Physical activity together for couples living with mild cognitive impairment (PAT-MCI): A feasibility study.

Mild cognitive impairment is a prodromal phase of Alzheimer's disease and related dementias. Cognitive and/or neuropsychiatric symptoms that could worsen over time cause challenges for patients and romantic partners, who often assume the role of informal caregivers. Although physical activity is beneficial, older adults with mild cognitive impairment and their romantic care partners are generally physically inactive. Our 16-week study was performed to see whether physical activity together is feasible to increase physical activity among four dyads (individuals with mild cognitive impairment and their spouses). Our dyadic intervention was feasible given more than 70 % of participants self-reported adherence to physical activity based on the guidelines for adults in the United States. In exit interviews, togetherness was highlighted as one of the biggest strengths of this study. Future studies with more representative samples are needed, as well as adopting a more tailored approach that accounts for individuals' levels of physical fitness.

Digital Health and Caregiving Resources Used by Family Caregivers of Older Adults During the COVID-19 Pandemic.

Caregiving is often associated with negative physical and mental health outcomes, and as the COVID-19 pandemic escalated, caregivers experienced more burden and provided more care with substantially less support. Digital resources may have been one way caregivers managed demands for care and needs for information. This mixed-methods study included surveys and semi-structured interviews with caregivers (n = 11) to describe experiences and use of digital health resources during the COVID-19 pandemic. Caregivers most often provided significant physical care and experienced reduced or no social support during the pandemic. Caregivers reported the need for improving the quality of telehealth services and digital health resources. COVID-19 will not likely be the last pandemic faced by contemporary society. Measures should be taken to reduce the anticipated negative impacts on caregivers and those receiving care during future pandemics.

Gait and/or balance disturbances associated with Alzheimer's dementia among older adults with amnestic mild cognitive impairment: A longitudinal observational study.

AIMS: To explore whether gait and/or balance disturbances are associated with the onset of Alzheimer's dementia (AD) among older adults with amnestic mild cognitive impairment (MCI). DESIGN: This study employed a longitudinal retrospective cohort design. METHODS: We obtained data from the National Alzheimer's Coordinating Center's Uniform Data Set collected from 35 National Institute on Aging Alzheimer's Disease Research Centers between September 2005 and December 2021. The mean age of participants (n = 2692) was 74.5 years with women making up 47.2% of the sample. Risk of incident AD according to baseline gait and/or balance disturbances as measured using the Postural Instability and Gait Disturbance Score, a subscale of the Unified Parkinson's Disease Rating Scale Motor Score, was examined by the Cox proportional hazards regression models adjusting for baseline demographics, medical conditions and study sites. The mean follow-up duration was 4.0 years. RESULTS: Among all the participants, the presence or the severity of gait and/or balance disturbances was associated with an increased risk of AD. The presence or the severity of gait and/or balance disturbances was associated with a higher risk of Alzheimer's dementia among the subgroups of female and male participants. CONCLUSION: Gait and/or balance disturbances may increase the risk of developing AD, regardless of sex. IMPACT: Gait and/or balance disturbances among community-dwelling older adults with amnestic MCI may need to be frequently assessed by nurses to identify potential risk factors for cognitive decline. NO PATIENT OR PUBLIC CONTRIBUTION: Given the secondary analysis, patients, service users, caregivers or members of the public were not directly involved in this study.

Longitudinal Cognitive Profiles by Anxiety and Depressive Symptoms in American Older Adults With Subjective Cognitive Decline.

