Efficacy of using telecare services for community-dwelling people with diabetes: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the glycated hemoglobin (HbA1c), blood pressure, self-efficacy, and quality of life efficacy of using telecare services for community-dwelling people with diabetes. METHODS: Cochrane Library, Web of Science, PsycINFO, PubMed, EMBASE, CINAHL, and Scopus databases were systematically searched from their inception dates to June 22, 2023. Two evaluators independently selected and evaluated eligible studies. A protocol was registered in PROSPERO. RESULTS: An analysis of 17 studies that included 3586 subjects showed that telecare significantly improved the management of patients with diabetes. Compared to controls, intervention care had significant benefits regarding HbA1c (MD = -0.30, 95 % CI = -0.44 - -0.17, 16 studies), systolic blood pressure (MD = -2.45, 95 % CI = -4.53 - -0.36, P = 0.02), self-efficacy (MD = 0.36, 95 % CI = 0.04 - 0.67, P = 0.03) and quality of life (MD = 0.37, 95 % CI = 0.05 - 0.70, P = 0.02). However, diastolic blood pressure (MD = -1.37, 95 % CI = -3.34 - -0.61, P = 0.17) was not found to be significantly affected. CONCLUSIONS: Telecare is effective in improving self-management among community-dwelling people with diabetes, suggesting an effective means for them to achieve self-management.

The effectiveness of brief reminiscence-based psychosocial interventions for cancer patients: A systematic review and meta-analysis.

AIM: To determine the effectiveness of brief reminiscence-based psychosocial interventions in alleviating psychological distress in cancer patients. BACKGROUND: Cancer patients suffer tremendous psycho-spiritual pain, which affects their quality of life. Brief reminiscence-based psychosocial interventions have demonstrated positive effects on the mental health of cancer patients; however, the efficacy of these interventions has been inconsistent. DESIGN: A systematic review and meta-analysis. METHODS: This review was conducted and reported in accordance with the PRISMA 2020 checklist provided by the EQUATOR network. The Cochrane Library, Web of Science, PsycINFO, PubMed, Embase, CINAHL and Scopus databases were systematically searched from inception to 27 November 2022 to identify randomised controlled trials (RCTs) published in English. RESULTS: Twenty studies involving 1744 cancer participants were included. The meta-analysis showed statistically significant effects of brief reminiscence-based psychosocial interventions on hope, anxiety and depression at post-intervention. A separate analysis revealed that brief reminiscence-based psychosocial interventions had a sustainable effect on hope, spiritual well-being, anxiety and depression at 1 month after the intervention. However, no statistically significant effect on quality of life was found in our study either immediately after the intervention or at 1 month. CONCLUSIONS: Brief reminiscence-based psychosocial interventions can significantly reduce anxiety and depressive symptoms and improve hope and spiritual well-being in cancer patients. RELEVANCE TO CLINICAL PRACTICE: This study further supports that brief reminiscence-based psychosocial interventions should be incorporated into the routine care of cancer patients to address their psychosocial distress. PATIENT OR PUBLIC CONTRIBUTION: All authors of this article contributed to the study conception and design. All authors of the included studies provided original data for this paper.

Comparative efficacy of various exercise interventions on depression in older adults with mild cognitive impairment: A systematic review and network meta-analysis.

