Effects of an Individualized Exercise Program Plus Behavioral Change Enhancement Strategies for Managing Fatigue in Older People Who Are Frail: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Although the evidence suggests that general fatigue is a strong indicator of rapid aging, frailty, and disability, general fatigue is undertreated in gerontological care. OBJECTIVE: The aim of this study is to investigate whether an individualized exercise program with and without behavioral change enhancement (BCE) strategies for older people who are frail and have general fatigue will reduce their fatigue and symptoms of frailty. DESIGN: A 3-arm, single-blind, cluster randomized controlled trial registered with ClinicalTrials.gov (NCT03394495) will be conducted. SETTING: The study will be conducted in a community setting. PARTICIPANTS: Two hundred eighty-five community-dwelling older people with general fatigue will be recruited from 12 district community health centers. INTERVENTION: People from each center will be randomized to one of three groups. The combined group will receive a 16-week combined intervention consisting of individualized exercise training and the BCE program, plus two booster sessions at 2 and 6 months after the program. The exercise group will receive exercise training and health talks only. The control group will receive health talks only. MEASUREMENTS: Outcome measures will be collected at baseline, at the midpoint (week 8) of the program, and then at 1 week, 6 months, and 12 months after the end of the program. The primary outcome---level of fatigue---will be measured using the Multidimensional Fatigue Inventory. Secondary outcomes will include the participants' frailty status, strength, mobility, exercise self-efficacy, and habitual physical activity. LIMITATIONS: A self-reported level of fatigue will be used. CONCLUSIONS: The effect of exercise and BCE strategies on general fatigue among older people who are frail is not known. This study will be a pioneering interventional study on how general fatigue among older people who are frail can be managed and how fatigue-related frailty can be prevented or minimized.

A qualitative descriptive study of the contextual factors influencing the practice of emergency nurses in managing emerging infectious diseases.

Purpose: Emergency nurses are engaged in the management of epidemic events that unfold along with the evolution of diseases. The goal of this study was to explore the contextual factors that inhibited the ability of emergency nurses to perform their duties in response to an outbreak. Methods: A qualitative descriptive design was used to explore the experiences and perceptions of emergency nurses. Participants were purposively recruited from 12 emergency departments in Hong Kong. Semi-structured face-to-face individual interviews were conducted with 26 emergency nurses. The audio-recorded interviews were transcribed verbatim and interpreted with a thematic analysis approach. Results: Four intertwined themes emerged from the analysis: resource constraints, threats of infection, ubiquitous changes and lingering uncertainties. These themes portrayed the constraints and challenges surrounding the work environment of emergency nurses. Conclusion: This study described the instabilities and vulnerabilities of the circumstances in which the emergency nurses were situated in during epidemic events. The findings shed light on the importance of hospitals and emergency departments in addressing both the technical problems and adaptive challenges that face emergency nurses during epidemic events.

Conceptual framework for cognitive function enhancement in people with dementia.

AIM: This aim of this study is to propose a conceptual framework for guiding interventions to enhance the cognitive function of people with dementia. BACKGROUND: Few studies have been published on non-pharmacological approaches with a conceptual framework for an intervention to enhance cognitive function. The Progressive Lowered Stress Threshold model is one of the useful theoretical models for predicting the occurrence of dysfunctional behaviour in people with dementia. Based on the theoretical assertion of the Progressive Lowered Stress Threshold model and empirical findings on the relationship of anxiety and depression with cognitive function, an expanded model is proposed. DESIGN: Discursive paper. METHOD: Literature regarding stress and anxiety in people with dementia was reviewed and critically analysed, and then integrated into the Progressive Lowered Stress Threshold Model. With careful considerations about the relationships between the variables indicated in the Model and the evidences and limitations suggested in the literature reviewed, an expanded model has been proposed, which may guide the development of non-pharmacological intervention for promoting cognitive functions of people with dementia. Recommendations or implications for practice have been given. CONCLUSION: There are three commonly used models in dementia care, including the biomedical, behavioural and Progressively Lowered Stress Threshold model. Their uses and weaknesses are given. An expanded model is suggested, and explanations are provided with regard to its merits in guiding the development of interventions for people with dementia. Further testing on this model is suggested. RELEVANCE TO CLINICAL PRACTICE: Cognitive function and dysfunctional behaviour are the major concerns of caregivers of dementia patients. Interventions that can alleviate the symptoms and enhance cognition are likely to improve the well-being of patients and their caregivers. This proposed model can guide the development of interventions.