subjective quality of life improved after participation in the pilot project for both male and female, and men improving more than women. Subjective quality of life for men was lower than women in the survey conducted before participation in the pilot project and men could be more positively affected by integrated care. Among the subjects in our study, the proportion of people living alone was high, and in previous study, socially isolated men's quality of life was significantly lower than that of women [ 42 ]. The analysis by age group shows that subjective quality of life increased in all age groups, with the young-old group (65–74 years old) improving more than the old-old group (75 years or older). These results suggest that integrated care is more effective in early old age than late old age. Hence, early intervention for older adults is important. Shapiro et al. (2002) found that community-based programs using early intervention case management had an appreciable impact on older adults’ lives [ 36 ]. Netuveli et al. (2006) reported that quality of life in early old age should be improved by addressing financial difficulties, functional problems, and a lack of trusting relationships with others [ 25 ]. In addition, according to other studies, the subjective quality of life of older adults is affected not only by age, but also by various factors such as physical health and social status; therefore, care interventions that consider these factors are necessary [ 2 ]. As an indicator of social relationships, the number of people who can help increased after participating in the pilot project, which is presumed to be a decrease in social isolation. Social isolation of older adults is influenced by aging and deteriorating health, as well as various factors in the community, such as the living environment and neighborhood [ 13 ]. Therefore, these results can be interpreted as indicating that a series of integrated care processes are effective in reducing older adults’ social isolation by providing services related to medical care, housing, and welfare according to the needs of the older adults. Similar findings have been reported in a study by Karacsony et al. (2022), suggesting that integrated care services promote positive social interaction among older adults [ 17 ]. Additionally, trust and positive relationships with healthcare providers, coordinators, and case managers have been reported to have a crucial impact on social relationships among older adults. When analyzed by sex, the number of people who can help was lower for men than for women, and after participating in the pilot project, there was a greater increase in men’s cases. Several previous studies have reported higher levels of isolation among older men than women, even after controlling for other sociodemographic factors [ 34 , 42 ]. Some have reported that women have larger social networks than men in old age [ 20 , 39 ], which may explain our finding that women are less socially isolated than men. Studies have shown that physical and mental functions decline with age, which can lead to loss of independence, loss of mobility, and social isolation [ 12 , 31 ]. In this study, when analyzed by age group, social isolation was resolved than before in all age groups, with the young-old group showing greater improvement than the old-old group. This suggests that older adults are more likely to improve their social relationships through integrated care in early old age. The social isolation of older adults who are in late old age and therefore more physically and mentally vulnerable, is more difficult to improve. Therefore, early intervention to quickly identify and address threats to social isolation among older adults is critical for successful integrated care implementation. Among social relationship indicators, the number of people who can help increased, whereas the number of people that older adults met decreased after the pilot project. Also, in the analysis by sex and age, the number of people met decreased. This result may have been affected by COVID-19, which began in 2019 [ 30 , 37 ]. Other studies similarly reported that the social activities of older adults decreased after COVID-19, with those of women decreasing more than those of men [ 35 ]. When analyzed by age group, the number of people met decreased more in the young-old group. A study by Chen (2021) reported that older adults in late old age (old-old group) spent more time in public than those in early old age (young-old group) during COVID-19; these factors may be related to our results. Limitations Although this study showed meaningful results, it had several limitations. First, as participants who had non-identifying data or did not use integrated care services were excluded from this study, these findings may not be generalizable to all older adults who need integrated care. Second, this study did not include older adults who did not participate in the pilot project for integrated care because of data limitations. In future studies, a comparative analysis should be conducted using a comparison group to confirm these effects more accurately. Third, in the project for integrated care in Korea, the type and extent of services provided to the participants differed according to their needs and the resources available in the region. Therefore, it was difficult to determine which services contributed to the physical and mental health of older adults. Future research should develop a standardized service model to evaluate the performance of specific services or combinations of services. Finally, there were restrictions on face-to-face services and social participation due to COVID-19. In the future, greater achievements in integrated care with reduced COVID-19 restrictions are expected. Conclusions Despite these limitations, this study is the first study to assess the results of the pilot project for integrated care conducted in Korea in terms of older adults’ quality of life and social relationships. We found that allowing older adults to live in their own homes and communities, rather than in nursing hospitals or facilities, contributed to their happiness and satisfaction and relieved their sense of isolation. These achievements can serve as the basis for developing and expanding integrated care in the future. Declarations Ethics approval and consent to participate The data used in this study are from National Health Insurance Service (NHIS) data and a survey conducted by local governments that participated in the pilot project for integrated care. The survey subjects were those who participated in the pilot project and who agreed to participate in the survey and signed the consent form. This study was approved by the Institutional Review Board of the NHIS (approval number: 2022-HR-03-024). Consent for publication Not applicable in this section. Availability of Data and Materials The data that support the findings of this study are available from NHIS but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of NHIS. Competing interests The authors declare no competing interests. Funding Not applicable in this section. Authors' contributions HJ Lee were responsible for overall research design, review of previous studies, data collection, statistical analysis, and result description, and JW Choi reviewed all processes. AJ Yoo and HJ Bang contributed to data collection and previous research review. All authors reviewed the manuscript. References Aroogh MD, Shahboulaghi FM. Social participation of older adults: A concept analysis. Int J community based Nurs midwifery. 2020;8(1):55. Bowling A, Gabriel Z. (2004). An integrational model of quality of life in older age. Results from the ESRC/MRC HSRC quality of life survey in Britain. Soc Indic Res, 1–36. Chappell NL, Badger M. Social isolation and well-being. J Gerontol. 1989;44(5):169–S176. Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61(12):1234–40. Chen J-H. Daily social life of older adults and vulnerabilities during the COVID-19 pandemic. Front Public Health. 2021;9:637008. Cheol Seong S, Kim Y-Y, Khang Y-H, Park H, Kang J, Lee H-J, H., et al. Data resource profile: the national health information database of the National Health Insurance Service in South Korea. Int J Epidemiol. 2017;46(3):799–800. Cho G. Suggestions for a Data-Based Community Care System in Korea. Annals of geriatric medicine and research. 2020;24(4):313. Choi JW, Yoo AJ. The Impact of Home-Based Primary Care on Outcomes Among Older Adults in South Korea. J Am Med Dir Assoc. 2023;24(7):985–990e982. 10.1016/j.jamda.2023.03.009 . Chon Y. The expansion of the Korean welfare state and its results - focusing on long-term care insurance for the elderly. Social Policy & Administration. 2014;48(6):704–20. Elderly Population Statistics in 2022. Korea Bureau of Statistics [on-line]. Available at: https://kostat.go.kr/board.es?mid=a10301010000& bid=10820&tag=&act=view&list_no=420896&ref_bid Accessed January 18 2023. Retrieved Date. Gabriel Z, Bowling ANN. Quality of life from the perspectives of older people. Ageing Soc. 2004;24(5):675–91. Garber CE, Greaney ML, Riebe D, Nigg CR, Burbank PA, Clark PG. Physical and mental health-related correlates of physical function in community dwelling older adults: a cross sectional study. BMC Geriatr. 