Long-term care facilities' response to the COVID-19 pandemic: An international, cross-sectional survey.

AIMS: To (i) assess the adherence of long-term care (LTC) facilities to the COVID-19 prevention and control recommendations, (ii) identify predictors of this adherence and (iii) examine the association between the adherence level and the impact of the pandemic on selected unfavourable conditions. DESIGN: Cross-sectional survey. METHODS: Managers (n = 212) and staff (n = 2143) of LTC facilities (n = 223) in 13 countries/regions (Brazil, Egypt, England, Hong Kong, Indonesia, Japan, Norway, Portugal, Saudi Arabia, South Korea, Spain, Thailand and Turkey) evaluated the adherence of LTC facilities to COVID-19 prevention and control recommendations and the impact of the pandemic on unfavourable conditions related to staff, residents and residents' families. The characteristics of participants and LTC facilities were also gathered. Data were collected from April to October 2021. The study was reported following the STROBE guidelines. RESULTS: The adherence was significantly higher among facilities with more pre-pandemic in-service education on infection control and easier access to information early in the pandemic. Residents' feelings of loneliness and feeling down were the most affected conditions by the pandemic. More psychological support to residents was associated with fewer residents' aggressive behaviours, and more psychological support to staff was associated with less work-life imbalance. CONCLUSIONS: Pre-pandemic preparedness significantly shaped LTC facilities' response to the pandemic. Adequate psychological support to residents and staff might help mitigate the negative impacts of infection outbreaks. IMPACT: This is the first study to comprehensively examine the adherence of LTC facilities to COVID-19 prevention and control recommendations. The results demonstrated that the adherence level was significantly related to pre-pandemic preparedness and that adequate psychological support to staff and residents was significantly associated with less negative impacts of the pandemic on LTC facilities' staff and residents. The results would help LTC facilities prepare for and respond to future infection outbreaks. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Promoting workplace retention during global crises: An international survey of the preventive role of psychological support among victims of social discrimination in long-term care facilities.

This international cross-sectional survey examined the potential role of organizational psychological support in mitigating the association between experiencing social discrimination against long-term care (LTC) facilities' healthcare professionals (HCPs) and their intention to stay in the current workplace during the COVID-19 pandemic. Participants included a convenience sample of 2,143 HCPs (nurses [21.5 %], nurse aids or residential care workers [40.1 %], social workers [12.1 %], and others [26.4 %]) working at 223 LTC facilities in 13 countries/regions. About 37.5 % of the participants reported experiencing social discrimination, and the percentage ranged from 15.3 % to 77.9 % across countries/regions. Controlling for socio-demographic and work-related variables, experiencing social discrimination was significantly associated with a lower intention to stay, whereas receiving psychological support showed a statistically significant positive association (p-value=0.015 and <0.001, respectively). The interaction term between social discrimination and psychological support showed a statistically significant positive association with the intention to stay, indicating a moderating role of the psychological support.

Preferences for end-of-life care and decision-making among Chinese community-dwelling older adults: A comparative cross-sectional study in Hong Kong and Wuhan in China.

This study aimed to describe and compare end-of-life care and decision-making preferences among Chinese community-dwelling older adults between Wuhan and Hong Kong in China. The study adopted a cross-sectional correlation design and recruited a convenience sample of 259 older adults, aged ≥65 years old from five community centers in Wuhan and Hong Kong. Participants completed a validated structured questionnaire that measured their end-of-life care and decision-making preferences. Multivariate logistic regression analyses were conducted. Results showed that Wuhan participants were significantly more likely to view "trying every means to extend the life span" as very important/important; and they perceived "support from religious personnel" as unimportant/very unimportant. Different from those older adults in Hong Kong, the Wuhan participants significantly chose their home as the preferred place for end-of-life care and death. They also tended to prefer family members to enact the decision-maker role in end-of-life decision situations. The study suggests older adults in Hong Kong and Wuhan have some differences in preferences for end-of-life care and decision-making, which provides the basis for future development of culturally relevant community-based end-of-life care.

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Upper Limb Motor Recovery in Stroke: A Randomized Controlled Trial.

