Preventing CXCL12 elevation helps to reduce acute exacerbation of COPD in individuals co-existing type-2 diabetes: A bioinformatics and clinical pharmacology study.

AIMS: To investigate the immunology shared mechanisms underlying chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM) and examine the impact of anti-diabetic drugs on acute exacerbation of COPD (AECOPD). METHODS: We analyzed GSE76925, GSE76894, GSE37768, and GSE25724 to identify differentially expressed genes. Hub-genes were identified through protein-protein interaction network analysis and evaluated by the receiver operating characteristic curve. CXCL12 emerged as a robust biomarker, and its correlation with lung function and CD8+ T cells were further quantified and validated. The activated signaling pathways were inferred through Gene set enrichment analysis (GSEA). The retrospective clinical analysis was executed to identify the influence of dipeptidyl peptidase-4 inhibitors (DPP-4i) on CXCL12 and evaluate the drug's efficacy in AECOPD. RESULTS: The significant up-regulation of CXCL12 expression in patients with two diseases were revealed. CXCL12 exhibited a negative correlation with pulmonary function (r = -0.551, p < 0.05). Consistent with analysis in GSE76925 and GSE76894, the positive correlation between the proportion of CD8+ T cells was demonstrated(r=0.469, p<0.05). GSEA identified "cytokines interaction" as an activated signaling pathway, and the clinical study revealed the correlation between CXCL12 and IL-6 (r=0.668, p<0.05). In patients with COPD and T2DM, DDP-4i treatment exhibited significantly higher serum CXCL12, compared to GLP-1RA. Analysis of 187 COPD patients with T2DM indicated that the DPP-4i group had a higher frequency of AECOPD compared to the GLP-1RA group (OR 1.287, 95%CI [1.018-2.136]). CONCLUSIONS: CXCL12 may represent a therapeutic target for COPD and T2DM. GLP-1RA treatment may be associated with lower CXCL12 levels and a lower risk of AECOPD compared to DPP-4i treatment. CLINICAL TRIAL REGISTRATION: China Clinical Trial Registration Center（ChiCTR2200055611）.

Quality of Life Among Older Adults With Frailty: A Structural Equation Modeling.

PURPOSE: Frailty is a complex age-related clinical condition among older adults. Quality of life (QOL) among older adults with frailty is an important topic of interest. The current cross-sectional study aimed to develop a structural equation model to identify factors affecting QOL. METHOD: A total of 180 older adults with frailty were recruited from general units in two hospitals in Fuzhou, China. Data were collected using the World Health Organization Quality of Life Brief Version, Pittsburgh Sleep Quality Index, Geriatric Depression Scale-15, and Simplified Coping Style Questionnaire. Structural equation modeling was used to analyze data. RESULTS: The final model exhibited a good fit. Poor sleep quality was associated with depression, passive coping style, and poor QOL. Depression was also associated with poor QOL. Passive coping style was associated with better QOL. CONCLUSION: This study demonstrated that sleep quality has direct and indirect effects on QOL of older adults with frailty through depression and passive coping style. Recommendations are that care providers pay attention to biological and physiological variables, symptom status, and functional status of older adults with frailty. This study also provides a theoretical basis for developing interventions that may lead to improvements in QOL among older adults with frailty. [Journal of Psychosocial Nursing and Mental Health Services, 62(5), 49-55.].

Prevalence of Frailty and Associated Factors Among Hospitalized Older Adults: A Cross-Sectional Study.

This study aimed to estimate the prevalence of frailty and associated factors among hospitalized older adults. It consisted of 184 hospitalized older adults recruited between October 2019 to January 2020. We used the FRAIL scale, Geriatric Depression Scale-15, and the Pittsburg Sleep Quality Index to collect data. Descriptive statistics, independent group t-test, Chi-square (χ2) tests, and logistic regression were applied to statistical analysis. It found that the prevalence of frailty among hospitalized older adults was 39.7%. Depression (Mild: OR = 5.312, 95% CI [2.384-11.833]; Moderate: OR = 6.630, 95% CI [2.077-21.160]) and low activities of daily living (ADL) (Slight dependence: OR = 5.667, 95% CI [1.308-24.557]; Moderate dependence: OR = 15.188, 95% CI [3.342-69.016]; Severe dependence: OR = 5.872, 95% CI [2.645-13.038]) were independent predictors of frailty. Future studies on the interventions to reduce depression, improve ADL and delay the progression of frailty are encouraged. We should focus more on ADL, emotional and psychological state of hospitalized older adults to prevent frailty.