BACKGROUND: Exercise is a promising nonpharmacological treatment for improving depression in older adults with MCI, but it is unclear which exercises are most effective. The objectives of this study were to compare and rank the effectiveness of various exercise interventions for depression in mild cognitive impairment (MCI) and to investigate the effects of exercise on depression. METHODS: The PRISMA-NMA guidelines were applied to the development and reporting of review criteria. The Cochrane Library, Web of Science, PsycINFO, PubMed, EMBASE, CINAHL, and Scopus databases were systematically searched by combining search terms for randomized controlled trial studies (RCTs) published in English from individual databases with the earliest available date set to March 10, 2023. Two evaluators independently selected and evaluated eligible studies of changes in depression in older adults with MCI after an exercise intervention. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42022377052). RESULTS: A network meta-analysis was conducted on 15 eligible RCTs consisting of 4271 subjects, including aerobic (n = 6), mind-body (n = 6) and multicomponent (n = 3) exercise trials. Compared to controls, mind-body exercise showed the strongest improvement in depressive symptoms (SMD = -0.63, 95% CI: -1.13, -0.14), followed by aerobic (SMD = -0.57, 95% CI: -0.88, -0.26) and multicomponent exercise (SMD = -0.53, 95% CI: -1.02, -0.03). Notably, there were no statistically significant differences between exercise types: aerobic vs. mind-body (SMD = 0.06, 95% PrI: -0.71, 0.84), multicomponent vs. mind-body (SMD = 0.11, 95% PrI: -0.75, 0.97), or multicomponent vs. aerobic (SMD = 0.04, 95% PrI: -0.771, 0.86). CONCLUSIONS: In this review, we found that mind-body exercise was most effective when compared to conventional controls and that multiple exercise modalities (aerobic, mind-body, and multicomponent exercise) had beneficial and comparable effects in reducing depressive states in older adults with MCI. These findings may guide clinical geriatric stakeholders and allied health professionals in providing more scientifically optimal exercise prescriptions for older adults with MCI. In the future, more high-quality, long-term clinical trials are needed to support the exploration of longer-term dynamic effects.

Virtual reality technology in the detection of mild cognitive impairment: A systematic review and meta-analysis.

BACKGROUND: In recent years, virtual reality technology has developed the potential to help in the early detection of mild cognitive impairment (MCI). However, integrative evidence of its detection performance for mild cognitive impairment is lacking, and meta-analysis or systematic reviews are required to further determine the effectiveness of virtual reality technology in screening for MCI. METHODS: Literature searches were performed for MCI screening tests in the Cochrane Library, Web of Science, PsycINFO, PubMed, EMBASE, CINAHL, and Scopus. The primary outcome was the performance of VR tests for MCI detection. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42022302139). RESULTS: A total of 14 studies in 13 reports were eventually included. The combined data with the bivariate random-effects model gave a summary point of 0.89 sensitivity (95 % confidence interval [CI]: 0.82-0.94) and 0.91 specificity (95 % CI: 0.82-0.96). The SROC curve was plotted, the DOR was 79.25 (95 % CI: 22.59-277.99), and the AUC was 0.95 (95 % CI: 0.93-0.97). CONCLUSIONS: Virtual reality-based tests have shown considerable detection performance in detecting MCI, and therefore, virtual reality-based tests can serve as recommended screening methods. Future studies can consider longitudinal assessment and follow-up programs to identify progressive changes.

Effects of virtual reality combined cognitive and physical interventions on cognitive function in older adults with mild cognitive impairment: A systematic review and meta-analysis.

OBJECTIVE: Combined cognitive and physical interventions based on virtual reality may help delay the progression of MCI to dementia or prevent dementia. However, their efficacy is less well studied compared to pharmaceutical treatments. The purpose of this review was to evaluate the effects of cognitive and physical interventions based on virtual reality on cognitive function (global cognition, memory or executive function/attention) of older adults with mild cognitive impairment. METHODS: We searched the PubMed, Web of Science, Scopus, Embase, Cochrane Library, PsycINFO, CINAHL and IEEE from inception to 13 May 2021. Only randomized controlled trials which incorporated virtual reality cognitive and physical components targeted to individuals with mild cognitive impairment were eligible. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation. RESULT: 7 randomized controlled trials were included in a total of 8 articles. No studies were rated as having a "high" risk of overall bias. The results of a meta-analysis showed that VR combined cognitive and physical interventions enhanced the global cognitive (MD = 2.66, 95% CI = 1.79-3.54, P = 0.03, I 2 = 68%) abilities of older adults with mild cognitive impairment. The meta-analysis indicated that after virtual reality combined cognitive and physical interventions, effects on memory (SMD = -0.03, 95% CI = -0.60 to 0.55, P = 0.78, I 2 = 0%) and executive function/attention (SMD = -0.19, 95% CI = -0.74 to 0.36, P = 0.09, I 2 = 53%) were not statistically significant. CONCLUSIONS: The present meta-analysis verifies the potential rehabilitative effects of virtual reality combined cognitive and physical interventions for older adults with mild cognitive impairment. More research is also needed to determine the optimal intensity and timing of interventions in the future.

