Nurses' Descriptions of Interdisciplinary Interactions in Stroke and Geriatric Rehabilitation Units: A Case Example of the Registered Practical Nurse.

AIM: To analyse how nurses describe their interactions with other interdisciplinary team members within stroke and geriatric rehabilitation. DESIGN: A secondary analysis of cross-sectional ethnographic interview data was conducted using Elo and Kyngäs' (2008) deductive content analysis. METHODS: Between April 12 and July 25, 2022, semi-structured interviews were conducted with 31 registered practical nurses recruited through convenience sampling from three tertiary hospital sites in Southwestern Ontario. Interview transcripts were reviewed to identify described interactions between nurses and interdisciplinary team members and were coded for: who were the interdisciplinary team member(s) involved; what content was addressed; and where, when, and why the interaction occurred. RESULTS: Categories representing how nurses describe their interactions with interdisciplinary team members were as follows: (1) arising from the unique roles owned by either the nurse or interdisciplinary team member(s); (2) requiring open communication to achieve patient goals and improve patient care; (3) occurring within what is perceived to be either the therapists' or nurses' physical space; and (4) contributing to supportive team environments that are mutually beneficial. CONCLUSIONS: While nurses view other interdisciplinary team members as 'owning' certain roles and physical spaces within rehabilitation, they also recognised their 'owned' spaces and roles. Unique contributions of all team members were valued as necessary to provide holistic, person-centred patient care and positive team-based support. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses' descriptions of their interactions with interdisciplinary team members demonstrated their essential contributions to team-based patient care and acknowledged nurse contributions to the rehabilitation process for patients. IMPACT: Findings elucidate the nature of interprofessional interactions and 'ownership' within the rehabilitation process. Results are beneficial for policymakers, educators, and healthcare organisations aiming to optimise the nursing role within rehabilitation spaces. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Integrated Health Education Programmes With Physical Activity Among Community-Dwelling Older Adults at Risk of Atherosclerotic Cardiovascular Disease: An Integrative Review of Experimental Studies.

AIMS: To examine the effects of integrated health education programmes with physical activity among community-dwelling older adults at risk of atherosclerotic cardiovascular disease (ASCVD). DESIGN: Integrative review. DATA SOURCES: A systematic search of experimental studies was conducted in six electronic databases and one registry from inception to December 2022. METHODS: Two researchers independently conducted the eligibility screening, quality appraisal and data extraction. A total of 11 studies, which were published between 1996 and 2021, were included in the review and were analysed by narrative synthesis. RESULTS: The 11 included studies involved 1973 participants. The findings indicate that integrated health education programmes with physical activity have potential benefit in short-term weight management among community-dwelling older adults at risk of ASCVD. Nevertheless, the programmes appear ineffective on body mass index, short-term lipid profiles, diastolic blood pressure (BP) and blood glucose. Further investigation is recommended to confirm the programme effects on physical activity level, exercise self-efficacy, systolic BP, waist circumference, long-term lipid profiles, long-term weight management and cardiac endurance. The findings suggest that body mass index may not be a sensitive indicator of obesity in the elderly population and should be measured along with waist circumference to better predict the risk of ASCVD. The available evidence is restricted in its robustness and generalisability. As most included studies were conducted in the United States, more studies should be implemented in other countries to enhance study generalisability. CONCLUSIONS: The effects of integrated health education programmes with physical activity among community-dwelling older adults at risk of ASCVD remain inconclusive. Further research with adequate statistical power and good methodology is warranted. IMPACT: The findings provide insights into whether health education programmes with physical activity effectively improve various outcomes, and suggest that researchers should include exercise self-efficacy and cardiac endurance in future studies. REPORTING METHOD: Adhered to PRISMA reporting guidelines. NO PATIENT OR PUBLIC CONTRIBUTION: This review was conducted without patient or public participation.

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study.

BACKGROUND: Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies. METHODS: Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach. RESULTS: Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies. CONCLUSION: Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

Effectiveness of the Bivalent mRNA COVID-19 Vaccine for Preventing Critical Infection From the SARS-CoV-2 Omicron Variant in the Republic of Korea.