BACKGROUND: Recent evidence has shown bilateral transcutaneous electrical nerve stimulation (Bi-TENS) combined with task-oriented training (TOT) to be superior to unilateral transcutaneous electrical nerve stimulation (Uni-TENS)+TOT in improving lower limb motor functioning following stroke. However, no research explored the effect of Bi-TENS+TOT in improving upper limb motor recovery. This study aimed to compare Bi-TENS+TOT with Uni-TENS+TOT, Placebo transcutaneous electrical nerve stimulation (Placebo-TENS)+TOT, and no treatment (Control) groups in upper limb motor recovery. METHODS: This is a 4-group parallel design. One hundred and twenty subjects were given either Bi-TENS+TOT, Uni-TENS+TOT, Placebo-TENS+TOT, or Control without treatment in this randomized controlled trial. Twenty 60-minute sessions were administered 3× per week for 7 weeks. The outcome measure was the Fugl-Meyer Assessment of Upper Extremity, which was assessed at baseline, after 10 sessions (mid-intervention) and 20 sessions (post-intervention) of intervention, and at 1- and 3-month follow-up. RESULTS: Patients in the Bi-TENS+TOT group showed greater improvement in the Fugl-Meyer Assessment of Upper Extremity scores than Uni-TENS+TOT (mean difference, 2.13; P=0.004), Placebo-TENS+TOT (mean difference, 2.63; P<0.001), and Control groups (mean difference, 3.11; P<0.001) at post-intervention. Both Bi-TENS+TOT (mean difference, 3.39; P<0.001) and Uni-TENS+TOT (mean difference, 1.26; P=0.018) showed significant within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores. Patients in the Bi-TENS+TOT group showed earlier within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores at mid-intervention than Uni-TENS+TOT. These improvements were maintained at the 3-month follow-up assessment. CONCLUSIONS: Bi-TENS combined with TOT is an effective therapy for improving upper limb motor recovery following stroke. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03112473.

The effects of involvement in training and volunteering with families of people with dementia on the knowledge and attitudes of volunteers towards dementia.

BACKGROUND: Volunteers have been a valuable resource in supporting people with dementia and their caregivers in the community. However, factors such as misconceptions, negative attitudes towards dementia, and a lack of motivation might impact the quality of volunteer care. The present paper aims to examine the effect of training and service provision on the knowledge and attitudes of volunteers towards dementia and the association between knowledge and attitudes with the levels of motivation to volunteer. METHODS: The present study is part of an effectiveness-implementation cluster randomized clinical hybrid trial using a music-with-movement intervention to promote the well-being of people with dementia and their informal caregivers. Volunteers were recruited to receive training to support the delivery of the intervention. Training and enrichment workshops were offered to volunteers during the one-year project. Before and after their training and service, the recruited volunteers were asked to complete the following assessments: Dementia Attitudes Scale, and the Alzheimer's Disease Knowledge Scale. The levels of motivation to volunteer was measured with Volunteer Functions Inventory at baseline. Wilcoxon signed-rank test and multiple regression test were applied for statistical analyses. RESULTS: A total of 107 volunteers were recruited, and 81 of them completed a mean period of 47.32 weeks of training and service. Significant improvements in their total score on the Alzheimer's Disease Knowledge Scale (p = .009) and Dementia Attitudes Scale (p < .001) were found. Dementia attitude (ß = .57, p < .001) and knowledge (ß = -.18, p = .038) were found to have the most significant association with the levels of motivation to be a volunteer at baseline. CONCLUSIONS: The present study illustrated the importance of quality volunteer training and voluntary service in improving the dementia knowledge and attitudes of volunteers. It also shed light on the association between knowledge and attitudes with the levels of motivation to volunteer. Accordingly, future research and public health policymakers should address more efforts to amplify the advantage of volunteers as a vital asset in dementia care. TRIAL REGISTRATION: NCT03575026 (ClinicalTrials.gov), First registration on 02/07/2018.

Decision-making preferences on end-of-life care for older people: Exploration and comparison of Japan, the Hong Kong SAR and South Korea in East Asia.