Factors associated with self-management behaviors of patients with chronic obstructive pulmonary disease.

AIMS: To examine self-management behaviors level and discuss the associated factors among chronic obstructive pulmonary disease (COPD) patients. METHODS: A descriptive study design was used. A convenience sample of 124 COPD patients was recruited from three hospitals in Fuzhou. Self-management Behaviors, Social Support Rating Scale and The Family APGAR Score were used to collect data. Descriptive statistics, one-way analysis of variance (ANOVA), Pearson correlation and multiple linear regression were used for data analysis. RESULTS: The overall score of self-management behaviors ranged 4-41, with a mean score of 21.26 ± 7.72. Pearson correlation analyses and ANOVA revealed that age, course of disease, education, marital status, family function, subjective support, objective support, and availability of support were positively correlated with overall self-management behaviors (p < .05). Multiple linear regression analyses revealed that subjective support and availability of support significantly predicted self-management behaviors. CONCLUSIONS: The level of self-management behaviors of COPD patients was suboptimal. We suggest that people in the patients' social network should provide support for them, and help them use available resources to improve the level of self-management behaviors.

Caregiver burden among informal caregivers of hospitalized patients with frailty: A cross-sectional survey.

This study aimed to investigate the status of caregiver burden among informal caregivers of hospitalized frail older patients and explore the associated factors. A total of 191 frail older patients and their informal caregivers were recruited from the inpatient units of the three teaching hospitals. We collected data using the FRAIL scale, the Zarit Burden Interview, and the Simplified Coping Style Questionnaire. We used descriptive statistics, Pearson correlation coefficients, one-way analysis of variance, and multiple linear regression for the data analysis. The caregivers of hospitalized frail older patients experienced a moderate caregiver burden (26.476±11.289). The regression model for caregiver burden was significant. Male caregivers, taking care of patients before hospitalization, experiencing negative emotions, and negative coping styles were significantly associated with caregiver burden, F (7, 183) = 15.13, p <. 001. The findings suggest that early identification of caregiver burden and focused interventions for alleviating caregiver burden are needed.

Psychosocial reactions to relocation to a nursing home among Chinese older adults.

OBJECTIVES: This study aimed to describe the psychosocial reactions to relocation to a nursing home from the perspective of older adults. METHOD: This study applied a qualitative interview design. Narratives from 23 Chinese nursing home residents in a life review program in Fuzhou, China were recorded, transcribed into sentences, and analyzed using qualitative content analysis. RESULTS: The following psychosocial reactions to relocation to a nursing home emerged: fear, struggle, compromise, acceptance, and contribution. The fear resulted from negative labels attached to nursing homes, fear of disconnection to society, fear of difficulties in establishing new relationships, and fear of being abandoned by their families. The behaviors of 'struggle' were complaining about family members, thinking of returning home, praying for change, and taking action to leave. The keys to compromise were a choice between maintaining harmony in family relations and the companionship of relatives, a choice between professional care and family care, and a choice between the cost and effectiveness of family care and nursing home care. The process of acceptance included accepting life yet with worries, affirming the benefits of living in a nursing home, and embracing nursing home life. Contribution was mainly reflected in two aspects, a sense of ownership and bring into full play their self-worth. DISCUSSIONS: This study generates new insights into knowledge on the psychosocial reactions to relocation to a nursing home. It provides both family members and nursing home staff with direction on how to ensure a smoother relocation process.

Living arrangements and life satisfaction: mediation by social support and meaning in life.

BACKGROUND: Living arrangements have impact on life satisfaction among older adults. However, the mechanism how it works has received less attention. This study aims to examine the mediating role of meaning in life and social support in the relationship between living arrangements and life satisfaction. METHODS: A total of 215 older adults from nine nursing homes and three communities were included in this study. The Social Support Rating Scale, Meaning in Life Questionnaire and Life Satisfaction Index A were adopted. Data were analyzed with Hayes' s bias-corrected bootstrapping method. RESULTS: Both social support and presence of meaning in life had positive correlations with life satisfaction (p<0.001), and they were significant mediators between living arrangements and life satisfaction (p<0.01). CONCLUSION: To improve the life satisfaction of nursing home residents, more emphasis should be placed on encouraging residents to seek or maintain a meaningful life and creating a more positive climate of social support.

Frailty as a predictor of future falls in hospitalized patients: A systematic review and meta-analysis.