PURPOSE: The objective of this study was to determine how anxiety and/or depressive symptoms differentially affect specific cognitive domains over time in persons with subjective cognitive decline (SCD). DESIGN: A longitudinal, observational study was conducted using data from the National Alzheimer's Coordinating Center-Uniform Data Set. Mean follow-up was 4.1 ± 2.4 years. METHODS: Using information from a total of 1401 participants (age 74.0 ± 8.2 years), linear mixed-effects regression models were used to assess longitudinal changes in global cognition, episodic memory, attention, language, and executive function by baseline psychological (anxiety [A] and/or depressive [D]) symptoms in individuals with SCD. Reference was the group having no symptoms (A-/D-). FINDINGS: The A+/D- group was not associated with any cognitive changes. The A-/D+ group was associated with a greater decline in episodic memory and executive function. The A+/D+ group had a greater decline in attention. Changes in global cognition and language were not predicted by any psychological symptoms. CONCLUSIONS: Depressive symptoms predicted lower episodic memory and executive function. CLINICAL RELEVANCE: Nurses need to pay attention to depressive symptoms in older adults with SCD because managing depressive symptoms may help protect against cognitive decline more typical of early Alzheimer's dementia.

Factors predicting episodic memory changes in older adults with subjective cognitive decline: A longitudinal observational study.

Episodic memory is affected early in the neuropathological process of Alzheimer's dementia. This study was performed to identify longitudinal associations between baseline vascular/neuropsychiatric risk factors and episodic memory changes over 4.1 ± 2.4 years in 1,401 older adults with subjective cognitive decline (age 74.0 ± 8.2 years). Data were from the National Alzheimer's Coordinating Center-Uniform Data Set and linear mixed effects regression models were used. Reference was those without risk factors. Participants with hypercholesterolemia and with former cigarette smoking had higher episodic memory scores, but current smokers had fewer points than reference at their first and follow-up visits. Despite no difference at baseline, episodic memory scores decreased in those with depressive symptoms relative to reference over time. In older adults with subjective cognitive decline, interventions managing current smoking and depressive symptoms could preserve episodic memory, which may result in delaying the onset of Alzheimer's dementia. Further research is required for the role of cholesterol and smoking.

Factors Predicting the Onset of Amnestic Mild Cognitive Impairment or Alzheimer's Dementia in Persons With Subjective Cognitive Decline.

The objective of the current retrospective cohort study was to identify vascular and/or neuropsychiatric risk factors predicting clinical progression in persons with subjective cognitive decline (SCD). Information on 1,525 persons with SCD (mean age = 73.8 [SD = 8.1] years) was obtained from the National Alzheimer's Coordinating Center. Clinical progression occurred from SCD to either amnestic mild cognitive impairment or Alzheimer's dementia over an average of 4.7 (SD = 2.9) years. Stepwise Cox regression was used. Compared to obesity (hazard ratio [HR] = 0.59) in the univariate unadjusted model, obesity (HR = 0.64), current smoking (HR = 2.02), and depressive symptoms (HR = 1.35) were significant after adjusting for covariates in the univariate model. In the multivariate adjusted model, obesity (HR = 0.64), current smoking (HR = 2.04), and depressive symptoms (HR = 1.36) remained significant predictors. Interventions should be designed to minimize transition by managing smoking and depressive symptoms. Further research is required for associations between obesity and clinical progression to test the hypothesis of obesity paradox. [Journal of Gerontological Nursing, 46(8), 28-36.].

Uncertainty and depression in people with Parkinson's disease: A cross-sectional study.

Adults with chronic disease may experience uncertainty and depression when coping with their illness. This study identifies degrees of uncertainty and depression, as well as factors associated with depression in people with Parkinson's disease. The 120 participants included patients who visited the neurology outpatient department of a tertiary hospital in Seoul and individuals who attended public events managed by the Korean Parkinson's Disease Association. The mean age of the sample was 65.01 and 50.8% of patients were men. The mean scores of uncertainty and depression, measured using the Mishel Uncertainty in Illness Scale and Short Form Geriatric Depression Scale were 99.03 and 6.73, respectively. Approximately 68% of participants scored above the cut-off score for depression. Multiple regression analyses showed that uncertainty, perceived health status, and fatigue were factors significantly associated with depression. Nurses should be aware of and address these factors and their effects in order to implement interventions to prevent depression in people with Parkinson's disease.

Psychometric evaluation of the Korean Version of the Self-Efficacy for Exercise Scale for older adults.