BACKGROUND: This retrospective observational matched cohort study assessed the differences in critical infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the omicron-predominant period of the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the vaccine effectiveness of bivalent mRNA vaccine compared to unvaccinated individuals. METHODS: We collected COVID-19 case data from the Korean COVID-19 vaccine effectiveness cohort. We calculated the probability of critical COVID-19 cases by comparing the vaccinated and unvaccinated groups. RESULTS: The risk of being critically infected due to SAR-CoV-2 infection was 5.96 times higher (95% confidence interval, 5.63-6.38) among older individuals who were unvaccinated compared to those who received the bivalent COVID-19 vaccine. CONCLUSION: Our findings indicate that the bivalent vaccine reduces the disease burden of the SARS-CoV-2 omicron variant, particularly among the older population. Further studies are warranted to determine the effectiveness of booster doses of vaccines for SARS-CoV-2 infection.

Understanding Organizational Resilience of Care Homes for Older People During COVID-19 in China: A Qualitative Study with Post-Pandemic Policy Implications.

The COVID-19 pandemic presented unprecedented challenges for residential care homes for older people. However, the obstacles they faced and their resilience strategies have received insufficient research attention. This study, focusing on 13 residential care homes in Southeast China, addressed this research gap. The homes were visited between February and March 2023; 38 staff members (managers, nurses, social workers, and care workers) were interviewed. Thematic analysis revealed that the homes faced multidimensional challenges, including infection risks, declining mental health among residents, heavy workloads, and financial difficulties. Despite these challenges, they exhibited organizational resilience, primarily in their ability to cope with immediate issues during the pandemic, although their capacity to anticipate and adapt was weak. Factors influencing organizational resilience included their knowledge base, critical resources, a stable team with high morale and motivation, better integration of healthcare services, and government anti-COVID policies. This research highlights valuable insights for improving the quality of care in residential care homes in the post-pandemic era and in aiding policymakers and administrators in strengthening the organizational resilience of residential care homes in future crises.

The Evolving Role of Palliative Care in older people with Glioblastoma.

Glioblastoma (GBM) is the most common and aggressive primary brain tumor in older adults and has a poor prognosis and limited response to treatment. The growing impact of palliative care on older people undergoing neurosurgery is becoming increasingly important. Palliative care aims to improve the quality of life for people and their families by addressing their physical, psychosocial, and spiritual needs. The prevalence of GBM peaks between 65 and 84 years of age and treatment options may be hindered by chronic multiple conditions in older people. Older people are at risk of receiving suboptimal end-of-life care due to factors such as a focus on curative medicine, acceptance of terminal illness, which may discourage the person, and lack of awareness of palliative care for people with a non-cancer diagnosis. People with GBM experience a significant illness burden, including neurological symptoms, mood disturbances, and cognitive impairment. A multidisciplinary approach, including palliative care, is recommended to improve treatment outcomes and quality of life. However, palliative care is often not consistently included in multidisciplinary teams despite the lack of curative treatment options and significant symptom burden. The palliative care needs of people with GBM can be complex, and published evidence in this area is limited. Nonetheless, there are similarities between the needs of people with GBM and those with other, more common cancer diagnoses and nonmalignant chronic neurologic illnesses. The integration of palliative care into the management of older people with GBM during neurosurgery is crucial for addressing their unique needs and improving their quality of life. In this review, we aimed to comprehensively evaluate the impact of palliative care on people with GBM and its importance.

Geriatric medicine and Olympic elite sports-parallels and philosophies.

The 30th Olympiad took place in July 2024. At first glance, sports science and training of elite athletes may appear to be of little relevance to geriatric medicine. However, there are important parallels between the practice of geriatric medicine and elite sports and lessons that we can learn from our sports science colleagues. Elite athletes and older people are operating at the margins of physiological capacity. Both benefit from tailored, scientifically informed training programmes delivered and monitored by a multidisciplinary team. There are parallels between the comprehensive geriatric assessment and the philosophy of marginal gains pioneered by British Cycling. Insights into the biology of skeletal muscle function are beginning to translate into the development of clinical interventions and substances that offer an unfair advantage in sport by improving muscle strength and physical performance may be of therapeutic benefit in sarcopenia. The 2024 Olympics provide an opportunity for us to learn lessons for excellence in our research and provide an opportunity to promote exercise across the life course-important for healthy ageing.

Intersection between person-centred practice and Montessori for dementia and ageing in residential aged care.

BACKGROUND: Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC. METHODS: This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied. RESULTS: Findings provide support for the intersection between PCC and Montessori with participants' descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents' strengths/abilities, maintaining function, using familiar objects, and guided repetition. CONCLUSIONS: Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC.

