Feasibility and preliminary effects of a mindfulness-based physical exercise (MBPE) program for community-dwelling older people with sarcopenia: A protocol for a parallel, two-armed pilot randomised controlled trial.

INTRODUCTION: Physical exercise (PE) is essential for alleviating the symptoms of sarcopenia. Low motivation is a major barrier to PE. Mindfulness-based intervention (MBI) has the potential to improve motivation. However, few studies have used a mindfulness-based PE (MBPE) intervention among older people with sarcopenia. OBJECTIVES: To assess the feasibility, acceptability and preliminary effects of the MBPE program among community-dwelling older people with sarcopenia. METHODS AND ANALYSIS: A two-arm pilot randomised controlled trial will be conducted to assess the feasibility, acceptability and preliminary effects of an MBPE program among community-dwelling older people with sarcopenia. A total of 60 participants will be randomised into the intervention group, receiving the MBPE intervention twice a week over 12 weeks, or the control group, receiving health education with the same duration, number of sessions and frequency as the intervention group. Each session of the MBPE program will last about 60 min, including 5-10- min introduction, 20-min MBI, 30-min PE and 5-10-min sharing and discussion. The primary outcomes will be the feasibility (i.e., the time spent recruiting participants, the eligibility rate and the recruitment rate) and acceptability (i.e., the attendance rate, completion rate and attrition rate) of the MBPE program. The secondary outcomes will be the preliminary effects of the MBPE program on symptoms of sarcopenia, motivation for PE, psychological well-being, mindfulness level, physical activity level and quality of life. Individual interviews will be conducted to identify the strengths, limitations and therapeutic components of the intervention. The quantitative data will be analysed by generalised estimating equations. The qualitative data will be analysed by Braun and Clarke's thematic approach. CONCLUSION: The findings of this study will be able to provide evidence for the health professionals in adopting MBPE as a supportive intervention for the older adults with sarcopenia and the groundworks for the researchers in developing non-pharmacological intervention for older adults. The positive effects could facilitate healthy ageing and relief the burden of the medical system, especially in the countries facing the ageing population. TRIAL REGISTRATION NUMBER: NCT05982067; ClinicalTrials.gov.

The Effects of Immersive Virtual Reality-Assisted Experiential Learning on Enhancing Empathy in Undergraduate Health Care Students Toward Older Adults With Cognitive Impairment: Multiple-Methods Study.

BACKGROUND: Immersive virtual reality (IVR)-assisted experiential learning has the potential to foster empathy among undergraduate health care students toward older adults with cognitive impairment by facilitating a sense of embodiment. However, the extent of its effectiveness, including enhancing students' learning experiences and achieving intended learning outcomes, remains underexplored. OBJECTIVE: This study aims to evaluate the impacts of IVR-assisted experiential learning on the empathy of undergraduate health care students toward older people with cognitive impairment as the primary outcome (objective 1) and on their learning experience (objective 2) and their attainment of learning outcomes as the secondary outcomes (objective 3). METHODS: A multiple-methods design was used, which included surveys, focus groups, and a review of the students' group assignments. Survey data were summarized using descriptive statistics, whereas paired 2-tailed t tests were used to evaluate differences in empathy scores before and after the 2-hour IVR tutorial (objective 1). Focus groups were conducted to evaluate the impacts of IVR-assisted experiential learning on the empathy of undergraduate health care students toward older people with cognitive impairment (objective 1). Descriptive statistics obtained from surveys and thematic analyses of focus groups were used to explore the students' learning experiences (objective 2). Thematic analysis of group assignments was conducted to identify learning outcomes (objective 3). RESULTS: A total of 367 undergraduate nursing and occupational therapy students were recruited via convenience sampling. There was a significant increase in the students' empathy scores, measured using the Kiersma-Chen Empathy Scale, from 78.06 (SD 7.72) before to 81.17 (SD 8.93) after (P<.001). Students expressed high satisfaction with the IVR learning innovation, with a high satisfaction mean score of 20.68 (SD 2.55) and a high self-confidence mean score of 32.04 (SD 3.52) on the Student Satisfaction and Self-Confidence scale. Students exhibited a good sense of presence in the IVR learning environment, as reflected in the scores for adaptation (41.30, SD 6.03), interface quality (11.36, SD 3.70), involvement (62.00, SD 9.47), and sensory fidelity (31.47, SD 5.23) on the Presence Questionnaire version 2.0. In total, 3 major themes were identified from the focus groups, which involved 23 nursing students: enhanced sympathy toward older adults with cognitive impairment, improved engagement in IVR learning, and confidence in understanding the key concepts through the learning process. These themes supplement and align with the survey results. The analysis of the written assignments revealed that students attained the learning outcomes of understanding the challenges faced by older adults with cognitive impairment, the importance of providing person-centered care, and the need for an age-friendly society. CONCLUSIONS: IVR-assisted experiential learning enhances students' knowledge and empathy in caring for older adults with cognitive impairment. These findings suggest that IVR can be a valuable tool in professional health care education.

