The Effect of Aerobic Exercises on Arterial Stiffness in Older People: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Aerobic exercise is a cost-effective intervention to improve arterial stiffness, but its effects on older people are unclear; this review aims to determine those effects. RESEARCH DESIGN AND METHODS: Five databases were searched for randomized controlled trials of aerobic exercises. Backward and forward citations and clinical trial registries were also reviewed. Data were extracted and synthesized. A random-effects model was used in a meta-analysis. The risk of bias and the certainty of the evidence were also assessed. The protocol of this review was registered (PROSPERO registration number: CRD42022349494). RESULTS: Eighteen studies (n = 775) were identified. Aerobic exercises included cycling, walking, swimming, standing core exercise, bench step exercise, aquarobic exercise, jogging, running, upper-limb cycling, and aquatic walking. Postintervention, improvements were seen in the pulse wave velocity (SMD9 = -0.89, 95% confidence interval (CI)-1.57 to -0.22), arterial velocity-pulse index (MD2 = -6.84, 95% CI -9.05 to -4.63), and arterial pressure-volume index (MD2 = -4.97, 95% CI -6.9 to -3.04), but not in the augmentation index, arterial compliance, or beta stiffness index. Exercise lasting >8 weeks but not 4-8 weeks significantly improved pulse wave velocity. Aerobic exercise had a beneficial effect on healthy older people but not on older people with disease. The overall risk of bias was high in 9 of the included studies, with some concerns in the remaining studies. The certainty of the evidence was very low. DISCUSSION AND IMPLICATIONS: Aerobic exercises, particularly those lasting >8 weeks, appear to be effective at improving pulse wave velocity in older people postintervention. Future trials with robust designs are needed.

Assessing the risk factors associated with sarcopenia in patients with liver cirrhosis: a case-control study.

Sarcopenia is a disease characterized by decreased muscle mass and strength, affecting 20-70% of patients with cirrhosis, and is associated with poor prognosis, complications, and high mortality. At present, the epidemiological investigation of sarcopenia in patients with liver cirrhosis is relatively limited, and because of the differences in population characteristics, regions, diagnostic criteria and diagnostic tools, the prevalence of sarcopenia in various studies varies greatly. The definition of sarcopenia in this study adopted the criteria of the Asian Working Group on Sarcopenia (AWGS 2019), including muscle mass and muscle strength / physical performance. A total of 271 patients with liver cirrhosis were included in this cross-sectional study to explore the influencing factors of sarcopenia in patients with liver cirrhosis. The prevalence of sarcopenia was 27.7%, 27.3% in male and 28.4% in female. The results of binary logistic regression analysis showed that age, physical activity, BMI, mid-upper arm muscle circumference, hepatic encephalopathy, nutritional status, alkaline phosphatase, albumin and total cholesterol were significantly correlated with the occurrence of sarcopenia in patients with liver cirrhosis. After adjusting for the potential influencing factors, it was found that the correlation between age and sarcopenia was weakened (OR = 0.870, 95% CI 0.338-2.239). The current findings show that sarcopenia is common in patients with cirrhosis and is independently associated with age, physical activity, BMI, nutritional status, and albumin, and serum alkaline phosphatase and total cholesterol are associated with the development of sarcopenia. Regular exercise may help maintain the grip strength of patients with cirrhosis and delay the deterioration of liver function.

The association of technology acceptance and physical activity on frailty in older adults during the COVID-19 pandemic period.