Care trajectories and transitions at the end of life: a population-based cohort study.

BACKGROUND: End-of-life periods are often characterised by suboptimal healthcare use (HCU) patterns in persons aged 65 years and older, with negative effects on health and quality of life. Understanding care trajectories (CTs) and transitions in this period can highlight potential areas of improvement, a subject yet only little studied. OBJECTIVE: To propose a typology of CTs, including care transitions, for older individuals in the 2 years preceding death. DESIGN: Retrospective cohort study. METHODS: We used multidimensional state sequence analysis and data from the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between a Canadian health survey and Quebec health administrative data. RESULTS: In total, 2080 decedents were categorised into five CT groups. Group 1 demonstrated low HCU until the last few months, whilst group 2 showed low HCU over the first year, followed by a steady increase. A gradual increase over the 2 years was observed for groups 3 and 4, though more pronounced towards the end for group 3. A persistent high HCU was observed for group 5. Groups 2 and 4 had higher proportions of cancer diagnoses and palliative care, as opposed to comorbidities and dementia for groups 3 and 5. Overall, 68.4% of individuals died in a hospital, whilst 27% received palliative care there. Care transitions increased rapidly towards the end, most notably in the last 2 weeks. CONCLUSION: This study provides an understanding of the variability of CTs in the last two years of life, including place of death, a critical step towards quality improvement.

Person-focused interventions for fall risk assessment, fall prevention and fall injury prevention in long-term care facilities: a scoping review.

OBJECTIVE: Falls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries can result in functional impairment, disability and death. Older adults living in LTCFs are at greater risk for falls than those in the community. Using scoping review methodology, we aimed to synthesise evidence examining intervention effects of person-focused interventions for risk assessment and prevention in LTCFs in order to identify evidence-based practices in LTCFs. METHODS: We included three databases (Ovid-Medline, CINAHL and EMBASE) to identify original research from 2007 to 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. From the initial search, we identified 988 articles. Following the removal of duplicates, title and abstract screening, and full-text review against inclusion/exclusion criteria, 20 studies remained for analysis. Then, we conducted a narrative synthesis to summarise the included studies. RESULTS: Identified evidence-based interventions for fall prevention include (1) exercise programmes (eg, high-intensity functional exercise, aerobic exercise, short stick exercises, etc); (2) multifactorial programmes; and (3) other interventions (eg, lavender olfactory stimulation). Outcomes of included studies included the number of falls, fall rate, risk of falls and fear of falls before and after interventions. CONCLUSION: Overall, most studies reported significant effects of person-focused interventions in LTCFs. Available evidence supports that well-designed person-focused interventions can reduce falls and fear of falls for individuals in LTCFs.

Association between different patterns of social participation and loneliness among the Chinese older people: is there a local-migrant gap?

BACKGROUND: Little empirical evidences were provided on the disparity in the level of loneliness between the migrant older with children (MOC) and their local counterpart in China. This study aimed to explore the association between social participation and loneliness and verify whether there was a local-migrant difference in this association. METHODS: A total of 1332 older people (60 +) were included in this study with 656 MOC and 676 natives. Loneliness was assessed by the University of California Los Angeles Loneliness Scale with eight items (ULS-8). Social participation was evaluated by three kinds of social activities concerning sports activities, hobby activities and community resident interaction. Univariate analysis was conducted to compare the local-migrant disparity as well as the level of loneliness between different subgroups. Hierarchical multiple linear regression analysis was used to examine the proposed relationship and the moderating influence of migration status. RESULTS: The average ULS-8 scores were 11.73 ± 4.02 for local subjects and 12.82 ± 4.05 for MOC respectively, indicating a lower level of loneliness among local older people. Participating in hobby activities (ß = -0.092, P = 0.003) and interacting with residents (ß = -0.216, P = 0.001) more frequently were related to lower level of loneliness while participating in square dancing was related to higher level of loneliness (ß = 0.087, P = 0.001). The negative relationships between hobby activities as well as resident interaction and loneliness were more profound in migrants than natives. CONCLUSIONS: Only two types of social participation could help alleviate loneliness. More attention to older migrants' loneliness and extending the scale and types of social activities were recommended for policymakers.

The temporal sequence and reciprocal relationships of frailty, social isolation and loneliness in older adults across 21 years.

