Effects of Otago exercise program on physical function in older adults: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Maintaining physical function is critical for older adults to achieve healthy aging. The Otago exercise program (OEP) has been widely used to prevent falls for older adults. However, the effects of OEP on physical function remain controversial and the possible effects modifiers have not been assessed. OBJECTIVE: To evaluate the effects of OEP on physical function in older adults and to explore potential moderators underlying the effects of OEP. METHODS: We searched five electronic databases and relevant systematic reviews to identify studies. We included randomized controlled trials (RCTs) evaluating the effects of OEP as a single intervention on physical function among older adults aged 65 and over. Meta-analysis was performed using the random-effects model. Standardized mean differences (SMD) for physical function changes, pertinent to balance, strength, and mobility, were outcome measures. Subgroup analyses on exercise protocol and participants' characteristics were performed. RESULTS: Thirteen RCTs consisting of 2402 participants were included in this systematic review and meta-analysis. Results indicated a significant effect of OEP on balance (SMD = 0.59, 95 % CI: 0.22∼0.96), lower body strength (SMD = 0.93, 95 % CI: 0.31∼1.55), and mobility (SMD = -0.59, 95 % CI: -0.95∼-0.22) against control groups. No significant OEP effects were found on upper body strength (MD = 1.48, 95 % CI: -0.58∼3.55). Subgroup analysis revealed that the video-supported delivery mode was more effective for improving balance (P = 0.04) and mobility (P = 0.02) than the face-to-face mode. Session durations over 30 min was more effective on lower body strength (P < 0.001) and mobility (P < 0.001) than those 1-30 min. Program period of 13-26 weeks was more effective on mobility (P = 0.02) than those of 4-12 weeks. However, the effects of OEP on physical function were not associated with age groups, and baseline falling risks. CONCLUSION: The OEP could improve physical function including balance, lower body strength, and mobility in older adults. Implementing the OEP in video-supported, more than 30 min per session and 4-12 weeks may be the most appropriate and effective exercise protocol for improving physical function among older adults. More RCTs with rigorous design and larger scale are needed to further assess the effectiveness of diverse OEP protocols and quantify the dose-effect relationship.

The role of motivation in the initiation and maintening mentoring relationships among nurses and midwives.

AIM: To understand clinicians' motivations to engage in mentoring to support newly graduated nurses and midwives working in hospital settings. BACKGROUND: Nursing and midwifery literature has established the benefits of mentoring and challenges that affect the effectiveness of formal mentoring programmes. No studies have explored hospital nurses' and midwives' motivations to mentor in the absence of the obligatory status and associated rewards of institutionalised mentoring. METHODS: A qualitative descriptive study with 35 nurses and midwives working in three public hospitals in the western, northern and northwestern parts of Uganda. Data were collected using semistructured interviews. Reflexive thematic analysis was applied to interpret the data. We have adhered to COREQ reporting guidelines. RESULTS: The study revealed three salient themes that capture nursing and midwifery professionals' mentoring perspectives. Participants expressed confidence in their inherent mentoring capacities and were often motivated by a desire to reciprocate prior mentoring experiences. Their mentoring approaches varied between self-focused and other-focused motivations, with some overlap in perspectives on hierarchical versus relational mentoring. Across the board, there was a strong consensus on the need of mentoring for individual clinicians, healthcare institutions and the broader profession. The study highlights five opportunities that can be harnessed to design future mentoring programmes. CONCLUSIONS: The findings delineate a complex interplay between self-centred and altruistic mentoring motivations, aligning with hierarchical or mutually beneficial mentoring paradigms. IMPLICATIONS FOR NURSING POLICY: Nurse managers should tailor mentoring programmes to align with these intrinsic motivations, affirm the enduring need for mentoring, and leverage existing institutional resources to create both acceptable and efficient mentoring frameworks.

Exploring the dark side of informal mentoring: Experiences of nurses and midwives working in hospital settings in Uganda.

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions of 35 nurses and midwives from three public hospitals located in the Western, Northern and North-western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self-improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity.

The impact of frailty on short-term prognosis in discharged adult stroke patients: A multicenter prospective cohort study.