2010;10:1–10. Grenade L, Boldy D. Social isolation and loneliness among older people: issues and future challenges in community and residential settings. Aust Health Rev. 2008;32(3):468–78. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: Results from two population-based studies. Res aging. 2004;26(6):655–72. James BD, Wilson RS, Barnes LL, Bennett DA. Late-life social activity and cognitive decline in old age. J Int Neuropsychol Soc. 2011;17:998–1005. Jeon B, Kwon S. Health and long-term care systems for older people in the republic of Korea: Policy challenges and lessons. Health Syst Reform. 2017;3(3):214–23. Karacsony S, Merl H, O'Brien J, Maxwell H, Andrews S, Greenwood M, Stirling C. (2022). What are the Clinical and Social Outcomes of Integrated Care for Older people? A Quanlitative Systematic Review. Int J Integr Care, 22(3). Kovar MG. Health of the elderly and use of health services. Public Health Rep. 1977;92(1):9. Looman WM, Fabbricotti IN, Huijsman R. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care. International jounal of integrated care; 2014. p. 14. McLaughlin D, Vagenas D, Pachana NA, Begum N, Dobson A. Gender differences in social network size and satisfaction in adults in their 70s. J Health Psychol. 2010;15(5):671–9. Ministry of Health and Welfare. A guide for the expansion of infrastructure in Long Term Care Insurance. Sejong, Republic of Korea; 2007. Ministry of Health and Welfare. Basic Plan for Community Integrated Care. Sejong, Republic of Korea; 2018. Ministry of Health and welfare. Guide of customized care for the elderly. Sejong, Republic of Korea; 2020. Miura KW, Sekiguchi T, Otake-Matsuura M, Sawada Y, Tanaka E, Watanabe T, Anme T. Patterns of social relationships among community-dwelling older adults in Japan: Latent class analysis. BMC Geriatr. 2022;22(1):75. Netuveli G, Wiggins RD, Hildon Z, Montgomery SM, Blane D. Quality of life at older ages: evidence from the English longitudinal study of aging (wave 1). Jounal of Epidemiology & Community Health. 2006;60(4):357–63. Newman BM, Newman PR. Development through life: A psychosocial approach. Cengage Learning; 2017. Nortey ST, Aryeetey GC, Aikins M, Amendah D, Nonvignon J. Economic burden of family caregiving for elderly population in southern Ghana: the case of a peri-urban district. Int J Equity Health. 2017;16:1–9. OECD. Better Life Index: Definitions and Metadata. Paris. OECD; 2015. OECD. How's Life? 2017 Measuring Well-being. Paris: OECD; 2017. Organization WH. (2020). Coronavirus disease 2019 (COVID-19): situation report, 73. Philip KE, Polkey MI, Hopkinson NS, Steptoe A, Fancourt D. Social isolation, loneliness and physical performance in older-adults: fixed effects analyses of a cohort study. Sci Rep. 2020;10(1):13908. Rockwood K. What can we expect of health in old age? The Lancet. 2016;387(10020):730–1. Roe B, Beech R, Harris M, Beech B, Russell W, Gent D, Dickinson A. Improving quality of life for older people in the community: findings from a local Partnerships for Older People Project innovation and evaluation. Prim health care Res Dev. 2011;12(3):200–13. Röhr S, Wittmann F, Engel C, Enzenbach C, Witte AV, Villringer A et al. (2021). Social factors and the prevalence of social isolation in a population-based adult cohort. Soc Psychiatry Psychiatr Epidemiol, 1–10. Ryu SI, Park Y-H, Kim J, Huh I, Chang SJ, Jang S-N et al. (2022). Impact of COVID-19 on the social relationships and mental health of older adults living alone: A two-year prospective cohort study. PLoS ONE, 17(7), e0270260. Shapiro A, Taylor M. Effects of a community-based early intervention program on the subjective well-being, institutionalization, and mortality of low-income elders. Gerontologist. 2002;42(3):334–41. Steptoe A, Di Gessa G. Mental health and social interactions of older people with physical disabilities in England during the COVID-19 pandemic: a longitudinal cohort study. The Lancet Public Health. 2021;6(6):e365–73. Tang B, Li Z, Hu S, Xiong J. Economic Implications of Health Care Burden for Elderly Population. Volume 59. INQUIRY: The Journal of Health Care Organization, Provision, and Financing; 2022. p. 00469580221121511. Turner RJ, Marino F. (1994). Social support and social structure: A descriptive epidemiology. J Health Soc Behav, 193–212. Valtorta NK, Moore DC, Barron L, Stow D, Hanratty B. Older adults’ social relationships and health care utilization: a systematic review. Am J Public Health. 2018;108(4):e1–e10. Van Leeuwen KM, Van Loon MS, Van Nes FA, Bosmans JE, De Vet HC, Ket JC, Ostelo RW. (2019). What does qualit of life mean to older adults? A thematic synthesis. PLoS ONE, 14(3), e0213263. Vandervoort D. Social isolation and gender. Curr Psychol. 2000;19:229–36. Vanleerberghe P, De Witte N, Claes C, Schalock RL, Verté D. The quality of life of older people aging in place: a literature review. Qual Life Res. 2017;26:2899–907. World Health Organization. Integrated care for older people. WHO: Swiss; 2018. Tables Table 1. General characteristics of study subjects variables older adults who participated in pilot project of community care N % Total 9,924 100.0 Sex Men 2,720 27.4 Women 7,204 72.6 Age 65-70 812 8.2 70-74 1,606 16.2 75-79 2,838 28.6 80≤ 4,668 47.0 Region Metropolitan city 20 0.2 Urban city 2,140 21.6 Rural area 7,763 78.2 Medical security National Health Insurance 6,764 68.2 Medical Aid 3,160 31.8 Household income Q1 (Lowest) 3,160 31.8 Q2 1,534 15.5 Q3 1,218 12.3 Q4 1,218 12.3 Q5 (Highest) 2,696 27.2 CCI 0 964 9.7 1 1,592 16.0 2 1,662 16.8 3 1,554 15.7 4 1,307 13.2 5 1,000 10.1 6≤ 1,845 18.6 Disability Yes 3,188 32.1 No 6,736 67.9 Living alone Yes 6,207 62.5 No 3,714 37.4 Table 2. Result of Pre-Post comparative analysis for Subjective quality of life and Social relationship Outcomes N Pre-participation Post-participation Pre-post differences Estimate (95% CI) p-value MEAN STD MEAN STD Subjective Quality of Life (unit; score) 9,695 4.59 2.02 4.93 2.00 0.35 0.35 (0.31, 0.39) <.001 Number of people who can help (unit; number) 9,691 1.11 1.62 1.20 1.59 0.09 0.09 (0.05, 0.12) <.001 Number of people met (unit; number) 9,731 2.39 3.80 2.19 3.17 -0.20 -0.21 (-0.28, -0.13) <.001 CI: Confidence Interval , STD: Standard Deviation Table3. Result of Pre-Post comparative analysis for Subjective quality of life and Social relationship by sex and age Outcomes Subgroup N Pre-participation Post-participation Pre-post differences Estimate(95% CI) p-value MEAN STD MEAN STD Subjective Quality of Life (unit; score) sex Men 2,642 4.57 2.00 4.93 2.00 0.36 0.36 (0.29, 0.43) <.001 Women 7,053 4.59 2.03 4.94 2.00 0.34 0.34 (0.30, 0.39) <.001 Number of people who can help (unit; number) Men 2,645 1.01 1.80 1.15 1.86 0.13 0.12 (0.06, 0.19) <.001 Women 7,046 1.15 1.55 1.23 1.48 0.07 0.07 (0.04, 0.11) <.001 Number of people met (unit; number) Men 2,661 2.29 4.13 2.14 3.52 -0.15 -0.18 (-0.32, -0.03) 0.016 Women 7,070 2.42 3.67 2.21 3.03 -0.22 -0.22 (-0.31, -0.13) <.001 Subjective Quality of Life (unit; score) age 65-74 2,371 4.56 2.12 5.01 2.07 0.45 0.45 (0.37, 0.53) <.001 75≤ 7,324 4.60 1.98 4.91 1.97 0.31 0.31 (0.27, 0.36) <.001 Number of people who can help (unit; number) 65-74 2,369 1.18 1.85 1.33 1.97 0.15 0.13 (0.06, 0.20) <.001 75≤ 7,322 1.09 1.54 1.16 1.45 0.07 0.07 (0.04, 0.10) <.001 Number of people met (unit; number) 65-74 2,380 2.57 4.40 2.27 3.21 -0.30 -0.32 (-0.49, -0.16) <.001 75≤ 7,351 2.33 3.58 2.16 3.16 -0.17 -0.17 (-0.25, -0.09) <.001 CI: Confidence Interval , STD: Standard Deviation Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Jul, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 09 Sep, 2024 Reviews received at journal 02 May, 2024 Reviews received at journal 16 Apr, 2024 Reviewers agreed at journal 14 Apr, 2024 Reviewers agreed at journal 04 Apr, 2024 Reviews received at journal 04 Apr, 2024 Reviewers agreed at journal 25 Mar, 2024 Reviewers agreed at journal 25 Mar, 2024 Reviewers invited by journal 25 Mar, 2024 Editor assigned by journal 08 Jan, 2024 Editor invited by journal 08 Jan, 2024 Submission checks completed at journal 08 Jan, 2024 First submitted to journal 29 Dec, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3820352","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":265817832,"identity":"a9884adf-cb3e-4860-875c-2cc5237b5088","order_by":0,"name":"Hyun-Ji Lee","email":"","orcid":"","institution":"National Health Insurance Service","correspondingAuthor":false,"prefix":"","firstName":"Hyun-Ji","middleName":"","lastName":"Lee","suffix":""},{"id":265817833,"identity":"47803907-48f6-4569-b85b-916be155f5e0","order_by":1,"name":"Ae Jung Yoo","email":"","orcid":"","institution":"National Health Insurance Service","correspondingAuthor":false,"prefix":"","firstName":"Ae","middleName":"Jung","lastName":"Yoo","suffix":""},{"id":265817834,"identity":"34f51c64-4c52-4b1e-a696-1a9dd6870671","order_by":2,"name":"Hyo