BACKGROUND: It is unclear whether social isolation and loneliness may precede frailty status or whether frailty may precipitate social isolation and loneliness. We investigated the reciprocal and temporal sequence of social isolation, loneliness, and frailty among older adults across 21 years. METHODS: We used seven waves of the Longitudinal Aging Study Amsterdam from 2302 Dutch older adults (M = 72.6 years, SD = 8.6, 52.1% female) ages 55 or older. Using random intercept cross-lagged panel models, we investigated between- and within-person associations of social isolation and loneliness with frailty. Frailty was measured using the Frailty Index. Loneliness was measured using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was measured using a multi-domain 6-item scale. RESULTS: Social isolation and loneliness were weakly correlated across waves. At the between-person level, individuals with higher levels of frailty tended to have higher levels of social isolation but not loneliness. At the within-person level, the cross-lagged paths indicated that earlier frailty status predicted future social isolation and loneliness over time. However, prior social isolation was not associated with subsequent frailty except at time point 5 (T5). Loneliness at specific time points (T1, T4 and T6) predicted greater frailty at later time points (T2, T5 and T7). The results also supported reciprocal and contemporaneous relations between social isolation, loneliness and frailty. CONCLUSIONS: Social isolation and loneliness are potential outcomes of frailty. Public health policies and health practitioners should prioritise interventions targeting social connection among older adults with pre-frailty or frailty.

Influence of intergenerational social mobility on brain structure and global cognition: findings from the Whitehall II study across 20 years.

BACKGROUND: Whether changes in socioeconomic position (SEP) across generations, i.e. intergenerational social mobility, influence brain degeneration and cognition in later life is unclear. OBJECTIVE: To examine the association of social mobility, brain grey matter structure and global cognition. METHODS: We analysed T1 brain MRI data of 771 old adults (69.8 ± 5.2 years) from the Whitehall II MRI substudy, with MRI data collected between 2012 and 2016. Social mobility was defined by SEP changes from their fathers' generation to mid-life status. Brain structural outcomes include grey matter (GM) volume and cortical thickness (CT) covering whole brain. Global cognition was measured by the Mini Mental State Examination. We firstly conducted analysis of covariance to identify regional difference of GM volume and cortical thickness across stable high/low and upward/downward mobility groups, followed with diagonal reference models studying the relationship between mobility and brain cognitive outcomes, apart from SEP origin and destination. We additionally conducted linear mixed models to check mobility interaction over time, where global cognition was derived from three phases across 2002 to 2017. RESULTS: Social mobility related to 48 out of the 136 GM volume regions and 4 out of the 68 CT regions. Declined volume was particularly seen in response to downward mobility, whereas no independent association of mobility with global cognition was observed. CONCLUSION: Despite no strong evidence supporting direct influence of mobility on global cognition in later life, imaging findings warranted a severe level of neurodegeneration due to downward mobility from their father's generation.

Propensity score matching analysis of early vs. delayed surgery for intertrochanteric fracture in older patients: a retrospective multicenter cohort study of 7414 patients with a mean 4-year follow up.

BACKGROUND: The widespread acceptance of early surgery as a treatment for acute intertrochanteric fracture (ITF) has been accompanied by ongoing controversy due to conflicting conclusions presented in previous studies. This study aims to compare the occurrence of perioperative complications and mortality, as well as functional outcomes in older patients with ITF who underwent either early or delayed surgery. METHODS: A retrospective multicenter cohort study involving 7414 patients with ITF between Jan. 2017 and Dec. 2021 was conducted. After predefined participants selection inclusion and exclusion criteria, 2323 surgically treated ITF patients were included and analyzed utilizing propensity score matching (PSM) method. Their demographics, injury-related data, surgery-related data, and perioperative adverse outcomes during hospitalization were collected and compared between the early or delayed surgery groups by PSM with a 1:4 ratio. All participants received a minimum of two-year follow-up and perioperative outcomes, functional outcomes, and survival analyses were conducted and compared. RESULTS: After adjustment for potential confounders, there were no significant difference in surgery duration, intraoperative blood loss, transfusion rate, mortality rates, functional outcomes, and perioperative complications rates including severe complications, cardiac complications, pulmonary complications, and neurological complications regardless of whether the patient was treated with early or delayed surgery (all P > 0.05). Although length of hospital stay (mean, 11.5 versus 14.4 days, P < 0.001), total hospital costs (mean, 39305 versus 42048 yuan, P < 0.001), and minor complications rates including hematological complications (31.7% versus 41.2%, P = 0.007) and nutritional/metabolic complications (59.3% versus 66.4%, P = 0.039) were lower in the early surgery group, our result indicated patients with early surgery were more inclined to receive more blood transfusion (mean, 2.8 versus 2.2 units, P = 0.004). CONCLUSIONS: Our findings suggest that a 48-hour delay in surgical intervention for older patients with an ITF does not result in a higher mortality rate, worse functional outcomes, and increased incidence of major perioperative complications when compared to early surgery. While expedited surgery is undoubtedly necessary for suitable patients, a reasonable preoperative delay of 48 h may be justified and safe for those with severe conditions, rather than strictly adhering to the current guidelines.