BACKGROUND: Frailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients. OBJECTIVE: To examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability. DESIGN: A multicenter prospective cohort study. SETTING: Two tertiary hospitals in Central and Northwest China. PARTICIPANTS: 667 adult stroke patients in stroke units were included from January 2022 to June 2022. METHODS: Baseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models. RESULTS: A total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [ß]: -2.68, 95 % CI: -3.78, -1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (ß: -0.39, 95 % CI: -1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (ß: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS. CONCLUSIONS: The finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke. TWEETABLE ABSTRACT: Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy.

Hospital nurses perceived challenges and opportunities in the care of people with dementia: A mixed-methods systematic review.

AIM: To synthesise evidence from the literature on hospital nurses' perceived challenges and opportunities in the care of people with dementia. BACKGROUND: People with dementia often have longer lengths of hospital stay and poorer health outcomes compared to those without dementia. Nurses play a pivotal role in the care of people with dementia. However, there is a scarcity of systematic reviews that synthesise the challenges and opportunities they perceive. METHODS: A mixed-methods systematic review was conducted with a database search covering Ageline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Embase, Medline, PsycINFO, ProQuest, Scopus and Web of Science in April 2022. In total, 27 articles that met the selection criteria were critically reviewed and included in this systematic review. Data from the selected articles were extracted and synthesised using a convergent segregated approach. RESULTS: Three main themes and eight subthemes were identified. Theme 1 described nurse-related factors consisting of the lack of capability in dementia care, experiencing multiple sources of stress and opportunities for nurses to improve dementia care. Theme 2 revealed people living with dementia-related factors including complex care needs and the need to engage family carers in care. Theme 3 explained organisation-related factors comprising the lack of organisational support for nurses and people with dementia and opportunities for quality dementia care. CONCLUSION: Hospital nurses experience multidimensional challenges in the care of people with dementia. Opportunities to overcome those challenges include organisational support for nurses to develop dementia care capability, reduce their stress and partner with the family caregivers. RELEVANCE TO CLINICAL PRACTICE: Hospitals will need to build an enabling environment for nurses to develop their capabilities in the care of people with dementia. Further research in empowering nurses and facilitating quality dementia care in acute care hospitals is needed. REPORTING METHOD: The review followed the PRISMA 2020 checklist. PATIENT OR PUBLIC CONTRIBUTION: No.

Prevalence of postprandial hypotension in older adults: a systematic review and meta-analysis.

BACKGROUND: Older adults with postprandial hypotension (PPH) increase susceptibility to falls, syncope, stroke, acute cardiovascular diseases and even death. However, the prevalence of this condition varies significantly across studies. We aimed to determine the prevalence of PPH in older adults. METHODS: Web of Science, PubMed, Cochrane Library, Embase and CINAHL were searched from their inception until February 2023. Search terms included 'postprandial period', 'hypotension' and 'postprandial hypotension'. Eligible studies were assessed using the Joanna Briggs Institute tool. Meta-analyses were performed among similar selected studies. RESULTS: Thirteen eligible studies were included, and data from 3,021 participants were pooled. The meta-analysis revealed a PPH prevalence of 40.5% [95% confidence interval (CI): 0.290-0.519] in older adults, and this was prevalent in the community (32.8%, 95% CI: 0.078-0.647, n = 1,594), long-term healthcare facility (39.4%, 95% CI: 0.254-0.610, n = 1,062) and geriatrics department of hospitals (49.3%, 95% CI: 0.357-0.630, n = 365). The pooled results showed significant heterogeneity (I2 > 90%), partially related to the different ages, sex, pre-prandial systolic blood pressure levels of participants, or the different criteria and methodology used to diagnose PPH. CONCLUSIONS: PPH is a prevalent condition in older adults. Further research is needed to confirm this result, and priority should be given to establishing international consensus on PPH diagnostic criteria and designing its diagnostic procedure.

Intrinsic capacity trajectories, predictors and associations with care dependence in community-dwelling older adults: A social determinant of health perspective.