Jung Bang","email":"","orcid":"","institution":"National Health Insurance Service","correspondingAuthor":false,"prefix":"","firstName":"Hyo","middleName":"Jung","lastName":"Bang","suffix":""},{"id":265817835,"identity":"6b1468b9-1f29-4db7-8ffb-d7b6607a5429","order_by":3,"name":"Jae Woo Choi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBACxgYGNgYGAxs5fvnDx8AibOzEaUkzlpzBlgbRwgwiE/DqAmphOJxocIPHDMInpIV5RvKzBx8KmBMMbvd8e/BzxzZ5PmYGtgcff+Bx2Iw0c8MZBmx5knfObjfsPXPbsI2Zgd1wBh5bGGfnsEnzGPAU8x3I3SbB23abEagFKEJYi0Riw4GcZ5J/227bg7X8IazFIHHCDSADaEsiWAs+7zPOf2YmOcMgwViy55iZtGzb7eQ2ZsY2yZ403FoMew4/k/jw578cP3vzM8m3bbdt57c3H5P4YYNHSwMWm7GIIQF5vLKjYBSMglEwCkAAAMdGTUgA46+2AAAAAElFTkSuQmCC","orcid":"","institution":"National Health Insurance Service","correspondingAuthor":true,"prefix":"","firstName":"Jae","middleName":"Woo","lastName":"Choi","suffix":""}],"badges":[],"createdAt":"2023-12-29 08:44:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3820352/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3820352/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-025-06191-2","type":"published","date":"2025-07-08T15:57:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":49367668,"identity":"74907ec9-9dee-45eb-aef1-b7eb8d9a2f9f","added_by":"auto","created_at":"2024-01-09 12:32:21","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":282847,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of study participants\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3820352/v1/a6092bb727c9fa383c822596.jpeg"},{"id":86699255,"identity":"fb7681b8-f6c3-48bf-a0bc-14f576b84332","added_by":"auto","created_at":"2025-07-14 16:05:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":886360,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3820352/v1/499930d9-358f-4259-8be4-0f612045ade5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of integrated care on the quality of life and social relationships of older adults in South Korea","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs population aging has become a serious worldwide phenomenon, social and economic problems, such as \u0026ldquo;the burden of supporting older adults\u0026rdquo; and \u0026ldquo;medical expenditure on older adults,\u0026rdquo; are being actively discussed [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Accordingly, various efforts are being made for the well-being, enhancing the quality of life, and aging in place (AIP) for older adults in various countries [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. South Korea is a country with one of the fastest aging populations, which is expected to exceed 40% of the national population by 2050 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn response, the Korean government implemented long-term care insurance (LTCI) in July 2008 to improve the quality of life of older adults and reduce the burden on caregivers [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. LTCI provides home- or facility-based care services to adults aged 65 years or older according to criteria such as physical functioning and behavioral and cognitive problems [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Concurrently, the Korean government implemented customized care services for frail older adults who were unable to receive LTCI services because they did not meet the qualification criteria despite having trouble completing daily activities [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Nevertheless, the LTCI and customized elderly care services remained insufficient to meet the needs of older adults who wanted to live at home. A further limitation was that the application process and qualification criteria were different for each service, such that either the necessary services could not be provided or it was difficult to receive related services because of segmentation of services. In response to these problems, the Korean government announced an integrated care roadmap in December 2018 and promoted a pilot project for integrated care in 2019. These pilot projects have been conducted by 13 of the 229 local governments over the past four years (2019\u0026ndash;2022). The integrated care policy in Korea has supplemented the lack of housing, medical, nursing, and welfare services based on LTCI and customized care services for older adults. In addition, the government planned a service delivery system centered on local governments to evaluate the various care needs of older adults and provide appropriate services locally. The purpose of this pilot project was to enable older adults to spend their old age in their own homes rather than entering a nursing hospital or facility, ultimately relieving caregivers\u0026rsquo; burden and improving older adults\u0026rsquo; quality of life [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo evaluate the outcomes of integrated care, it is necessary to observe quality of life and social relationships, which are key components for measuring well-being in older adults. Quality of life is the ultimate goal of integrated care and an important factor mentioned as the goal of several policies to support older adults [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Social relationships are also an important factor for successful aging. Connections with society, including friends and family, contribute to older adults\u0026rsquo; happiness and life satisfaction. In addition, it not only improves individual emotional well-being but is also prevent cognitive deterioration [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and reduce rates of readmission to hospital [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. It is, therefore, a necessary factor to measure when assessing the performance of integrated care aimed at healthy aging in the community [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, no study has been conducted that has observed the effects of integrated care in Korea in terms of quality of life and social relationships. Overseas, there have been studies that have observed the effects of the integrated care model conducted in the Netherlands in various aspects, including quality of life, were observed; however, the observation period was only three months, which was too short to observe changes in the participants [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This study is meaningful because it includes all different participation periods for each person and observes more participants for a long period of 3 years. And this study aimed to evaluate the effect of integrated care by observing changes in the quality of life and social relationships of the older adults who participated in the integrated care pilot project implemented in Korea.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData and study sample\u003c/h2\u003e \u003cp\u003e In this study, we combined National Health Insurance Service (NHIS) data and a survey conducted by local governments that participated in the pilot project for integrated care. In Korea, the entire population subscribes to the National Health Insurance (NHI), and the NHIS holds all claims data for medical services in the NHI and LTCI as a single insurer. The data included information on birth, death, residence, disability, and income [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The data comprised the results of a survey conducted before and after the pilot project to measure changes in the older adults who participated in the pilot project. The survey period was from August 2019 to August 2022, and the survey was conducted at the time of registration and at the end of the pilot project. It comprised questions that measured individual perceptions, such as subjective quality of life and social relationships, which could not be observed in the NHIS data. In addition, personal information, dates of registration and termination of the pilot project, and the type of service used during the pilot project were included.