Impact of Transfer Income on Cognitive Impairment in the Elderly

Volume 118 No. 19 2018, 1613-1631 ISSN: 1311-8080 (printed version); ISSN: 1314-3395 (on-line version) url: http://www.ijpam.eu ijpam.eu Impact of Transfer Income on Cognitive Impairment in the Elderly Jin Jung 1, Jai-woo Oh* 2 1 Department of Health Management & Education, Kyungdong University, Korea 2 Department of Health Management & Education, Kyungdong University, Korea 2002jin@kduniv.ac.kr 1, sbaby69@kduniv.ac.kr 2 Corresponding author* Phone:+82-10-3745-2892 February 4, 2018 Abstract Background/Objectives: The purpose of this study is to identify and analyze the association of cognitive impairment with thetransfer income of the elderly. Methods/Statistical analysis: Cognitive disorder was examined using K-MMSE (Korean mini-mental state examination) in the elderly aged 65 and over who were admitted to the Department of Neurology A and Department of Psychiatry B in Suwon City and Osan City, Gyeonggi-do Province. The transfer income is comprised of private income transfers and public transfer incomes. This survey was conducted from November 2015 to March 2016 and a total of 214 questionnaires were received. Except for 7 unsuitable questionnaires, the rest of the 207 were analyzed with frequency analysis, descriptive statistics, t-test, ANOVA, Pearson correlation analysis and multiple regression analysis using SPSS WIN 20.0. Findings: In the correlation analysis of transfer income, there was a statistically significant proportional relation of 1 1613

various allowances, national pension, property income, basic pension, special occupational pension, and personal pension, respectively. Only the basic livelihood security recipients showed an inverse proportional relation. Multiple regression analysis was done to examine the effects of private income transfer on cognitive impairment. The result was that there was a statistically significant proportional relation on various allowance money and property income, respectively. The explanatory power of the model was 31.9%. The public income transfer showed a statistically significant proportional relation in the national pension, special occupation pension, and basic pension, sr. The basic livelihood pension had a statistically significant inverse proportional relation and the explanatory power of the model was 31.1%. The effect of transfer income of the elderly on cognitive impairment was confirmed. Improvements/Applications: The study of public transfer income is necessary to provide alternatives to the existing mental health policy for the elderly. Through more detailed and accurate research using cohort and other types of studies, various approaches to public transfer income of the elderly are suggested. Key Words: Cognitive impairment,transfer income, elderly, K-MMSE. 1 Introduction The human life span is continually increasing due to the continuous development of modern medicine and improvements at the socioeconomic level. As a result, interest in mental illnesses of the elderly such as dementia, a representative disorder occurring in old age, is increasing. Worldwide, the prevalence of dementia is 5% in elderly people aged 65 and over, and doubles every 5 years thereafter with dementia being prevalent in over half the elderly over 85 years old 1. According to the documents released by the Ministry of Health and Welfare in 2012, the prevalence of dementia in Korea is also increasing widely, and it is expected to double in number every 20 years from 2030 onward. The Mini-Mental State Examination (MMSE) is widely used in epidemiological studies and clinical studies worldwide as a test tool 2 1614

for assessing cognitive function 2. In Korea, Korean Mini-Mental Status Examination (K-MMSE) and (MMSE-K) Mini-Mental State Examination for Koreans are mainly used. Research on identifying and analyzing factors related to cognitive impairment is increasing along with the development of screening tools. It has been reported that demographic characteristics are influential, and depression is reported in other mental disorders 3. Studies related to income have not been promoted as much. In Korea, there are no studies on the relationship between income and cognitive impairment of the elderly. Inequalities in income and progress have recently led to an increase the polarization in elderly income 4. The economic situation of the elderly is relatively worsening, and the economic difficulties of the elderly affect their emotions. Studies on the quality of life and income satisfaction of the elderly reveal their satisfaction rate at the highest with a monthly income of over 2 million won 5. The lower their economic level, the lower the quality of life of the elderly 6.The more stable economically stable they are, the higher their quality of life and satisfaction 7. Thus, income is an important factor in the life of the elderly. Studies on the income and cognitive functions of the elderly showed that groups with higher incomes scored higher in cognitive function than those with lower incomes 8. Theres also a study that researched the cognitive function of women over 65 which revealed that income was related to cognitive functions 9. Currently, the studies on the relationship between cognitive impairment and income are used as one of variables of demographic and sociological characteristics. The relationship between cognitive impairment and income is not specifically described; it is simply compared with whether there is monthly income, the approximate amount, or the rise and fall of the income level. The income of the elderly is considered a complex factor that needs a more detailed investigation, not a simple factor for analysis like other demographic and sociological variables. In 2011, the total annual income per household of the elderly was estimated to be 21.61 million won and the annual gross income per person was estimated to be 8.49 million won in a study on the conditions of the elderly by the Ministry of Health and Welfare. In this survey, private income transfer, public income transfer, property income, work and business income, 3 1615