AIMS: To identify intrinsic capacity trajectories, predictors of intrinsic capacity trajectories and associations between intrinsic capacity trajectories and care dependence in community-dwelling older adults in China. METHODS: A retrospective longitudinal study was conducted, and the data were obtained from a five-year national longitudinal cohort study of older adults in China between 2011 and 2015. The social determinants of health framework informed the data analysis and interpretation. RESULTS: A total of 3893 older adults met the selection criteria and were included in the study. Three intrinsic capacity trajectories were identified: high trajectory (15.7 %), stable trajectory (52.7 %) and declining trajectory (31.6 %). Social determinants contribute to intrinsic capacity decline in older adults. Decreased cognitive function, psychological status, and locomotion at baseline were associated with care dependence. CONCLUSION: Approximately thirty percent of the older adults in this cohort study experienced a decline in intrinsic capacity within a 5-year period. Social determinants contributed to this decline in older adults.

The Effectiveness of a Community Nurse-Led Support Program for Dementia Caregivers in Chinese Communities: The Chongqing Ageing and Dementia Study.

Background: As the primary caregivers for people with dementia in China, family caregivers face a significant care burden that can negatively impact their mental and physical health. It is vital to investigate ways to support these caregivers. Objective: To assess the effectiveness of a program led by community nurses to support caregivers of individuals with dementia. Methods: A total of 30 caregivers received nurse-led support in addition to usual care, while 28 caregivers received only usual care. The primary outcome was caregivers' sense of competency in providing dementia care, which was measured using the Short Sense of Competence Questionnaire (SSCQ). Secondary outcomes included caregivers' ability to perform daily activities, behavioral and psychological symptoms of dementia (BPSD) using a neuropsychiatric inventory questionnaire, and quality of life using the short form health survey (SF-36). The trial was registered at the Chinese Clinical Trial Registry (ChiCTR 2300071484). Results: Compared to the control group, the intervention group had significantly higher SSCQ scores and a lower caregiver distress index over time. Physical and mental health-related quality of life also improved significantly among caregivers in the intervention group. However, there was no significant difference between the two groups in terms of activities of daily living and BPSD. Conclusions: The community nurse-led support program significantly improved caregivers' competency in providing dementia care and quality of life and reduced distress. These findings have important implications for dementia care policies, resources, and workforce development in China, including strengthening community dementia care services through collaboration with specialists in hospitals.

Improving the lives of ethnically diverse family carers and people living with dementia using digital media resources - Protocol for the Draw-Care randomised controlled trial.

Objectives: Ethnically diverse family carers of people living with dementia (hereafter carers and people with dementia) experience more psychological distress than other carers. To reduce this inequality, culturally adapted, multilingual, evidence-based practical assistance is needed. This paper details the Draw-Care study protocol including a randomised control trial (RCT) to test the effectiveness of a digital intervention comprising a multilingual website, virtual assistant, animated films, and information, on the lives of carers and people with dementia in Australia. Methods: The Draw-Care intervention will be evaluated in a 12-week active waitlist parallel design RCT with 194 carers from Arabic, Cantonese, Greek, Hindi, Italian, Mandarin, Spanish, Tamil, and Vietnamese-speaking language groups. Our intervention was based on the World Health Organization's (WHO) iSupport Lite online carer support messages and was co-designed with carers, people with dementia, service providers, and clinicians. Culturally adapted multilingual digital resources were created in nine languages and English. Results: In Phase I (2022), six co-design workshops with stakeholders and interviews with people with dementia informed the development of the intervention which will be trialled and evaluated in Phases II and III (2023 and 2024). Conclusions: Digital media content is a novel approach to providing cost-effective access to health care information. This study protocol details the three study phases including the RCT of a co-designed, culturally adapted, multilingual, digital intervention for carers and people with dementia to advance the evidence in dementia and digital healthcare research and help meet the needs of carers and people with dementia in Australia and globally.

Evaluating psychometric properties of three mentoring scales among nurses and midwives in hospital settings: A methodological study.