\u003c/p\u003e \u003cp\u003eAmong the 28,669 individuals who participated in the pilot project over four years (2019\u0026ndash;2022), 3,047 who participated in the project more than once and were entered in duplicate were excluded, leaving only the most recent registration standard data. We also excluded individuals with incorrect residence registration numbers in the promotion performance data (n\u0026thinsp;=\u0026thinsp;18), individuals under the age of 65 (n\u0026thinsp;=\u0026thinsp;1,101), older adults who did not fill in the project selection or termination dates (n\u0026thinsp;=\u0026thinsp;69), and integrated care services that were not linked or those that were canceled (n\u0026thinsp;=\u0026thinsp;1,889). Additionally, those who were not linked to the NHIS data (n\u0026thinsp;=\u0026thinsp;39) and those who did not agree to the use of their personal information (n\u0026thinsp;=\u0026thinsp;72) were excluded from the analysis. Among the 22,343 study participants, 12,510 without pre\u0026ndash;post-survey data for observation were excluded, and the final study comprised 9, 924 participants (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInterventions\u003c/h3\u003e\n\u003cp\u003eAlthough there are differences in details depending on the local government, the pilot project for integrated care provided meal support such as lunch box delivery, housework support, house repair, movement assistance when going out. Additionally, the pilot project provided LTCI services (Home-visit care, Home-visit nursing, Home-visit bath, day or night care, short-term care, etc.) for eligible, and home-based primary care (HBPC) for homebound older patients discharged from the hospital so they could remain at home. The HBPC services was usually provided counseling or education on arrangement of medications and healthy lifestyle. And in some cases, a team consisting of nurses, physical therapists, etc. provided injections for pain, exercise therapy and rehabilitation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eWe measured \u0026ldquo;subjective quality of life\u0026rdquo; and \u0026ldquo;social relationships\u0026rdquo;, which consisted of \u0026ldquo;the number of people who can help\u0026rdquo; and \u0026ldquo;number of people met\u0026rdquo;. The measurement method and definition of each indicator were as follows, and all variables were measured as a continuous variable.\u003c/p\u003e \u003cp\u003eSubjective quality of life refers to \u0026ldquo;the degree of satisfaction with one\u0026rsquo;s life over the past week\u0026rdquo; and responses consist of a score between 0 (very low) and 10 (very high) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Social relationships among older adults were measured using two indicators: \u0026ldquo;the number of people who can help\u0026rdquo; and \u0026ldquo;the number of people met\u0026rdquo;. \u0026ldquo;the number of people who can help\u0026rdquo; refers to the number of people who can help when there is a problem in daily life, measured by the number of friends or relatives excluding immediate family members [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. \u0026ldquo;The number of people met\u0026rdquo; indicates the number of people an older adult has met in the past week. It was measured focusing on the number of friends and relatives that older adults met with except for immediate family members [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePotentially confounding factors included sex, age, region of residence, medical security, household income, Charlson Comorbidity Score (CCI), disability, living alone. The household income was categorized into five levels: Q1 (\u0026lt;\u0026thinsp;20th percentile, lowest), Q2 (21th\u0026ndash;40th percentile), Q3 (41th\u0026ndash;60th percentile), Q4 (61th\u0026ndash;80th percentile), or Q5 (81th\u0026ndash;100th percentile, highest). The CCI is the summation of weighted scores assigned to many major health conditions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The CCI is the summation of weighted scores assigned to many major health conditions and was calculated utilizing records for one year before first utilization date of participation in the pilot project.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData on the demographic and health characteristics of participants were collected. To observe the changes before and after participation in the pilot project, the average and standard deviation of the pre- and post-measurement results were calculated. Regression analysis was performed using the generalized estimation equations considering the characteristics of repeated measurement data. Regression results are comparative analysis of the results of repeated measurements before and after project participation for the same subject, and were analyzed by adjusting potential confounding variables. Additionally, we performed the same analysis by sex and age. Age was divided into young-old (65\u0026ndash;75 years old) and old-old (75 years or older) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The survey subjects were those who participated in the pilot project and who agreed to participate in the survey and signed the informed consent to participate form. This study was approved by the Institutional Review Board of the NHIS (approval number: 2022-HR-03-024).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe older adults who participated in the pilot project were observed for an average of 217.6 days (SD: 241.8). Table 1 shows the general characteristics of older adults who participated in the pilot project.\u0026nbsp;Of the participants, 72.6% were women and 27.4% were men. Regarding age distribution, 8.2% were 65\u0026ndash;70 years old, 16.2% were 70\u0026ndash;74 years old, 28.6% were 75\u0026ndash;79 years old, and 47.0% were 80 years old or older. Regarding the region where they lived, 78.2% of the older adults lived in rural areas, followed by 21.6% and 0.2% who lived in urban and metropolitan cities, respectively. The proportion of older adults covered by medical aid was 31.8% while 68.2% were covered by the NHI. Older adults with high household income comprised 27.2% of the participants and those with low household income comprised 31.8%. As a result of determining the CCI score, older adults with CCI scores of 1 or higher comprised 90.3% of the participants. Older adults with disability and living alone comprised 32.1% and 62.5%, respectively.\u003c/p\u003e\n\u003cp\u003eTable 2 shows the changes in subjective quality of life, number of people who can help, and the number of people met before and after the older adults participated in the pilot project. Subjective quality of life significantly increased by 0.35 (95% CI 0.31, 0.39) after participation in the pilot project. The number of people who can help significantly increased by 0.09 (95% CI 0.05, 0.12) from 1.11 before participation to 1.20 after participation. On the other hand, the number of people met significantly significantly decreased by 0.20 people (95% CI -0.28, -0.13) from an average of 2.39 before participating in the pilot project to 2.19 after participating.\u003c/p\u003e\n\u003cp\u003eTable 3 shows the results for changes in subjective quality of life, the number of people who can help, and the number of people met before and after the older adults participated in the pilot project by sex and age. When analyzed by sex, subjective quality of life of men significantly increased by 0.36 (95% CI 0.29, 0.43), and score of women increased by 0.34 (95% CI 0.30, 0.39).\u0026nbsp;The number of people who can help increased significantly increased by 0.13 for men (95% CI 0.06, 0.19) and by 0.07 (95% CI 0.04, 0.11) for women. The number of people met significantly decreased by 0.15 (95% CI -0.32, -0.03) for men, and by 0.22 (95% CI -0.31, -0.13) for women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the results of the analysis by age, the scores for subjective quality of life significantly increased by 0.45 (95% CI 0.37, 0.53) for older adults aged 65\u0026ndash;74. Meanwhile, the scores for older adults aged 75 and over significantly increased by 0.31 (95% CI 0.27, 0.36). The number of people who can help significantly increased by 0.15 (95% CI 0.06, 0.20) for older adults aged 65\u0026ndash;74 and by 0.07 (95% CI 0.04, 0.10) for aged 75 and over. The number of people met significantly decreased by 0.30 (95% CI -0.49, -0.16) for older adults aged 65-74, and by 0.17 (95% CI -0.25, 0.09).\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to evaluate the changes in the subjective quality of life and social relationships of older adults who participated in a pilot project for integrated care. In our study, the subjective quality of life and social relationship aspects of older adults demonstrated a significant improvement after participation in the pilot project compared with before participation.