Effects of a Family Caregiver-Delivered MultiSensory Cognitive Stimulation Intervention for Older People With Dementia During Coronavirus 2019: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Many community dementia services such as home-visiting services and center-based activities were suspended during the coronavirus 2019 pandemic. This study investigated the efficacy of a caregiver-delivered cognitive stimulation therapy (CDCST) on people with dementia during the pandemic. RESEARCH DESIGN AND METHODS: This was a 2-arm randomized controlled trial involving 241 patient-caregiver dyads assigned to a 15-week CDCST or control group (usual care). We hypothesized that CDCST would facilitate significant improvements among people with dementia (cognition, behavioral/psychiatric symptoms, and quality of life) and their caregivers (caregiving appraisal, attitudes, and psychological well-being) at postintervention (T1) and at the 12-week follow-up (T2). Generalized estimating equations evaluated the study outcomes. RESULTS: A total of 230 dyads completed the study, with good program adherence (93%). Participants in the CDCST showed significant improvements in cognition (p < .001), behavioral and psychiatric symptoms (p =. 027), and quality of life (p =.001) at the 3-month follow-up period. Family caregivers had improved positive aspects of caregiving (p = .008; p = .049) and decreased negative attitudes toward people with dementia (p =. 013; p < .001) at both T1 and T2. There were nonsignificant changes in the caregivers' perceived burden, distress, and psychological well-being. DISCUSSION AND IMPLICATIONS: Family caregivers could be trained to provide cognitive stimulation at home for people with dementia, which could benefit both parties. CDCST could manage to improve the cognition, neuropsychiatric symptoms, and quality of life of people with dementia, while also improving caregiving appraisal and negative attitudes among family caregivers. CLINICAL TRIAL REGISTRATION NUMBER: NCT03803592.

Virtual reality-based simulation intervention for enhancing the empathy of informal caregivers of people with dementia: A mixed-methods systematic review.

Dementia is a long-term and progressive syndrome that not only influences the person with dementia (PWD) but also the caregiver. However, informal caregivers are not always empathic and understand the symptoms of dementia, leading to destructive caregiving relationships and poor quality of caregiving. VR-based simulation interventions can provide a more realistic and memorable learning experience for caregivers to walk in PWDs' shoes. This review aimed to provide practitioners and researchers with insights on developing and/or adopting an effective VR-based simulation intervention for enhancing the empathy of informal caregivers of PWD. A mixed-methods systematic review was conducted. Quantitative, qualitative, and mixed-methods studies were searched from MEDLINE, PsycINFO, CINAHL, Scopus, Embase, and Cochrane Library updating. Standard JBI critical appraisal instruments were used for the quality appraisal. A convergent segregated approach was used to synthesize and integrate the data. A total of seven studies were included. Inconsistent quantitative results were reported on the effects of VR-based simulation on empathy enhancement. Significant effects were reported on knowledge of dementia and emotion-focused coping strategies. Two themes were generated from the qualitative studies, including "Informal caregivers gained better insight into problems encountered by older people with dementia" and "Thinking from the perspective of older people with dementia, leading to changes in attitudes and behaviours towards dementia". The qualitative synthesized evidence showed that informal caregivers gained better insight into problems encountered by PWD, but the quantitative synthesized results are inconsistent. Yet, informal caregivers experienced a change in attitude by thinking from the perspective of PWD.

Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia.

OBJECTIVES: Family caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such as behavioural activation (BA) and mindfulness practice (MP) have been shown to be potentially effective at reducing depressive symptoms, the best sequence and combination of these interventions for caregivers are unknown. This study aims to develop and identify a two-stage adaptive intervention with prespecified rules guiding whether, how or when to offer different interventions initially/over time to reduce depressive symptoms in FG-of-PWD. METHODS: A sequential multiple assignment randomised trial design will be adopted. 272 FG-of-PWD with mild to moderate depressive symptoms will be recruited from the community. Four two-stage, embedded adaptive interventions involving BA and MP of different sequences and dosages (eg, 8 weeks of BA followed by booster sessions for responders and 8 weeks of MP for non-responders) will be assigned to the participants following a set of decision rules. The primary outcomes will be depressive symptoms (measured using the Patient Health Questionnaire-9), assessed after the second stage of the intervention. Other outcomes, such as positive aspects of caregiving (measured using the Positive Aspects of Caregiving Scale), sleep quality (measured using the Pittsburgh Sleep Quality Index) and time points will also be assessed. The analyses will follow the intention-to-treat principle. Several process indicators (eg, engagement in meaningful activities and level of mindfulness) will also be assessed. The findings will have strong implications for the further development of psychosocial adaptive interventions to reduce depressive symptoms among FC-of-PWD. ETHICS AND DISSEMINATION: This study has received ethical approval from the Human Research Ethics Committee at The Hong Kong Polytechnic University (HSEARS20211223001). The findings will be presented at academic conferences and submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER: NCT05634317.

The Effects of Immersive Virtual Reality Applications on Enhancing the Learning Outcomes of Undergraduate Health Care Students: Systematic Review With Meta-synthesis.

BACKGROUND: Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students' competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. OBJECTIVE: This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. METHODS: MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students' learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P<.05 was used to test for statistical significance using SPSS (version 28; IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. RESULTS: A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15; 95% CI 16.3%-67.7%; P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90%; P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. CONCLUSIONS: This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger sample size and robust study design are required to evaluate the effects of IVR teaching. TRIAL REGISTRATION: International prospective register of systematic reviews (PROSPERO) CRD42022313706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=313706.

Evaluation of a Physical-Psychological Integrative (PPI) intervention for community-dwelling spinal cord injury survivors: Study protocol of a preliminary randomized controlled trial.

INTRODUCTION: There is a considerably large group of community-dwelling spinal cord injury (SCI) survivors living with low quality of life. Physical inactivity, depression, and chronic pain are major problems faced by SCI survivors discharged from the acute phase of treatment or inpatient rehabilitation. This study aims to evaluate the feasibility, acceptability, and preliminary effects of a Physical-Psychological Integrative (PPI) online group intervention on community-dwelling SCI survivors' physical activity, depression, and chronic pain. METHODS: This is a two-arm pilot randomized controlled trial with repeated measures (pre-, post-intervention, and 3-month follow-up) design. Seventy-two participants will be randomly assigned to two study groups. The PPI intervention group will receive a video program for physical activity training and eight-week online group psychological interventions using skills of group-based motivational interviewing and mindfulness-based stress reduction. The control group will receive an eight-week online didactic education programed. Focus-group interviews will be conducted post-intervention to explore their views about acceptance and suggested improvements to the intervention. The feasibility of study procedures and the acceptability of interventions will be evaluated. The effectiveness of the PPI intervention will be evaluated by leisure-time physical activity, depression, chronic pain, exercise efficacy, mindfulness, and quality of life. We will use the generalized estimating equation to assess intervention effects and content analysis for interview data. This study has received ethical approval from the Hong Kong Polytechnic University (HSEARS20210705004) and was registered in ClinicalTrials.gov (NCT05535400). DISCUSSION: This study will be the first to provide empirical data on the evaluation of an online-group intervention integrating both physical activity promotion and psychological approaches, aimed at reducing physical inactivity, depression, and chronic pain for community-dwelling SCI survivors in Hong Kong. The findings could provide evidence supporting the use of PPI intervention as a novel online group support, in addressing both the physical and psychological needs of community-dwelling SCI survivors.