BACKGROUND: Physical activity was known to be the protective factor against frailty. Technology acceptance is associated with behavioural intention to technology usage. Technology has been effective in promoting healthy behaviour of physical activity. The purposes of this study were to examine the association between physical activity and technology acceptance with frailty and examine the moderation effect of technology acceptance on physical activity and frailty. We hypothesize that 1) physical activity and technology acceptance are associated with frailty, and 2) technology acceptance moderates the association of physical activity with frailty. METHODS: This study employed a cross-sectional design and was conducted in the community settings of Hong Kong in 2021. Eligible participants were old people aged ≥60 and were community-dwelling. Key variables included physical activity measured by Rapid Assessment of Physical Activity (RAPA), social network measured by Lubben Social Network Scale-Six items (LSNS-6); depressive symptoms measured by Patient Health Questionnaire-Nine items (PHQ-9), technology acceptance measured by Senior Technology Acceptance Model-14 items (STAM-14) and frailty measured by Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight scale (FRAIL). Ordinal logistic regression was employed to test the hypotheses. The moderation effect was examined by introducing an interaction term formed by the multiplication of an independent variable (i.e., physical activity) and a moderating variable (i.e., technology acceptance). RESULTS: This study recruited 380 eligible participants with a mean age of 66.5 years. Technology acceptance (Beta = - 0.031, p < 0.001, Pseudo-R2 = 0.087) and physical activity (Beta = - 0.182, p = 0.003, Pseudo-R2 = 0.027) were associated with frailty in the unadjusted models. Technology acceptance (Beta = - 0.066, p < 0.001) and physical activity (Beta = - 1.192, p < 0.001) were also associated with frailty in the fully adjusted model (Pseudo-R2 = 0.352). Interaction term formed by the multiplication of technology acceptance and physical activity (Beta = 0.012, p = 0.001) was associated with frailty. Physical activity was significantly associated with frailty in the lower technology acceptance subgroup (Beta = - 0.313, p = 0.002) in the subgroup analysis. However, in the subgroup of higher technology acceptance, the association of physical activity (Beta = 0.104, p = 408) on frailty became positive but not significant. CONCLUSIONS: This study showed that physical activity and technology acceptance were associated with frailty, and technology acceptance moderated the association of physical activity with frailty. This study recommends engaging older adults in physical activity to combat frailty preferentially in those with a lower level of technology acceptance.

A Health App for Post-Pandemic Years (HAPPY) for people with physiological and psychosocial distress during the post-pandemic era: Protocol for a randomized controlled trial.

Objective: This article describes a protocol for a randomized controlled trial to evaluate the effects of a three-level Health App for Post-Pandemic Years (HAPPY) on alleviating post-pandemic physiological and psychosocial distress. Methods: Convenience and snowball sampling methods will be used to recruit 814 people aged 18+ with physiological and/or psychosocial distress. The experimental group will receive a 24-week intervention consisting of an 8-week regular supervision phase and a 16-week self-help phase. Based on their assessment results, they will be assigned to receive interventions on mindfulness, energy conservation techniques, or physical activity training. The waitlist control group will receive the same intervention in Week 25. The primary outcome will be changes in psychosocial distress, measured using the Kessler Psychological Distress Scale (K10). Secondary outcomes will include changes in levels of fatigue (Chinese version of the Brief Fatigue Inventory), sleep quality (Chinese version of the Pittsburgh Sleep Quality Index), pain intensity (Numeric Rating Scale), positive appraisal (Short version of the 18-item Cognitive Emotion Regulation Questionnaire), self-efficacy (Chinese version of the General Self-efficacy Scale), depression and anxiety (Chinese version of the 21-item Depression Anxiety Stress Scale), and event impact (Chinese version of the 22-item Impact of Event Scale-Revised). All measures will be administered at baseline (T0), Week 8 after the supervision phase (T1), and 24 weeks post-intervention (T2). A generalized estimating equations model will be used to examine the group, time, and interaction (Time × Group) effect of the interventions on the outcome assessments (intention-to-treat analysis) across the three time points, and to compute a within-group comparison of objective physiological parameters and adherence to the assigned interventions in the experimental group. Conclusions: The innovative, three-level mobile HAPPY app will promote beneficial behavioral strategies to alleviate post-pandemic physiological and psychosocial distress. Trial registration: ClinicalTrials.gov, NCT05459896. Registered on 15 July 2022.

Sensitivity and specificity of conventional and new face validation in determining the incomprehensible items by older people: Empirical evidence of testing 106 quality-of-life items.

Objective: This methodological research aimed to investigate and compare the sensitivity and specificity of conventional and new face validation in identifying incomprehensible items empirically. Methods: A purposive sample of 15 older people living in three residential care homes (RCHs) in Hong Kong was used to evaluate a newly developed 106 items covering seven quality-of-life dimensions. The abbreviated Mental Test (Hong Kong version; AMT) was used as a screening tool for excluding those with impaired cognition. The interview was audiotaped, and incomprehensible items were identified by the research panel accordingly (served as the gold standard). The socio-demographics of the respondents were described. Understandability (yes/no, conventional face validation method) and interpretability (4-point Likert scale, new method) were compared and used to compute the Kappa value (representing chance agreement), sensitivity, and specificity analysis. Results: Fifteen older people were interviewed and responded to the structured interview of 106 items regarding understandability and interpretability. 61 items (57%) obtained 100% positive understandability while only 35 items (33%) obtained 100% correct interpretability.The Kappa coefficient was 0.388 (P < 0.001) of the chance agreement between understandability and interpretability. The panel confirmed that 32% of items required revision (i.e., incomprehensible items). The false negative rate of using the conventional approach was up to 70.59% while both the false positive and negative rates of using the new approach were low (0%-5.88%). Conclusion: This empirical evidence indicated that the conventional approach of face validation for checking incomprehensible items by older people encountered a high false negative rate. On the contrary, the new approach was recommended because it demonstrated high sensitivity and specificity and low false positive and negative rates in identifying incomprehensible items.