and other income were categorized as factors of income aggregation. In detail, the annual gross income of each elderly person was 8.49 million won with public income transfer the highest at 2.529 million won, followed by private income transfer, business income, property income, earned income and other income. As for the composition ratio by income, private income transfer is the highest at 39.8%. However, it has been decreasing since 2005. The percentage of transfer income is high. The purpose of this study is to identify the impact of transfer income on cognitive impairment among the elderly and to provide a practical alternative. The purpose of this study is to differentiate between private and public income transfer and understand the effect of each. The income factors of private income transfer are divided into various allowances, property income, and personal pension. The factors of public transfer income include national pension, special occupation pension, and basic livelihood pension. These factors are studied to understand their effects on cognitive impairment to help prevent dementia as well as to improve the mental health of the elderly with measures for national pension and basic pension. The purpose of this study is also to provide basic data for the improvement of the cognitive impairment, quality of life and satisfaction of the elderly. 2 Materials and Methods 2.1 Research Subjects The subjects of this study were seniors aged 65 years or older who were admitted to the Department of Neurology A and Department of Psychiatry B in Suwon City and Osan City, Gyeonggi-do Province. Suwon, Gyeonggi-do Province is a typical urban development area, and the residences are mainly composed of large apartment complexes. Osan, located in the center of Hwaseong city, is both rural and urban. Specialists conducted surveys on the elderly who were examined by K-MMSE. They explained the purpose of the study and conducted surveys regarding transfer income. Surveys and screenings started in November 2015 and lasted for about six months until March 2016. There wasnt a large number of elderly people examined by the new K-MMSE at each hospital, so 4 1616

it was difficult to collect subjects. 95 questionnaires were collected from the Department of Neurology A and 119 from the Department of Psychiatry B. A total of 214 questionnaires were collected. Of these, 207 were used for the final analysis as 7 were not suitable for data processing. 2.2 Research Tools 2.2.1 Cognitive Impairment Cognitive impairment is a concept which includes high-level processing of all the information received by an organism of human beings. It means the impairment in memories of conscious activities and the impairment in all learning and understanding processes 10. In this study, cognitive impairment was examined using the Korean Mini-Mental State Examination (K-MMSE). The K-MMSE was developed by Folstein et al. in 1975 by amending the items in MMSE. This test has 30 questions with the highest score being 30 points. The questions are about orientation, memory registration, memory recall, attention and calculation, language function, and understanding and area of judgment. 5 points for orientation (time), 5 points for orientation (location), 3 points for memory registration, 3 points for memory recall, 5 points for attention and calculation, and 9 points for language, time and space composition. In this study, the K-MMSE score was considered to be normal for 24 points and above on a scale of 30, slight weak cognitive impairment is for a score of 18 to 23 points, and severe cognitive impairment for scoring below 17 points 11. Cronbach s coefficient was 0.697 in the reliability test measurement tool. 2.2.2 Transfer Income The transfer income is composed of the subdivision of aggregate factors of the income of the elderly surveyed by Statistics Korea. The amount of allowance for various kinds of allowance surveyed by Statistics Korea in 2011 regarding private income transfer was based on 200,000 won per month and categorized into less than 100,000 won per month; 110,000 won to 200,000 won; 210,000 to 300,000 won; 310,000 to 400,000 won; 410,000 to 500,000 won; and above 510,000 won. This was an average monthly allowance received from 5 1617