Effects of a Social Media-Based Mind-Body Intervention Embedded With Acupressure and Mindfulness for Stress Reduction Among Family Caregivers of Frail Older Adults: Pilot Randomized Controlled Trial.

BACKGROUND: Family caregivers of frail older adults experience high levels of stress. Mind-body interventions (MBIs) focused on caregiver stress are often limited in teaching approaches, difficult to practice, and costly. A social media-based MBI embedded with mindfulness meditation (MM) and self-administered acupressure (SA) may be effective for family caregivers, offer greater usability, and lead to greater adherence. OBJECTIVE: The aim of this study was to test the feasibility and preliminary effects of a social media-based MBI embedded with MM and SA on family caregivers of frail older adults and to investigate the preliminary effects of the intervention using a pilot randomized controlled trial. METHODS: A 2-arm randomized controlled trial design was adopted. Family caregivers of frail older adults (n=64) were randomized into either the intervention group (n=32), receiving 8 weeks of social media-based MM and SA, or the control group (n=32), receiving brief education on caregiving for people with frailty. The primary outcome (caregiver stress) and secondary outcomes (caregiver burden, sleep quality, and mindfulness awareness and attention) were measured using a web-based survey at baseline (T0), immediately after the intervention (T1), and at the 3-month follow-up (T2). RESULTS: The feasibility of the intervention was established with a high attendance rate (87.5%), high usability score (79), and low attrition rate (1.6%). The generalized estimating equation results showed that participants in the intervention group at T1 and T2 experienced a significant improvement in stress reduction (P=.02 and P=.04, respectively), sleep quality (P=.004 and P=.01, respectively), and mindful awareness and attention (P=.006 and P=.02, respectively) compared with the control group. There were no substantial improvements in caregiver burden at T1 and T2 (P=.59 and P=.47, respectively). A focus group session conducted after the intervention had 5 themes: impact on the family caregivers, difficulty in practicing the intervention, the strength of the program, the limitations of the program, and perception of the intervention. CONCLUSIONS: The findings support the feasibility and preliminary effects of social media-based MBI embedded with acupressure and MM on reducing stress among family caregivers of frail older people and enhancing sleep quality and mindfulness levels. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the intervention. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100049507; http://www.chictr.org.cn/showproj.aspx?proj=128031.

Health maintenance through home-based interventions for community-dwelling older people with sarcopenia during and after the COVID-19 pandemic: A systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has greatly impacted people's lifestyles and changed the delivery of health interventions, especially interventions for community-dwelling older people with sarcopenia. OBJECTIVE: To summarize the components and explore the effectiveness of home-based interventions for improving sarcopenia and other health-related outcomes among community-dwelling older people with sarcopenia. DESIGN: Systematic review and meta-analysis. METHODS: The Cochrane Library, Scopus, EMBASE, Web of Science, CINAHL, Medline (via PubMed), and PsycINFO were searched for relevant papers published from January 1, 2010 to March 29, 2022. Only papers written in English were included. The modified version of Cochrane's risk-of-bias tool was used to assess the risks of bias in the included studies. The template for intervention description and replication checklist was used to summarize the intervention components. The mean difference (MD) or standard mean difference with a 95 % confidence interval (CI) was used to determine the effect size of studies using the same or different measuring methods. Random-effects models were in meta-analyses to pool the effects of home-based interventions on the included outcomes. RESULTS: After detailed screening and exclusion, 11 randomized controlled trials including 1136 older people with sarcopenia were included in our analyses. Three categories of home-based interventions were identified: exercise interventions, nutritional interventions, and combined exercise and nutritional interventions. The overall analysis of the outcomes (e.g., appendicular skeletal muscle mass index, lean mass, body fat mass, handgrip strength, and gait speed), showed that the effects of home-based exercise interventions were inconclusive. Compared with passive controls, home-based exercise interventions significantly improved knee extension strength (MD = 0.56 kg, 95 % CI: 0.09, 1.03, p = 0.020) and reduced the time required to complete the Timed Up and Go Test (MD = -1.41 s, 95 % CI: -2.28, -0.54, p = 0.001). Home-based nutritional interventions were effective in improving appendicular skeletal muscle mass (MD = 0.25 kg, 95 % CI: 0.02, 0.49, p = 0.030), gait speed (MD = 0.06 m/s, 95 % CI: 0.03, 0.09, p = 0.0001), and quality of life in terms of both the physical component summary (MD = 13.54, 95 % CI: 0.73, 26.34, p = 0.040) and mental component summary scores (MD = 8.69, 95 % CI: 2.98, 14.41, p = 0.003). CONCLUSION: Home-based exercise interventions have the potential to improve muscle strength and physical function, while home-based nutritional interventions are effective in increasing muscle mass, physical function, and quality of life. Both of these can be applied at home during and after the COVID-19 pandemic to alleviate sarcopenia and improve health-related outcomes in community-dwelling older people.