The effects of therapeutic virtual reality experience to promote mental well-being in older people living with physical disabilities in long-term care facilities.

BACKGROUND: Mental well-being is poor in long-term care facilities (LTCF) residents. Physical disabilities, impaired social engagement, and environmental stress are also common in LTCF which exacerbate the decline of the mental well-being of older people living in LTCF. Protective elements, including nature-based, reminiscence, outdoor, and group activities, are known to be effective to promote the mental well-being of older people living in LTCF. However, limited by their physical disabilities and poor social support, older people living in LTCF are not likely to benefit from these effective measures. Virtual reality has been proven to be feasible to be environmentally unrestricted to providing LTCF residents with all protective elements promoting mental well-being. However, its effects on the mental well-being of LTCF residents living with physical disabilities are unclear. METHODS: This study employs a single-blinded, two-parallel-group (intervention-to-control group ratio = 1:1), non-inferiority, randomized controlled trial. Eligible participants are aged 60 years or above, LTCF residents, and living with physical disabilities. The study will be conducted in LTCF. In the intervention group, participants will receive a 6-week VR experience program. In the control group, participants will receive the usual care provided by the LTCF. The primary outcome is mental well-being, as measured by World Health Organization Five Well-being Index at the time point of baseline (i.e., week 0) and after completion of the intervention (i.e., week 7). This study aims to recruit a total of 216 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention. TRIAL REGISTRATION: The trial has been registered at ClinicalTrials.gov (Identifier: NCT05818579 ), Registered on April 5, 2023. The latest version of the protocol was published online on 19 April 2023. All items come from the World Health Organization Trial Registration Data Set. This study has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2023158). The findings will be disseminated in peer-reviewed journals, presented at international and local conferences with related themes, and shared in local media.

The Global Leadership Mentoring Community: An evaluation of its impact on nursing leadership.

AIM: To evaluate a year-long mentorship program, pairing nurses from different regions across the world to support their global leadership capability, and identifying additional consequences of their participation. BACKGROUND: Investment in developing nurse leaders continues as a strategic global imperative. Building on the first cohort's recommendations, this second program illustrates continued progress. PROGRAM EVALUATION: Using the logic model of program evaluation, this non-empirical paper uses data collected from anonymized questionnaires and participants' stories to help improve the program, illustrating innovative practices to develop the confidence and competence of emerging and established nurse leaders globally. DISCUSSION: The value of mentorship was recognized, and there were gains for both mentors and mentees in the development of leadership confidence and competence. Through engagement and collaboration with the whole community, participants were encouraged to understand their own and others' cultures avoiding assumptions and stereotypes. CONCLUSION: This evaluation illustrates that in addition to helping improve future programs, mentorship has enabled the growth of individuals' skill sets and the confidence to reach out to peers across the world to understand the meaning of global health and to make a meaningful contribution to the challenges they face. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers should be encouraged to develop and formalize a mentoring culture to benefit the leadership competence and well-being of their workforce. IMPLICATIONS FOR NURSING POLICY: Every nurse has a responsibility to invest in nursing leadership for themselves and others. Mentorship can assist nurse leaders to build workforce capability to lead and contribute to the policy agenda locally, nationally, and internationally. Starting early and at the individual level, global mentorship programs can develop leadership expertise to help nurses find their voice and strengthen their confidence and competence to lead and therefore build the strategic leaders of the future.

Experiences and perspectives of healthcare professionals implementing advance care planning for people suffering from life-limiting illness: a systematic review and meta-synthesis of qualitative studies.

