Correlation Between Lifestyle Patterns and Cognitive Function Among Community-Dwelling Older Chinese Adults in the Pre-Dementia Stages: A Latent Class Analysis.

Lifestyle activity engagement is a modifiable factor for cognitive decline. We aimed to identify lifestyle patterns (LPs) among community-dwelling older adults in the pre-dementia stages and to explore the links between LPs, cognitive function, and individual characteristics. 702 older Chinese adults were recruited. Three LPs were identified by latent class analysis: active aging lifestyle pattern (AALP), leisure lifestyle pattern (LLP), and work-centered lifestyle pattern (WLP). AALP refers to participation in various activities that are meaningful to individuals and benefit their well-being. LLP is the pattern of activities aimed at recreation. WLP refers to the LP where individuals are most likely to engage in work-related activities. However, only AALP is protected against mild cognitive impairment (MCI). Multinomial logistic regression models revealed the differences in individual characteristics among participants with different LPs, indicating the importance of tailored intervention strategies. As a protective factor against MCI, AALP should be highlighted in community-based care.

Study protocol for a prediction model for mild cognitive impairment in older adults with diabetes mellitus and construction of a nurse-led screening system: a prospective observational study.

INTRODUCTION: With an increasing number of older adults in China, the number of people with cognitive impairment is also increasing. To decrease the risk of dementia, it is necessary to timely detect mild cognitive impairment (MCI), which is the preliminary stage of dementia. The prevalence of MCI is relatively high among older adults with diabetes mellitus (DM); however, no effective screening strategy has been designed for this population. This study will construct a nurse-led screening system to detect MCI in community-dwelling older adults with DM in a timely manner. METHODS AND ANALYSIS: A total of 642 participants with DM will be recruited (n=449 for development, n=193 for validation). The participants will be divided into MCI and none-MCI groups. The candidate predictors will include demographic variables, lifestyle factors, history of diseases, physical examinations, laboratory tests and neuropsychological tests. Univariate analysis, least absolute shrinkage and selection operator regression screening, and multivariate logistic regression analysis will be conducted to identify the outcome indicators. Based on the multivariate logistic regression equation, we will develop a traditional model as a comparison criterion for the machine learning models. The Hosmer-Lemeshow goodness-of-fit test and calibration curve will be used to evaluate the calibration. Sensitivity, specificity, area under the curves and clinical decision curve analysis will be performed for all models. We will report the sensitivity, specificity, area under the curve and decision curve analysis of the validation dataset. A prediction model with better performance will be adopted to form the nurse-led screening system. ETHICS AND DISSEMINATION: This prospective study has received institutional approval of the Medical Ethics Committee of Qidong Hospital of TCM (QDSZYY-LL-20220621). Study results will be disseminated through conference presentations, Chinese Clinical Trial Registry and publication. TRIAL REGISTRATION NUMBER: ChiCTR2200062855.

Cross-cultural adaptation and validation of the positive and negative social exchange scale in older adults with disabilities in China.

PURPOSE: This study translated the Positive and Negative Social Exchange (PANSE) scale into Chinese, examined its psychometric characteristics, and explored its feasibility for use among older adults with disabilities from China. MATERIALS AND METHODS: A two-stage study procedure was employed. In the first stage, the English version of the PANSE scale was translated and cross-culturally adapted. In the second stage, the reliability and validity of the scale were assessed based on item-total correlation, internal consistency, test-retest reliability, content validity, structural validity, concurrent criterion validity, and known group validity. RESULTS: A total of 357 older adults with disabilities participated in the survey. The Chinese version of the PANSE scale consisted of two parts, the Positive Social Exchange Scale and the Negative Social Exchange Scale. Exploratory factor analysis extracted six communal factors. The cumulative contribution of the two parts of the scale was 69.90% and 77.88%, respectively. The item-total correlation was 0.353 to 0.802, the internal consistency of the PANSE was 0.653 to 0.886. The PANSE demonstrated good content validity and it was correlated with the SSRS scale. CONCLUSION: The Chinese version of the PANSE is a valid and reliable instrument for assessing social exchange in Chinese older adults with disabilities.Implication for rehabilitationDespite the growing number of older adults with disabilities being a concern in China, the lack of tools to measure the type of social support limits research related to the health status of these people.This study cross-culturally adapted, translated into Chinese and validated the Positive and Negative Social Exchange (PANSE) scale as the measurement tool to be used in the cultural context of China.The two subscales of PANSE were validated in the Chinese population of older adults with disabilities.The PANSE scale measures social exchange among older adults with disabilities in China, which can guide the development of interventions to address issues in the social exchange of these people.