AIMS AND OBJECTIVES: The aim of this study was to examine and compare decision-making preferences on end-of-life care for older people in Japan, the Hong Kong SAR and South Korea. BACKGROUND: Cultural values and beliefs influence decision-making on end-of-life care. DESIGN: A cross-sectional design was adopted. METHODS: Community-dwelling people aged ≥65 with additional requirements were recruited in 2016-2017 in the three regions. Their decision-making preferences on end-of-life care were assessed using Pang et al.'s questionnaire. These preferences and their sociodemographic and personal experience variables were compared and analysed using univariate and multiple logistic regressions. The STROBE checklist was followed. RESULTS: This study involved 415 participants. In all three regions, the most preferred decision maker and person with whom to discuss end-of-life care issues was a family member. Participants in the Hong Kong SAR were less likely to select a family member as their preferred decision maker than those in Japan (adjusted odds ratio = 0.129). Koreans were less likely to discuss end-of-life care issues with medical professionals than people in Japan (adjusted odds ratio = 0.278). More than 70% of the participants in each region indicated that they would not prefer to leave an advance directive to decide their end-of-life care. CONCLUSION: Older Asians prefer to make their own decisions after consulting others. Family members play an important role in helping older people plan their preferred end-of-life care arrangements, even acting as decision makers when older people become incapable of deciding for themselves. RELEVANCE TO CLINICAL PRACTICE: Sufficient information should be provided to older people and their families for the older people to determine their preferred care. Helping families to understand and support the planned care and advance directives is a strategy for maximising family compliance with the care. Continuous efforts should be made to promote advance care planning and advance directives.

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.

Home care providers' perceptions of shared decision-making with older clients (and their caregivers): A cross-sectional study.

Interprofessional care teams can play a key role in supporting older adults (and caregivers) in making informed health decisions, yet shared decision making is not widely practiced in home care. Based on an earlier needs assessment with older adults (and caregivers) with home care experience, we aimed to explore the perceptions of home care teams on the decisions facing their clients and their perceived involvement in shared decision making. A cross-sectional study was conducted with 614 home care providers (nurses, personal support workers, rehabilitation professionals) in three Canadian provinces (Quebec, Ontario, and Alberta). Home care providers considered the decision "to stay at home or move" as the most difficult for older adults. Those most frequently involved in decision making with older adults were family members and least involved were physicians. Although all home care providers reported high levels of shared decision-making, we detected an effect of respondent's discipline on self-perceived shared decision-making; nurses and rehabilitation professionals reported significantly higher levels of shared decision making than personal support workers. A more tailored approach is required to support shared decision making in interprofessional care teams.

Contribution of sleep quality to fatigue following a stroke: a cross-sectional study.

BACKGROUND: The prevalence of fatigue and sleep disturbances is high in stroke populations. Sleep quality can be targeted by interventions to alleviate fatigue following a stroke. This study aimed to determine the prevalence of fatigue and poor sleep quality, and to quantify the contribution of sleep quality to fatigue following a stroke, in chronic (≥1 year) stroke survivors. METHODS: A cross-sectional design was adopted. A total of 112 stroke survivors (mean age ± standard deviation [year], 64.18 ± 5.77) at 6.08 ± 4.80 years post-stroke completed this study. All participants were assessed using the Fatigue Assessment Scale, the Pittsburgh Sleep Quality Index, the Visual Analogue Scale-Pain, the Fugl-Meyer Assessment of the upper and lower extremities, the 5-Time Sit-To-Stand Test, the Epworth Sleepiness Scale, the Frenchay Activities Index, the Life-Space Assessment, the Community Integration Measure, and the Multidimensional Scale of Perceived Social Support. Pearson and partial correlation coefficients were used to examine the correlation between fatigue and other variables. A multiple linear regression (the forced entry method) was performed to quantify the independent contribution of sleep quality to prediction of fatigue. RESULTS: Of the 112 participants, 52.7% reported experiencing fatigue and 64.3% reported poor sleep quality. Sleep quality could independently account for 5.9% of the variance in fatigue scores after a stroke. CONCLUSIONS: There is a high prevalence of fatigue and poor sleep quality in Chinese stroke survivors. Sleep quality is an independent predictor of fatigue in those living in the community who have survived a stroke for a year or longer.

Testing the psychometric properties of the Chinese version of the Neurological Fatigue Index-Stroke.

