The psychometric properties of the Physical Resilience Instrument for Older Adults (PRIFOR): a Rasch analysis.

BACKGROUND: Prior psychometric evidence of the Physical Resilience Instrument for Older Adults (PRIFOR) showed good criterion-related validity, concurrent validity, known-group validity, predictive validity, and internal consistency. However, it is unclear whether older patients with different treatment diagnoses interpret the PRIFOR similarly. AIMS: This study aimed to test the psychometric properties of the PRIFOR scores among different treatment diagnoses of older patients. METHODS: We recruited 413 hospitalized older patients with a medical diagnosis and 207 with a surgical diagnosis in a 1343-bed tertiary-care medical center in Taiwan. Data analyses included Rasch models, Principal Components Analysis (PCA), and Pearson correlations. RESULTS: The Rasch analyses showed that all PRIFOR items were embedded within their belonged constructs, reflecting good construct validity and unidimensionality. Person and item separation reliability support the internal consistency of the studied samples and PRIFOR items. However, six PRIFOR items were found to have meaningful differential item functioning (DIF) problems among treatment diagnoses. CONCLUSIONS: The PRIFOR is a solid measurement and can be used for monitoring the status of older adults' physical resilience. However, because six items were found to have meaningful DIF among treatment diagnosis groups, future studies should consider designing specific items for different patient populations to assess their needs in physical resilience.

Widowhood and health in late life: does health change before or after widowhood in older Taiwanese men and women?

This study investigated (a) whether significant health changes occur before imminent widowhood and (b) the effects of widowhood on the physical and psychological health of men and women ≥ 50 years old. Generalized estimating equations were used to examine a matched-pair sample of the Taiwanese Elderly. We found that for men, the major effect of widowhood was on psychological health, but that for women, the major effect was on physical health. Psychological health was significantly worse for widowed than for non-widowed women, but not for men. The difference in psychological health between widowed and non-widowed women, however, changed before widowhood.

Measurement equivalence across gender and education in the WHOQOL-BREF for community-dwelling elderly Taiwanese.

BACKGROUND: The WHOQOL-BREF, a generic quality of life (QoL) instrument, has been widely used clinically and for research on older populations. However, its measurement equivalence/invariance (ME/I) has not been well examined for the elderly (≥ 65 years) across some different demographics. METHODS: The data were derived from a cross-sectional study with a convenience sampling design in Taiwan. We enrolled 244 elderly participants: men = 143 (58.6%); educational level ≤ primary school = 121 (49.6%). The ME/I was examined using multiple group confirmatory factor analysis (MGCFA) across gender and educational level. RESULTS: The fit indices were satisfactory for the configural models of gender and educational level (standardized root mean square residual [SRMR] = 0.0742 and 0.0770; root mean square error of approximation [RMSEA] = 0.0655 and 0.0686; comparative fit index [CFI] = 0.953). In addition, MGCFAs showed that ME/I was supported across gender (ΔSRMR = 0.001 to 0.019; ΔRMSEA = -0.003 to 0.001; ΔCFI = -0.003 to 0.000) and educational level (ΔSRMR = 0.002 to 0.006; ΔRMSEA = -0.002 to 0.004; ΔCFI = -0.007 to 0.000). CONCLUSION: The WHOQOL-BREF Taiwan version is appropriate for combined use and for comparisons in older people across gender and different educational levels.

Predictors of regular exercise among older residents of long-term care institutions.

The purpose of this study was to apply self-efficacy theory to explore predictors of regular exercise among older residents of long-term care institutions. Convenience sampling was used to collect data from 151 older adults residing in three residential care homes in Taiwan. Data collection instruments included a background data sheet, Self Efficacy for Exercise Scale, Outcome Expectations for Exercise Scale and self-reported regular exercise. Results indicated that older residents who exercised regularly had fewer chronic diseases, better perceived health status and functional status, and higher self-efficacy expectations and outcome expectations related to exercise. Older residents with a regular exercise habit prior to institutionalization were more likely to engage in regular exercise. Logistic regression analysis indicated past exercise participation and self-efficacy expectations to be significant positive predictors of regular exercise. To promote regular exercise within this population, these can be potential target areas for interventions. These factors should be targeted in the development and implementation of interventions to promote regular exercise among older residents of long-term care institutions.

[The Impacts of Widowhood on the Health and Life of Elderly People and R elated Nursing Care].

