Effects of Mindfulness-Based Elder Care (MBEC) on symptoms of depression and anxiety and spiritual well-being of institutionalized seniors with disabilities: a randomized controlled trial.

BACKGROUND: Despite the need to incorporate seniors from various settings into mindfulness-based empirical research, issues of geriatric frailties and non-compliance remain. This study aimed to evaluate the effects of a mindfulness-based elder care (MBEC) program on mental health and spiritual well-being among seniors with disabilities in long-term care residential settings. METHODS: This single-blind, randomized controlled trial (RCT) randomly assigned seventy-seven participants into an MBEC group or control group of an eight-week MBEC program. Participants were assessed every four weeks at baseline (T0), mid-intervention (T1), post-intervention (T2) and follow-up (T3) using the Geriatric Depression Scale Short Form (GDS-SF), the State-Trait Anxiety Inventory (STAI) and the Spiritual Well-Being Scale (SWBS), respectively. RESULTS: Linear mixed model (LMM) showed that MBEC participants' mental health improved significantly after completing the intervention; compared with controls, the MBEC group exhibited significantly lower anxiety (state-anxiety at T2; trait-anxiety at T2 and T3) and fewer depressive symptoms. Spiritual well-being was also significantly enhanced compared to that in the control group. CONCLUSIONS: MBEC has positive effects on both mental health and spiritual well-being outcomes among seniors with disabilities. In long-term care facilities, seniors with abilities have the potential to adhere to and engage in activities of a mindfulness-based intervention. This low risk, easily accessible, and effective 8-week program is recommended to be integrated into regular long-term care institutional routines. TRIAL REGISTRATION: This study was registered with Clinical Trial Registry (ClinicalTrials.gov - U.S. National Library of Medicine #NCT05123261. Retrospectively registered on 07/04/2021.). The CONSORT 2010 guidelines were used in this study for properly reporting how the randomized trial was conducted.

Effects of a biopsychosocial-spiritual group therapy on quality of life among institutionalized older adults with disabilities: A randomized controlled trial.

The traditional biomedical care approach has been unsatisfactory to meet the complex needs of seniors with long-term multimorbidity and irreversible disability, particularly for those living in residential LTC facilities. This study aimed to develop and evaluate the effectiveness of an 8-week biopsychosocial-spiritual (BPS-S) group intervention with the attempt to enhance quality of life (QoL) and meaning in life among senior residents with disability. This single-blind randomized controlled trail was conducted in eight residential LTC facilities. The primary outcome, 'participants' overall and subdomain QoL', and the secondary outcome, 'meaning in life', were repeatedly assessed, including four time points: before, mid- and post-intervention, and at a 1-month follow-up. A generalized linear mixed model (GLMM) was used to assess between-group differences over time. The post-intervention differences indicated significant higher improvement on senior residents' overall and all 4 domains of QoL, as well as their meaning in life, between the baseline and both times of post-intervention and 1-month follow-up. On the other hand, participants' family QoL have improved immediately in the midst of intervention. This study provides preliminary evidence to support the feasibility and effectiveness of an 8-week BPS-S group therapy. We recommend the BPS-S be integrated into routine institutional care activities to help maximize senior residents' own capacity for self-healing, achieve a state of harmonious balance between body, mind, social and spiritual relationships; and in turn, enhance holistic health of this group.

Increasing serum iron levels and their role in the risk of infectious diseases: a Mendelian randomization approach.

OBJECTIVES: Increased iron stores have been associated with elevated risks of different infectious diseases, suggesting that iron supplementation may increase the risk of infections. However, these associations may be biased by confounding or reverse causation. This is important, since up to 19% of the population takes iron supplementation. We used Mendelian randomization (MR) to bypass these biases and estimate the causal effect of iron on infections. METHODS: As instrumental variables, we used genetic variants associated with iron biomarkers in two genome-wide association studies (GWASs) of European ancestry participants. For outcomes, we used GWAS results from the UK Biobank, FinnGen, the COVID-19 Host Genetics Initiative or 23andMe, for seven infection phenotypes: 'any infections', combined, COVID-19 hospitalization, candidiasis, pneumonia, sepsis, skin and soft tissue infection (SSTI) and urinary tract infection (UTI). RESULTS: Most of our analyses showed increasing iron (measured by its biomarkers) was associated with only modest changes in the odds of infectious outcomes, with all 95% odds ratios confidence intervals within the 0.88 to 1.26 range. However, for the three predominantly bacterial infections (sepsis, SSTI, UTI), at least one analysis showed a nominally elevated risk with increased iron stores (P <0.05). CONCLUSION: Using MR, we did not observe an increase in risk of most infectious diseases with increases in iron stores. However for bacterial infections, higher iron stores may increase odds of infections. Hence, using genetic variation in iron pathways as a proxy for iron supplementation, iron supplements are likely safe on a population level, but we should continue the current practice of conservative iron supplementation during bacterial infections or in those at high risk of developing them.

