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

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

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

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

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

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

Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents.

BACKGROUND: Hearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids. METHODS: Secondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses. RESULTS: Results for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline. CONCLUSION: In LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.

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

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

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

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

Frailty measurements in hospitalised orthopaedic populations age 65 and older: A scoping review.

AIMS AND OBJECTIVES: To identify and compare frailty instruments used with hospitalised orthopaedic patients aged over 65. BACKGROUND: Frailty predicts clinical events in orthopaedic patients aged over 65. However, the strengths and limitations of different approaches to measuring frailty in this population are rarely discussed. As such, a comprehensive review to address the gap is needed. DESIGN: Scoping review using Arksey and O'Malley framework. METHODS: PubMed, CINAHL, PsycINFO, Scopus and EMBASE databases were searched to identify studies published from 2006 to 2020 regarding frailty instruments in older orthopaedic patients. The Preferred Reporting Items for Systematic Reviews and Meta-analyses were followed. RESULTS: The initial search resulted in 1,471 articles. After review against inclusion and exclusion criteria, a final set of 31 articles containing 15 unique frailty instruments were evaluated. Most of the articles were from Western countries. Fried's phenotype and Frailty Index were commonly used. The frailty index was mostly modified to measure frailty. In hip fracture, physical function items were frequently modified in the measurement of frailty. Trained physicians and nurses administered most frailty instruments. Frailty screening was commonly conducted at hospital admission and used to prognosticate both postoperative complications and hospital outcomes. Most instruments could be completed within 10 min. Reported psychometrics had acceptable reliability and validity. CONCLUSION: Many reliable frailty measures have been used in the inpatient orthopaedic settings; however, evidence is still lacking for a gold standard frailty instrument. More research is needed to identify the best-performing measure. Frailty evaluation in patients with physical limitations is challenging with existing instruments. Clinical context, resources required and instrument quality are essential factors in selecting a frailty instrument. RELEVANCE TO CLINICAL PRACTICE: Musculoskeletal symptoms in older patients may bias frailty assessment. Proactive frailty screening with valid and practical instruments is vital to strengthen preoperative risk stratification and improve post-surgical outcomes.

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.

Effects of dance intervention on agitation and cognitive functioning of people living with dementia in institutional care facilities: Systematic review.

INTRODUCTION: Agitation and impaired cognitive functioning are common symptoms of dementia, which require costly medication regimens that are associated with adverse effects. This study investigates the effects of dance interventions on agitation and cognitive function in people living with dementia in institutional care facilities. METHODS: Five electronic databases were searched for eligible studies on dance interventions for people living with dementia published between 2002 and 2021. Standard deviation and post mean values were extracted. Within-group Hedges' g was computed for individual studies. RESULTS: Six randomised controlled trials and three non-randomised studies of satisfactory quality, with a total of 610 participants, were included. Statistical analysis found significant improvements in agitation and cognitive functioning with dance interventions. DISCUSSION: This review provided favourable evidence on the effects of dance interventions on agitation and cognitive functions in people with dementia. However, given the limited evidence, more studies are needed to confirm the effects.

Strategies to engage people with dementia and their informal caregivers in dyadic intervention: A scoping review.

Dyadic interventions simultaneously engage both people with dementia (PWD) and their informal caregivers (ICGs). This scoping review study identified the strategies for engaging dyads, described the perceptions of the dyads on these strategies, and reported the attrition rates of the dyadic interventions reported in the literature. Articles published up to July 2020, reporting a PWD-ICG-dyads intervention were searched in PubMed (Medline), PsycInfo, CINAHL, and the SSCI. Backwards citation chasing was conducted. A total of 37 studies were included. Seven engagement strategies were identified, which involved: ensuring a good-quality interventionist; offering take-home supporting materials; establishing peer support among the participants; tailoring the intervention content; conducting the intervention in a convenient location; conducting the intervention in a comfortable physical environment, and using a short and succinct programme. The dyads' subjective experiences of these strategies were reported. The attrition rates of the included studies were ranged 0% - 59.1%.

Maladaptive Fall Risk Appraisal and Falling in Community-Dwelling Adults Aged 60 and Older: Implications for Screening.

OBJECTIVES: We aimed to examine the characteristics of maladaptive fall risk appraisal (FRA), discrepancies between physical and perceived-fall risk, and their associations with falls. METHODS: Fall risk appraisal was determined using the full-tandem stand test as an objective measure and the Fall Efficacy Scale-International as a subjective measure, and 433 adults aged ≥60 years from Thailand were classified into four groups: irrational (low physical/high perceived risk), incongruent (high physical/low perceived risk), congruent (high physical/high perceived risk) and rational (low physical/low perceived risk) FRAs. RESULTS: Only 20.8% of adults aged ≥60 years had rational FRA. The rest of the participants had either irrational (57.3%) or incongruent (2.3%), or congruent (19.6%) FRAs. Approximately 74% of those with congruent FRA reported experiencing a fall last year, followed by incongruent (60%), irrational (41.1%), and rational FRAs (27.8%, p < .001). After covariates adjustment, participants with congruent FRA were 3.06 times more likely of falling than those with rational FRA (p = .011). CONCLUSIONS: Maladaptive FRA is highly prevalent among adults aged ≥60. Identifying maladaptive FRA is essential for ensuring that adults aged ≥60 receiving early treatment associated with falls. CLINICAL IMPLICATIONS: Preventing a transition from rational to irrational, incongruent, and congruent fall risk appraisals is vital to prevent falls and mitigate this problematic health condition.