BACKGROUND: Life-limited patients may lose decision-making abilities during disease progression. Advance care planning can be used as a discussion method for healthcare professionals to understand patients' future care preferences. However, due to many difficulties, the participation rate of healthcare professionals in advance care planning is not high. AIM: To explore the facilitators of and barriers to healthcare professionals' provision of advance care planning to life-limited patients to better implement it for this population. METHODS: We followed ENTREQ and PRISMA to guide this study. We conducted a systematic search of PubMed, Web of Science, Embase, CINAHL, PsycINFO, CNKI, and SinoMed to include qualitative data on the experiences and perspectives of healthcare professionals in different professional fields in providing advance care planning for life-limited patients. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies. RESULTS: A total of 11 studies were included. Two themes were identified: unsupported conditions and facilitative actions. Healthcare professionals regarded cultural concepts, limited time, and fragmented record services as obstacles to implementation. They had low confidence and were overly concerned about negative effects. They needed to possess multiple abilities, learn to flexibly initiate topics, and facilitate effective communication based on multidisciplinary collaboration. CONCLUSION: Healthcare professionals need an accepting cultural environment to implement advance care planning, a sound legal system, financial support, and a coordinated and shared system to support them. Healthcare systems need to develop educational training programs to increase the knowledge and skills of healthcare professionals and to promote multidisciplinary collaboration to facilitate effective communication. Future research should compare the differences in the needs of healthcare professionals in different cultures when implementing advance care planning to develop systematic implementation guidelines in different cultures.

The effects of an e-health brisk walking intervention in increasing moderate-to-vigorous physical activity in physically inactive older people with cognitive frailty: study protocol for a randomized controlled trial.

BACKGROUND: Cognitive frailty is a risk for many adverse health outcomes that are commonly observed in older people. Physical activity is known to be effective to reserve cognitive frailty but the prevalence of physical inactivity is still high in older people. E-health enhances behavioural change effects through an innovative way to deliver behavioural change methods that can enhance the behavioural change effects. However, its effects on older people with cognitive frailty, its effects compared with conventional behavioural change methods, and the sustainability of the effects are unclear. METHODS: This study employs a single-blinded, two-parallel-group, non-inferiority, randomized controlled trial design with a 1:1 group allocation ratio. Eligible participants are aged 60 years or above, have cognitive frailty and physical inactivity, and possess a smartphone for more than six months. The study will be conducted in community settings. In the intervention group, participants will receive a 2-week brisk-walking training followed by a 12-week e-health intervention. In the control group, participants will receive a 2-week brisk-walking training followed by a 12-week conventional behavioural change intervention. The primary outcome is minutes of moderate-to-vigorous physical activity (MVPA). This study aims to recruit a total of 184 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention. ETHICS AND DISSEMINATION: The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) on 7th March 2023, https://clinicaltrials.gov/ct2/show/NCT05758740 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022136). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields. TRIAL REGISTRATION: The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) and all items come from the World Health Organization Trial Registration Data Set. The latest version of the protocol was published online on 7th March 2023.

Factors associated with the perceptions of eHealth technology of Chinese nurses and nursing students.

AIM: The current study sought to assess the perceptions of eHealth technology of nurses and nursing students in China and to examine the association between these perceptions and demographic factors. BACKGROUND: Despite the increasing use of eHealth technologies in China and across the globe, the perceptions of practicing and student nurses remain minimally explored. Findings from such an inquiry can potentially inform actions and policies to improve the uptake of eHealth technologies among Chinese nurses. DESIGN: This was a cross-sectional study with a real-time online survey. METHODS: A convenience sample of 1338 nurses and nursing students from Mainland China participated in the study. Their perceptions of eHealth technology were collected using the Chinese version of the Perceptions of eHealth Technology Scale. The Kruskal-Wallis test and multiple linear regression analysis were used to examine the relationship between demographic variables (age group, gender, occupation, education level, position and clinical experience) and perceptions of eHealth technology. All study procedures adhered to the STROBE guidelines. RESULTS: Most participants were aged between 20 and 29 (55.8%). Nearly half (42.5%) were frontline clinical nursing staff, some were nursing students (36.2%), academic nursing staff (12.3%) and clinical nursing management staff (9.0%). Regardless of the differences in their demographic characteristics, the participants had higher mean scores in "Perception of eHealth applications" and lower mean scores in "Knowledge of eHealth technology". Participants with doctoral degree had a higher mean total score and higher sub-scale scores in knowledge of eHealth technology, perception of the advantages of eHealth technology and perception of eHealth applications; and the lowest scores in perception of the disadvantages of eHealth technology and perception of eHealth applications. Occupation, position and clinical experience were found to be the demographic characteristics associated with eHealth perceptions, before adjusting for age and gender. Education level was associated with eHealth perceptions regardless of adjustment. CONCLUSION: Overall, participants had higher scores on perceptions of eHealth applications but lower scores on knowledge of eHealth technology. Considering the association between education and all subscales and overall scores, it may be essential to implement continuing professional education for nurses to improve their knowledge of eHealth applications. Encouragement to use available eHealth digital technologies may also be helpful to improve perceptions of eHealth.