Dementia and the history of disease in older adults in community.

INTRODUCTION: Many studies have revealed the effect of medical history on dementia. The aim of this study was to explore the relationship between the history of disease and onset of dementia. METHODS: This was a multi-center, cross-sectional study, with 2595 older adults enrolled. The onset of dementia was evaluated with Revised Hasegawa Dementia Scale (HDS-R). The diagnosed diseases after the age of 40 of the participants were investigated, including respiratory system diseases, digestive system diseases, cardiovascular diseases, endocrine disorders, genitourinary system diseases, nervous system disease, sensory system diseases, dental/oral diseases, bone/joint diseases and mental illnesses. RESULTS: Data of 2458 older adults were analyzed. Univariate analysis showed that diabetes, thyroid disease, mental illness, hearing loss, stroke, dental/oral disease, Denture use, fracture/osteoporosis, kidney disease and number of diseases were risk factors for dementia. After controlling for demographic sociological variables, diabetes, dental/oral disease, and denture use were independent risk factors for dementia. Thyroid disease (P = 0.313), mental illnesses (P = 0.067), hearing loss (P = 0.595), stroke (P = 0.538), fractures/osteoporosis (P = 0.069), kidney disease (P = 0.168) were no longer significant to dementia. CONCLUSION: Diabetes, dental/oral disease and denture use were main risk factors for dementia.

A pathway model of chronic pain and frailty in older Chinese cancer patients: The mediating effect of sleep.

This study aimed to explore the association between chronic pain, sleep quality, and frailty, and whether sleep quality will mediate the relationship between chronic pain and frailty. A cross-sectional study was conducted between June 2020 and July 2021 among 308 patients in Nantong city. The relationship between chronic pain and frailty was tested using linear regression. The bootstrap method was used to examine mediating effect of sleep quality. Chronic pain was significantly correlated with frailty (r=0.271, P<.001). Sleep quality played a partially mediating role between chronic pain and frailty (ß=0.160, R2=32%, P<.001). Interventions to scientifically manage chronic pain and improve sleep quality may be effective in reducing the incidence of frailty in elderly cancer patients.

Effects of transitional care based on the social support theory for older patients with osteoporotic vertebral compression fractures: A quasi-experimental trial.

OBJECTIVES: This study aimed to investigate the effects of transitional care (TC) programs on the health outcomes of discharged older patients with osteoporotic vertebral compression fractures (OVCFs). METHODS: A total of 160 older patients were recruited from two campuses of a public teaching hospital in China. Patients were grouped according to the campus to which they were admitted. The TC programs commenced one day before discharge and lasted 6 months after discharge. Repeated-measures analysis of variance was used to analyse the effects of the TC programs. RESULTS: The TC programs improved the discharge of older patients with OVCF in their activities of daily living (ADLs), pain levels and social support, and decreased fracture recurrence rates. CONCLUSIONS: This study provides evidence of concurrent clinical improvements and health outcomes in discharged older patients with OVCFs from the effects of TC programs based on social support theory.

Multidimensional measure of instrumental support in transitional care - design and pilot test of a questionnaire assessing instrumental support among older adults with chronic diseases.