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.

Behavioural activation for family dementia caregivers: A systematic review and meta-analysis.

The current study aims to investigate the effectiveness of behavioral activation (BA) for family dementia caregivers. A systematic literature search was conducted through PubMed, Medline, CINAHL, Cochrane, Embase and PsycINFO for studies published from March 1988 to September 2019. Standardized mean differences (SMDs) were combined to synthesize pooled effect measures using random effects. The review was based on ten randomized controlled trials. Depression was significantly reduced after participants received BA (n = 9; 786 participants; SMD = -0.69; 95% CI: -1.12 to -0.25; p = 0.002). BA also has a positive impact on other areas of psychological health (e.g., self-efficacy, anxiety, and distress) and physical health (e.g., interleukin-6) in family dementia caregivers. In conclusion, BA not only has a moderate effect on reducing depression but also has the potential to improve other areas of psychological and cardiovascular health in family caregivers. However, more interventional studies of BA for family dementia caregivers are needed.

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.

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.

A Randomized Controlled Trial Examining the Effect of Acupressure on Agitation and Salivary Cortisol in Nursing Home Residents with Dementia.

BACKGROUND: Acupressure has been used to manage agitation in people with dementia because it is safe and inexpensive. However, its effect on agitation and at the biochemical level is uncertain. METHODS: This randomized controlled trial examined the effect of acupressure on agitation, as measured by the Cohen-Mansfield Agitation Inventory (CMAI); and on salivary cortisol, as measured at baseline (T0) and in the 3rd (T1), 5th (T2), and 8th (T3) weeks. There were 119 agitated residents with dementia randomized into 3 groups: acupressure (n = 39), sham (n = 41), and usual-care group (n = 39). RESULTS: A downward trend in agitation over time was noted in the acupressure group, which almost reached a level of significance in interaction effects between groups and time points (p = 0.052). Post hoc pairwise tests in the acupressure group showed that acupressure significantly reduced agitation at T2 (mean difference -6.84, 95% CI -10.60, -3.08) compared to baseline. Significant interaction effects between groups and time points were observed on the level of salivary cortisol (p = 0.022). CONCLUSION: Acupressure is a multicomponent intervention that can reduce agitation. Acupoint activation may not be a significant component in reducing agitation, although this result may have been limited by the inadequate sample size. Acupressure is effective in reducing salivary cortisol in people with dementia.

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

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

The Use of Immersive Virtual Reality Training for Developing Nontechnical Skills Among Nursing Students: Multimethods Study.

BACKGROUND: Immersive virtual reality (IVR) is a niche technology rising in popularity in nursing education. Although there is an abundance of evidence to demonstrate the effect of virtual reality (VR) on desired learning outcomes, this evidence is limited to technical or procedural skills or managing a single patient with clinical problems. Nontechnical skills (NTS), such as communication, decision-making, teamwork, situation awareness, and managerial skills, have not been explored using IVR technology. OBJECTIVE: This study aimed to (1) investigate the potential efficacy of the IVR system virtual reality hospital (VR-Hospital, or VR-Hosp), a single-user game we developed, on nursing students' NTS, sense of presence in the virtual clinical environment, and satisfaction and self-confidence in learning; (2) identify variables that predict NTS; and (3) explore students' experience in using VR-Hosp. METHODS: A multimethods design with a quantitative and qualitative approach was adopted. Participants were provided with VR-Hosp with 3 scenarios in training. VR-Hosp adopted a multibed, multipatient, multitask approach and was embedded with various clinical situations. Learning outcomes were measured after the training, followed by group interviews. RESULTS: In total, 202 students joined the study. Results revealed high levels of satisfaction and self-confidence in learning. Significant achievement in NTS was perceived by the students. The levels of satisfaction and self-confidence in learning and the involvement and sensory fidelity domains in the sense of presence were positive predictors of NTS. CONCLUSIONS: The promising results offer a basis for designing IVR activities for nursing education. Further investigations are imperative to determine the impact of IVR technology on learning outcomes in clinical practice.

Coping strategies of internally displaced persons and the host community in a region of armed conflict: A cross-sectional study.

BACKGROUND: Conflict leads to the displacement of people, making it more difficult for them to cope with increasing stress. In war-affected regions, people use different strategies to cope with their stress. This study examines the coping strategies of internally displaced persons (IDPs) and those in host communities in war zones. METHODS: People living in the IDP camp and host communities in Maiduguri, Nigeria were recruited using a convenient sampling strategy. A 28-item Hausa version of the Brief COPE Scale wasused for data collection. Data were analyzed using linear regression and presented as unstandardized beta (B) and standard error (SE). RESULTS: A total of 562 participants were recruited (IDPs, n = 281; and the host communities, n = 281). Problem- and emotion-focused coping strategies were identified as the most common approaches used in host communities; however, dysfunctional strategies were morecommon among the IDPs. Age (younger or older adulthood) was identified as a predictor forthe use of emotion-, problem-, and dysfunctional-focused coping strategies. CONCLUSION: Host communities were more likely to use a problem-and emotion-focused approach to coping, while IDPs were more likely to use dysfunctional strategies. Location and demographic factors (being single, aged 18-29years, >50 years and older) also influenced coping.

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

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