\u003c/p\u003e \u003cp\u003eA study by Looman et al (2014) reported that integrated care for older adults had a positive effect on the quality of life in the short term (three months) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Our results confirmed that integrated care was effective in improving subjective quality of life in older adults over the longer term as data were obtained from observations over a longer period of time. A study by Aroogh et al. (2020) also reported that participation in community-based activities, interpersonal interactions, and care services increase the quality of life of older adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs indicated by the analysis by sex, the subjective quality of life improved after participation in the pilot project for both male and female, and men improving more than women. Subjective quality of life for men was lower than women in the survey conducted before participation in the pilot project and men could be more positively affected by integrated care. Among the subjects in our study, the proportion of people living alone was high, and in previous study, socially isolated men's quality of life was significantly lower than that of women [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe analysis by age group shows that subjective quality of life increased in all age groups, with the young-old group (65\u0026ndash;74 years old) improving more than the old-old group (75 years or older). These results suggest that integrated care is more effective in early old age than late old age. Hence, early intervention for older adults is important. Shapiro et al. (2002) found that community-based programs using early intervention case management had an appreciable impact on older adults\u0026rsquo; lives [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Netuveli et al. (2006) reported that quality of life in early old age should be improved by addressing financial difficulties, functional problems, and a lack of trusting relationships with others [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In addition, according to other studies, the subjective quality of life of older adults is affected not only by age, but also by various factors such as physical health and social status; therefore, care interventions that consider these factors are necessary [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs an indicator of social relationships, the number of people who can help increased after participating in the pilot project, which is presumed to be a decrease in social isolation. Social isolation of older adults is influenced by aging and deteriorating health, as well as various factors in the community, such as the living environment and neighborhood [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, these results can be interpreted as indicating that a series of integrated care processes are effective in reducing older adults\u0026rsquo; social isolation by providing services related to medical care, housing, and welfare according to the needs of the older adults. Similar findings have been reported in a study by Karacsony et al. (2022), suggesting that integrated care services promote positive social interaction among older adults [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, trust and positive relationships with healthcare providers, coordinators, and case managers have been reported to have a crucial impact on social relationships among older adults.\u003c/p\u003e \u003cp\u003eWhen analyzed by sex, the number of people who can help was lower for men than for women, and after participating in the pilot project, there was a greater increase in men\u0026rsquo;s cases. Several previous studies have reported higher levels of isolation among older men than women, even after controlling for other sociodemographic factors [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Some have reported that women have larger social networks than men in old age [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], which may explain our finding that women are less socially isolated than men. Studies have shown that physical and mental functions decline with age, which can lead to loss of independence, loss of mobility, and social isolation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In this study, when analyzed by age group, social isolation was resolved than before in all age groups, with the young-old group showing greater improvement than the old-old group. This suggests that older adults are more likely to improve their social relationships through integrated care in early old age. The social isolation of older adults who are in late old age and therefore more physically and mentally vulnerable, is more difficult to improve. Therefore, early intervention to quickly identify and address threats to social isolation among older adults is critical for successful integrated care implementation.\u003c/p\u003e \u003cp\u003eAmong social relationship indicators, the number of people who can help increased, whereas the number of people that older adults met decreased after the pilot project. Also, in the analysis by sex and age, the number of people met decreased. This result may have been affected by COVID-19, which began in 2019 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Other studies similarly reported that the social activities of older adults decreased after COVID-19, with those of women decreasing more than those of men [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. When analyzed by age group, the number of people met decreased more in the young-old group. A study by Chen (2021) reported that older adults in late old age (old-old group) spent more time in public than those in early old age (young-old group) during COVID-19; these factors may be related to our results.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eAlthough this study showed meaningful results, it had several limitations. First, as participants who had non-identifying data or did not use integrated care services were excluded from this study, these findings may not be generalizable to all older adults who need integrated care. Second, this study did not include older adults who did not participate in the pilot project for integrated care because of data limitations. In future studies, a comparative analysis should be conducted using a comparison group to confirm these effects more accurately. Third, in the project for integrated care in Korea, the type and extent of services provided to the participants differed according to their needs and the resources available in the region. Therefore, it was difficult to determine which services contributed to the physical and mental health of older adults. Future research should develop a standardized service model to evaluate the performance of specific services or combinations of services. Finally, there were restrictions on face-to-face services and social participation due to COVID-19. In the future, greater achievements in integrated care with reduced COVID-19 restrictions are expected.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDespite these limitations, this study is the first study to assess the results of the pilot project for integrated care conducted in Korea in terms of older adults\u0026rsquo; quality of life and social relationships. We found that allowing older adults to live in their own homes and communities, rather than in nursing hospitals or facilities, contributed to their happiness and satisfaction and relieved their sense of isolation. These achievements can serve as the basis for developing and expanding integrated care in the future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are from National Health Insurance Service (NHIS) data and a survey conducted by local governments that participated in the pilot project for integrated care. The survey subjects were those who participated in the pilot project and who agreed to participate in the survey and signed the consent form. This study was approved by the Institutional Review Board of the NHIS (approval number: 2022-HR-03-024).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable in this section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from\u0026nbsp;NHIS\u0026nbsp;but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of\u0026nbsp;NHIS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable in this section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHJ Lee were responsible for overall research design, review of previous studies, data collection, statistical analysis, and result description, and JW Choi reviewed all processes. AJ Yoo and HJ Bang contributed to data collection and previous research review. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAroogh MD, Shahboulaghi FM. Social participation of older adults: A concept analysis. Int J community based Nurs midwifery. 2020;8(1):55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBowling A, Gabriel Z. (2004). An integrational model of quality of life in older age. Results from the ESRC/MRC HSRC quality of life survey in Britain. Soc Indic Res, 1\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChappell NL, Badger M. Social isolation and well-being. J Gerontol. 1989;44(5):169\u0026ndash;S176.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61(12):1234\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J-H. Daily social life of older adults and vulnerabilities during the COVID-19 pandemic. Front Public Health. 2021;9:637008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheol Seong S, Kim Y-Y, Khang Y-H, Park H, Kang J, Lee H-J, H., et al. Data resource profile: the national health information database of the National Health Insurance Service in South Korea. Int J Epidemiol. 2017;46(3):799\u0026ndash;800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho G. Suggestions for a Data-Based Community Care System in Korea. Annals of geriatric medicine and research. 2020;24(4):313.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi JW, Yoo AJ. The Impact of Home-Based Primary Care on Outcomes Among Older Adults in South Korea. J Am Med Dir Assoc. 2023;24(7):985\u0026ndash;990e982. