Translation and adaptation of Shared Care Instrument-Revised for the older adults and their caregivers in Taiwan.

BACKGROUND: The aging population in Taiwan has resulted in an increase in the dependent population and the care load on caregivers. Shared care is an interpersonal process in which support is "traded" to "handle" chronic illnesses by home-care patients and family caregivers. The scale of shared care has received little attention in the Taiwanese cultural context. Thus, this study examined the reliability and validity of the Taiwanese versions of Shared Care Instrument-Revised (SCI-R). METHODS: The content validity, construct validity, and discriminant validity were used to test the validity of the translated questionnaires. The Cronbach's α was used to examine reliability. A total of 500 older adults and their caregivers were recruited from three counties in Taiwan. RESULTS: The reliability and validity of the Chinese version of the scale were within the acceptable range. The Cronbach's α was between 0.838 and 0.95. However, the scale's reliability was higher than that of the original version. This might be because of the inclusion of participants with less severe diseases than the participants in the original study, high social expectations in the Chinese traditional culture, and a large number of similar items. Future research should simplify the items and consider adopting diverse participant selection criteria. CONCLUSIONS: The results of this study can be used to understand shared care in Taiwan.

Relationship between Walking Activity and Sleep Quality among Community-Dwelling Older Adults.

PURPOSE: To explore the relationship between walking activity and sleep quality among elderly. DESIGN: A cross-sectional, correlation study with purposive sampling was conducted on participants with a walking habit but not regular moderate-intensity exercise. METHODS: Data were collected by structured questionnaires, including the Walking Activity Questionnaire and the Pittsburgh Sleep Quality Index. FINDINGS: The total walking time per week and frequency of walking per day were significant predictors of sleep quality. CONCLUSIONS: Walking can help older community-dwelling adults improve their sleep quality. CLINICAL EVIDENCE: Walking more than once per day and total walking time per week ≥210 minutes were associated with good sleep quality.

Factors associated with 14-day hospital readmission in frail older patients: A case-control study.

Frailty is a key predictor of readmission among older patients. However, studies on the factors associated with readmission of frail older patients are lacking. This study aims to examine factors associated with 14-day hospital readmission in frail older patients. A retrospective case-control study was conducted. Patients were eligible for inclusion if they were age 65 and over and if their Clinical Frailty Scale (CFS) score was above 4. A total of 210 frail older patients were included. Patients who had partners, experienced a fall within 6 months before hospitalization, had pressure injuries, received surgery or chemotherapy, and received rehabilitation therapy from a physical therapist during hospitalization had increased odds of being readmitted to the hospital within 14 days. Moreover, patients receiving comprehensive geriatric assessment (CGA) services during hospitalization showed a significantly reduced risk of readmission. Adapting CGA and developing continuity care plans from hospitals to the community are crucial.

Spiritual Needs and Influencing Factors of Indonesian Muslims With Cancer During Hospitalization.

Introduction: Although Muslims constitute nearly one fourth of the global population, many non-Muslims are not familiar with Islam. To address this unique need from such a specific cultural context, the present study aimed to examine the spiritual needs and influencing factors of Indonesian Muslims with cancer. Method: A cross-sectional research design with 122 cancer patients was conducted by using the Bahasa-version Spiritual Needs Questionnaire. Results: The degree of spiritual needs was generally high. Religious needs were the strongest aspect, and "praying five times a day" was the highest scoring item. Gender (p = .04), age (p = .01), and duration of being diagnosed with cancer (p = .01) were associated with spiritual needs. Female gender (p = .005) and older age (p < .001) were predictors of spiritual needs. Discussion: As expected to provide cultural-congruent spiritual interventions, nurses could meet Muslim patients' need to pray five times a day during hospitalization, thus help them manage and endure the illness.

[Factors Influencing the Recovery of Walking Ability in Older Adults After Hospital Discharge].

BACKGROUND: Functional decline is a common complication in hospitalized older adults, and decline in the ability to walk is often the first change in physical functioning in this population. Decline in walking ability leads to a loss of independence in the activities of daily living in older adults after discharge from the hospital. PURPOSE: To explore the factors associated with the recovery of walking ability in older adults after discharge from the hospital. METHODS: This study used a longitudinal research design. Potential participants were recruited from a tertiary medical center in southern Taiwan. Patients were eligible for inclusion if they were at least 65 years old and were affected by a decline in walking ability at discharge. The data collected at discharge included: demographic information, Charlson Comorbidity Index, Modified Katz Index of Independence in Activities of Daily Living (walking item), Mini Nutritional Assessment, Mini-Mental State Examination, and ambulation during hospital stay. The follow-up data collected at three months after discharge included: Modified Katz Index of Independence in Activities of Daily Living (walking item), exercise habit, rehabilitation, and social support. RESULTS: A total of 78 older adults were enrolled as participants. Three-quarters (75.64%) of the participants had regained their ability to walk at three months after discharge. Moreover, nutritional status, cognitive function, and exercise habit were significantly associated with the recovery of walking ability. The results of multiple logistic regression analysis showed having an exercise habit to be significantly associated with the recovery of walking ability at three months after discharge (OR = 10.212, p = .004). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: In addition to treating the acute medical issues of older patients, healthcare professionals should screen and provide them with appropriate nutritional, cognitive, and physical care plans. Moreover, emphasizing the importance of an exercise habit in nursing discharge plans is also important. This effort may help older adults recover their walking ability and maintain their independence.