BACKGROUND: Scales used to evaluate nurses' perspectives of mentoring programmes are mainly designed in developed countries, making them unsuitable for nurses and midwives working in resource-poor developing countries. AIM: To explore the psychometric properties of the perceived cost of mentoring (PCM) scale, negative mentoring experiences (NME) scale and relational mentoring index (RMI) for adaptation in hospital settings in Uganda. METHODS: A cross-sectional study design was used. In total, 303 hospital nurses/midwives in Ugandan participated in the study to evaluate the psychometric properties of the three mentoring scales. RESULTS: Revisions based on word choice were made in adapting the scales to the Ugandan context. The PCM showed three factors (risk to reputation, mentoring effort and nepotism) and had an intra-class correlation (ICC) of 0.609 (95% CI, 0.324-0.793) and Cronbach's alpha of 0.705. The NME scale had two factors (lack of mentor expertise and mismatch between the dyad) consistent with the original scale with an ICC of 0.568 (95% CI, 0.271-0.767) and Cronbach's alpha of 0.841. The RMI showed two factors (individual influence and relational quality) with an ICC of 0.664 (95% CI, 0.410-0.824) and Cronbach's alpha of 0.933. CONCLUSIONS: The initial psychometric assessment indicates satisfactory validity and reliability of the scales for implementation among nurses and midwives within Ugandan hospital contexts. Subsequent research is warranted to validate the factor structures of the scales on a different sample. IMPLICATIONS FOR NURSING AND HEALTH POLICY: In using mentoring programmes to develop the hospital workforce, nurse and midwifery policymakers need to use culturally adapted and validated PCM, NME, and RMI scales to evaluate the quality of these mentoring programmes to maximise the benefits while avoiding unintended consequences.

'It's Too nice': Adapting iSupport Lite for Ethnically Diverse Family Carers of a Person with Dementia.

OBJECTIVES: Resources to support dementia carers from ethnically diverse families are limited. We explored carers' and service providers' views on adapting the World Health Organization's iSupport Lite messages to meet their needs. METHODS: Six online workshops were conducted with ethnically diverse family carers and service providers (n = 21) from nine linguistic groups across Australia. Recruitment was via convenience and snowball sampling from existing networks. Data were analyzed using thematic analysis. RESULTS: Participants reported that iSupport Lite over-emphasized support from family and friends and made help-seeking sound "too easy". They wanted messages to dispel notions of carers as "superheroes", demonstrate that caring and help-seeking is stressful and time-consuming, and that poor decision-making and relationship breakdown does occur. Feedback was incorporated to co-produce a revised suite of resources. CONCLUSIONS: Beyond language translation, cultural adaptation using co-design provided participants the opportunity to develop more culturally relevant care resources that meet their needs. These resources will be evaluated for clinical and cost-effectiveness in future research. CLINICAL IMPLICATIONS: By design, multilingual resources for carers must incorporate cultural needs to communicate support messages. If this intervention is effective, it could help to reduce dementia care disparities in ethnically diverse populations in Australia and globally.

Supportive care needs of patients who had a stroke: a scoping review protocol.

INTRODUCTION: Incidences of stroke are on the rise and approximately 80 million stroke survivors worldwide live with disabilities. Supportive care needs of stroke survivors are not adequately defined, and the assessment tools to help care service providers identify these needs are unclear. The overall aim of this scoping review will be to map the supportive care needs of stroke survivors against the Supportive Care Needs Framework. METHODS AND ANALYSIS: This scoping review will be conducted following Arksey and O'Malley's methodological framework and Joanna Briggs Institute (JBI) updated methodological guidance for scoping review. This review will mainly use Arksey and O'Malley's methodological framework as the basic framework. The review will also follow JBI's updated methodological guidance for scoping reviews to optimise the review. For the search strategy, the three-step method recommended by the JBI will be used in the study. The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Six English databases, including PubMed, CINAHL, Web of Science, Embase, Cochrane Library and PsycInfo, and four Chinese databases, including CNKI, Wanfang, VIP and China Biomedical Literature Database will be systematically searched from inception to the present. Studies published in English and Chinese will be included. ETHICS AND DISSEMINATION: Ethical approval is not required as this scoping review does not involve human participants. The findings shall be disseminated at scientific conferences and published in a peer-reviewed journal.