OBJECTIVE: To test the psychometric properties of a Chinese version of the Neurological Fatigue Index-Stroke (C-NFI-Stroke) in stroke survivors. DESIGN: This was a validation study. Cross-cultural adaptation of the scale was conducted according to standard guidelines. Reliability, validity, responsiveness, and interpretability were measured. SETTING: Self-help groups and a community center. SUBJECTS: One hundred and twelve Chinese stroke survivors and 65 healthy Chinese older people living in the community. INTERVENTIONS: Not applicable. MAIN MEASURES: The C-NFI-Stroke, Fatigue Severity Scale, Mental Fatigue Scale, General Self-Efficacy Scale, and Geriatric Depression Scale were used. RESULTS: Cronbach's α coefficients were 0.69-0.88; the item-level agreement was 70.4%-88.9%; the weighted Kappa value was 0.47-0.79; and the intra-class correlation coefficients were 0.88-0.93. The C-NFI-Stroke had no ceiling and floor effects. It had good content validity and had two factors, "lack of energy" and "tiredness/weakness." The confirmatory factor analysis showed a good fit to the model. The C-NFI-Stroke significantly correlated with existing fatigue scales (rs = 0.55-0.63), self-efficacy (rs = -0.31 to -0.37), and depressive symptoms (rs = 0.53-0.60). The C-NFI-Stroke could discern differences between stroke survivors and healthy older people. CONCLUSIONS: The C-NFI-Stroke is a reliable and valid tool for clinical and research use on people who have been diagnosed with stroke for a year or more, although its factor structure differs from that of the original English version.

Income-Generating Processes of Free Web-Based Digital Health Tools to Engage Patients: Qualitative Analysis.

BACKGROUND: In recent years, digital tools have become a viable means for patients to address their health and information needs. Governments and health care organizations are offering digital tools such as self-assessment tools, symptom tracking tools, or chatbots. Other sources of digital tools, such as those offered through patient platforms, are available on the internet free of charge. We define patient platforms as health-specific websites that offer tools to anyone with internet access to engage them in their health care process with peer networks to support their learning. Although numerous social media platforms engage users without up-front charges, patient platforms are specific to health. As little is known about their business model, there is a need to understand what else these platforms are trying to achieve beyond supporting patients so that patients can make informed decisions about the benefits and risks of using the digital tools they offer. OBJECTIVE: The aim of this study is to explore what patient platforms are trying to achieve beyond supporting patients and how their digital tools can be used to generate income. METHODS: Textual and visual data collected from a purposeful selection of 11 patient platforms from September 2013 to August 2014 were analyzed using framework analysis. Data were systematically and rigorously coded and categorized according to key issues and themes by following 5 steps: familiarizing, identifying a thematic framework, indexing, charting, and mapping and interpretation. We used open coding to identify additional concepts not captured in the initial thematic framework. This paper reports on emergent findings on the business models of the platforms and their income-generating processes. RESULTS: Our analysis revealed that in addition to patients, the platforms support other parties with interests in health and information exchanges. Patient platforms did not charge up-front fees but generated income from other sources, such as advertising, sponsorship, marketing (eg, sending information to users on behalf of sponsors or providing means for sponsors to reach patients directly), supporting other portals, and providing research services. CONCLUSIONS: This study reports on the mechanisms by which some patient platforms generate income to support their operations, gain profit, or both. Although income-generating processes exist elsewhere on social media platforms in general, they pose unique challenges in the health context because digital tools engage patients in health and information exchanges. This study highlights the need to minimize the potential for unintended consequences that can pose health risks to patients or can lead to increased health expenses. By understanding other interests that patient platforms support, our findings point to important policy implications, such as whether (and how) authorities might protect users from processes that may not always be in their best interests and can potentially incur costs to the health system.

Factors associated with frailty transition at different follow-up intervals: A scoping review.

Frailty is a dynamic process. Identifying the factors associated with frailty transition may increase the opportunities for success in interventions for frailty. This scoping review, following Arksey and O'Malley's methodological framework, aimed to identify the factors associated with frailty transition and the rate of frailty transition among community-dwelling older people. A literature search was conducted. Among the included studies, 5, 13, and 3 involved follow-up intervals of 2-3 years (short term), 4-6 years (intermediate term), and >6 years (long term), respectively. Reportedly, life course characteristics, diseases, and psychological factors were related to frailty transitions at all follow-up intervals. Physical factors were related to frailty transition at both short and intermediate follow-up intervals, while social factors were related to frailty transition at intermediate follow-up intervals. The rate of improvement in frailty seemed to decrease, and that of worsening seemed to increase when the follow-up intervals lengthened.

Capacity building in nurse educators in a Global Leadership Mentoring Community.

Globally, nurse educators participate in the three main role activities of teaching, scholarship, and service. Matching for different global locations and career stages, 12 mentor-mentee pairs completed a one-year coordinated virtual program through Sigma Theta Tau International's Global Leadership Mentoring Community and mentees reported building their nurse educator capacities. The authors describe factors that potentially influence international mentoring such as language, time, technology, and key characteristics of mentoring relationships. Growth in educator roles occurred in the contexts of the culture of academe itself and Boyer's definitions of scholarship. Consistent with Sigma's vision statement, nurse educators have a global presence and responsibility to prepare competent nurses who can advance the health of the world's people. Readers may benefit for future planning of mentoring activities to build capacities in nurse educator roles through international interactions.