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jamda.2023.03.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jamda.2023.03.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChon Y. The expansion of the Korean welfare state and its results - focusing on long-term care insurance for the elderly. Social Policy \u0026amp; Administration. 2014;48(6):704\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElderly Population Statistics in 2022. Korea Bureau of Statistics [on-line]. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://kostat.go.kr/board.es?mid=a10301010000\u0026amp;\u003c/span\u003e\u003cspan address=\"https://kostat.go.kr/board.es?mid=a10301010000\u0026amp;\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ebid=10820\u0026amp;tag=\u0026amp;act=view\u0026amp;list_no=420896\u0026amp;ref_bid Accessed January 18 2023. Retrieved Date.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGabriel Z, Bowling ANN. Quality of life from the perspectives of older people. Ageing Soc. 2004;24(5):675\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarber CE, Greaney ML, Riebe D, Nigg CR, Burbank PA, Clark PG. Physical and mental health-related correlates of physical function in community dwelling older adults: a cross sectional study. BMC Geriatr. 2010;10:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrenade L, Boldy D. Social isolation and loneliness among older people: issues and future challenges in community and residential settings. Aust Health Rev. 2008;32(3):468\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: Results from two population-based studies. Res aging. 2004;26(6):655\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames BD, Wilson RS, Barnes LL, Bennett DA. Late-life social activity and cognitive decline in old age. J Int Neuropsychol Soc. 2011;17:998\u0026ndash;1005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeon B, Kwon S. Health and long-term care systems for older people in the republic of Korea: Policy challenges and lessons. Health Syst Reform. 2017;3(3):214\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaracsony S, Merl H, O'Brien J, Maxwell H, Andrews S, Greenwood M, Stirling C. (2022). What are the Clinical and Social Outcomes of Integrated Care for Older people? A Quanlitative Systematic Review. Int J Integr Care, 22(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKovar MG. Health of the elderly and use of health services. Public Health Rep. 1977;92(1):9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLooman WM, Fabbricotti IN, Huijsman R. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care. International jounal of integrated care; 2014. p. 14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLaughlin D, Vagenas D, Pachana NA, Begum N, Dobson A. Gender differences in social network size and satisfaction in adults in their 70s. J Health Psychol. 2010;15(5):671\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health and Welfare. A guide for the expansion of infrastructure in Long Term Care Insurance. Sejong, Republic of Korea; 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health and Welfare. Basic Plan for Community Integrated Care. Sejong, Republic of Korea; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health and welfare. Guide of customized care for the elderly. Sejong, Republic of Korea; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiura KW, Sekiguchi T, Otake-Matsuura M, Sawada Y, Tanaka E, Watanabe T, Anme T. Patterns of social relationships among community-dwelling older adults in Japan: Latent class analysis. BMC Geriatr. 2022;22(1):75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNetuveli G, Wiggins RD, Hildon Z, Montgomery SM, Blane D. Quality of life at older ages: evidence from the English longitudinal study of aging (wave 1). Jounal of Epidemiology \u0026amp; Community Health. 2006;60(4):357\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewman BM, Newman PR. Development through life: A psychosocial approach. Cengage Learning; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNortey ST, Aryeetey GC, Aikins M, Amendah D, Nonvignon J. Economic burden of family caregiving for elderly population in southern Ghana: the case of a peri-urban district. Int J Equity Health. 2017;16:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOECD. Better Life Index: Definitions and Metadata. Paris. OECD; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOECD. How's Life? 2017 Measuring Well-being. Paris: OECD; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. (2020). Coronavirus disease 2019 (COVID-19): situation report, 73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhilip KE, Polkey MI, Hopkinson NS, Steptoe A, Fancourt D. Social isolation, loneliness and physical performance in older-adults: fixed effects analyses of a cohort study. Sci Rep. 2020;10(1):13908.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRockwood K. What can we expect of health in old age? The Lancet. 2016;387(10020):730\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoe B, Beech R, Harris M, Beech B, Russell W, Gent D, Dickinson A. Improving quality of life for older people in the community: findings from a local Partnerships for Older People Project innovation and evaluation. Prim health care Res Dev. 2011;12(3):200\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR\u0026ouml;hr S, Wittmann F, Engel C, Enzenbach C, Witte AV, Villringer A et al. (2021). Social factors and the prevalence of social isolation in a population-based adult cohort. Soc Psychiatry Psychiatr Epidemiol, 1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyu SI, Park Y-H, Kim J, Huh I, Chang SJ, Jang S-N et al. (2022). Impact of COVID-19 on the social relationships and mental health of older adults living alone: A two-year prospective cohort study. PLoS ONE, 17(7), e0270260.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShapiro A, Taylor M. Effects of a community-based early intervention program on the subjective well-being, institutionalization, and mortality of low-income elders. Gerontologist. 2002;42(3):334\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteptoe A, Di Gessa G. Mental health and social interactions of older people with physical disabilities in England during the COVID-19 pandemic: a longitudinal cohort study. The Lancet Public Health. 2021;6(6):e365\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang B, Li Z, Hu S, Xiong J. Economic Implications of Health Care Burden for Elderly Population. Volume 59. INQUIRY: The Journal of Health Care Organization, Provision, and Financing; 2022. p. 00469580221121511.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurner RJ, Marino F. (1994). Social support and social structure: A descriptive epidemiology. J Health Soc Behav, 193\u0026ndash;212.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValtorta NK, Moore DC, Barron L, Stow D, Hanratty B. Older adults\u0026rsquo; social relationships and health care utilization: a systematic review. Am J Public Health. 2018;108(4):e1\u0026ndash;e10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Leeuwen KM, Van Loon MS, Van Nes FA, Bosmans JE, De Vet HC, Ket JC, Ostelo RW. (2019). What does qualit of life mean to older adults? A thematic synthesis. PLoS ONE, 14(3), e0213263.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVandervoort D. Social isolation and gender. Curr Psychol. 2000;19:229\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanleerberghe P, De Witte N, Claes C, Schalock RL, Vert\u0026eacute; D. The quality of life of older people aging in place: a literature review. Qual Life Res. 2017;26:2899\u0026ndash;907.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Integrated care for older people. WHO: Swiss; 2018.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.505050505050505%\" colspan=\"2\"\u003e\n \u003cp\u003eTable 1. General characteristics of study subjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.505050505050505%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003evariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.494949494949495%\" colspan=\"2\"\u003e\n \u003cp\u003eolder adults who participated in pilot project of community care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.02040816326531%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48.97959183673469%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.505050505050505%\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e9,924\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e100.0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e2,720\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e27.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e7,204\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e72.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e65-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e812\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e8.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e70-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,606\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e16.