Gustatory stimulus interventions for older adults with dysphagia: a scoping review.

BACKGROUND: Gustatory stimulus interventions have been shown to improve swallowing function in older adults with dysphagia. However, the optimal intervention strategies as well as their effects and safety remain unclear. AIMS: To explore current evidence regarding gustatory stimulus interventions for dysphagia in older adults. METHODS: Nine electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Sinomed) were searched from their inception to August 2022. RESULTS: This review identified 263 articles, and 15 met the inclusion criteria. The types of gustatory stimulus interventions included spicy (n = 10), sour (n = 3), and mixed (sour-sweet) stimuli (n = 2), with most studies focusing on spicy stimuli. The most frequently reported spicy stimulus was capsaicin. Further, the most commonly reported intervention frequency was thrice a day before meals for 1-4 weeks. The stimuli concentrations and dosages could not be standardized due to the among-study heterogeneity. These studies reported 16 assessment tools and 42 outcomes, which mainly included videofluoroscopy and swallowing response time respectively. More than half of the included studies reported no adverse effects of gustatory stimulus interventions. CONCLUSION AND DISCUSSIONS: Gustatory stimulus interventions improved swallowing function in older adults with dysphagia. However, assessment tools and outcomes for dysphagia should be standardized in the future, and explore personalized interventions based on different diseases and their stages, to determine the most cost-effective interventions, and to prevent its complications.

Anxiety subtypes in rural ischaemic stroke survivors: A latent profile analysis.

AIM: To determine the potential profile classes of anxiety reported by ischaemic stroke survivors in rural China, and to explore the characteristics of patients having different types of post-stroke anxiety. DESIGN: A cross-sectional survey. METHODS: A cross-sectional survey was conducted by using convenience sampling to collect data from 661 ischaemic stroke survivors in rural Anyang city, Henan Province, China, from July 2021 to September 2021. The parameters included in the study were the socio-demographic characteristics, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and the Barthel index of daily activity ability. Potential profile analysis was done to recognize subgroups of post-stroke anxiety. The Chi-square test was performed to explore the characteristics of individuals with different types of post-stroke anxiety. RESULTS: The model fitting indices of stroke survivors supported three classes of anxiety models which were as follows: (a) Class 1, low-level, stable group (65.3%, N = 431); (b) Class 2, moderate-level, unstable group (17.9%, N = 118) and (c) Class 3, high-level, stable group (16.9%, N = 112). The risk factors associated with post-stroke anxiety were female patients, lower levels of education, living alone, lower monthly household income, other chronic diseases, impaired daily activity ability and depression. CONCLUSIONS: This study identified three different subgroups of post-ischaemic stroke anxiety and their characteristics in patients in rural China. IMPACT: This study has significance in providing evidence for the development of targeted intervention measures to reduce negative emotions in different subgroups of post-stroke anxiety patients. PATIENT OR PUBLIC CONTRIBUTION: In this study, the researchers arranged the time of questionnaire collection with the village committee in advance, gathered the patients to the village committee for face-to-face questionnaire survey and collected the household data of the patients with mobility difficulties.

Nursing Home Residents' Perceptions of Challenges and Coping Strategies during COVID-19 Pandemic in China.

Older people in nursing homes are at a high risk of being infected by coronavirus disease 2019 (COVID-19). They also experienced nursing home lockdowns that harm their psychological wellbeing. Better support for this vulnerable population requires understanding their perceptions of challenges and coping strategies during the COVID-19 pandemic. A qualitative descriptive study was conducted using semi-structured interviews. Thematic analysis approach was used to analyze the data. Participants were recruited from six nursing homes in three cities in Hunan Province, China. Fourteen nursing home residents participated in the study. Four themes were identified from interviews and described as: mental stress and coping strategies, self-regulation to respond to lockdown, the lack of social connection and coping strategies, and the need for medical care services and coping strategies. This study revealed that nursing home residents perceived stress during the nursing home lockdown, but they reported initiating activities to maintain health and connections with their families and peers. Resilience improvement interventions are necessary to enable residents' autonomy and develop their resilience in coping with difficulties and hardship during crises. The findings also indicate that a supportive environment with interactions from families, peers, and staffs played a key role in enabling residents' positive health and wellbeing during the lockdown.

Staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes.

AIMS AND OBJECTIVES: To explore and compare staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes. BACKGROUND: Staff and residents in ethno-specific and mainstream nursing homes in most developed countries have shown increased cultural and linguistic diversity. This socio-demographic change poses significant challenges for staff to support resident self-determination of their own care. In-depth understanding of those challenges in the two types of nursing homes is much needed to inform practice in nurse-led nursing home care settings. METHOD: A qualitative description approach with thematic analysis was used in the study. Data were collected through five focus groups with 29 various direct care workers from two ethno-specific nursing homes and a mainstream nursing home in Australia between March-September 2020. The study report followed the COREQ checklist. RESULTS: Four themes were identified from focus group data. First, participants perceived communication challenges in identifying residents' preferences, especially in ethno-specific nursing homes. Second, team efforts that included residents and their family members were highly valued as a way to meet residents' preferences. Third, participants described various levels of staff engagement in residents' care planning. In addition, staff in ethno-specific nursing homes possessed richer resources to maintain meaningful relationships for residents compared with their counterparts in the mainstream nursing home. CONCLUSIONS: Staff in ethno-specific nursing homes experience more challenges in supporting resident self-determination but have richer resources to develop culturally safe and culturally competent care compared with their counterparts in the mainstream nursing home. RELEVANCE TO CLINICAL PRACTICE: Findings provide new insights into challenges and practical solutions in supporting residents to self-determine their own care in cross-cultural aged care. PATIENT OR PUBLIC CONTRIBUTION: This study was co-designed with three aged care organisations who funded the study. Staff employed by these organisations participated in the study.

Trajectories of physical functioning and its predictors in older adults: A 12-year longitudinal study in China.

Objective: Maintaining and delaying a decline in physical function in older adults is critical for healthy aging. This study aimed to explore trajectories, critical points of the trajectory changes, and predictors among older people in the Chinese community. Design: This study was one with a longitudinal design performed in China. Setting and participants: The target population was community-dwelling older adults aged over 65 years. A total of 2,503 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included in this study. Methods: Physical functioning was measured by instrumental activities of daily living (IADL). Population-based trajectory models were used to identify potential heterogeneity in longitudinal changes over 12 years and to investigate associations between baseline predictors and different trajectories for different cohort members using LASSO regression and logistic regression. Results: Four trajectories of physical function were identified: slow decline (33.0%), poor function and moderate decline (8.1%), rapid decline (23.5%), and stable function (35.4%). Older age, male sex, worse self-reported health status, worse vision status, more chronic diseases, worse cognitive function, and a decreased frequency of leisure activity influenced changes in the trajectory of physical function. Having fewer teeth, stronger depressive symptoms, a lack of exercise, and reduced hearing may increase the rate of decline. Conclusion and implications: Four trajectories of physical function were identified in the Chinese elderly population. Early prevention or intervention of the determinants of these trajectories can maintain or delay the rate of decline in physical function and improve healthy aging.

Exercise for preventing falls in post-stroke patients: A network meta-analysis.

Falls are a great concern for poststroke patients. Various interventions have been developed over the past few decades to prevent falls. However, the effectiveness of these interventions remains to be investigated. These authors aimed to evaluate the effects of exercise interventions on the prevention of poststroke falls. CNKI, Wan Fang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and CINAHL were searched for randomized controlled trials (RCTs) on the prevention of falls after stroke from inception to September 2021. The primary result was the number of falls. Two reviewers independently screened and extracted data and assessed the risk of bias for all studies. In Stata 15.1, the effects of multiple interventions were compared using Bayesian networks. A total of 15 RCTs with 8 kinds of exercise interventions were included. Balance training (BT) was the most effective way to prevent falls (odds ratio [OR] = 0.24, 95% confidence interval [CI] = 0.13-0.46, p < 0.05). Moreover, cognition and movement multitask training (CMM) (OR = 0.30, 95% CI = 0.09-0.96, p < 0.05); Multimodal Exercise (OR = 0.31, 95% CI = 0.11-0.84, p < 0.05) and Resistance Exercise (OR = 0.35, 95% CI = 0.15-0.84, p < 0.05) were ranked as second, third and fourth most effective, respectively. The effect of Walking-based Intervention was the worst (OR = 1.63, 95% CI = 0.57-4.67, p > 0.05). BT and CMM are the preferred exercise interventions for the prevention of poststroke falls. A further investigation is needed to compare the effectiveness between BT and CMM for populations at high risk of falling after stroke.