BACKGROUND: Previous studies indicated that poor quantity and quality of instrumental support are one of the main barriers in the application of transitional care. Instrumental support, as one common function of social support, is the provision of financial assistance, material goods, or services. The purpose of our study is to develop an Instrumental Support in Transitional Care Questionnaire (ISTCQ) and use this questionnaire to make an assessment among older adults with chronic diseases. METHODS: The draft questionnaire was examined by 18 experts from different professional fields performing three rounds of content validity testing with the Delphi method. Afterward, we conducted a pilot test recruiting 174 participants as a convenience sample in Nantong, China. The construct validity was confirmed via exploratory factor analysis and reliability was assessed using Cronbach's alpha. RESULTS: The authority coefficient of experts was 0.74-0.99 and Kendall harmony coefficient W was 0.381. The exploratory factor analysis indicated that the questionnaire can be interpreted by three factors: namely, anticipated support (items 1, 2, 3, 4), received support (items 5, 6, 7, 8) and support satisfaction (items 9, 10, 11, 12). These three factors (eigenvalues > 1 and factor loading > 0.4) explained 69.128% of the total variance. Furthermore, the calculation of Cronbach's alpha and test-retest reliability have shown good reliability among each dimension of the 12-item questionnaire (Cronbach's alpha 0.711-0.827, test-retest reliability 0.704-0.818). CONCLUSION: Results from the pilot test demonstrated excellent reliability and validity of ISTCQ through each dimension and as an entire.

Factors associated with instrumental support in transitional care among older people with chronic disease: a cross-sectional study.

BACKGROUND: Instrumental support, which is defined as practical, tangible, and informational assistance extended to patients, is crucial for older people in transition. However, little is known about instrumental support in transitional care. Thus, the aim of this study was to evaluate the instrumental support of older people in transitional care. METHODS: This cross-sectional study was conducted using the Questionnaire of Instrumental Support in Transitional Care (QISCT) to collect data from 747 older people in China from September to November 2020. Survey items consisted of a sociodemographic characteristics questionnaire and the QISCT. Multiple regression analyses were conducted to examine the association between independent variables and the QISCT scores. RESULTS: The total score of the QISCT was 39.43 (± 9.11), and there was a significant gap between the anticipated support and received support. The satisfaction of instrumental support was low. Multiple regression analyses showed that educational level, the number of intimate relationships, monthly family income, monthly costs of transitional care, diabetes, and chronic obstructive pulmonary disease were associated with instrumental support in transitional care. CONCLUSIONS: To cope with the burden caused by chronic disease, the government and transitional care teams should establish a demand-oriented transitional care service model and pay more attention to helping older people obtain adequate and satisfactory instrumental support.

Effects of internet-based interventions on improvement of glycemic control and self-management in older adults with diabetes: Systematic review and meta-analysis.

PURPOSE: To assess and summarize the effects of internet-based interventions on diabetes control and self-management of older adults with diabetes. METHODS: PubMed, Web of Science and three Chinese databases were searched to identified articles published in until December 2021. Clinical trials if they covered the effects of internet-based interventions on diabetes control and self-management of older adults with diabetes were included. All data analysis were performed by Review Manager 5.3. RESULTS: Sixteen studies with a total of 5604 participants met the inclusion criteria. Our primary outcomes included HbA1c control and self-management. (1) HbA1c control: results indicated statistically difference and high heterogeneity [Q = 112.9, df = 8, p < 0.001, I2 = 93%], in the subgroup analysis of studies in China, results showed a significant influence of internet-based interventions on HbA1c control [Q = 21.31, df = 5, p = 0.03, I2 = 77%]; (2) self-management: in the subgroup analysis of study duration ≤ 6 months [Q = 84.62, df = 2, p < 0.001, I2 = 98%]. CONCLUSION: Internet-based interventions are promising on diabetes control and self-management of older adults with diabetes, but still preliminary due to the heterogeneity of intervention components and the limited number of higher methodological quality trials. AVAILABILITY OF DATA AND MATERIAL: Applicable.

Effects of an emotional support programme on older adults living in nursing homes: A quasi-experimental study.

This study aimed to examine the feasibility and validity of an emotional support programme developed for older adults living in nursing homes, using a quasi-experimental design. Older adults in the intervention group attended a 12-week emotional support programme while those in the control group received usual care. Outcome variables, assessed at baseline and at 1-month and 3-month follow ups, included nursing home adjustment, perceived social support, and quality of life. Group-by-time interaction effects were found concerning nursing home adjustment and perceived social support. Significant improvements in the two variables were observed in the intervention group, but no significant difference was found in quality of life. The emotional support programme based on social learning theory resulted in significant improvements in nursing home adjustment and perceived social support. To respond to the demands of an ageing society, further studies are needed on this topic.