We evaluated the psychometric properties of the Korean version of the Self-Efficacy for Exercise Scale (SEE-K). The SEE-K consists of nine items and was translated into Korean using the forward-backward translation method. We administered it to 212 community-dwelling older adults along with measures of outcome expectation for exercise, quality of life, and physical activity. The validity was determined using confirmatory factor analysis and Rasch analysis with INFIT and OUTFIT statistics, which showed acceptable model fit. The concurrent validity was confirmed according to positive correlations between the SEE-K, outcome expectation for exercise, and quality of life. Furthermore, the high physical activity group had higher SEE-K scores. Finally, the reliability of the SEE-K was deemed acceptable based on Cronbach's alpha, coefficients of determination, and person and item separation indices with reliability. Thus, the SEE-K appears to have satisfactory validity and reliability among older adults in South Korea.

The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis.

BACKGROUND: Health and Wellness Coaching (HWC) may be beneficial in chronic condition care. We sought to appraise its effectiveness on quality of life (QoL), self-efficacy (SE), depression, and anxiety. METHODS: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL for randomized trials published January 2005 - March 2023 that compared HWC to standard clinical care or another intervention without coaching. We examined QoL, SE, depression, or anxiety outcomes. Meta-analysis utilizing the random-effects model was used to estimate the pooled standardized mean difference (SMD). RESULTS: Thirty included studies demonstrated that HWC improved QoL within 3 months (SMD 0.62 95 % CI 0.22-1.02, p = 0.002), SE within 1.5 months (SMD 0.38, 95 % CI 0.03-0.73, p = 0.03), and depression at 3, 6, and 12 months (SMD 0.67, 95 % CI 0.13-1.20, p = 0.01), (SMD 0.72, 95 % CI 0.19-1.24, p = 0.006), and (SMD 0.41, 95 % CI 0.09-0.73, p = 0.01) Certainty in the evidence for most outcomes was either very low or low primarily due to the high risk of bias, heterogeneity, and imprecision. CONCLUSION: HWC improves QoL, SE, and depression across chronic illness populations. Future research needs to standardize intervention reporting and outcome collection. PRACTICE IMPLICATIONS: Future HWC studies should standardize intervention components, reporting, and outcome measures, apply relevant chronic illness theories, and aim to follow participants for greater than one year.

Multimorbidity and healthcare utilization among Black Americans: A cross-sectional study.

AIM: Racial disparities between multimorbidity presence and healthcare utilization are present within the United States, but less is known about the relationship between multimorbidity presence and healthcare utilization among Black Americans. This study was conducted to examine the relationship between multimorbidity and healthcare utilization among Black Americans. DESIGN: Cross-sectional study. METHODS: This study (n = 425, 57% female) used adult level data from the 2012-2013 Connecticut Health Care Survey. RESULTS: Multivariate logistic regressions indicated that multimorbidity presence predicted a doctor and a specialist visit, but not a dentist visit. CONCLUSION: This study identified multimorbidity presence as a predictor for healthcare utilization, but further research is necessary to understand healthcare utilization experiences among Black Americans with multimorbidity to assess the quality of care. Appropriate measures should also be considered to increase access to dental care for Black Americans with multimorbidity.

The Effects of Multi-Domain Interventions on Cognition: A Systematic Review.

This review aimed to evaluate the effects of multi-domain interventions on cognition among individuals without dementia. Multi-domain interventions refer to those combining any single preventive measure such as physical activity, cognitive training, and/or nutrition to prevent dementia. Seventeen studies were included (n = 10,056 total participants; mean age = 73 years), eight of which were rated as strong in quality while the other nine showed moderate quality. The standardized mean difference (SMD; d) was used to calculate the effect size for each included study. Multi-domain interventions consisting of physical activity, cognitive training, cardioprotective nutrition, and/or cardiovascular health education exerted beneficial effects on global cognition, episodic memory, and/or executive function with very small to moderate effect sizes (0.16-0.77). Nurses may consider combining these components to potentially stave off dementia. Future research is warranted to identify the optimal multi-domain intervention components that can induce clinically significant beneficial effects on cognition.

Association of adherence to high-intensity physical activity and the Mediterranean-dietary approaches to stop hypertension intervention for neurodegenerative delay diet with cognition: A cross-sectional study.