Cohort comparison of vision and hearing in 75- and 80-year-old men and women born 28 years apart.

PURPOSE: We compared the vision and hearing of older men and women born 28 years apart. In addition, we explored factors explaining the possible cohort differences. METHODS: Two independent cohorts of 75- and 80-year-old men and women were assessed as a part of the Evergreen study in 1989-1990 (n = 500) and the Evergreen II study in 2017-2018 (n = 726). Studies were conducted with similar protocols, and differences between cohorts were compared for distance visual acuity and hearing acuity. We also studied whether educational level and health factors (i.e. total cholesterol, blood pressure, BMI, and smoking status) underlie the possible cohort differences. Independent samples t-test, Pearson chi-squared test, and linear regression analyses were used as statistical analyses. RESULTS: Across age and sex groups, the later-born cohort had better visual acuity and a lower prevalence of visual impairment compared to the earlier-born cohort. In hearing, 75-year-old men in the later-born cohort had better hearing acuity, with average hearing level at 32 dB compared to 36 dB in the earlier-born cohort, and 80-year-old men had a lower prevalence of moderate or worse hearing loss (74 % vs. 54 %) than men in the earlier-born cohort. Similar differences were not observed for women. The cohort differences in distance visual acuity and hearing acuity attenuated when adjusting for education level. CONCLUSIONS: Today older adults retain better vision longer than before, but cohort differences in hearing are less obvious. Differences between cohorts may be partly due to advances in education.

Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Randomized Controlled Trial.

Background: As dementia progresses, patients exhibit various psychological and behavioral symptoms, imposing a significant burden on families and society, including behavioral and psychological symptoms of dementia. However, caregivers lack professional care knowledge and skills, making it difficult for them to effectively cope with the diverse challenges of caregiving. Therefore, it is necessary to provide caregivers with professional knowledge and skills guidance. Objective: This study aimed to analyze the impact of internet-based training on behavioral and psychological symptoms of dementia in patients, and explore how this training model affects the caregiving abilities and caregiving burden of the family caregivers of patients with dementia. Methods: Using a consecutive enrollment method, the Department of Geriatrics at Zhejiang Hospital (Zhejiang, China) recruited 72 informal caregivers of patients with dementia. These caregivers were randomly divided into an intervention group and a control group, with 36 participants in each group. The intervention group underwent caregiver skill training via a web-based platform, whereas the control group initially received face-to-face follow-up guidance and was subsequently offered web-based training after 6 months. To assess the effectiveness of the intervention program, we used the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Chinese version of the Zarit Burden Interview (CZBI), and the Sense of Competence in Dementia Care Staff Scale (SCIDS) for evaluations conducted before the intervention, 3 months after the intervention, and 6 months after the intervention. Results: Between July 2019 and December 2020, a total of 66 patients successfully completed the intervention and follow-up. After 6 months of intervention, the NPI-Q score of the intervention group was 3.18 (SD 3.81), the CZBI score was 10.97 (SD 5.43), and the SCIDS score was 71.88 (SD 4.78). The NPI-Q score of the control group was 8.09 (SD 8.52), the CZBI score was 30.30 (SD 13.05), and the SCIDS score was 50.12 (SD 9.10). There were statistically significant differences in NPI-Q (P=.004), CZBI (P<.001), and SCIDS scores (P<.001) between the intervention group and the control group. Repeated measures analysis of variance showed that compared with before the intervention, there were statistically significant differences in CZBI (P<.001) and SCIDS (P<.001) scores 3 months after the intervention, while the difference in NPI-Q (P=.11) scores was not significant. The total scores of NPI-Q (P<.001), CZBI (P<.001), and SCIDS (P<.001) were significantly improved 6 months after the intervention. In addition, the results of the covariance analysis showed that after excluding the time effect, the web-based training intervention significantly reduced the NPI-Q score (-2.79, 95% CI -4.38 to -1.19; P<.001) of patients with dementia and the CZBI score (-13.52, 95% CI -15.87 to -11.16; P<.001) of caregivers, while increasing the SCIDS score (12.24, 95% CI 9.02-15.47; P<.001). Conclusions: Internet-based training could significantly reduce the level of behavioral symptoms in older patients with dementia and alleviate the burden on caregivers, enhancing their caregiving abilities. Our results confirmed the effectiveness and feasibility of web-based training, which was of great significance in providing caregiving knowledge training for informal caregivers of persons with dementia.