The Effect of a New Ligation and Venipuncture Method on Vena Basilica Vessel.

Objective: This study evaluated the impact of a novel venipuncture method on vascular parameters of vena basilica to provide a new technical option for the clinical management of difficult venipuncture. Methods: 32 volunteers examined by ultrasound at the Medical Imaging Center of The First People's Hospital of Nantong, Jiangsu province, from February 2020 to April 2020 were randomly selected. One hand of each patient was ligated with the traditional single tourniquet and the new ligation method for 20 seconds. Then, the distance between the left or right vena basilica and the skin and the diameter of blood vessels were measured by ultrasound. 98 patients with peripheral venipuncture difficulty who were examined by ultrasound of a third-grade hospital from April 2019 to March 2020 were selected and randomly divided into control group (n = 49) and experimental group (n = 49). The traditional method was used in the control group, and the new peripheral venipuncture was used in the experimental group. The success rate of single puncture, preparation time before puncture, time required for puncture operation, pain reaction during puncture, intravascular congestion after puncture, subcutaneous tissue injury, and vascular reuse rate after puncture were compared between the two methods. Results: The new ligation and puncture method increased the diameter of peripheral superficial vein vessels by 0.51 ± 0.04 mm, and the change of vena basilica diameter was not significantly associated with gender and age of patient. The success rate of single puncture and the vascular reuse rate were significantly higher in the experimental group than in the control group, while the preparation time and venipuncture time, as well as the patient's pain response, were significantly lower in the experimental group compared to the control group, and the intravascular congestion and subcutaneous tissue injury were lower. In addition, the mean satisfaction score of patients in the experimental group was higher than that of the control group. Conclusion: The new ligation and puncture method was an effective vena basilica dilation technique for filling the peripheral superficial veins, improving puncture success rate of peripheral difficult vein, and reducing patient pain, which was worth popularizing and applying in clinic.

Factors Influencing Wearing Face Mask in Public During COVID-19 Outbreak: A Qualitative Study.

OBJECTIVE: Wearing face masks is believed to mitigate coronavirus disease 2019 (COVID-19) virus transmission by filtering respiratory droplets. This study was to explore the factors influencing wearing face masks in public in China during COVID-19 outbreak. METHODS: This study was a qualitative semi-structured interview research design and was guided by the Protection Motivation Theory. Participants from Jiangxi Province China were interviewed by means of WeChat video call. Thematic analysis was used to analyze the data. RESULTS: Recruitment efforts were suspended when 21 participants (aged 23 to 72 y) were successfully enrolled and the data reached thematic saturation. Four themes were identified when participants described factors influencing them to wear face masks: knowledge of disease (subthemes were severity of disease, and individual vulnerability to disease), environmental facilitators and constraints (subthemes were government recommendations, public opinion, and affordability and availability of face masks), understanding of protection effectiveness (subthemes were protection effectiveness of wearing face masks, and selection of protective measures), and past experiences. CONCLUSIONS: Individuals' decision to wear face masks was influenced by the combination of factors identified. Identification of these factors provides guidance for explaining wearing face masks in public and helps policy-makers develop feasible recommendations for wearing face masks during COVID-19 outbreak.

Factors Associated With Informational Support in Transitional Care for Older Adults With Chronic Diseases: A Cross-Sectional Study.

To evaluate the current situation and associated factors of informational support for older adults with chronic diseases in transitional care. Study was conducted in five hospitals of five different cities in Jiangsu Province, China. A random cluster sample of 800 older adults with chronic diseases responded to the informational support questionnaire of transitional care survey. Descriptive analysis, t-tests, variance analysis, and stepwise multiple linear regression were used to analyze data. The STROBE statement for observational studies was applied. Total score of ISQTC for older adults with chronic diseases was (44.05 ± 17.21). Marital status, educational level, past occupation, close friends, medical insurance, complications, and exercise habits were significantly correlated with informational support. The level of informational support in transitional care for older adults with chronic diseases was low. Clinical staff should periodically and primarily assess their informational support, help find information resources for those who have low initial informational support, and identify which information they preferred to carry out accurate transitional care.

Informational support for depression and quality of life improvements in older patients with cancer: a systematic review and meta-analysis.