BACKGROUND: Prevention is a priority in the absence of a cure for dementia. Physical activity and a neuroprotective diet such as the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet are healthy lifestyle behaviors that may slow the onset of dementia. However, research on the relationship between the combination of physical activity and the MIND diet and cognition is rare. OBJECTIVES: The purpose of this study was to investigate whether the combination of high-intensity physical activity and the MIND diet is associated with better cognition compared with either behavior alone or neither behavior. DESIGN: A population-based, cross-sectional study was conducted using data from the Health and Retirement Study. METHODS: Using information from a total of 3463 participants (age 68.0 ±â€¯10.0 years), multivariate linear regression models and binary logistic regression models with interaction terms between high-intensity physical activity (PA) and the MIND diet (MIND) were used to assess associations of PA and MIND with global cognition and odds of cognitive decline. Group comparisons were conducted among four groups: PA-/MIND-, PA+/MIND-, PA-/MIND+, and PA+/MIND+. RESULTS: PA+/MIND- did not predict cognitive outcomes (versus PA-/MIND-). PA-/MIND+ was associated with better global cognition (mean difference [d] = 0.81; 95% confidence interval [CI] = 0.50-1.11; p < 0.001) and lower odds of cognitive decline (odds ratio [OR] = 0.68; 95% CI = 0.54-0.86; p = 0.001) (versus PA-/MIND-). PA+/MIND+ predicted better global cognition (d = 0.98; 95% CI = 0.59-1.36; p < 0.001) and lower odds of cognitive decline (OR = 0.69; 95% CI = 0.50-0.94; p = 0.004) (versus PA-/MIND-). PA+/MIND+ was associated with better global cognition (d = 0.60; 95% CI = 0.08-1.12; p < 0.001), but did not predict lower odds of cognitive decline (versus PA+/MIND-). PA+/MIND+ did not predict cognitive outcomes (versus PA-/MIND+). CONCLUSIONS: Combining high-intensity physical activity and the MIND diet was associated with better cognitive health than high-intensity physical activity alone or non-adherence to both behaviors. To potentially exert additive effects, it will be important to encourage these two healthy habits. More research on the role of combined physical activity and dietary change is necessary to further inform policy and clinical guidance.

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures.

OBJECTIVE: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. METHODS: Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. RESULTS: A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. CONCLUSION: This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Impacts of an Exercise Program and Motivational Telephone Counseling on Health-Related Quality of Life in People With Parkinson's Disease.

PURPOSE: The purpose of this study was to test the effects of group exercise and telephone counseling on physical and psychosocial health in people with Parkinson's disease (PD). DESIGN: This was a quasiexperimental study with a nonequivalent control group. METHODS: This study took place in Seoul, South Korea. Twenty-two and 20 subjects participated in the intervention and comparison groups, respectively. The intervention group performed group exercises twice a week and received motivational telephone counseling every 2 weeks for 12 weeks. FINDINGS: Significant effects of the intervention were found in overall health-related quality of life (HRQOL; p = .012) and in the following HRQOL dimensions: stigma (p = .026), social function (p = .003), cognition (p = .028), and communication (p = .014). No other variables such as activities of daily living, functional fitness, and depression exhibited statistically significant effects. CONCLUSION/CLINICAL RELEVANCE: These results indicate that group exercise with telephone counseling positively affects some aspects of HRQOL in PD patients.

Does Health Coaching Grow Capacity in Cancer Survivors? A Systematic Review.