Widowhood, an unavoidable and stressful situation, has been associated with negative effects in elderly people during later life. This article reviews and summarizes the influences of widowhood on the health, daily life, and social life of elderly people. The influences of widowhood on elderly people may vary by gender, spousal relationship, and cohort background. In order to provide nursing care as early as possible, nurses must cooperate with professionals from social-welfare and / or community-support systems to identify high-risk widowed elderly. When nurses assess the influences of widowhood on elderly people, they should consider the interactions among gender, spousal relationship, and cohort background. Furthermore, nurses may apply various strategies based on the needs of elderly people to improve the health and quality of life of patients. Suggestions include providing appropriate nursing care, offering positive social support, adjusting daily-life routines, and arranging activity programs based on care-recipient interests and resources.

Gender differences in the predictors of physical activity among assisted living residents.

PURPOSE: To explore gender differences in the predictors of physical activity (PA) among assisted living residents. DESIGN AND METHODS: A cross-sectional design was adopted. A convenience sample of 304 older adults was recruited from four assisted living facilities in Taiwan. Two separate simultaneous multiple regression analyses were conducted to identify the predictors of PA for older men and women. Independent variables entered into the regression models were age, marital status, educational level, past regular exercise participation, number of chronic diseases, functional status, self-rated health, depression, and self-efficacy expectations. FINDINGS: In older men, a junior high school or higher educational level, past regular exercise participation, better functional status, better self-rated health, and higher self-efficacy expectations predicted more PA, accounting for 61.3% of the total variance in PA. In older women, better self-rated health, lower depression, and higher self-efficacy expectations predicted more PA, accounting for 50% of the total variance in PA. CONCLUSIONS: Predictors of PA differed between the two genders. The results have crucial implications for developing gender-specific PA interventions. CLINICAL RELEVANCE: Through a clearer understanding of gender-specific predictors, healthcare providers can implement gender-sensitive PA-enhancing interventions to assist older residents in performing sufficient PA.

Motivators for physical activity among ambulatory nursing home older residents.

The purpose of this study was to explore self-identified motivators for regular physical activity among ambulatory nursing home older residents. A qualitative exploratory design was adopted. Purposive sampling was performed to recruit 18 older residents from two nursing homes in Taiwan. The interview transcripts were analyzed by qualitative content analysis. Five motivators of physical activity emerged from the result of analysis: eagerness for returning home, fear of becoming totally dependent, improving mood state, filling empty time, and previously cultivated habit. Research on physical activity from the perspectives of nursing home older residents has been limited. An empirically grounded understanding from this study could provide clues for promoting and supporting lifelong engagement in physical activity among older residents. The motivators reported in this study should be considered when designing physical activity programs. These motivators can be used to encourage, guide, and provide feedback to support older residents in maintaining physical activity.

The relationships between activity and quality of life for older men and women at different ages in Taiwan.

This study investigated the relationships between types of activity and quality of life (QOL) for older men and women at different ages. Based on cross-sectional data that included 220 community-dwelling elderly persons aged 65 and older in southern Taiwan, the results showed that the participation rates in many activities declined with age for both genders. Social activity and solitary leisure activity were significantly associated with QOL for old-old men, but not for young-old men. Only social activity was significantly associated with QOL for young-old women, but there was no significant association between any activity and QOL for old-old women.

Development and testing of a four-item version of the physical resilience instrument for older adults (PRIFOR-4).

The 16-item Physical Resilience Instrument for Older Adults (PRIFOR) has good clinimetric properties; however, a shortened PRIFOR would greatly enhance physical resilience measurements in clinical settings. The current analysis aimed to reduce the number of PRIFOR while maintaining its clinimetric properties, emphasizing on its factor structure and convergent validity. A longitudinal study was conducted among 863 patients aged 65 years or older. Four PRIFOR items with high factor loadings were selected to generate the short version of PRIFOR (PRIFOR-4). The PRIFOR-4 was found to have a unidimensional structure (comparative fit index = 0.999; Tucker-Lewis index = 0.998 in the confirmatory factor analysis results) with good convergent validity with various external measures (absolute r = 0.109-0.597; p-values<0.01). Because the PRIFOR-4 contains only four items, the completion time for the respondents reduced three fourths from the original PRIFOR, which may have a marked reduction in the response burden. The PRIFOR-4 is thus an easy-to-use measurement that saves time for healthcare professionals in clinical practice.

Gender differences in the relationship of social activity and quality of life in community-dwelling Taiwanese elders.

This study explores the gender differences in the relationship between social activity and quality of life (QOL). A cross-sectional survey of 220 community-dwelling elderly people was conducted in southern Taiwan. Social activity was classified into six categories. The brief version of the World Health Organization QOL (WHOQOL-BREF) was used to measure QOL. Findings revealed that the associations of six types of social activities with QOL were weaker among women than men. The regression analyses further showed that for women, only religious activity was positively related to total QOL, while for men only involvement in formal group activity was positively related to total QOL.

Exploration of Geriatric Care Competencies in Registered Nurses in Hospitals.