all acquaintances, including children, relatives, etc. Property income is based on income generated by the activities of all assets, including movable and real estate. Accordingly, it was classified as below 500,000 won; 510,000 to 1 million won; 1.01 to 1.50 million won; 1.51 to 2 million won; and 2 million won or more. Personal pensions include both pension savings and pension insurance depending on whether there were income deductions or not. 20 years of insurance payment and 20 years of receiving pension were used and categorized into less than 500,000 won; 510,000 won to 1 million won; 1.01 to 1.50 million won; 1.51 to 2 million won; and 2.01 million won or more. The national pension is calculated based on the total amount of payments by the National Pension Service (based on the payers of wages at the end of December 2015) based on the monthly average of 380,000 won and is in units of 200,000 won, categorized into 200,000 won or less; 210,000 to 400,000 won; 410,000 to 600,000 won; 610,000 to 800,000 won; 810,000 to 1 million won; and 1 million won or more. The special occupational pension is given the most by the Government Employees Pension Service, and is divided into units of 500,000 won based on 2 million won. The basic pension recipients were classified as below 200,000 won or less, and none and basic livelihood security recipients as applicable or not applicable. 2.2.3 Method of Analysis The collected data were analyzed using SPSS / PC WIN 20.0 statistical program as follows. Frequency analysis was performed to understand the general characteristics of the subjects. A descriptive statistical analysis was conducted to examine the mean and standard deviation of cognitive impairment scores. In order to verify whether there is a difference in cognitive impairment according to the general characteristics and cognitive impairment of the subjects, and transfer income, various methods of comparisons and analyses were conducted. As the method of comparison and analysis, the t-test was used when there were two categories, and one-way ANOVA was used for the three categories. Fourth, correlation analysis was performed through Pearson correlation coefficient to investigate the correlation between cognitive impairments by subject s transfer income. Fifth, multiple regression analysis was conducted 6 1618

to investigate the effect of transfer income on cognitive impairment. 3 Results and Discussion 3.1 General Characteristics of Survey Subjects Table 1 shows the general characteristics of the survey subjects such as age, sex, household size, residence, education, and religion. The most common age was 75 to 79 years old with 63 participants, and there were more women than men, with 145 being women and 62 being men. The household size for 152 was living together with others, which was three times higher than that of 55 living alone. The highest number of participants, 97, lived in metropolitan cities. The highest number of participants had a middle school education at 65 people, and 62 people had no religion. Table 1. General Characteristics of Surveyed Subjects 7 1619

3.2 Cognitive Impairment of Surveyed Individuals As shown in Table 2, 129 people (62.3%) were normal, 61 people (29.5%) had cognitive impairment, and 17 people (8.2%) had severe cognitive impairment. Table 2. Cognitive Impairment by Level of Surveyed Individuals The overall average of the K-MMSE scores was 23.27 points as in Table 3. Table 3. K-MMSE Average Score 3.3 Cognitive Impairment According to General Characteristics 3.3.1 Difference in Cognitive Impairment According to General Characteristics The results of the comparison and analysis of the cognitive impairment according to general characteristics of the survey subjects are shown in Table 4. Cognitive impairment showed statistically significant differences among the general characteristics of age, residence, and education level. The mean score was the highest at ages 65 to 69 (F = 20.137, p = 0.000). According to the residence, the smallest city was the highest (F = 5.821, p = 0.003). According to education level, university graduation was the highest (F = 25.905, p = 0.000). Table 4. Comparison of Cognitive Impairment General Characteristics of Surveyed Subjects 8 1620

3.3.2 Correlation between General Characteristics and Cognitive Impairment The results of the analysis of the correlation between general characteristics and cognitive impairment were as shown in Table 5. Cognitive impairment showed a statistically significant proportional relation correlation with educational attainment (r = 0.573, p <0.01). There was a statistically significant inverse proportion correlation between age (r = -0.552, p <0.01) and residence (r = -0.157, p <0.05). Table 5. Correlation between General Characteristics and Cognitive Impairment 9 1621

3.4 Transfer Income of Surveyed Individuals The results of the transfer income survey are shown in Table 6. Among the factors, various allowance was the highest at 59.9% and there were the most, 39 people, with 210,000 to 300,000 won. Property income had 23 people in the range from 510,000 won to 1 million won, there were the most with less than 500,000 won for personal pension. The national pension was the largest at 410,000 to 600,000 won, and the special occupational pension was the highest at 1.51 to 2 million won. The basic pension was 100 persons under 200,000 won, and 188 persons and 19 persons were not eligible for basic livelihood security. Table 6. Characteristics of Income of Surveyed Individuals 10 1622

3.5 Transfer Income According to Cognitive Impairment 3.5.1 Difference in Cognitive Impairment According to Transfer Income The results of the comparison of cognitive impairments by transfer income are shown in Table 7. Cognitive impairment showed statistically significant differences among the income factors according to various allowance, property income, national pension, special occupation pension, basic pension, and basic livelihood security recipients. The average score was the highest for 410,000 to 500,000 won (F = 9.214, p = 0.000) for various allowances. According to property income, the highest was 1.51 to 2 million won (F = 8.543, p = 0.000). According to the national pension, the highest was 810,000 to 1 million won (F = 8.082, p = 0.000). According to 11 1623