Interventions that grow patient capacity to do the work of health care and life are needed to support the health of cancer survivors. Health coaching may grow capacity. This systematic review of health coaching interventions explored coaching's ability to grow capacity of cancer survivors. The authors included randomized trials or quasi-experimental studies comparing coaching to alternative interventions, and adhered to PRISMA reporting guidelines. Data were analyzed using the Theory of Patient Capacity (BREWS: Capacity is affected by factors that influence ability to reframe Biography ["B"], mobilize or recruit Resources ["R"], interact with the Environment of care ["E"], accomplish Work ["W"]), and function Socially ["S"]). The authors reviewed 2210 references and selected 12 studies (6 randomized trials and 6 pre-post). These studies included 1038 cancer survivors, mean age 57.2 years, with various type of cancers: breast, colorectal, prostate, and lung. Health coaching was associated with improved quality of life, mood, and physical activity but not self-efficacy. Classified by potential to support growth in patient capacity, 67% of included studies reported statistically significant outcomes that support "B" (quality of life, acceptance, spirituality), 75% "R" (decreased fatigue, pain), 67% "W" (increased physical activity), and 33% "S" (social deprivation index). None addressed changing the patient's environment of care. In cancer survivors, health coaching improved quality of life and supported patient capacity by several mechanisms, suggesting an important role for "Capacity Coaching." Future interventions that improve self-efficacy and patients' environments of care are needed. Capacity Coaching may improve health and quality of life of cancer survivors.

Historical difference between traditional Korean medicine and traditional Chinese medicine.

BACKGROUND: Although traditional Korean medicine (TKM) has been influenced by traditional Chinese medicine (TCM), it has developed distinctive features. Around the tenth century, Chinese medical books were introduced to Korea. In those days, Koreans started movement to develop its own medical system. METHODS: We reviewed Korean and Chinese medical literatures, and analysed the characteristics between two medical systems. RESULTS: In the early 17th century, Dongeuibogam was published by Dr Joon Hur. He provided a turning point to establish Korean medical system independent from TCM. TKM emphasizes specific characteristics of the individual who suffered from the disease, rather than single symptom. The concept was elaborated by Dr Jae Ma Lee who published Dongeuisusaebowon in the early 20th century. CONCLUSION: Through historical development, TKM has established the unique characteristic and modality as the whole-person-centered medicine.

Effects of Non-Pharmacological Treatments on Quality of Life in Parkinson's Disease: A Review.

Parkinson's disease is a neurodegenerative chronic condition with a declining trajectory and lack of a cure, making quality of life an important aspect of care. The purpose of this literature review was to analyze the state-of-the-science on the effects of non-pharmacological treatments on quality of life in person's with Parkinson's disease. Literature search was conducted using keywords in electronic databases up to September 1, 2016 and cross-searching the references of identified articles. Of the 259 articles generated, 26 met the eligibility criteria and were included in this review. The majority of studies (77%) were Level I evidence and 23% Level II evidence. The levels of study quality were: strong (50%), moderate (15%), and weak (35%). The interventions varied across studies with 15 studies evaluating a similar intervention. About 58% of the studies showed that the interventions improved quality of life. In conclusion, a variety of non-pharmacological interventions have been increasingly studied for their effects on quality of life in Parkinson's disease, showing initial promising results. However, most interventions were only examined by a limited number of studies and the minimal and optimal intervention doses needed for improving quality of life are yet unknown.

Health coaching interventions for persons with chronic conditions: a systematic review and meta-analysis protocol.

BACKGROUND: Chronic conditions are increasingly more common and negatively impact quality of life, disability, morbidity, and mortality. Health coaching has emerged as a possible intervention to help individuals with chronic conditions adopt health supportive behaviors that improve both quality of life and health outcomes. METHODS/DESIGN: We planned a systematic review and meta-analysis of the contemporary health coaching literature published in the last decade to evaluate the effect of health coaching on clinically important, disease-specific, functional, and behavioral outcomes. We will include randomized controlled trials or quasi-experimental studies that compared health coaching to alternative interventions or usual care. To enable adoption of effective interventions, we aim to explore how the effect of intervention is modified by the intervention components, delivering personnel (i.e., health professionals vs trained lay or peer persons), dose, frequency, and setting. Analysis of intervention outcomes will be reported and classified using an existing theoretical framework, the Theory of Patient Capacity, to identify the areas of patients' capacity to access and use healthcare and enact self-care where coaching may be an effective intervention. DISCUSSION: This systematic review and meta-analysis will identify and synthesize evidence to inform the practice of health coaching by providing evidence on components and characteristics of the intervention essential for success in individuals with chronic health conditions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016039730.