The effects of Digital Buddy programme on older adults' mental well-being: study protocol for a multi-centre, cluster randomized controlled trial.

INTRODUCTION: Mental well-being is associated with many mental health symptoms, including depression and health-related quality of life. Digital divide could impact mental health, particularly during the COVID-19 pandemic. Information and communication technology (ICT)-based tools and interventions could effectively provide social support. Intergenerational mentoring between college students and older adults could promote eHealth literacy and self-efficacy, and it is advocated to bridge the digital divide for older adults. However, the effectiveness of an intervention which employs ICT-based tools and intergenerational mentoring strategies (i.e. Digital Buddy) on mental well-being is unclear. METHODS: This study will employ a multi-centre, cluster-randomized, two-parallel-group, noninferiority, controlled trial design with a 1:1 group allocation ratio. In the intervention group, a Digital Buddy (i.e. a young volunteer) is assigned to a group of older adults in a 1:10 ratio. A series of training sessions for a minimum of 23 h will be provided to the older adults by Digital Buddy, who will also follow through the intervention period with the older participants. The training contents include ICT and mental health care knowledge and skills. The whole intervention period will last for 6 months between 14 sessions. In the control group, participants will receive the usual care. The primary outcome measure is mental well-being. We aim to recruit 292 older participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention. ETHICS AND DISSEMINATION: This trial has been registered at ClinicalTrials.gov (NCT05553730) on 23 September 2022, https://clinicaltrials.gov/ct2/show/NCT05553730 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022143). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields.

The Experience of Participating in Remotely Delivered Online Exercise Classes During the COVID-19 Pandemic Among Community-Dwelling Older Adults and Its Postpandemic Implications.

The COVID-19 pandemic has accelerated the use of videoconferencing-delivered online exercise classes among community-dwelling older adults. This phenomenon is new, and no research has investigated older adults' relevant experiences and postpandemic perspectives. This study is situated in a naturalistic paradigm and adopted a descriptive qualitative methodology to understand the phenomenon. In-depth interviews were conducted with 23 older adults (aged 55-89 years) who have participated in videoconferencing-delivered online exercise since the COVID-19 pandemic. Utilizing thematic analysis, eight key themes were identified. Older adults experienced convenience, exercise regularity, technological transformation, and motivation when using this new form of exercise delivery. At the same time, they also experienced certain technological barriers and compromised quality of instructor supervision. Looking forward, older adults welcomed the increased opportunity for supervised exercise due to increased virtual capacity. They also envisaged that mobility-restricted groups such as frail older adults and caregivers would benefit from this form of exercise delivery.

Groningen Frailty Indicator-Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy.

BACKGROUND: The early identification of pre-frailty and frailty among older people is a global priority because of the increasing incidence of frailty and associated adverse health outcomes. This study aimed to validate the Groningen Frailty Indicator-Chinese (GFI-C), a widely used screening instrument, and determine the optimal cut-off value in Chinese communities to facilitate pre-frailty and frailty screening. METHODS: This methodological study employed a cross-sectional and correlational design to examine the psychometric properties of GFI-C, namely, internal consistency, stability, and concurrent and construct validities. The appropriate cut-off values for pre-frailty and frailty screening in the receiver-operating characteristic (ROC) curve were determined through sensitivity and specificity analysis. RESULTS: A total of 350 community older people had been assessed and interviewed by a nurse. The GFI-C showed satisfactory internal consistency (Cronbach's α = 0.87) and two-week test-retest reliability (intra-class correlation coefficient = 0.87). Concurrent validity (r = 0.76, p < 0.001) showed a moderate correlation with Fried's frailty phenotype. The known-groups method, hypothesis testing and confirmatory factory analysis (three-factor model; χ2/df = 2.87, TLI = 0.92, CFI = 0.93, GFI = 0.92, RMR = 0.014; RMSEA = 0.073) were suitable for the establishment of construct validity. Based on the ROC and Youden's index, the optimal cut-off GFI-C values were 2 (sensitivity, 71.5%; specificity, 84.7%) for pre-frailty and 3 for frailty (sensitivity, 88.2%; specificity, 79.6%). CONCLUSIONS: The result indicated that GFI-C is a reliable and valid instrument for pre-frailty and frailty screening among older Chinese people in communities. For optimal diagnostic accuracy, the cut-off values of 3 for frailty and 2 for pre-frailty are recommended.