Effectiveness of clown intervention for pain relief in children: A systematic review and meta-analysis.

BACKGROUND: Pain is common in children receiving medical procedures, and there is a lack of adequate awareness and management. In addition, children who undergo medical procedures involving pain may also experience stress, crying and prolonged hospitalisation. Clown intervention is a promising nonpharmacological intervention. However, studies on the effectiveness of clown intervention in pain management have reported conflicting findings. OBJECTIVE: To evaluate the effectiveness of clown intervention in relieving pain in children, as well as its effects on cortisol levels, crying duration and length of hospital stay. DESIGN: Systematic review and meta-analysis of randomised controlled studies. DATA SOURCES: PubMed, Web of Science (SCI), Embase, PsycINFO, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Weipu (VIP), Wanfang Data and SinoMed were systematically searched from inception date to December 31, 2020. REVIEW METHODS: Two reviewers independently used the Cochrane risk of bias tool to assess the risk of bias of the included studies. Meta-analysis was conducted when data were available, otherwise, a narrative description was provided. Data were analysed using Review Manager 5.3. The review process is reported according to PRISMA. RESULTS: Nine studies including 852 children met the inclusion criteria. The results showed that compared with standard care, clown intervention was beneficial for relieving pain. Further subgroup analysis showed that it was more effective with children aged 2-7 years. The duration of crying after the procedure and the length of stay were shortened, but there was no significant difference in cortisol levels. CONCLUSION: Clown intervention may be a promising way to relieve acute pain in children, especially those aged 2-7 years. It also seems to shorten the duration of crying and the length of hospital stays, but the effect on cortisol levels is still uncertain. More high-quality randomised controlled trials are needed to confirm these results and take into account different age groups, cultural backgrounds and specific populations.

The effect of combined cognitive intervention and physical exercise on cognitive function in older adults with mild cognitive impairment: a meta-analysis of randomized controlled trials.

BACKGROUND: The state of mild cognitive impairment (MCI) provides an optimal window for preventing progression to dementia. Combined cognitive intervention and physical exercise may yield additive and synergistic effects on cognition in older adults with MCI. OBJECTIVES: The purpose of this study was to assess the efficacy of a combined intervention to improve cognition in older adults with MCI by comparing a control group that underwent only cognitive intervention, a control group that underwent only physical exercise, and a control group that did not undergo cognitive intervention or physical exercise. DESIGN: Meta-analysis of randomized controlled trials (RCTs). DATA SOURCES: The online databases of PubMed, Web of Science, Embase, the Cochrane Library, PsycINFO, and CINAHL were systematically searched. REVIEW METHODS: The outcomes were global cognition, memory, and executive function/attention. A sensitivity analysis was conducted when the I2 statistic was > 50%. RESULTS: A total of 16 studies were included. The results showed that the combined intervention had positive effects on global cognition compared to the effects of the other control group [SMD = 0.27, 95% CI (0.09, 0.44), p = 0.003]. Regarding memory, the combined intervention had positive effects compared to the effects observed in the single physical exercise group [SMD = 0.25, 95% CI (0.07, 0.44), p = 0.006] and the other control group [SMD = 0.29, 95% CI (0.12, 0.47), p = 0.001]. For executive function/attention, the combined intervention had also positive effects compared to the effects of the single cognitive intervention group [SMD = 0.28, 95% CI (0.09, 0.47), p = 0.004], the single physical exercise group [SMD = 0.32, 95% CI (0.16, 0.49), p = 0.0002], and the other control group [SMD = 0.23, 95% CI (0.05, 0.41), p = 0.01]. CONCLUSIONS: The combined intervention resulted in cognitive benefits in older adults with MCI and exhibited limited superiority over the single cognitive intervention and the single physical exercise on cognitive subdomains.