Effectiveness of a simplified reablement program to minimize functional decline in hospitalized older patients.

AIM: To examine the effects of a simplified reablement program on physical function and quality of life in hospitalized older patients. METHODS: The randomized controlled trial enrolled 114 older patients aged ≥65 years who, 2 weeks before admission, had been able to walk independently. Patients randomized to the reablement group received supervision and assistance to carry out the simplified reablement program 30 min daily during their hospital stay. Patients in the reminding group received only oral encouragement to continue the reablement program for 30 min daily. The control group received only usual care that included medical intervention consistent with the patient's diagnosis. The main outcome was improvement in physical function, including the modified version of the Katz Activities of Daily Living (ADL) score, Timed Up and Go test (TUG) and Hand Grip Strength (HGS). Secondary outcomes included the EuroQoL 5 Dimension (EQ-5D) Questionnaire and Visual Analog Scale (VAS). RESULTS: The intervention had no significant effect on the Katz ADL score. However, a significant within-group improvement in TUG occurred in the reminding group and reablement group. In addition, a significant time-dependent improvement in HGS occurred only in the reablement group. With respect to secondary outcomes, the EQ5D score improved significantly only in the reablement group at 3 months after discharge. CONCLUSIONS: The simplified reablement program may be beneficial to optimize physical function and improve quality of life in hospitalized older patients. It is recommended that health professionals should assist or encourage older patients to do simplified reablement during their hospital stay. Geriatr Gerontol Int 2020; 20: 436-442.

Functional Status in Older Intensive Care Unit Survivors.

Older ICU survivors are often challenged with clusters of geriatric syndromes and functional decline. The purpose of this study was (a) to assess patterns of geriatric syndromes and functional status from admission to 6 months post discharge and (b) to examine the predictors of longitudinal functional status. This is a prospective cohort study. Demographic information, clinical variables, geriatric syndromes, and functional status were collected longitudinally. A total of 192 medical ICU older adult survivors were included in the analysis. Factors associated with reductions in functional status over 6 months were (a) institutionalized prior to hospitalization, (b) pressure sore before admission, (c) existing delirium, (d) impaired mobility at baseline, (e) increased APACHE II score upon ICU admission, and (f) use of mechanical ventilation during the ICU stay. Importantly, overweight was the only factor that was associated with increased functional level over 6 months.

Gender differences in inappropriate use of urinary catheters among hospitalized older patients.

This study investigated the incidence, rationales, and associated factors of inappropriate urinary catheter use among hospitalized older patients by gender. A longitudinal study of 321 patients with urinary catheter was conducted. Demographic factors, present health factors, urinary catheter factors, and indications of catheter use were collected. A total of 53.7% of urinary catheter-days were inappropriate. For both men and women, there was no significant difference in the incidence and common rationales of inappropriate use. Women, however, have another associated factor with inappropriate use. More tailored alternatives are needed for women to increase comfort to avoid inappropriate catheter use.

Gender differences in the relationship between walking activity and sleep disturbance among community-dwelling older adult with diabetes in Taiwan.

This study explored the gender differences in the relationship between walking activity and sleep disturbances. A cross-sectional study of 201 community-dwelling older adults with diabetes was conducted in southern Taiwan. Using the Taiwanese version of the International Physical Activity Questionnaire, self-administered short version (IPAQ-SS), information on physical activity and sleep disturbance conditions was collected. Among older female adults with diabetes, 54.2% reported sleep disturbance significantly higher than males (38.1%). Logistic regression analysis suggested that for women, in addition to the active group, older adults in the low-active, high-walking group exhibited a significantly lower rate of sleep disturbance than did those who walked less.

Information Reception and Expectations Among Hospitalized Elderly Patients in Taiwan: A Pilot Study.

BACKGROUND: Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied. PURPOSE: The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan. METHODS: A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis. RESULTS: Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. "Desire to know the reasons for discomfort" and "discharge date" were the messages most expected by the participants. CONCLUSIONS: This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians. Written materials and the involvement of principal caregivers in the medical informing process may be necessary. Besides, before providing medical information, medical professionals should be cognizant of the key concerns of their patients.

Dynamic changes in the appropriateness of urinary catheter use among hospitalized older patients in the emergency department.