The effectiveness of acupressure in the management of depressive symptoms and in improving quality of life in older people living in the community: a randomised sham-controlled trial.

Objective: The primary aim of the current trial was to assess the clinical effectiveness of acupressure in the management of depression in elderly people compared to patients receiving sham acupressure or standard care alone.Methods: Randomized sham-controlled trial of acupressure, sham acupressure and standard care alone in older patients with depression living in the community. Patients with a score>/=8 in the Geriatric Depression Scale were recruited for this study. Intervention/sham treatments were provided four times/week for three months. Assessments related to depressive symptoms (primary outcome), well-being, resilience, spirituality and quality of life domains were carried out at baseline, end of the intervention and three-months after the intervention.Results: 118 patients were randomized to intervention (n = 40), sham (n = 40) or control arm (n = 38), with 84 patients providing final analysis data. Significant reduction in mean score of depressive symptoms was found in the acupressure group (from 10.6 (sd = 0.03) to 7.7 (sd = 0.07), p < 0.001 at end of intervention and 8.7 (sd = 0.8), p = 0.002 at follow-up) and the sham acupressure group (from 10.5 (sd = 0.3) to 8.4 (sd = 0.8), p = 0.005) at end of intervention and 8.4 (sd = 0.8), p = 0.006 at follow-up but not in the control group (from 10.8 to 9.9, p = 0.20). Resilience (p = 0.02) and spirituality (p = 0.02) were also improved in the intervention group at the end of intervention assessment but this change was not sustained at follow-up. Mind-body-spirit well-being and social functioning were improved both at the end of intervention and follow-up in the experimental as well as sham group. The sham group showed additional improvements in daily functioning and environmental quality of life.Conclusions: Although acupressure improved outcomes, a placebo effect was evident. Acupressure may be an effective approach to manage depression in elderly patients, but more evidence is needed in the future before it can be recommended for practice as well as more clear elucidation of any placebo effects.

Factors Associated With Improving or Worsening the State of Frailty: A Secondary Data Analysis of a 5-Year Longitudinal Study.

PURPOSE: This study aims to examine the frailty transition patterns of older adults recruited from both community and residential care settings within a 5-year period, and to identify the physical and psychosocial factors associated with the transitions. DESIGN: This study is a secondary data analysis of a longitudinal study for tracking the change of health status of older adults 60 years of age or older. Participants who had undergone at least two assessments during 2013-2017 were selected for analysis. Guided by the Gobben's Frailty Model, biopsychosocial predictors were comprehensively identified from the literature, and their relationship to frailty state transition was explored. METHODS: We compared the baseline characteristics of participants at the frail, pre-frail, and robust states (categorized using the Fried Frailty Index). A generalized estimating equation was used to identify factors associated with an improvement or a deterioration in frailty. The probability of transitions between frailty states was calculated. FINDINGS: Among the 306 participants, 19% (n = 59) improved and 30% (n = 92) declined in frailty within the project period. Sleep difficulties (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.07-2.90; p = .027), better cognitive status (OR = 0.80-0.84; 95% CI: 0.66-0.98 and 0.73-2.73; p = .031 and .018), good nutritional status (OR = 0.74; 95% CI: 0.59-0.91; p = .005), slow mobility (OR = 1.03-1.13; 95% CI: 1.00-1.05 and 1.03-1.25; p = .047 and .014), hearing impairment (OR = 2.83; 95% CI: 1.00-8.01; p = .05), better quality of health-physical domain (OR = 0.95; 95% CI: 0.92-0.99; p = .006), and better functional ability (OR = 0.85-0.97; 95% CI: 0.79-0.92 and 0.96-0.99; p < .001 and p = .003) were significant associated factors in the worsening group. More physical activity (OR = 1.01; 95% CI: 1.00-1.01 and 1.01-1.02; p = .026 and p < .001), hearing impairment (OR = 0.26; 95% CI: 0.08-0.86; p = .028), and slow mobility (OR = 0.93; 95% CI: 0.87-1.00; p = .037) were significant associated factors in the improvement group. CONCLUSIONS: Frailty is a crucial global public health issue. This study provides evidence for nurses to holistically consider the associated factors and to design effective interventions to combat frailty in our ageing society. CLINICAL RELEVANCE: Frailty is a transient state that can be reversed. Professional nurses working in both community and residential care settings should be able to identify older adults at risk and improve their health conditions appropriately.