A Virtual Supermarket Program for the Screening of Mild Cognitive Impairment in Older Adults: Diagnostic Accuracy Study.

BACKGROUND: Mild cognitive impairment (MCI) is often a precursor of dementia, and patients with MCI develop dementia at a higher rate than healthy older adults. Early detection of cognitive decline at the MCI stage supports better planning of care and interventions. At present, the use of virtual reality (VR) in screening for MCI in older adults is promising, but there is little evidence regarding the use of virtual supermarkets to screen for MCI. OBJECTIVE: The objectives of this study are to validate a VR game-based test, namely, the Virtual Supermarket Program (VSP), for differentiating patients with MCI and healthy controls and to identify cutoff scores for different age levels. METHODS: Subjects were recruited from several nursing homes and communities in Changchun, China. They were divided into a healthy control group (n=64) and an MCI group (n=62). All subjects were administered the VSP and a series of neuropsychological examinations. The study determined the optimal cutoff, discriminating validity, concurrent validity, and retest reliability of the VSP. We used the area under the receiver operating characteristic curve (AUC) to evaluate the discriminating validity and obtain the optimal cutoff values. Pearson correlation analysis and the intraclass correlation coefficient were used to evaluate the concurrent validity and retest reliability, respectively. RESULTS: A cutoff score of 46.4 was optimal for the entire sample, yielding a sensitivity of 85.9% and specificity of 79.0% for differentiating individuals with MCI and healthy controls, and the AUC was 0.870 (95% CI 0.799-0.924). The median index of VSP score was 51.1 (range 42.6-60.0). There was a moderate positive correlation between the VSP total score and Mini-Mental State Examination score (r=0.429, P<.001). There was a strong positive correlation between VSP total score and Montreal Cognitive Assessment score (r=0.645, P<.001). The retest reliability of the VSP was feasible (r=0.588, P=.048). CONCLUSIONS: The VSP is interesting and feasible for subjects. It shows high sensitivity and specificity for the identification of MCI in older adults, which makes it a promising screening method. The VSP may be generalized to older adults in other countries, although some cultural adaptation may be necessary. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000040074; https://www.chictr.org.cn/showprojen.aspx?proj=64639.

How Exercise Protects Against Mild Cognitive Impairment in Nursing Home-Dwelling Older Adults: A Path Analysis.

ABSTRACT: To explore how exercise protects against mild cognitive impairment (MCI) from physical, psychological, and social perspectives, we conducted a cross-sectional study in four nursing homes in Changchun, China, selected by convenience sampling. A total of 338 older adults aged 60 years or more with normal cognition or MCI were included. Data including demographic characteristics, exercise habits, frailty status, depression, sleep quality, social support, and cognitive status were collected. Weighted least squares estimation with mean and variance adjusted chi-square and bootstrapping with 2000 resamples were used to conduct the analyses through Mplus 8.3. The results showed that both direct and indirect effects of exercise on MCI were significant. Frailty and depression were two independent mediating factors, and depression could also play a mediating role when combined with sleep quality or frailty. Social support played a partial mediating role between exercise and depression. Formulations of exercise programs for MCI prevention and improvement in nursing home-dwelling older adults should consider the mediating factors.

Effects of music intervention on sleep quality of older adults: A systematic review and meta-analysis.