The aims of this review were to identify prospective studies examining associations between frailty and falls and to combine the risk measures to synthesize pooled evidence on frailty as a predictor of falls. A systematic literature search was conducted through Embase, Scopus, PubMed, CINAHL Plus, and the Cochrane Library for studies published from inception through May 2018. Odds ratios (OR) and hazard ratios (HR) extracted from the studies were combined to synthesize pooled effect measures using random-effects or fixed-effects models. Six studies involving 3881 hospitalized patients were included in this study. Frailty was found to be significantly associated with future falls among three studies with OR (pooled OR = 1.323, 95%confidence interval = 1.137-1.538, P < 0.000) and three studies with HR (pooled OR = 1.890, 95%confidence interval = 1.456-2.453, P < 0.000). Frailty was a significant predictor of future falls in hospitalized patients. Paying more attention to frailty may lead to lowering fall risks.

Attitude of Nurses Toward the Care of Older Adults in China.

Introduction: The aim of this study was to assess the attitudes of registered nurses toward older adults in China. Method: An online questionnaire was sent to registered nurses of five hospitals. The sample included 1,367 registered nurses in this study. Kogan's Attitudes toward Older People Scale and Facts of Aging Quiz were used to collect data. Descriptive statistics, independent t-tests, one-way analysis of variance and logistic regression were used for data analysis. Results: Registered nurses held a positive attitude toward older adults (155.09 ± 21.94). The experience of being cared by older adults (odds ratio [OR] = 1.545, p = .007) and relationship with older adults (OR = 2.440, p = .000) were associated with the attitudes of registered nurses. Discussion: Registered nurses in China held a positive attitude toward older adults. The results contribute to care practice for the older adults in hospitals.

Life review for Chinese older adults in nursing homes: cultural acceptance and its effects.

ABSTRACTObjectives:To explore the acceptance and effects of life review on older adults. DESIGN: A mixed-method study design was utilized in this study. SETTING: Four nursing homes located in Fuzhou, China. PARTICIPANTS: Sixty-two older adults from four nursing homes were selected according to the criteria set for this study. METHOD: Sixty-two older adults were randomly assigned to either the life review group or the control group, and 55 of them completed the study. Twenty-four participants took part in qualitative interviews after the life review program concluded. The Geriatric Depression Scale-15, Rosenberg Self-Esteem Scale, and Purpose in Life Test were adopted to measure depression, self-esteem, and meaning in life, respectively. RESULTS: The findings indicated that life review can reduce depressive symptoms and may be effective at improving self-esteem and meaning in life among Chinese elderly people. More importantly, it revealed that cultural factors such as values, beliefs, and attitudes could interfere with participation in a life review. CONCLUSIONS: A culturally sensitive life review program could be an alternative approach to psychotherapy for promoting mental health in older adults.

Effects of Life Review Intervention on Life Satisfaction and Personal Meaning Among Older Adults With Frailty.

The current study aimed to examine the effects of life review intervention on life satisfaction and personal meaning among frail older adults. Seventy-four participants were randomly assigned to either the intervention or control group. The intervention group received the Haight Structured Life Review with modified guiding questions and memory prompts. The control group received usual nursing home care. The Life Satisfaction Index A and Purpose in Life Test questionnaires were administered at baseline and immediately after the intervention. Participants in the life review group demonstrated significant improvement in life satisfaction compared to the control group, but no significant differences in personal meaning. The study suggests that life review is a promising psychospiritual intervention for older adults, which could be delivered as a separate program or integrated into usual care in nursing homes. [Journal of Psychosocial Nursing and Mental Health Services, 56(7),30-36.].

Effects of life review interventions on psychosocial outcomes among older adults: A systematic review and meta-analysis.