Older Adults' Acceptance of a Virtual Reality Group Intervention in Nursing Homes: Pre-Post Study Under Naturalistic Conditions.

Background: Virtual reality (VR) group activities can act as interventions against inactivity and lack of meaningful activities in nursing homes. The acceptance of VR among older adults has been explored from different perspectives. However, research on the impact of older adults' individual characteristics on the acceptance of VR group activities in nursing homes is necessary. Objective: This study investigates the impact of individual characteristics (eg, psychosocial capacities) on VR acceptance among older adults in nursing homes, as well as this group's perceptions of VR after participating in a VR intervention. Methods: In this pre-post study conducted in nursing homes, we applied a VR group intervention with 113 older adult participants. These participants were categorized into two groups based on their naturalistic choice to join the intervention: a higher VR acceptance group (n=90) and a lower VR acceptance group (n=23). We compared the two groups with respect to their sociodemographic characteristics, psychosocial capacities, and attitudes toward new technologies. Additionally, we examined the participants' perceptions of VR. Results: The results show that those with lower acceptance of VR initially reported higher capacities in organizing daily activities and stronger interpersonal relationships compared to older adults with higher VR acceptance. The VR group activity might hold limited significance for the latter group, but it offers the chance to activate older adults with lower proactivity. Openness to new technology was associated with a favorable perception of VR. After the VR intervention, the acceptance of VR remained high. Conclusions: This study investigates the acceptance of VR group events as meaningful activities for older adults in nursing homes under naturalistic conditions. The results indicate that the VR group intervention effectively addressed low proactivity and interpersonal relationship issues among older adults in nursing homes. Older adults should be encouraged to experience VR if the opportunity to participate is offered, potentially facilitated by caregivers or trusted individuals.

Knowledge of aging, attitudes toward older people and willingness to engage in geriatric rehabilitation among rehabilitation students in southwestern China: a cross-sectional study.

BACKGROUND: As the global elderly population rises, providing quality care for older adults is increasingly challenging. Rehabilitation technicians are crucial in this effort. Their knowledge and attitudes significantly impact care quality and their willingness to work with the elderly. While many studies have examined healthcare professionals' attitudes toward older adults, few focus on rehabilitation students. This study assesses Chinese rehabilitation students' knowledge of aging, attitudes toward older individuals, willingness to care for them, and the factors influencing these aspects. METHODS: A sample of 890 rehabilitation students from three colleges and universities in southwestern China was investigated with a self-administered questionnaire, which included socio-demographic information, the Palmore Facts on Aging Quiz, the Kogan's Attitude towards Older People Scale and the Chinese Version of the Interpersonal Reactivity Index. Data analyses were conducted using SPSS version 25.0. Descriptive statistics were used to illustrate the demographic characteristics of the respondents. The frequency and percentage of responses was calculated. Means and standard deviations were computed for general knowledge of aging, attitudes toward older people, and empathy. Independent t-tests and one-way ANOVA assessed differences in FAQ, KAOP, and IRI-C scores between groups. Pearson's correlation examined correlations among general knowledge of aging, attitudes toward older people and empathy ability. Chi-square or Fisher's exact tests compared willingness to engage in geriatric rehabilitation across different respondent characteristics. Hierarchical multiple regression analysis explored the independent effect of different variables on attitudes toward older people. RESULTS: The Chinese rehabilitation students from three colleges and universities in southwestern China displayed a relatively low level of knowledge about aging, but a generally positive attitude towards older people. Females had significantly more positive attitudes toward older people than males(p<0.01). The students who had previous experience of being cared for by (maternal) grandparents, living with the elderly, and taking care of the elderly showed significantly more positive attitudes toward older people (p = 0.001, 0.007 and 0.007, respectively) and a significantly stronger willingness to engage in geriatric rehabilitation(p = 0.013, <0.01 and <0.01, respectively) than those who had not had these experiences. Students with good relationships with older people had more positive attitudes toward the elderly (p < 0.01) and greater willingness to engage in geriatric rehabilitation (p < 0.01). Those with frequent contact with the elderly also showed more positive attitudes (p < 0.01) and a stronger willingness to engage in geriatric rehabilitation (p = 0.002) compared to those with less contact. Knowledge of aging and empathy ability were both significantly positively related to attitudes toward older people and both independent predictors of attitudes toward older people(r = 0.143, p<0.01 and r = 0.337, p<0.01). CONCLUSIONS: It is crucial to prepare rehabilitation students with adequate knowledge and positive attitudes to ensure the quality of rehabilitation and care provided to older people. Educators should adopt effective strategies to promote rehabilitation students' geriatric rehabilitation knowledge and increase their positive attitudes toward older people.