BACKGROUND: Music interventions have several benefits for sleep quality. However, the effects of music interventions on sleep quality in older adults are controversial. OBJECTIVE: To summarize and evaluate the efficacy of music interventions on sleep quality in older adults. METHODS: The Cochrane Library, Embase, PubMed, Web of Science and Chinese National Knowledge Infrastructure (CNKI) were systematically retrieved until June 2020, updated on March 13, 2021. Both experimental and quasi-experimental studies were included if they evaluated the efficacy of music interventions on sleep outcomes in older adults. The methodological quality was assessed by the Cochrane RoB 2.0 and ROBINS-I Tool. The random effects models and effect measure (MD) were adopted, and sensitivity analysis by omitting each study was conducted to explore the source of heterogeneity. RESULTS: A total of 489 participants from 9 studies met the inclusion criteria. 6 studies were included in meta-analysis and sensitivity analysis, and 3 studies were included in the qualitative analysis. Main concerns about risk of bias were lack of blinding participants and investigators, and confounding factors might exist in non-RCTs. The Post-hoc meta-analysis indicated that music interventions might have a positive effect on sleep quality [MD = -2.64, 95 % CI (-3.76, -1.53), p <  0.001; I2 = 75.0 %]. Only one study evaluated adverse events and reported zero discomfort. CONCLUSIONS: The results indicated that music interventions might be beneficial for improving sleep quality, especially in sleep latency, sleep duration, sleep efficiency and sleep of daytime dysfunction in elderly individuals.

Experiences of nursing home-dwelling older adults with mild cognitive impairment participating in a Chinese square dancing program: A qualitative study.

To explore the experiences of older adults with mild cognitive impairment participating in a Chinese square dancing program, we conducted a qualitative study through individual semistructured interviews between September 2019 and November 2019 in the nursing home where the program was implemented. Purposive sampling was used to select participants from those completing the dancing program. The sample size was determined by data saturation. Thirteen participants were included. The data were analyzed using content analysis. Three main categories, including benefits associated with exercise, facilitators of adherence, and barriers to adherence, emerged. In conclusion, participants reported multiple positive experiences; thus, square dancing may be an acceptable and desirable intervention for older adults with mild cognitive impairment. In future promotion processes, attention should be paid to the progressive nature of the activity, the use of professionally trained instructors, participants' awareness of the benefits gained, and the forgetfulness of participants.

Effect of humour intervention programme on depression, anxiety, subjective well-being, cognitive function and sleep quality in Chinese nursing home residents.

AIM: To evaluate the effect of an 8-week humour intervention programme on reducing depression and anxiety and improving subjective well-being, cognitive function and sleep quality in nursing home residents. DESIGN: A single-blinded and quasi-experimental design with repeated measures. METHODS: Seventy-four older adults were recruited from May 2018-September 2018, with 37 older adults in the humour group received humour intervention and 37 in the control group received no intervention. The intervention was an 8-week humour intervention programme for older adults to learn to use humour and release their emotions. Primary outcomes include depression, anxiety and subjective well-being and secondary outcomes were cognitive function and sleep quality. Two-way repeated measures ANOVA was used to compare the differences of outcome measures between the two groups. Outcomes were measured at baseline, 8 and 16 weeks. RESULTS: There was no significant difference between the two groups at baseline. The adherence to the sessions of humour intervention over the 8-weeks was 97.6%. Two-way repeated measures ANOVA revealed significant improvement in depression, anxiety, subjective well-being and sleep quality during the postintervention (8 weeks) and follow-up (16 weeks) periods in the humour group versus the control group. However, a significant time × group interaction for cognitive function was only found during postintervention. CONCLUSION: The humour intervention programme was effective in reducing depression and anxiety symptoms and increasing subjective well-being, cognitive function and sleep quality in older adults. IMPACT: Physical and mental health problems are common among older adults in nursing homes. The study demonstrated that humour intervention has feasibility and potential to be used as an effective non-pharmacological intervention in improving well-beings of Chinese nursing home residents. TRIAL REGISTRATION: ChiCTR1800016148.

Effects of dance intervention on frailty among older adults.