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e75-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e2,838\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e28.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e80\u0026le;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e4,668\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e47.0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eMetropolitan city\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e0.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eUrban city\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e2,140\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e21.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eRural area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e7,763\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e78.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003eMedical security\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eNational Health Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e6,764\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e68.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eMedical Aid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e3,160\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e31.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003eHousehold income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eQ1 (Lowest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e3,160\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e31.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eQ2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,534\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e15.5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eQ3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,218\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e12.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eQ4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,218\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e12.3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eQ5 (Highest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e2,696\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e27.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003eCCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e964\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e9.7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,592\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e16.0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,662\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e16.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,554\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e15.7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,307\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e13.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e10.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003e6\u0026le;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e1,845\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e18.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003eDisability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e3,188\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e32.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e6,736\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e67.9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003eLiving alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e6,207\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e62.5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.21212121212121%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.292929292929294%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\"\u003e\n \u003cp\u003e3,714\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e37.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"10\"\u003e\n \u003cp\u003eTable 2. Result of Pre-Post comparative analysis for Subjective quality of life and Social relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.166666666666668%\" rowspan=\"2\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.208333333333333%\" rowspan=\"2\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" colspan=\"2\"\u003e\n \u003cp\u003ePre-participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" colspan=\"2\"\u003e\n \u003cp\u003ePost-participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" rowspan=\"2\"\u003e\n \u003cp\u003ePre-post differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eEstimate (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28%\"\u003e\n \u003cp\u003eMEAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eSTD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32%\"\u003e\n \u003cp\u003eMEAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003eSTD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.78723404255319%\"\u003e\n \u003cp\u003eSubjective Quality of Life (unit; score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e9,695\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e4.59\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e2.02\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e4.93\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e2.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.957446808510639%\"\u003e\n \u003cp\u003e0.35\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e0.35\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.638297872340425%\"\u003e\n \u003cp\u003e(0.31, 0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.78723404255319%\"\u003e\n \u003cp\u003eNumber of people who can help\u0026nbsp;(unit; number)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e9,691\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1.11\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e1.62\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e1.20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e1.59\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.957446808510639%\"\u003e\n \u003cp\u003e0.09\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e0.09\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.638297872340425%\"\u003e\n \u003cp\u003e(0.05, 0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.78723404255319%\"\u003e\n \u003cp\u003eNumber of people met (unit; number)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e9,731\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e2.39\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e3.80\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e2.19\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e3.17\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.957446808510639%\"\u003e\n \u003cp\u003e-0.20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e-0.21\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.638297872340425%\"\u003e\n \u003cp\u003e(-0.28, -0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCI: Confidence Interval , STD: Standard Deviation\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\"\u003e\n \u003cp\u003eTable3. Result of Pre-Post comparative analysis for Subjective quality of life and Social relationship by sex and age\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eSubgroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003ePre-participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003ePost-participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003ePre-post differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eEstimate(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMEAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSTD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMEAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSTD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eSubjective Quality of Life\u003c/p\u003e\n \u003cp\u003e(unit; score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2,642\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.93\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.36\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.36\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.29, 0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7,053\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.59\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.03\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.94\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.34\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.34\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.30, 0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eNumber of people who can help\u0026nbsp;(unit; number)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2,645\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.01\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.80\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.15\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.86\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.13\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.06, 