AIM: The present study aimed to evaluate the effects of life review interventions on psychosocial outcomes among older adults. METHODS: We searched PubMed, Ovid, CINHAL, Cochrane library, PsycINFO, Springer Link, Oxford Journals Collection, FRMS, CBM, VIP, CNKI, and Wanfang to identify randomized controlled trials and controlled clinical trials that evaluate the effects of life review among older adults. The quality of studies included was evaluated and the relevant information was extracted. Then, a meta-analysis was carried out with RevMan software. RESULTS: We identified 15 studies that met the inclusion criteria, and 11 studies were allowed for meta-analysis. The combined results of the meta-analysis showed that life review significantly reduced depression (standardized mean difference 0.57, 95% CI 0.73 to -0.42) and hopelessness (mean difference [MD] 4.01, 95% CI 6.13 to -1.89). There was a significant improvement in well-being (standardized mean difference 0.54, 95% CI 0.01-1.06) and specific memory (MD 1.05, 95% CI 0.07-2.03). However, other study findings did not support its effect in life satisfaction (MD 2.15, 95% CI 0.69- 5.00), self-esteem (MD 0.21, 95% CI 2.09-2.50), the quality of life (standardized mean difference 0.15, 95% CI 0.96-0.66), extended memory (MD 0.03, 95% CI 0.61-0.55), categorical memory (MD 0.48, 95% CI 1.08- 0.12) and no recall (MD 0.30, 95% CI 1.12- 0.52). CONCLUSIONS: Life review is a worthwhile intervention for reducing depression and hopelessness, and improving quality of life, well-being and specific memory in older adults. More well-designed trials with a large sample and long-term follow up are necessary to confirm the effects of life review on other psychosocial outcomes. Geriatr Gerontol Int 2017; 17: 1344-1357.

The effects of life review on psycho-spiritual well-being among patients with life-threatening illness: a systematic review and meta-analysis.

AIM: The aim of this study was to examine the strength of evidence regarding the effects of life review on psycho-spiritual well-being among patients with life-threatening illness. BACKGROUND: Life-threatening illness not only causes physical symptoms but also psycho-spiritual burdens. Life review has been widely implemented to assist people coping with these burdens. However, the effectiveness of life review is not clear. To date, no systematic review or meta-analysis has been published on this topic. DESIGN AND REVIEW METHODS: A systematic review with meta- analysis consistent with the recommendations of the Cochrane Collaboration was conducted. DATA SOURCES: Database searches included MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, CNKI and VIP et al. up to April 2015. We also searched the grey literature, reviewed reference lists from relevant articles and book chapters and contacted experts. RESULTS: Nine randomized controlled trials (RCTs) and two controlled clinical trials (CCTs) were eligible for this systematic review and meta-analysis. The risk of bias for those studies were rated as moderate (n = 11). The meta-analyses demonstrated significant standardized mean differences or mean differences in favour of life review compared with the control for depression, quality of life and self-esteem. CONCLUSION: The findings indicate that life review can decrease depressive symptoms, improve quality of life and enhance self-esteem among patients with life-threatening illnesses. Multi-centre studies with adequate sample size and rigorous designs are needed in future research.

The Effect of a Meditative Movement Intervention on Quality of Sleep in the Elderly: A Systematic Review and Meta-Analysis.

BACKGROUND/OBJECTIVES: Sleep disorders are one of the most common difficulties facing older people. Meditative movement interventions (MMIs), a new category of exercise integrating physical activity and meditation (e.g., t'ai chi, yoga, and qigong), may benefit older people with sleep problems. This systematic review synthesized the evidence on the effect of MMIs on older people's quality of sleep. METHODS: PubMed, EMBASE, CINAHL, PsycINFO, Scopus, the Cochrane Library, the China Science and Technology Journal Database (CSTJ) and the China National Knowledge Infrastructure (CNKI) were searched-from 1950 to March 2014-for randomized controlled trials. Articles were screened and selected by two researchers. Data were extracted from the included studies using specified forms. The same researchers independently evaluated the quality of each article. A meta-analysis was conducted to examine the pooled effect of MMI on sleep quality compared with the control groups. RESULTS: Fourteen of 1049 studies were included, involving 1225 participants. Interventions included t'ai chi, yoga, qigong, and multicomponent MMI and lasted 12-24 weeks. Ten studies had a low risk of bias. The interventions resulted in significantly better sleep quality scores than either active therapy or usual care/wait-list controls (standardized mean difference, -0.70;95% confidence interval, -0.96 to -0.43). Subgroup analyses revealed that the effect of MMI on sleep quality was not influenced by the type or duration of the intervention. However, pooled results of studies with intervention frequency of fewer than 3 times per week did not show a positive effect on sleep quality. Lower-quality studies had larger effect sizes than high-quality studies. No adverse events were reported. CONCLUSION: The current review demonstrated that MMI had a moderate effect on improving the quality of sleep for older people with sleep complaints. However, the evidence is inconclusive because of the varying study quality and MMI modalities. This study highlights the need for higher-quality randomized, controlled trials and more sufficient fidelity of intervention implementation to confirm the results. It also highlights the need for comparing the effectiveness of MMI on different subgroups of the elderly population.