Frequency of nurse-provided spiritual care: An international comparison.

AIMS AND OBJECTIVES: To compare the frequency of nurse-provided spiritual care across diverse cultures. BACKGROUND: Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement. DESIGN: This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument. METHODS: Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n = 4062). STROBE guidelines for cross-sectional observational studies were observed. RESULTS: Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics. CONCLUSIONS: In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care. RELEVANCE TO CLINICAL PRACTICE: Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.

Health Effects of Calcium: Evidence From Mendelian Randomization Studies.

Calcium is widely used in conjunction with vitamin D to prevent osteoporosis. The use of calcium supplementation is also promoted for its potential benefits in lowering the risk for metabolic syndromes and cancers. However, the causal link between calcium and various health outcomes remains unclear. This review focuses on the evidence from 24 Mendelian randomization (MR) studies that were designed to minimize bias from confounding and reverse causation. These MR studies evaluated the effect of lifelong genetically higher serum calcium levels on various health outcomes. Overall, available MR studies found no conclusive effects of serum calcium levels on bone mineral density and fracture, ischemic stroke and heart failure, cancers, type 2 diabetes, Parkinson disease, or offspring birth weight. However, a higher serum calcium concentration was reported to have estimated causal effects on increased risks for coronary artery disease (especially myocardial infarction), migraine, renal colic, allergy/adverse effect of penicillin, and reduced risks for osteoarthrosis and osteoarthritis. In conclusion, supplementation of calcium in individuals from the general population is not predicted to influence the risk of most investigated diseases to date. Moreover, long-term high serum calcium concentrations may result in adverse health outcomes. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Vitamin D and COVID-19 susceptibility and severity in the COVID-19 Host Genetics Initiative: A Mendelian randomization study.

BACKGROUND: Increased vitamin D levels, as reflected by 25-hydroxy vitamin D (25OHD) measurements, have been proposed to protect against COVID-19 based on in vitro, observational, and ecological studies. However, vitamin D levels are associated with many confounding variables, and thus associations described to date may not be causal. Vitamin D Mendelian randomization (MR) studies have provided results that are concordant with large-scale vitamin D randomized trials. Here, we used 2-sample MR to assess evidence supporting a causal effect of circulating 25OHD levels on COVID-19 susceptibility and severity. METHODS AND FINDINGS: Genetic variants strongly associated with 25OHD levels in a genome-wide association study (GWAS) of 443,734 participants of European ancestry (including 401,460 from the UK Biobank) were used as instrumental variables. GWASs of COVID-19 susceptibility, hospitalization, and severe disease from the COVID-19 Host Genetics Initiative were used as outcome GWASs. These included up to 14,134 individuals with COVID-19, and up to 1,284,876 without COVID-19, from up to 11 countries. SARS-CoV-2 positivity was determined by laboratory testing or medical chart review. Population controls without COVID-19 were also included in the control groups for all outcomes, including hospitalization and severe disease. Analyses were restricted to individuals of European descent when possible. Using inverse-weighted MR, genetically increased 25OHD levels by 1 standard deviation on the logarithmic scale had no significant association with COVID-19 susceptibility (odds ratio [OR] = 0.95; 95% CI 0.84, 1.08; p = 0.44), hospitalization (OR = 1.09; 95% CI: 0.89, 1.33; p = 0.41), and severe disease (OR = 0.97; 95% CI: 0.77, 1.22; p = 0.77). We used an additional 6 meta-analytic methods, as well as conducting sensitivity analyses after removal of variants at risk of horizontal pleiotropy, and obtained similar results. These results may be limited by weak instrument bias in some analyses. Further, our results do not apply to individuals with vitamin D deficiency. CONCLUSIONS: In this 2-sample MR study, we did not observe evidence to support an association between 25OHD levels and COVID-19 susceptibility, severity, or hospitalization. Hence, vitamin D supplementation as a means of protecting against worsened COVID-19 outcomes is not supported by genetic evidence. Other therapeutic or preventative avenues should be given higher priority for COVID-19 randomized controlled trials.