OBJECTIVE: The aims of this study were to examine the effects of dance intervention on frailty in pre-frail and frail older persons. DESIGN: This is a quasi-experimental, two-group trial. SETTING: Older adults living nursing home. PARTICIPANTS: Participants aged ≥ 60 years with low physical activity (mean age was 81.8 years; 71 % were female) (N = 66). METHODS: Participants allocated to the dance group attended 40 min dance sessions in a nursing home, three times a week for 12-weeks. Participants allocated to the control group maintained their normal daily activities. Assessments were conducted at baseline, 6 weeks, and 12 weeks by researchers blinded to the allocation. Frailty was measured based on Fried criteria. Estimates of frailty between groups over time were calculated using the generalized estimating equations (GEE) and mixed effects models. RESULTS: The prevalence of frailty decreased over time in the dance group compared to the control group (P = 0.002). The mean frailty scores decreased 0.69 at 6 weeks and 1.06 at 12 weeks. Compared to the control group, the prevalence of slowness (p = 0.002), weakness (p = 0.005), and low physical activity (p < 0.001) significantly decreased in the dance group. CONCLUSIONS: Dance intervention may reduce the presence and severity of frailty in older adults. Slowness and low physical activity improve following 12 weeks of dance intervention.

Detection of Mild Cognitive Impairment Based on Virtual Reality: A Scoping Review.

BACKGROUND: To delay the decline in cognition and reduce the incidence of dementia, the precise detection of Mild Cognitive Impairment (MCI) is necessary. The application of Virtual Reality (VR) technology in this detection can overcome the shortage of traditional paper-and-pencil tests. OBJECTIVE: This review aimed to summarize the research progress of the detection of MCI using VR. METHODS: Eight databases from their inception to November 19, 2019, were systematically searched for studies applying VR in the detection of MCI. A thematic analysis was conducted according to the specific detection purpose and the main corresponding cognitive domains assessed were summarized; characteristics of the VR applications were also summarized. RESULTS: Twenty-eight studies were finally included. The detection purposes included discrimination between healthy controls and those with MCI, discrimination between aMCI subtypes, detection of MCI patients at risk of Alzheimer's Disease (AD), and discrimination between MCI and AD. VR tasks assessing spatial memory were applicable for all detection purposes, and the assessment of combinations of memory and executive function seemed more sensitive. Executive function and intentional episodic memory could be assessed to discriminate among healthy controls, individuals with MCI and those with AD. Incidental episodic memory was effective in detecting MCI with hippocampal atrophy. The most common characteristics of the VR applications were the use of semi-immersion, joysticks or gamepad interactions and simple, one-time behavioral assessments. CONCLUSION: VR applications are promising in the detection of MCI, but further research is needed for clinical use.

Sleep Quality and Health-Related Quality of Life in Older People With Subjective Cognitive Decline, Mild Cognitive Impairment, and Alzheimer Disease.

We aimed to investigate sleep quality and health-related quality of life (HRQOL) in older adults with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer disease (AD). A total of 221 participants were divided into the following five groups: normal controls (NCs), SCD without memory concerns (SCD-0), SCD with memory concerns (SCD-1), MCI, and AD according to their cognitive status. Compared with NC, individuals with SCD-0, SCD-1, MCI, and AD had more sleep problems and reduced HRQOL. Participants with poor sleep quality had an increased risk of cognitive impairment compared with participants with good sleep quality. Within all five subgroups, individuals with poor sleep quality reported more difficulties in HRQOL than individuals with good sleep quality. Future studies employing a longitudinal design, larger samples, and objective evaluation tools are needed.

Effect of exergames on physical outcomes in frail elderly: a systematic review.