special working pension, the highest was 1.51 to 2 million won (t = 4.813, p = 0.000). According to recipients of basic life security, those who are not applicable are higher than those who are (t=5.709, p=0.000). Table 7. Comparison of Cognitive Impairment by Subject s Income 3.5.2 Correlation between Transfer Income and Cognitive Impairment The results of analysis of correlation between cognitive impairment and transfer income are shown in Table 8. Cognitive impairment was significantly associated with age at the time of enrollment (r = 0.427, p <0.01), national pension (r = 0.409, p <0.01), property 12 1624

income (r = 0.404, (R = 0.201, p <0.01) and personal pension (r = 0.155, p <0.05) were statistically significant proportional relation correlations. There was a statistically significant inverse proportion correlation between basic livelihood security recipients (r = -0.370, p <0.01). Table 8.Correlation with Cognitive Impairment by Income 3.5.3 The Effects of Private Transfer Income on Cognitive Impairment The results of multiple regression analysis are shown in Table 9 to examine the effect of private transfer income on cognitive impairment. The various allowance (β=0.385, p=0.000), property income (β=0.361, p=0.000), respectively, had a statistically significant proportional relation and the explanatory power of the model was 31.9%. Table 9. The Effects of Private Income on Cognitive Impairment 3.5.4 The Effects of Public Income Transfer on Cognitive Impairment The results of multiple regression analysis are shown in Table 10 to examine the effect of public income transfer on cognitive impairment. National pension (β=0.334, p=0.000), special occupation 13 1625

pension (β=0.136, p=0.025), basic pension (β=0.133, p=0.038), respectively, showed a statistically significant proportional relation effect, and basic livelihood pension (β=-0.282, p=0.000) showed an inverse proportional relation effect, with the explanatory power of the model being 31.1%. Table 10. Impact of Transfer Income on Cognitive Impairment 4 Conclusion The transfer income was investigated and analyzed by being subdivided to analyze and understand the effect of the transfer income of the elderly on cognitive impairment. The mean score was 22.87 points for 75 to 79-year olds, which was a sharp drop from the 25.70 points in 70 to 74-year olds. 80 to 84-year olds had a mean score of 22.28, 85 to 89-year olds had a score of 20.52, and those over 90 years old had a score of 16.16. The statistically significant difference decreased as age increased. The average score was the highest for college graduates or higher, followed by high school graduates, middle school graduates, elementary school graduates, and those with no schooling. There was no statistically significant difference in gender, household size, and religion. Gender differences are difficult to interpret since it is not easy to judge whether these dissimilarities are due to biological differences between men and women or whether they come from interaction with social factors such as education and culture. 129 (62.3%) were normal, 61 (29.5%) were cognitively impaired, and 17 (8.2%) were severely cognitively impaired. This seems to be the result of surveying elderly people who 14 1626

were admitted to neurology and psychiatry departments which specialized in cognitive disorders, rather than general elderly people in urban or rural areas. The prevalence of dementia in Korea in 2012 has been reported by Statistics Korea as 9.18% in the elderly over 65 years of age. This reveals that although MMSE is very useful as a screening test, its use as a diagnostic tool is not appropriate. The total average of K-MMSE of the subjects was 23.27 points. According to surveys on transfer income, various allowances account for 59.9% of the total factors, and the largest portion of the allowance is 210,000 to 300,000 won, which is higher than the survey by the Ministry of Health and Welfare in 2011 at 39.8%. Overall property income was 55 people (26.6%), which was higher than the 2011 survey by the Ministry of Health and Welfare. The total number of people with personal pensions was 16 at 7.7%. 56 people (27.1%) accounted for the national pension. There were twelve people with special occupation pension, and basic pension was applicable to 100 people at under 200,000won. There were 19 elderly people who were eligible for basic livelihood security. Compared with the data of Statistics Korea in 2014, it was somewhat higher. The average comparison of transfer income showed statistically significant differences in various allowance money, property income, national pension, special occupational pension, basic pension, and basic livelihood security recipients. The amount of allowance was 410,000 to 500,000 won, which was the highest at 26.84 points. Property income was the highest among the total amount of income from all of the income factors, from 1.51 to 2 million won at 29.66 points., and the number of special occupational pensions was high at 27.75 points with 1.51 to 2 million won. The national pension was the highest at 810,000 to 1 million won (29.50 points). The basic pension was less than 200,000 won, at 25.06 points, higher than those without basic pension at 22.54 points. And those who are not basic livelihood security recipients were found to be higher than 19.15 (24.22). In the correlation analysis by transfer income, there was a statistically significant positive correlation in the order of various allowances, national pension, property income, basic pension, special occupational pension, and personal pension. Only statistically significant (-). This is the current cross-sectional survey that can be viewed as the cognitive functioning status of recipients of basic life security. The average score also varied by about five 15 1627