PURPOSE: To assess and summarize the effects of informational support on depression and quality of life of older patients with cancer. METHODS: PubMed, MEDLINE, and Web of Science were searched to identify articles written in English and published until March 2021. Studies within 10 years period (2010-2021) were included. Randomized controlled trials were included if they evaluated the impact of informational support on depression and quality of life. All analyses were performed with Review Manager 5.3. RESULTS: Twelve studies with a total of 2374 participants met the inclusion criteria. Our primary outcomes included depression and quality of life. (1) Depression: results indicated no statistically significant difference and low heterogeneity [SMD = 0.28, 95% CI (- 0.24,0.80), p = 0.45; I2 = 0%], (2) Quality of life: in the subgroup analyses of EORTC QLQ-C30, results indicated a significant effect of informational support on quality of life [SMD = 2.84, 95% CI (0.63, 5.05), p = 0.03; I2 = 79%]; in the subgroup analyses of FACT and SF-36, there were no significance. CONCLUSIONS: Informational support could reduce depression and did improve the quality of life in older cancer patients with statistical significance. The findings suggested that informational support was an effective approach to improve depression and quality of life in older patients with cancer.

Analysis of the Status Quo and Influencing Factors of Community Residents' Awareness of Basic Life Support and Willingness to Attempt Rescue.

OBJECTIVE: This study aimed to investigate community residents' awareness of basic life support (BLS) and their willingness to attempt rescue. METHODS: From October to December 2020, in the communities of Nantong City, a stratified three-stage random sampling method was adopted to select residents from 12 neighborhood committees over the age of 18 with whom to conduct a cross-sectional questionnaire survey. A self-designed questionnaire was adopted, the contents of which included the general situation of the respondent, knowledge, attitude, and behavior in relation to BLS; the Cronbach's α coefficient of the questionnaire was 0.719. RESULTS: A total of 3000 questionnaires were distributed, of which 2812 were valid, with a valid response rate of 93.73%. Of the 2812 respondents, 41.18% had seen an automatic external defibrillator (AED), 48.83% had experience of' cardiopulmonary resuscitation (CPR), and 25.07% of the respondents had experience of' AEDs. When an accident occurred, 50.50% of residents were willing to attempt rescue, 70.80% were willing to attempt rescue under professional guidance, and 71.23% were willing to attempt rescue after learning BLS techniques. Of the residents who were unwilling to attempt rescue, 32.75% were worried about their lack of ability, 27.91% were concerned about legal issues, 14.01% feared infectious diseases, and 10.35% were unwilling to perform mouth-to-mouth artificial respiration. Age, occupation, education level, and whether they had participated in first aid training were the influencing factors. CONCLUSION: Residents in Nantong have less knowledge of BLS, and their knowledge of CPR is better than that of AEDs. Residents have a strong willingness to learn BLS. Measures need to be taken to improve their understanding of BLS and their application skills. Residents have high levels of willingness to attempt rescue, but a certain percentage of residents have concerns. Interventions can be made to target the different reasons.

A cross-sectional study using the national standard to examine differences between public and private non-profit nursing homes in China.

AIM: Most studies on nursing home quality focus on developed countries, with little coverage in developing countries. Our study aimed to compare the differences between Chinese public and private non-profit nursing homes using the latest national standard. METHODS: A cross-sectional study was conducted including 232 nursing homes in Jiangsu and Zhejiang provinces, China. We conducted statistical analyses (chi-square and independent sample t test) to investigate differences in public and private non-profit nursing homes. We fitted a binary logistic regression model with whether or not the nursing home received a 3-star or higher rating as the dependent variable, and the ownership type as explanatory variable, after adjusting for nursing home characteristics. RESULTS: Of the 232 nursing homes included in the study sample, 44.8% were public nursing homes and 55.2% were private non-profit nursing homes. The t test analysis comparing the measures of nursing homes yielded significant results for 4 measures, 3 of which (overall rating, environment, and services) favored private non-profit nursing homes. A regression analysis using whether or not the nursing home received a 3-star or higher rating as the dependent variable showed that when adjusting for nursing home characteristics, private non-profit nursing homes were more likely to have a 3 or higher star compared with public nursing homes (odds ratio = 1.961, 95% confidence interval: 1.056-3.643). CONCLUSION: These results suggested that private non-profit nursing homes performed better than public nursing homes when using the Chinese national standard for nursing homes.