AIM: The aim of this systematic review was to understand the exergames that can be applied to the pre-frail and frail elderly people, to evaluate whether these games have a positive impact on physical outcomes in pre-frail and frail older adults, and to explore user's subjective feelings and compliance. METHODS: PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane Library were searched until January 15, 2019. Only randomized controlled trials published in English for human beings were eligible. The review included studies which examined the effects of exergames on physical outcomes, feasibility and/or subjective feelings of pre-frail and frail older adults. Two researchers assessed the risk bias of all articles independently using the Cochrane collaboration's tool for assessing risk of bias. RESULTS: Seven randomized controlled trials with 243 pre-frail and frail older adults met inclusion criteria and were included in this review. Results of the studies were heterogeneous. Physical outcomes (included muscle strength, balance ability, mobility function, gait and falls), subjective feeling outcomes, feasibility, attendance and some other functional outcomes were reported. CONCLUSION: Exergames improved balance and mobility function of frail elderly, and it showed a tendency to increase muscle strength when combined with resistance training. As far as the limited evidence was concerned, exergames were feasible and generally accepted by participants.

Effects of Chinese square dancing on older adults with mild cognitive impairment.

The present study aimed to explore the effects of square dancing on global cognition, depressive symptoms, balance, and quality of life of older adults with mild cognitive impairment. We studied 66 older adults with mild cognitive impairment in a large nursing home. Participants were assigned to the intervention group (n = 33) or the control group (n = 33), according to their residential floor, which was determined by coin tossing. The intervention group underwent a 12-week Chinese square dancing routine, while the control group maintained usual lifestyle (without square dancing). Outcomes were assessed at baseline and at weeks 6 and 12. The results showed positive effects of square dancing on all outcomes assessed, especially on depressive symptoms and quality of life-related mental well-being of the participants. This study showed that square dancing is a promising strategy for older adults with mild cognitive impairment and that long-term adherence can be beneficial.

A meta-analysis of randomized controlled trials of laughter and humour interventions on depression, anxiety and sleep quality in adults.

AIM: To quantify the effect of laughter and humour interventions on depression, anxiety, and sleep quality in adults. DESIGN: A meta-analysis of randomized controlled trials. DATA SOURCES: PubMed, Embase, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Weipu, and Wanfang Data were searched from their inception up to December 2018. REVIEW METHODS: The reporting of this meta-analytical review was conducted according to the guidelines of the Cochrane Collaboration. Two reviewers selected the studies, extracted the data, and evaluated the risk of bias (Cochrane Collaboration bias assessment tool) of the included papers independently. RESULTS: Ten studies comprising 814 participants were included. Meta-analysis showed that these interventions significantly decreased adults' depression, anxiety, and improved their sleep quality. The results of subgroup analysis showed that depression benefits more from long-term laughter intervention. CONCLUSIONS: This meta-analysis revealed that laughter and humour interventions are effective in relieving depression, anxiety, and improve sleep quality in adults. More studies with high quality and follow-up assessment should be conducted for future research. IMPACT: This review synthesized current evidence using laughter and humour interventions to reduce negative emotion and promote better results in adults, especially with respect to target the applicability between different populations or intervention methods. In addition, humour and laughter interventions are safe, convenient, interesting and can promote interpersonal relationship in both patients and medical workers, which have great feasibility and potential to be used as an aspect of psychotherapy for clinical and nursing to improve well-beings in adults.

Nonpharmacological interventions to improve sleep in nursing home residents: A systematic review.

Sleep disturbance is one of the most prevalent symptoms among elderly adults, especially those living in nursing homes. Sleep disturbance adversely affects the healthcare system as well as elderly adults' quality of life. Nonpharmacological interventions have shown promising results regarding improvements in sleep. This systematic review intended to identify the effects of nonpharmacological interventions on sleep quality and nighttime sleep among nursing home residents. We searched both English and Chinese databases through December 2018 and found 28 eligible studies describing five types of interventions: physical activity (n = 6), light therapy (n = 5), mind-body practices (n = 2), complementary and alternative therapy (n = 8), and multicomponent interventions (n = 7). Although the wide variety of interventions in each category limited the generalizability of the results, physical activity, mind-body practices, acupressure and chamomile extract intake demonstrated positive and promising impacts on sleep quality and nighttime sleep. Due to the small number of included trials, the results should be interpreted cautiously. Further higher-quality studies concerning nonpharmacological treatments are needed.