Does life story work improve psychosocial well-being for older adults in the community? A quasi-experimental study.

BACKGROUND: Previous studies have demonstrated that life story work has positive effects when used on older adults. This study aimed to examine the effect of life story work on the general mental well-being, self-esteem, and life satisfaction of older adults by comparing two groups - one with and one without depressive symptoms. METHODS: A quasi-experimental design was adopted in this study. One hundred and twenty-three adults aged 60 or above were recruited from community centers through convenience sampling. They were allocated into two groups based on their level of depressive symptomatology as measured by the Geriatric Depression Scale (GDS). The intervention was to produce a written life story with pictures and memorabilia in four to six semi-structured sessions facilitated by trained volunteers. The outcome measures included general mental well-being (General Health Questionnaire, GHQ), life satisfaction (Life Satisfaction Scale Index A, LSI-A), and self-esteem (Rosenberg's Self-esteem Scale, RSES). Data were collected at baseline (T0), immediately post-intervention (T1), and at the 3-month follow-up (T2). Generalized estimating equations were used to examine the effect of the intervention on the outcomes. RESULTS: There was a significant interaction effect between the two groups at T1 (ß = 0.244, p < 0.05) with improvements in the GHQ observed in the group with depressive symptomology. No significant time and interaction effects were seen on the LSI-A and RSES. The Friedman test was also used to examine whether the intervention itself would have any effects on the GDS score, with two groups combined. A reduction in the mean GDS score was found to be close to reaching a level of significance (χ2 = 5.912, p = 0.052). CONCLUSION: The findings of this study provided some preliminary evidence that life story work was effective at improving the general mental well-being of community-dwelling older adults with depressive symptomology. Because older adults with different levels of depressive symptoms might respond differently to life story work interventions, our findings offer interesting directions for future studies - for instance, on what population would benefit the most from Life Story Work and what would be the mechanism that renders Life Story Work effective.

A simplified 10-step Tai-chi programme to enable people with dementia to improve their motor performance: a feasibility study.

OBJECTIVE:: To evaluate the feasibility and preliminary effects of a simplified 10-step Tai-chi programme to improve the motor performance of people with dementia. DESIGN:: A two-arm, single-blinded cluster randomized controlled trial, registered with ClinicalTrials.gov (NCT03341091). SETTING:: Community health centres. PARTICIPANTS:: Twenty-six dyads of people with dementia and their family caregivers were recruited, with mean (SD) ages of 82.2 (7.43) and 51.3 (18.97), respectively. INTERVENTIONS:: The experimental group underwent a 16 week 10-step simplified Tai-chi training programme, with additional measures to enhance engagement. The control group joined recreational activities organized by the centres. MAIN OUTCOME MEASURE(S):: The feasibility assessment included recruitment, attrition, adherence to, and engagement in the Tai-chi programme. The preliminary effects were assessed by the participants' performance in mobility tests. RESULTS:: Preliminary feasibility was established, with an acceptable recruitment rate of 58% (26 out of 45 assessed dyads) and a high attendance rate of 81% (25.88 out of 32 Tai-chi sessions). There was positive engagement in the training sessions, and no adverse incidents. However, five participants withdrew from the Tai-chi group, for a high attrition rate of 38%, and the mean home practice time decreased between weeks 8 and 16. In most of the motor performance tests, a slight but insignificant improvement was observed in the Tai-chi group compared to the control group. CONCLUSION:: A tailored Tai-chi programme for people with dementia using a dyadic approach has been found to be feasible. However, stronger support must be provided to family caregivers to improve the participants' sustained participation.

Classification of long-term care wards and their functional characteristics: analysis of national hospital data in Japan.