Long-term effects of e-Health secondary prevention on cardiovascular health: a systematic review and meta-analysis.

AIMS: Despite the well-documented short-to-medium-term effectiveness of e-Health (electronic health) secondary prevention interventions on patients with cardiovascular disease (CVD), there is limited empirical evidence regarding long-term effectiveness. This review aims to evaluate the long-term effects of e-Health secondary prevention interventions on the health outcomes of patients with CVD. METHODS AND RESULTS: This systematic review and meta-analysis followed Cochrane Handbook for Systematic Reviews of Interventions. EMBASE, Medline, Web of Science, and Scopus were searched from 1990 to May 2022. Randomized controlled trials investigating the effects of e-Health secondary prevention on health outcomes of CVD patients that collected endpoint data at ≥ 12 months were included. RevMan 5.3 was used for risk of bias assessment and meta-analysis. Ten trials with 1559 participants were included. Data pooling suggested that e-Health programmes have significantly reduced LDL cholesterol [n = 6; SMD = -0.26, 95% confidence interval (CI): (-0.38, -0.14), I2 = 17%, P < 0.001]; systolic blood pressure [n = 5; SMD = -0.46, 95% CI: (-0.84, -0.08), I2 = 90%, P = 0.02]; and re-hospitalization, reoccurrence, and mortality [risk ratio = 0.36, 95% CI: (0.17, 0.77), I2 = 0%, P = 0.009]. Effects on behavioural modification, physiological outcomes of body weight and blood glucose, and quality of life were inconclusive. CONCLUSION: e-Health secondary prevention is effective in improving long-term management of risk factors and reducing the reoccurrence of cardiac events in patients with CVD. Results are inconclusive for behaviour modification and quality of life. Exploring, implementing, and strengthening strategies in e-Health secondary prevention programmes that focus on maintaining behaviour changes and enhancing psychosocial elements should be undertaken. REGISTRATION: PROSPERO CRD42022300551.

Dual-Task Zumba Gold for Improving the Cognition of People With Mild Cognitive Impairment: A Pilot Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Integrating mental activities with physical exercises (e.g., dual-tasking) may potentially improve cognition in older adults and people with mild cognitive impairment (MCI). This study investigated the preliminary efficacy of a new intervention called dual-task Zumba Gold (DTZ) on people with MCI to guide an adequately-powered full-scale trial. RESEARCH DESIGN AND METHODS: This is a 2-arm pilot randomized controlled trial with 60 people with MCI assigned to a 12-week DTZ intervention or control group (health education). We hypothesized that DTZ would facilitate significant improvements in global cognition (primary outcome) and other psychological/physical measures at postintervention (T1) and 6-week follow-up (T2). Generalized estimating equations with an intention-to-treat approach were used to evaluate intervention effects. Postintervention qualitative interviews explored the participants' program perceptions. RESULTS: Fifty-one participants completed the study, with no adverse events reported. DTZ participants showed significant improvements in global cognition (p < .001, d = 0.75-0.78), executive function (p < .001, d = 0.28-0.33), immediate recall (p < .001, d = 0.50-0.54), delayed recall (p = .003, d = 0.66-0.71), quality of life (p = .027, d = 0.59-0.63), and mobility (p = .005, d = 0.53-0.56) at T1 and T2. There were nonsignificant changes in working memory, depressive symptoms, blood pressure, body mass index, and waist circumference. Participants conveyed intervention acceptability, including challenges/barriers, enablers, and future recommendations. DISCUSSION AND IMPLICATIONS: DTZ is a potentially feasible intervention for people with MCI that may improve cognition, quality of life, and mobility. A full-scale trial is recommended for confirmatory evaluation. CLINICAL TRIAL REGISTRATION NUMBER: NCT04788238.