Effectiveness of Integrated Care for Older Pepole (ICOPE) in Improving Intrinsic Capacity in Older Adults: A Systematic Review and Meta-Analysis.

OBJECTIVE: Conduct a systematic review of existing studies on intrinsic capacity (IC) and a meta-analysis of studies to assess the overall effectiveness of ICOPE in improving IC in older adults. METHODS: Ten databases were systematically searched from inception to November 8, 2023, and the search was last updated on January 2, 2024. Randomised controlled trials (RCTs) were included. The main outcomes were IC (cognition, psychological, sensory, vitality and locomotion). RESULTS: The results showed ICOPE had a significant effect in improving cognitive function (SMD = 0.36; 95% CI, 0.17 to 0.56, p < 0.001, 12 RCTs, 7926 participants) and depressive symptoms (SMD = -0.70; 95% CI, -0.96 to -0.43, p < 0.001, 26 RCTs, 11,034 participants), but there was no statistically significant difference in improving locomotion (SMD = 0.16; 95% CI, -0.03 to 0.34, p = 0.098, 3 RCTs, 1580 participants). Meta-regression analysis shows that intervention duration should be paid attention to when the source of heterogeneity is discussed on the cognition. CONCLUSION: The results suggest that ICOPE may be a potentially effective approach to help improve the IC in older adults, showing significant potential for improving cognitive function and reducing depressive symptoms in particular. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: ICOPE is expected to provide effective strategies to enhance issues such as IC and may be an innovative way to improve the overall health of older adults. This result provides strong support for geriatric nursing practice and encourages the adoption of ICOPE as a viable nursing approach to promote healthy ageing.

Telomere length and 4-year changes in cognitive function in an older Mediterranean population at high risk of cardiovascular disease.

BACKGROUND: Cognitive decline, a common process of brain ageing, has been associated with telomere length (TL). Delving into the identification of reliable biomarkers of brain ageing is essential to prevent accelerated cognitive impairment. METHODS: We selected 317 non-smoking 'Prevención con Dieta Mediterránea-Plus' (PREDIMED-Plus) participants (mean age, 65.8 ± 5.0 years) with metabolic syndrome from two trial centres who were following a lifestyle intervention. We measured TL and cognitive function at baseline and after 3 and 4 years of follow-up, respectively. Associations between baseline or 3-year changes in TL and baseline or 4-year changes in cognitive function were analysed using multivariable regression models. RESULTS: Baseline TL was not associated with baseline cognitive performance. Nevertheless, longer baseline TL was associated with improved 4-year changes in the Executive Function domain (ß: 0.29; 95%CI: 0.12 to 0.44; P < 0.001) and the Global Cognitive Function domain (ß: 0.19; 95%CI: 0.05 to 0.34; P = 0.010). Besides, a positive association was found between longer baseline TL and improved 4-year changes in the animal version of the Verbal Fluency Test (ß: 0.33; 95%CI: 0.12 to 0.52; P = 0.002). By contrast, 3-year changes in TL were not associated with changes in cognitive function after 4 years. CONCLUSIONS: Longer baseline TL could protect from cognitive decline and be used as a useful biomarker of brain ageing function in an older Mediterranean population at risk of cardiovascular disease and cognitive impairment.