Factors influencing the self-perceived competencies in spiritual care of nurses in the long-term care facilities.

AIMS: To identify key factors influencing institutional nurses' self-perceived competencies in spiritual care. BACKGROUND: In the past decade, interest in spiritual care has been increasing; however, in long-term care facilities, limited knowledge is available about nurses' competencies in spiritual care. METHODS: The cross-sectional study was conducted with 202 nurses in 11 long-term care facilities. Data were collected in a survey using the Spirituality and Spiritual Care Rating Scale, the Nurse Spiritual Care Therapeutics Scale, the Spiritual Care Competence Scale and demographic questions. Data were analysed using stepwise linear regression. RESULTS: Study findings revealed that nurses' perceptions of spirituality and spiritual care, frequency of spiritual care provision and self-satisfaction with the spiritual care given all significantly predicted overall spiritual care competence, which together explain 58% of the total variance. CONCLUSIONS: Improving nurses' perceptions of spirituality and spiritual care and encouraging the performance of spiritual care may be an effective pathway to enhance the spiritual care competence of institutional nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Additional continuing education on spiritual care topics and the establishment of clear guidance and support from institutional administrators are required to enable nurses to deal with spiritual issues as they arise and improve the quality of holistic care.

The Relationship of Physiopsychosocial Factors and Spiritual Well-Being in Elderly Residents: Implications for Evidence-Based Practice.

BACKGROUND: Older adults in residential settings frequently suffer from functional decline, mental illness, and social isolation, which make them more vulnerable to spiritual distress. However, empirical evidence of the interrelationships between physiopsychosocial variables and spiritual well-being are still lacking, limiting the application of the biopsychosocial-spiritual model in institutional healthcare practice. AIMS: To explain the mechanisms by which these variables are linked, this cross-sectional study tested a causal model of predictors of spiritual well-being among 377 institutionalized older adults with disability using a structural equation modeling approach. METHODS: The primary variables in the hypothesized model were measured using the Barthel Index for functional ability, the Geriatric Depression Scale-short form for depression, the Personal Resources Questionnaire 85-Part 2 for perceived social support, and the Spiritual Well-Being Scale for spiritual well-being. RESULTS: The model fit indices suggest that the hypothesized model had a reasonably adequate model fit (χ2 = 12.18, df = 6, p = .07, goodness-of-fitness index [GFI] = 0.99, adjusted GIF index [AGFI] = 0.93, nonnormed fit index [NFI] = 0.99, comparative fit index [CFI] = 0.99). In this study, perceived social support and depression directly affected spiritual well-being, and functional ability indirectly affected spiritual well-being via perceived social support or depression. In addition, functional ability influenced perceived social support directly, which in turn influenced depression and ultimately influenced spiritual well-being. DISCUSSION: This study results confirm the effect of physiopsychosocial factors on institutionalized older adults' spiritual well-being. However, the presence and level of functional disability do not necessarily influence spiritual well-being in late life unless it is disruptive to social relationships and is thus bound to lead to low perceived social support and the onset of depression. LINKING EVIDENCE TO ACTION: The findings address the fact that the practice of spirituality is multidimensional and multileveled. Psychosocial interventions for institutionalized elders with disabilities should focus on increasing nurse-patient interaction and providing access to meaningful social activities to improve mental health and spiritual well-being.

Predictors of Adherence to Relaxation Guided Imagery During Pregnancy in Women with Preterm Labor.

OBJECTIVES: To examine adherence to relaxation guided imagery in women experiencing preterm labor as well as predictors influencing adherence. METHODS: This study used a longitudinal follow-up approach. Each of the 57 participating women received a mini-MP3 player containing a 13-minute relaxation guided imagery audio program that they were instructed to follow daily until giving birth. Follow-up interviews were conducted weekly. A generalized estimating equation was used to predict adherence. RESULTS: The total adherence rate was 58%. Higher adherence was predicted by the presence of at least a college degree (p=0.006), greater perceived stress (p=0.006), a higher risk of preterm delivery (p<0.001), and greater relaxation effects (p=0.028). Older maternal age was associated with lower adherence (p=0.001). In addition, adherence decreased significantly over time (p<0.001). Adherence was not related to marital status, employment, parity, the baseline level of anxiety, or hospitalization. CONCLUSIONS: Pregnant women with a high risk for preterm birth and greater perceived stress showed higher adherence to relaxation guided imagery. For women with a lower adherence to relaxation guided imagery, health care professionals may consider individual preferences regarding relaxation techniques.