The utilization of a nurse-led clinic by older people with cognitive complaints: Do they follow our advice?

AIM: Cognitive assessment services were found to be beneficial to older people with cognitive complaints but information is limited on adherence to the recommendations provided. This study aimed to identify predictors of clients' adherence to nursing recommendations after attending a community-based nurse-led cognitive assessment service in Hong Kong. METHODS: A cross-sectional design was adopted. We analysed a dataset routinely collected from clients attending the services between January 2012 and January 2018. Multiple regression analyses were conducted to identify predictors (demographics, functional health status and cognitive performance) of the clients' adherence. Their satisfaction with the services was also examined. RESULTS: Two hundred and twenty-three clients attended the clinic. Of the 133 who completed the telephone follow-up at the 6 months postconsultation, 44.1% did not adhere to the recommendations. Clients with a higher Clinical Dementia Rating (OR = 4.17), lower Clock Drawing Test score (OR = 1.13) and lower education level (OR = 0.91) were found to be less likely to adhere to the nursing recommendations. Ninety-six percent (190/198) were satisfied with the overall services. CONCLUSION: Cognitive assessment services in nurse-led clinics could provide a self-referred service for older people with cognitive complaints. However, low adherence to nursing recommendations was found among clients with poorer cognitive functions and lower education levels.

Evaluating the effectiveness of a 6-week hybrid mindfulness-based intervention in reducing the stress among caregivers of patients with dementia during COVID-19 pandemic: protocol of a randomized controlled trial.

BACKGROUND: Mindfulness-based intervention (MBI), an emotion-focused approach, has been shown promising and sustainable effects on enhancing the well-being of caregivers of patients with dementia (PWD). However, the conventional MBI was quite demanding, had high rates of attrition and inconsistent long-term effect. The social distancing measures introduced during the COVID-19 pandemic also restricted face-to-face psychosocial intervention. The study aims to evaluate the effectiveness of a 6-week hybrid MBI in caregivers of PWD over a 6-month follow up. METHODS: This is a single-blinded, parallel-group randomized controlled trial (RCT). Eligible participants from three local nongovernmental organizations (NGOs) will be randomly divided into intervention groups and control groups in a ratio of 1:1. The participants in the intervention group will receive 6 weekly 90-min group-based sessions delivered through a face-to-face and online approach. The participants in the control group will receive brief education on dementia care with the same group size, duration, and frequency as the sessions in the intervention group. Immediately after the intervention and at the 6-month follow-up, caring stress and other outcomes will be assessed. Besides, a focus group interview will be conducted to identify the strengths, limitations, and therapeutic components of the intervention from their perspectives. For quantitative data, intention-to-treat analysis and Generalized Estimating Equations (GEE) will be used. For qualitative data, content analysis will be used. DISCUSSION: This proposed hybrid model of MBI has several advantages, such as lower duration, longer follow-up period and easier access by family caregivers. Also, physiological indicators (e.g., heart rate viability and neuropsychiatric symptoms) will be measured in this study to show the body change after MBI. The quantitative and qualitative data of this research can also benefit the development of online or hybrid MBI for caregivers of PWD during the COVID-19 pandemic. Despite these strengths, it does have practical challenges and limitations. However, this proposed intervention has the potential to benefit not only the participants, but also the researcher as well as public health providers. TRIAL REGISTRATION: NCT05242614. Registered on 2022-02-16, https://clinicaltrials.gov/ct2/show/NCT05242614.