Perception of E-health Technology Scale in Chinese Brief (PETS-C Brief): Translation, item reduction, and psychometric testing.

Introduction: Perception of e-health is a broad concept involving many aspects of values and thoughts related to e-health. It is an important precursor to using e-health technologies to promote health. The purpose of this study is to validate an instrument for measuring perceptions of e-health technology among healthcare professionals. Methods: This methodological study was conducted in China. We based on an existing instrument to develop a new instrument (i.e. PETS-C Brief). In phase 1, we modified and translated the existing instrument into Chinese. Subsequently, we employed the modified and translated instrument to conduct a cross-sectional survey. In phase 2, we randomly selected data from 400 participants to run an exploratory factor analysis and item analysis to reduce the number of items and develop factors. In phase 3, we employed the data from the remaining participants to run a confirmatory factor analysis to confirm the instrument structure. Results: In phase 1, the modified and translated instrument showed good content and face validities (S-CVI = 0.96, mean comprehensibility = 93.5%). 1338 participants completed the survey. In phase 2, the number of items was reduced from 40 to 19, which demonstrated a 4-factor model. In phase 3, the goodness-of-fit of the 4-factor PETS-C Brief was shown to be acceptable (χ2/d.f. = 6.40, CFI = 0.93, RMR = 0.40, NFI = 0.92, RMSEA = 0.076, IFI = 0.93). Discussion: This study suggests using this instrument to survey perceptions of e-health technology in Chinese people. Future studies should examine its other important psychometric properties, including convergent/discriminant and predictive validity on behaviors using e-health technology.

The effects of interventions to enhance cognitive and physical functions in older people with cognitive frailty: a systematic review and meta-analysis.

INTRODUCTION: Cognitive frailty is the co-existence of mild cognitive impairment and physical frailty that increases the risk of adverse health outcomes. The existing systematic reviews on cognitive frailty in the literature have focused only on identifying associated factors and adverse outcomes, and their relationship with frailty and cognition. This study aimed to examine the effects of interventions on cognitive functions, frailty, and physical functions and provide an overview of intervention components used in older people with cognitive frailty. METHODS: This is a systematic review and meta-analysis. Medline, PubMed, CINAHL, Embase, PsycINFO, and Cochrane were searched for publishing during 2013-2021. Studies were selected based on the following eligibility criteria: 1) older people (age ≥ 60 years), 2) cognitive frailty, 3) outcomes on frailty or cognition or physical function, and 4) randomized controlled trial with any type of intervention. The Physiotherapy Evidence Database (PEDro) scale was used to rate the quality of the included studies. The review protocol was registered with PROSPERO (CRD42021251321). RESULTS: Two thousand five hundred six studies were identified, 9 were eligible, and 8 were included in the meta-analysis. The standardized mean difference (Hedges G) between groups of cognitive functions was 0.95, frailty status was 0, physical function in walking was -1.67, and the physical function in core strength assessment was 3.39. Physical activity appeared as an essential component in all interventions for older people with cognitive frailty. DISCUSSION: All interventions include physical activity as one of the components. Other components include cognitive training, nutrition education, behavioural intervention, mind-body intervention, psychosocial support, and virtual reality. The interventions are effective to promote cognitive and physical functions, but not physical frailty.

The utilization of a nurse-led clinic by older people with cognitive complaints: Do they follow our advice?