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7,046\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.15\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.55\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.23\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.48\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.04, 0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eNumber of people met (unit; number)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2,661\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.29\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.13\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.14\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.52\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.15\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.18\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(-0.32, -0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.016\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7,070\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.42\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.67\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.21\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.03\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.22\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.22\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(-0.31, -0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eSubjective Quality of Life\u003c/p\u003e\n \u003cp\u003e(unit; score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2,371\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.56\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.12\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.01\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.45\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.45\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.37, 0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e75\u0026le;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7,324\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.98\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.91\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.97\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.31\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.31\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.27, 0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eNumber of people who can help\u0026nbsp;(unit; number)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2,369\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.18\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.85\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.33\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.97\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.15\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.13\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.06, 0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e75\u0026le;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7,322\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.09\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.54\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.16\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.45\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(0.04, 0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eNumber of people met\u003c/p\u003e\n \u003cp\u003e(unit; number)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2,380\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.57\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.40\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.27\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.21\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.30\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.32\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(-0.49, -0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e75\u0026le;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7,351\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.33\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.58\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.16\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.16\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.17\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.17\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(-0.25, -0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCI: Confidence Interval , STD: Standard Deviation\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"integrated care, older adults, quality of life, social relationships","lastPublishedDoi":"10.21203/rs.3.rs-3820352/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3820352/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThis study examined the effects of integrated care on the subjective quality of life and social relationships of older adults in South Korea.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe combined data from the National Health Insurance Service and a survey of older adults across local governments participating in a pilot project for integrated care. To compare before and after participation in the pilot project, regression analysis was performed using the generalized estimation equations. The dependent variables were subjective quality of life and social relationships comprising the number of people who can help and the number of people met.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOlder adults’ subjective quality of life significantly improved by 0.35 points, and the number of people who could help them significantly increased by 0.09 people after participation in the pilot project for integrated care. The results were similar when anayzed by sex and age. When analyzed by sex, subjective quality of life increased by 0.36 for men and by 0.34 for women. The number of people who can help increased by 0.13 for men and by 0.07 for women. As a results of analysis according to age, subjective quality of life significantly increased by 0.45 for older adults aged 65-74, by 0.31 for older adults aged 75 and over. The number of poeplle who can help significantly increased by 0.15 for older adults aged 65-74 and by 0.07 for aged 75 and over. The number of people met decreased slightly overall.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e Integrated care in Korea helped older adults feel more satisfied with their lives and alleviated their feelings of isolation by enabling them to live in their own homes and communities rather than in nursing hospitals or facilities. This study is the first to evaluate the achievements of an integrated care conducted in Korea in terms of older adults' quality of life and social relationships, and this can serve as the basis for developing integrated care in the future.\u003c/p\u003e","manuscriptTitle":"Effects of integrated care on the quality of life and social relationships of older adults in South Korea","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-09 12:32:16","doi":"10.21203/rs.3.rs-3820352/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-09T13:16:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-02T15:56:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-16T18:10:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2411e467-ac08-45de-865d-01db363197c2","date":"2024-04-14T11:21:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0eac0399-147b-4cdf-8a4f-46eed00464d3","date":"2024-04-04T22:49:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-04T08:48:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69dcc5e1-09ae-4098-b33e-e3431a37c695","date":"2024-03-25T23:56:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"e47a45ee-9d3d-4725-92b7-15deda5308fe","date":"2024-03-25T08:24:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-25T08:18:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-08T06:34:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-01-08T05:03:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-08T05:01:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2023-12-29T08:39:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75208c59-d9ac-438a-8f53-8f24f30f9209","owner":[],"postedDate":"January 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-14T15:59:02+00:00","versionOfRecord":{"articleIdentity":"rs-3820352","link":"https://doi.org/10.1186/s12877-025-06191-2","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-07-08 15:57:01","publishedOnDateReadable":"July 8th, 2025"},"versionCreatedAt":"2024-01-09 12:32:16","video":"","vorDoi":"10.1186/s12877-025-06191-2","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06191-2","workflowStages":[]},"version":"v1","identity":"rs-3820352","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3820352","identity":"rs-3820352","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}