BACKGROUND: In a rapidly aging society that has promoted extensive reforms of the healthcare system, clarifying functional patterns in long-term care wards is important for developing regional healthcare policies. This study aimed to classify patterns of inpatient characteristics among Japanese long-term care wards and to examine hospital/ward characteristics. METHODS: We analyzed data from 1856 long-term care wards extracted from the 2014 Annual Report for Functions of Medical Institutions in Japan. We classified five clusters of long-term care wards based on inpatients' medical acuity/activities of daily living using cluster analysis, and compared hospital/ward characteristics across the clusters with a chi-square test or analyses of variance. RESULTS: Cluster 1 was low medical acuity/high activities of daily living (n = 175); cluster 2, medium medical acuity/high activities of daily living (n = 340); cluster 3, medium medical acuity/low activities of daily living (n = 461); cluster 4, high medical acuity/low activities of daily living (n = 409); and cluster 5, mixed (n = 471). Although clusters 1 and 2 had similar higher proportions of home discharge (48.1% and 34.6%, respectively), there was a difference in length of hospital stay between the clusters (154.6 and 216.6 days, respectively). On the other hand, clusters 3 and 4 experienced a longer length of hospital stay (295.7 and 239.8 days, respectively) and a higher proportion of in-hospital deaths (42.7% and 50.2%, respectively). Characteristics of cluster 5 were not significantly different from the average of overall wards. CONCLUSIONS: There were distinctive differences across hospitals in their use of long-term care wards. Wards with different functions have different support needs; the clusters with high activities of daily living needed support in promoting home discharge, while those with low activities of daily living needed support in providing quality end-of-life care. Our results can be useful for constructing the future regional healthcare system. This study also suggests introducing a standardized patient classification system in long-term care settings.

The effects of the music-with-movement intervention on the cognitive functions of people with moderate dementia: a randomized controlled trial.

OBJECTIVE: The aim of this study was to examine the effects of the six-week music-with-movement (MM) intervention, as compared with music listening (ML) and social activity (SA), on the cognitive functions of people with moderate dementia over time. METHODS: A multi-center randomized controlled trial was conducted on 165 nursing home residents with moderate dementia. The MM intervention protocol was developed based on a critical literature review, and tested in three rounds of pilot studies before undergoing testing in this study. The participants were randomly allocated into three groups. Intervention participants (n = 58) received a 12-week MM program led by a trained health care professional, while the participants in the comparison ML group (n = 54) listened to their preferred music, and those in the SA group (n = 53) engaged in social chatting. Cognitive functions, depressive symptoms, and anxiety were measured at baseline, the sixth week, and six weeks post-intervention. RESULTS: Greater improvements in memory and depressive symptoms for the MM group were revealed in the univariate analysis and pairwise comparisons. The effects on memory could last for at least six weeks post-intervention. However, a mixed multivariate analysis of variance (MANOVA) analysis indicated that there were no significant interactions of group by time effect Conclusion: The findings revealed that the MM intervention may be useful for enhancing the cognitive functions of people with dementia. However, there is insufficient evidence to show that the effects of the MM intervention on outcome variables over time significantly different from those observed among the comparison groups.

Knowledge, Practice, and Attitude of Nursing Home Staff Toward the Use of Physical Restraint: Have They Changed Over Time?

PURPOSE: Use of physical restraints is common in nursing homes, although empirical evidence has shown it to be a hazardous measure. This article aims to understand whether there were any changes in nursing home staff's knowledge, attitudes, and practices of using physical restraints in Hong Kong, after years of deliberation on this topic. METHODS: A questionnaire about the knowledge, attitude, and practice of using physical restraint was sent to all 298 staff members in four nursing homes in Hong Kong run by a nongovernmental organization. The results were compared with previous findings from 1999 using the same questionnaire. RESULTS: Overall, the staff had satisfactory knowledge of the daily application of physical restraints, such as the operational procedure and daily assessment. Concerning the conceptual knowledge of minimizing physical restraint use, their performance in the survey was less satisfactory. For example, only 6.6% of respondents were aware that residents had a right to reject the use of physical restraints, and 70% believed that there were no good alternatives to restraints. They showed appropriate attitudes in their practice of daily use of physical restraints. Compared with the previous study in 1999, a significant improvement was found in the attitudes (p = .0014) and practice (p = .0002) of using restraints, but there was no difference in their knowledge test results (p = .29). CONCLUSIONS: The results of this study show a significant improvement among the nursing home staff in terms of their attitudes and practice of using restraints. In-service training for nursing staff should focus more on their knowledge of ethical considerations and the hands-on practice of using alternative devices (e.g., motion detectors or anti-slip pads). CLINICAL RELEVANCE: The findings of this study suggest that in-service training for nursing staff should focus more on their knowledge of ethical considerations, the principles of using physical restraint, and the alternatives to restraint in order to fill the knowledge gaps of staff and improve the quality of care in nursing homes.