AIM: Cognitive assessment services were found to be beneficial to older people with cognitive complaints but information is limited on adherence to the recommendations provided. This study aimed to identify predictors of clients' adherence to nursing recommendations after attending a community-based nurse-led cognitive assessment service in Hong Kong. METHODS: A cross-sectional design was adopted. We analysed a dataset routinely collected from clients attending the services between January 2012 and January 2018. Multiple regression analyses were conducted to identify predictors (demographics, functional health status and cognitive performance) of the clients' adherence. Their satisfaction with the services was also examined. RESULTS: Two hundred and twenty-three clients attended the clinic. Of the 133 who completed the telephone follow-up at the 6 months postconsultation, 44.1% did not adhere to the recommendations. Clients with a higher Clinical Dementia Rating (OR = 4.17), lower Clock Drawing Test score (OR = 1.13) and lower education level (OR = 0.91) were found to be less likely to adhere to the nursing recommendations. Ninety-six percent (190/198) were satisfied with the overall services. CONCLUSION: Cognitive assessment services in nurse-led clinics could provide a self-referred service for older people with cognitive complaints. However, low adherence to nursing recommendations was found among clients with poorer cognitive functions and lower education levels.

Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial.

Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment's feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants' experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.

"Am I entitled to take a break in caregiving?": Perceptions of leisure activities of family caregivers of loved ones with dementia in China.

Leisure activities are essential for family caregivers of loved ones with dementia living in the community, yet these caregivers tend not to engage in them, especially in China, wherein it may have a negative impact on their physical and psychological health. To date, limited knowledge exists regarding underlying reasons that deter these family caregivers from doing leisure activities. This study aims to explore perceptions of family caregivers of people living with dementia and their engagement in leisure activities. A qualitative descriptive research design was used with semi-structured, face-to-face, individual in-depth interviews. The data were collected in Shijiazhuang, China between October and November 2019. Content analysis was used to develop categories. Results of 20 family caregivers (5 men and 15 women, mean age = 55.6±12.7) reported their perceptions under four main categories: (i) "the condition of leisure life," (ii) "needs for leisure activities," (iii) "reasons for the reluctance to do leisure activities," and (iv) "motivations supporting the implementation of leisure activities." In addition to the heavy caregiving workload and lack of support, traditional Chinese beliefs including filial commitment and "fatalistic voluntarism" were the reasons that prevented Chinese family caregivers of people living with dementia from doing leisure activities. However, engaging their loved ones in leisure activities, like doing exercise together, could motivate family caregivers themselves to participate in leisure activities. These findings encourage healthcare professionals to consider the influence of culture on family caregivers' engagement in leisure activities which is one of the ways to reduce stress. Family caregivers may benefit from the leisure activities by learning how to better cope with and balance caregiving tasks with their leisure pursuits in the community.

Sarcopenia and its association with objectively measured life-space mobility and moderate-to-vigorous physical activity in the oldest-old amid the COVID-19 pandemic when a physical distancing policy is in force.

INTRODUCTION: The oldest-old are highly vulnerable to sarcopenia. Physical distancing remains a common and effective infection-control policy to minimize the risk of COVID-19 transmission during the pandemic. Sarcopenia is known to be associated with impaired immunity. Moderate-to-vigorous physical activity (MVPA) and life-space mobility (LSM) are potential strategies for minimizing the risk of sarcopenia. However, a physical distancing policy might jeopardize the practice of MVPA and LSM. The purposes of this study were to identify the prevalence of sarcopenia and examine the association between MVPA and LSM with sarcopenia in the community-dwelling oldest-old during the COVID-19 pandemic. METHODS: This study employed a cross-sectional and observational design. The study was conducted in 10 community centres for older people in Hong Kong during the period of the COVID-19 pandemic (September to December 2020). Eligible participants were the oldest-old people aged ≥85 years, who were community-dwelling and had no overt symptoms of cognitive impairment or depression. Key variables included sarcopenia as measured by SARC-F, LSM as measured by a GPS built into smartphones, and MVPA as measured by a wrist-worn ActiGraph GT3X+. Variables were described by mean and frequency. A multiple linear regression was employed to test the hypotheses. The dependent variable was sarcopenia and the independent variables included LSM and MVPA. RESULTS: This study recruited 151 eligible participants. Their mean age was 89.8 years and the majority of them were female (n = 93/151, 61.6%). The prevalence of sarcopenia was 24.5% (n = 37/151) with a margin of error of 6.86%. MVPA was negatively associated with sarcopenia in older people (ß = - 0.002, SE = 0.001, p = 0.029). However, LSM was not associated with sarcopenia. CONCLUSION: The prevalence of sarcopenia in the community-dwelling oldest-old population is high. MVPA is negatively associated with sarcopenia. LSM is unrelated to sarcopenia. Sarcopenia should be recognized and the oldest-old with sarcopenia should be accorded priority treatment during the COVID-19 pandemic.