Effects of an internationalization at home (IAH) programme on cultural awareness among medical and nursing students in Hong Kong and Indonesia during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: The COVID-19 pandemic has severely impacted the learning experience of students by limiting their opportunities for face-to-face intercultural exchanges. Given the importance of cultural competence in medical education, there is a need to develop a programme that promotes cultural awareness, but that offers more flexibility in terms of outbound mobility. This study aims to evaluate the effectiveness of an internationalization at home programme and to explore the learning experiences of medical and nursing students from Hong Kong and Indonesia. METHODS: Students were recruited from two universities in Hong Kong and Indonesia. They attended an online internationalization at home programme designed by members of the research team from both countries. A mixed-methods study was conducted using a concurrent triangulation approach. A pre-test post-test design was used to evaluate the effects of the programme on cultural awareness, and four focus groups were conducted to explore the students' experiences in the programme. Quantitative and qualitative data were analysed by T-test and reflexive thematic analysis, respectively. Data were integrated and triangulated using joint displays by comparing findings from both sources. RESULTS: One hundred and forty-eight students from Hong Kong and Indonesia participated in the study. After the programme, there was a significant improvement in cultural awareness. Three themes were identified: (1) learning process: enjoyable, but a desire remains for face-to-face cross-cultural communication; (2) learning outcomes: gained cultural awareness, developed cultural sensitivity, had an opportunity to practice language and learn about new learning styles; (3) factors influencing learning outcomes: facilitators (micro-movie and active communication) and barriers (language barrier, inappropriate time arrangement, insufficient prior briefing). CONCLUSION: This programme achieved the learning outcomes by successfully enhancing the cultural awareness of students during a time of pandemic when outbound student exchanges were not possible. Further adaptations of the programme are required to enhance different learning outcomes.

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

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

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

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

Exploring nursing students' learning experiences and attitudes toward older persons in a gerontological nursing course using self-regulated online enquiry-based learning during the COVID-19 pandemic: A mixed-methods study.

BACKGROUND: During the COVID-19 pandemic, universities adopted online teaching as the primary teaching and learning method. Most of the online teaching, however, has been limited to the broadcasting of asynchronous lectures and sharing of teaching materials. OBJECTIVES: To explore undergraduate nursing students' self-regulated learning experiences, satisfaction, and attitudes toward older persons in a gerontological nursing course using online self-regulated enquiry-based learning (EBL) during the COVID-19 pandemic. DESIGN: A mixed-methods design was adopted. SETTING: A university in Hong Kong providing pre-registration nursing programmes. PARTICIPANTS: 155 students studying in the fourth year in a five-year Bachelor of Nursing programme participated in the quantitative study in which 18 joined the focus groups (4 groups with group size of 4-5). METHODS: Five video-based scenarios along with two interactive online workshops, a mind-map development exercise, gamified assessments, reading materials, group discussions, and presentations were adopted in a gerontological nursing course offered in 2019-2020 to enhance the students' learning, driven by a process of enquiry. Attitudes toward older people were measured at baseline and one week after the course (post-test). Information on self-regulated learning experiences, satisfaction, and confidence were collected at post-test only. Paired t-tests and descriptive statistics were used to analyse the data. Focus groups were conducted through semi-structured interviews and transcribed verbatim for inductive content analysis. RESULTS: A significant improvement was demonstrated in the students' attitude toward older people. The students appreciated the opportunities provided by the online EBL to apply key concepts of gerontology in the teaching and learning activities and to enhance their critical thinking skills. Three major themes were revealed from the focus group: Perception of the teaching pedagogy, Improvement of cognitive skills, and Positive and negative aspects of the learning experience. CONCLUSIONS: The online self-regulated EBL improved the students' online learning experience in a gerontological nursing course during the pandemic and improved their attitudes toward older people.