Study protocol: A cross-sectional study on instrumental support for transitional care among older adults with chronic diseases.

AIMS: In this paper, we present a study aiming to develop a questionnaire on instrumental support for transitional care as a tool for investigating services, staff, equipment and supplies, and funds of transitional care and conduct a cross-sectional study on the current instrumental support for transitional care in older adults with chronic diseases. DESIGN: A cross-sectional study combining instrumental support with transitional care through a mixed-method approach. METHODS: Data are collected through two sources: distribution of the questionnaire to older adults with chronic diseases and interviews with experts from different specialties such as nursing, clinical medicine, geriatrics, sociology and government. RESULTS: The developed questionnaire and expert interviews will be used to investigate the current instrumental support for transitional care among older adults with chronic diseases in China. These findings can help leaders identify areas for improvement in transitional care and contribute to the long-term positive development of transitional care.

Development of an informational support questionnaire of transitional care for aged patients with chronic disease.

OBJECTIVES: We developed an informational support questionnaire of transitional care (ISQTC) for aged patients with chronic disease and investigated its reliability and validity. SETTING: This study was conducted in three large general hospitals in Nantong, Jiangsu Province, China. PARTICIPANTS: A total of 130 aged patients with chronic diseases, admitted into outpatient and inpatient departments from three hospitals in China, participated in the study. The inclusion criteria were: (1) patients must provide consent to participate; (2) being 60 years and above; (3) being diagnosed with at least one chronic disease and hospitalised more than two times within the last 1 year; (4) being able to listen, speak, read and write. The exclusion criteria were: (1) refusing to participate; (2) language expression and communication barriers (and having no caregiver to assist in participation); (3) being in intensive care or long-term hospitalisation. PRIMARY AND SECONDARY OUTCOME MEASURES: The developed questionnaire was validated and tested for reliability. The content validity of the questionnaire was determined through experts' interviews and Delphi expert consultation, and the structure validity of the questionnaire was determined by performing exploratory factor analysis. The coefficient of reliability of the questionnaire was measured using Cronbach's alpha. RESULTS: Through Delphi expert consultation and exploratory factor analysis, the questionnaire was reduced from four dimensions and 12 items to three dimensions and 11 items. A total of 130 patients responded to the questionnaire. The alpha coefficient was 0.747. CONCLUSION: The ISQTC is a reliable and valid instrument for evaluating aged patients with chronic disease in transitional care. TRIAL REGISTRATION DETAILS: ChiCTR1900020923. The trial was registered on 22 January 2019.

Impact of transitional care for discharged elderly stroke patients in China: an application of the Integrated Behavioral Model.

Background: Transitional care (TC) has been shown to improve stroke rehabilitation in discharged stroke patients. Previous TC interventions did not report satisfactory stroke rehabilitation outcomes or risk management. Incorporating a health behavior theory in interventions can effectively improve health behaviors and metabolic indicators.Objectives: This study was a clinical controlled trial to investigate the impact of the Integrated Behavioral Model (IBM)-based 3-month TC on health behaviors, clinical outcomes, and stroke knowledge in discharged elderly stroke patients.Methods: Sixty elderly patients were recruited from two wards of a public teaching hospital in China. To prevent potential treatment contamination, patients were allocated into either a control or intervention group depending on which wards they were admitted to. The TC intervention considered all the IBM constructs to provide patients assistance in implementing health behaviors as recommended by the Chinese stroke guidelines. The TC intervention commenced one day before discharge and lasted three months after discharge. A linear mixed model was used to measure the impact of the intervention.Results: The TC intervention improved the discharged elderly stroke patients' health behaviors, activities of daily living, quality of life, and stroke knowledge. The intervention also controlled the patients' systolic blood pressure, body mass index, total cholesterol, triglycerides, and low-density lipoprotein cholesterol.Conclusions: This study provided evidence of concurrent self-reported and objective clinical indicators in discharged elderly stroke patients for the impact of the IBM-based 3-month TC intervention, which can be recommended for clinical practice.