BACKGROUND: Older adults occupy one third of acute care hospital beds, and the regular duties of many nurses include caring for older patients. A working knowledge of geriatric care competencies is necessary for nurses to provide high-quality care to older patients and their families. It is unclear how nurses who work in acute care hospitals self-evaluate their geriatric care competencies and how these self-evaluated abilities differ from the objective abilities of these nurses. PURPOSES: This study was designed to explore the geriatric care competencies of nurses in hospitals and to identify the factors associated with these competencies. METHODS: This was a cross-sectional study. Nurses who were employed and directly caring for patients aged 65 years and older in any of the adult wards of a medical center located in southern Taiwan were recruited as participants. A structured questionnaire was developed based on a review of the relevant literature and validated using expert consensus. This questionnaire included a demographic datasheet, knowledge of geriatric care scale, attitude of geriatric care scale, self-evaluation of geriatric care competency, and geriatric care competency test. Descriptive and inferential statistics were used to analyze the geriatric care competencies of the participants and related factors. RESULTS: One hundred seventy nurses were enrolled as participants. The average self-evaluation score for geriatric care competency was 67.74 (SD = 0.84). However, the average percentage of correct answers given on the geriatric care competency test was much lower (17.6%). The self-evaluation score was found to be significantly associated with job satisfaction and having received continuing education in geriatric care. In addition, age was shown to significantly affect the percentage of correct answers given on the geriatric care competency test. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: A significant gap was found between the self-perceived and actual competencies of nurses in terms of providing geriatric care. Appropriate policies are necessary to improve the geriatric care competencies of nurses working in hospitals and to oversee the implementation of effective educational methods in Taiwan.

Short versions of the Geriatric Depression Scale (GDS) among widowed older people in Taiwan: Comparing their psychometric properties.

OBJECTIVE: To compare the psychometric properties of different short versions of the Geriatric Depression Scale (GDS) among community-dwelling widowed older people. METHODS: A cross-sectional design was conducted between February 2018 and August 2019 in southern Taiwan (n = 330). The GDS short versions included Hoyl et al's 5-item version, Molloy et al's 5-item version and van Marwijk et al's 4-item version. RESULTS: All GDS short versions had satisfactory internal consistency (α = 0.83-0.90), with strong item loading embedded in the same construct of depression (0.43-0.72). The activity of daily living (ADL) scores had strong associations with van Marwijk et al's 4-item version (absolute standardised coefficient [|ß|] = 0.15-0.59), Hoyl et al's 5-item version (|ß| = 0.16-0.45) and Molloy et al's 4-item version (|ß| = 0.09-0.40). CONCLUSIONS: Hoyl et al's 5-item version was found to be more suitable than the other two versions of the GDS to assess the precise construct of depression. Meanwhile, van Marwijk et al's 4-item version can be used when the focus is on ADL performance. However, the conclusion should be interpreted with caution since the results were derived only from a widowed population in Taiwan. More research on this topic among other populations is thus needed to corroborate our conclusion.

Gender Differences in the Factors Associated With the Fear of COVID-19 Among Taiwanese Older People.

Objectives: Due to the COVID-19 pandemic, older people are threatened, and there may be different psychological responses toward COVID-19 between women and men. The present study explored the factors and gender differences related to the fear of COVID-19 among older women and men in Taiwan. Methods: Geriatric patients (n = 139; 42 men; mean age = 71.73 years) who visited outpatient departments were recruited. They self-reported demographic data and completed questions asking about (i) their fear of COVID-19, (ii) whether they paid attention to COVID-19 news, (iii) whether searched for COVID-19 news, (iv) whether they believed in COVID-19 news, and (v) their preventive COVID-19 behaviors. Results: Both women and men reported a low fear of COVID-19, paid close attention to COVID-19 news, and practiced good preventive COVID-19 infection behaviors. The perceived chance of COVID-19 infection was a significant factor contributing to the fear of COVID-19 among both women and men. Preventive behaviors had a positive effect in lowering the fear of COVID-19. News about COVID-19 had a negative effect in lowering the fear of the disease among women but not men. Conclusions: As the performing of preventive COVID-19 infection behaviors was associated with a lower fear of COVID-19, healthcare providers should consider strategies for improving preventive behaviors among older people to help ease their worries and fears concerning COVID-19.

Comparing Fear of COVID-19 and Preventive COVID-19 Infection Behaviors Between Iranian and Taiwanese Older People: Early Reaction May Be a Key.