points. The average score of recipients of basic livelihood security is 19.15 points, which is included in the cognitive impairment group. However, it is necessary to consider the limitation that the frequency is 19 people (9.2%). In order to examine the effect of private income transfer on cognitive impairment, multiple regression analysis showed that there was a positive statistically significant effect of various pocket money and property income in order. The explanatory power of the model was 31.9%. In order to examine the effect of public transfer income on cognitive impairment, multiple regression analysis showed that there was a statistically significant proportional relation effect in the order of national pension, special occupation pension, and an inverse proportional relation effect for basic livelihood pension, with the explanatory power of the model being 31.1%. The results of this study show that the effect of the cognitive impairment of elderly people s transfer income is sufficiently confirmed, and sufficient data is meaningful in that it provides basic data on the relationship between the transfer income and the cognitive impairment. However, it is regrettable that the frequency of personal pension is small and that detailed investigation of those with basic livelihood pension is difficult. In order to examine the effect of private income transfer on cognitive impairment, multiple regression analysis showed that there was a positive statistically significant effect of various pocket money and property income in order. The explanatory power of the model was 31.9%. In order to examine the effect of public transfer income on cognitive impairment, multiple regression analysis showed that there was a statistically significant proportional relation effect in the order of national pension, special occupation pension, and an inverse proportional relation effect for basic livelihood pension, with the explanatory power of the model being 31.1%. The results of this study show that the effect of the cognitive impairment of elderly people s transfer income is sufficiently confirmed, and sufficient data is meaningful in that it provides basic data on the relationship between the transfer income and the cognitive impairment. However, it is regrettable that the frequency of personal pension is small and that detailed investigation of those with basic livelihood pension is difficult. Based on the results of the study, the following suggestions are 16 1628

made for the elderly mental health policy. There is a continuing need for research on the relationship between the income of the elderly and cognitive impairment. As can be seen from the results of the study, the transfer income portion of the elderly is proved to be a factor that requires more detailed investigation affecting cognitive impairment rather than merely being a demographic and sociological factor. In order to promote the mental health of the elderly, there is a need to elaborate more precisely and accurately by using a strategic cohort study. It is necessary to study public income transfer as an alternative to the elderly mental health policy. There is a need to study the part of public transfer income according to the results of the research. In the future, the mental health policy for the elderly needs efforts such as expanding the scope of government support and application of public transfer income in connection with the part of public transfer income such as national pension and basic pension. References [1] Benedict, K. B., Nacoste, D. B., Dementia and depression in the elderly: A framework for addressing difficulties in differential diagnosis. Clinical Psychology Review, 1990. 10, pp. 513-537. [2] Folstein, M. F., Folstein, S. E., & McHugh, P. R., Mini-Mental State a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12, pp. 189-198 [3] Wilson, R. S., Barnes L. L., Mendes de Leon C. F., Aggarwal N. T., et al., Depressive symtoms, cognitive decline, and risk of AD in older person. Neurology, 2002, 59, pp. 364-370 [4] Shon B D, Income Inequality of the Aged: Trends and Factor Decomposition. International Journal of Gerontological Social welfare, 2009, 29(4), pp. 1445-1461. [5] Kim, Y. H., Kim, K. S., A Study on the Relationship between Self-Esteem and Quality of Life of the Elderly. International 17 1629

Journal of Gerontological Social welfare, 2002, 34(3), pp. 157-189. [6] Kim, Y. S., Kim, J. H., A Study on the Living Arrangement, Housing Environment and Quality of Life for Elderly. Journal of Korean Gerontological Nursing, 2002,.6(2), pp. 189-201. [7] Choe Y M, Lee S J., Relationship between the Quality of Life and the Social Support Network for Single Home-owned Old Peopl.. International Journal of Gerontological Social welfare, 2003, 22, pp. 193-217. [8] Jeong, Y. M., Kim, J. H., Comparison of Cognitive Levels, Nutritional Status, Depression in the Elderly according to Living Situations. Journal of Korean Academy of Nursing, 2004, 34(3), pp. 495-503. [9] Kim, J H., Han, G S., Lee, Y H., Between Dietary Factors and Cognitive Impairment in older Korean Women Living in the Community. Journal of Preventive Medicine and Public Health, 2004, 37(2), pp. 174-181. [10] Geriatric psychiatry, Journal of Korean Geriatirc Psychiatry. Jung AngMoonhasa Press, 1998. [11] Lee S H, Dementia in the Primary Care. Korean Journal of Family Medicine, 1999, 20 (4), pp. 295-308. 18 1630

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