Cultural adaptation of World Health Organization iSupport for Dementia program for Chinese-Australian caregivers.

BACKGROUND: Home-based dementia care is common in the Chinese-Australian community. However, dementia education programs for Chinese-Australians in the language of their choice are scarce. The World Health Organization has developed iSupport for Dementia, an online education program for informal caregivers. Cultural adaptation of the program for Chinese-Australian caregivers is an opportunity to address this gap in caregiver support. AIM: The aims of the study were (1) to understand stakeholders' perspectives on the cultural and linguistic appropriateness of the Chinese iSupport for Dementia content and design and (2) to explore factors affecting the future implementation of the Chinese iSupport program in Australia. METHODS: A qualitative descriptive design was applied to address the aims of the study. Focus group discussions with Chinese-Australian caregivers and community aged care workers were conducted to collect data. Thematic analysis was used to analyse data. RESULTS: In total, six focus groups were conducted with 18 Chinese-Australian caregivers and 17 care workers. Six themes were identified and described as follows: (1) appropriateness of the Chinese iSupport content; (2) acceptability of the online Chinese iSupport design; (3) motivations to engage in the iSupport program; (4) desire to interact with peers and professional facilitators; (5) concerns about program accessibility; and (6) the need to extend the iSupport program to care workers. CONCLUSIONS: Engagement with Chinese-Australian caregivers and care workers will inform further revisions of the Chinese iSupport program contents to ensure the program is culturally congruent to Chinese-Australian caregivers. Factors affecting the implementation of the program identified in the study will be considered in the intervention phase of the program.

Effectiveness and acceptability of non-pharmacological interventions in people with mild cognitive impairment: Overview of systematic reviews and network meta-analysis.

BACKGROUND: To explore effectiveness and acceptability of non-pharmacological interventions in mild cognitive impairment (MCI). METHODS: Overview of systematic reviews and network meta-analysis were conducted. Systematic reviews (SRs) were searched via seven databases from June 2015 to June 2020. Randomized controlled trials (RCTs) were retrieved. The Methodological quality was assessed by AMSTAR 2 and RoB 2. Outcomes were effectiveness and acceptability measured by standardized mean differences (SMDs) and odd ratios (ORs) with 95% confidence interval (CI). Pairwise meta-analysis was first conducted, followed by network meta-analysis. RESULTS: A total of 22 SRs and 42 RCTs with 4401 participants were included. The methodological quality of included SRs and RCTs were moderate. There were four interventions, with three types of physical activity (aerobic, muscle-strengthening, and mind-body), three types of cognitive (rehearsal-based, compensatory, and mixed), multicomponent (physical and cognitive component), and nutrition intervention. No significant inconsistency was identified. Regarding intervention effectiveness, muscle-strengthening (SMDs 0.87, 95% CI 0.31-1.43; rank 1), mind-body (0.76, 0.38-1.14; rank 2) and aerobic (0.34, 0.13-0.50; rank 3) were significantly better than the control group and there was no significant difference among these types of intervention . Cognitive intervention of rehearsal-based (1.33, 0.30-2.35; rank 1) and mixed (0.55, 0.00-1.11; rank 2) were significantly better than the control group and there was no significant difference among these types of intervention. Multicomponent intervention (0.32, 0.02-0.62) were significantly better than the control group but not better than the single component group. Regarding acceptability, there was no significant difference among types of intervention. CONCLUSION: Physical activity, cognitive, and multicomponent intervention could be provided regardless of their types and acceptability due to their effectiveness on improved cognitive function for people with MCI.