This study assessed fear of the novel coronavirus-2019 (COVID-19), preventive COVID-19 infection behaviors, and the association between fear of COVID-19 and preventive COVID-19 infection behaviors among older people in Iran and Taiwan. Older people aged over 60 years (n = 144 for Iranians and 139 for Taiwanese) completed the Fear of COVID-19 Scale (FCV-19S) and two items on preventive COVID-19 infection behaviors (i.e., hand washing and mouth covering when sneezing). Iranian older people had a significantly higher level of fear of COVID-19 than did Taiwanese older people. Moreover, Iranian older people had significantly lower frequencies of preventive COVID-19 infection behaviors than did Taiwanese older people. Different timings in implementing COVID-19 infection control policies in Iran and Taiwan may explain why Iranian older people had greater fear of COVID-19 and lower preventive COVID-19 infection behaviors than did Taiwanese older people.

[A review of current studies on leisure activities performed by community-dwelling elders].

This article reviewed and summarized the findings of previously published studies on the leisure activities of community elders over 55 years of age. A total of 17 related articles, published before 2008, were identified in the search of electronic databases, which included the Chinese Periodical Table of Contents Index Image System, CEPS, Medline and Ageline. Leisure activities measurements used in this study consisted of recoding activities either categorically or by frequency. The majority of research indicated that elderly engage in primarily static activities and that participation in leisure activities had positive effects on cognitive and psychological health. However, inconsistencies in results were found due to differences in measurement tools and sample populations used among studies, making it difficult to conduct a valid comparison of specific features of elderly leisure activities. Most current leisure activity studies utilize cross-sectional research methodologies with restricted topics, which result in limited applicability of research results. In conclusion, we suggest that future studies should develop instruments to assess leisure activities that correspond to local conditions identified through qualitative research. With such, researchers can study different age groups by applying relevant ageing theories to construct empirical data related to current elderly leisure activities.

Risk of incident dementia in late-life depression treated with antidepressants: A nationwide population cohort study.

BACKGROUND: Antidepressants are frequently used to treat depression in patients with dementia. In addition, late-life depression is associated with the incidence of subsequent cognitive impairment or dementia. However, the association between exposure to antidepressants in late-life depression and the development of incident dementia remains understudied. METHODS: Through a population-based retrospective cohort design, data were extracted from the Taiwan National Health Insurance Research Dataset of medical claims registered from 1998-2013. We collected data of individuals who had received a new diagnosis of depression between 2000 and 2007. We excluded those who received a diagnosis of depression and were given antidepressants before 2000 and those younger than 60 years. The primary outcome was the occurrence of incident dementia. The time from the prescription of antidepressants or the diagnosis of depression until the outcome or the end of 2013 was calculated as the time to event. A total of 563,918 cases were included and were divided into either antidepressant users or antidepressant nonusers. Cox proportional hazards models were used to calculate the hazard ratio and 95% confidence interval. RESULTS: Exposure to antidepressants did not increase the risk of dementia in patients with late-life depression at either a low exposure dosage (hazard ratio: 1.06, 95% confidence interval: 0.91-1.23) or a high exposure dosage (hazard ratio: 1.07, 95% confidence interval: 0.95-1.20). To confirm the validity of our results, we performed a sensitivity analysis and subgroup analysis, and the post-hoc results were consistent with the main results. CONCLUSION: Antidepressants did not increase the risk of incident dementia in patients with late-life depression.

[Holistic care for the elderly].

It is evident that the population of elderly people is increasing in size in the 21st century. Because ageing causes declines in various aspects of health, health care personnel should adopt a holistic approach to caring for them. The purposes of this paper are to discuss the meaning of holism and the health characteristics of the elderly, and to consider, in the light of these characteristics, how best to provide holistic care to the elderly. The author hopes that this article can contribute to improvements in health care for the elderly.

Volunteer transitions and physical and psychological health among older adults in Taiwan.

OBJECTIVES: This study examines the relationship between transitions in volunteering activity and physical and psychological health outcomes among older adults in Taiwan. METHOD: We used 3 waves of a longitudinal survey from Taiwan (1999, 2003, and 2007) including 1,847 older adults aged 58-74. We categorized volunteer activity over time into 5 categories and used generalized estimating equations to examine the relationship between volunteer transition group membership and health outcomes. RESULTS: Approximately, 3% of older volunteers kept volunteering and 7% stopped or started their volunteering over time. Engaging in any volunteering, including continuous volunteering, discrete volunteering, active-to-inactive volunteering, and inactive-to-active volunteering, was significantly associated with better self-rated health and higher life satisfaction when compared with the nonvolunteering group. Only those in the continuous volunteer group and those who shifted from inactive-to-active volunteering showed a positive association with better physical function and less depression, compared with the nonvolunteering group. DISCUSSION: The results suggest that the positive relationship between volunteering and health may decline when older adults discontinue or withdraw from volunteering. More research is needed to explore the mechanism behind older people's desistance from, persistence in, and resumption of volunteer engagement.