OBJECTIVES: To investigate incidence, rationales, related factors and outcomes for changing from appropriate catheter placement to inappropriate use among hospitalized older patients in the emergency department. METHODS: A secondary analysis was adopted from a longitudinal study that was designed to follow the lifecycle of the urinary catheter among hospitalized older patients. Patients aged 65 and older with a urinary catheter that had been placed in the emergency department were included. Demographic factors, present health conditions, conditional factors of catheter placement, and rationales for daily urinary catheter use were collected from the original data. Inappropriate urinary catheter days were evaluated as an outcome. RESULTS: Appropriate urinary catheters were placed in the emergency department in 117 of the 156 patients (75%). Of these patients, 77 patients (65.8%) experienced a change from appropriate placement to inappropriate use, with a mean duration of 2.88±1.56 days. The common rationales were post-operation for hip fracture (36.3%) and no longer needing to monitor urine output (27.2%). A hierarchical regression model shows that a change from appropriate catheter placement to inappropriate use was associated with a diagnosis of urinary tract infection (OR = 0.15; 95% CI = 0.03-0.77; p = 0.02) and no record of the indication for catheter placement (OR = 4.76; 95% CI = 1.20-18.90; p = 0.02), and all variables together explained 35.9% of the variance. In addition, a change from appropriate placement to inappropriate use was further associated with prolonging inappropriate catheter-days (ß = 5.34; 95% CI: 3.72-6.97; p <0.001). CONCLUSIONS: The study highlights a considerable percentage of change from appropriate placement to inappropriate use. Efforts to construct reminder intervention, to improve the record of catheter placement and continued attention to catheter use are necessary to reduce inappropriate urinary catheter use.

Perception of Spirituality and Spiritual Care among Muslim Nurses in Indonesia.

This cross-sectional study was conducted to examine 256 Muslim nurses' perception of spirituality and spiritual care in Indonesia. The Spirituality and Spiritual Care Rating Scale (SSCRS) was translated and culturally adapted. Moderately high degrees in five domains and total SSCRS were found. Specialty, education level, clinical seniority, having spiritual training, and previous spiritual caring experience could impact on the SSCRS. Most nurses have cared for patients with spiritual needs, but denied having any formal training in providing spiritual care. Providing adequate curriculum and on-job training to equip nurses' knowledge and competence of spiritual care is urgent in Muslim healthcare environment.

Difficulties in Surgical Decision Making and Associated Factors Among Elective Surgical Patients in Taiwan.

BACKGROUND: Respect for the autonomy of patients is essential in life-threatening medical decisions such as surgery. Even if a patient has the competency to make decisions, many obstacles exist that may influence his or her willingness to participate in the surgical decision-making process. PURPOSE: The aim of this study was to explore the perceived difficulties in surgical decision making and related factors among elective surgical patients. METHODS: This was a cross-sectional correlational study. A convenience sampling method was used to recruit patients from a medical center in southern Taiwan. Patients who had received elective surgery, were older than 20 years old, and were competent to make medical decisions were invited to participate. A structured questionnaire was developed by the researchers to collect demographic data, decision patterns, and perceived difficulties in surgical decision making. Acceptable validity and reliability of the questionnaire were confirmed before data collection. RESULTS: Over 80% of the participants made the surgical decision by themselves or in collaboration with their family or physician. Less than 15% expected to make the surgical decision by themselves. Illness-related suffering was the greatest difficulty that participants faced. The patients who tended toward passive decision making faced greater difficulties in the dimensions of "do not understand information," "physician's lack of concern," and "difficulty in freely communicating with the physician" than their active decision-making peers. Male participants reported having more difficulty in communicating with their physician than their female peers. Age, education, and marital status were not significantly associated with perceived difficulties in surgical decision making. CONCLUSIONS: Family participation in the medical decision-making process is expected by most patients. Although less than 20% of the participants in this study were categorized as passive decision makers, this group reported more difficulties than the active decision-making group. Healthcare professionals should be more active in communicating with patients who are largely silent during the decision-making process to elicit their preferences and needs with regard to surgical decisions.

Inappropriate urinary catheter reinsertion in hospitalized older patients.

BACKGROUND: We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes. METHODS: A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge. RESULTS: A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. CONCLUSIONS: This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion.

Changes of geriatric syndromes in older adults survived from Intensive Care Unit.

Nearly 90% of the older adult patients discharged from hospital with a cluster of geriatric syndromes. The patterns of geriatric syndromes in older adult ICU survivors are to be further explored. The aim of this study was to examine the risk factors and patterns of geriatric syndromes among older adult patients before admitting to ICU and throughout their hospitalization. A total of 137 older adult patients (age 76.9 ± 6.6; 52.6% male) participated in the study. The results showed significant increase in the occurrence of geriatric syndromes from T0 (upon ICU admission) to T1 (transition to inpatient care unit), with improvement at T2 (hospital discharge), but did not return to the baseline. The three most prevalent geriatric syndromes were: functional decline, urination incontinence, and defecation incontinence. Polypharmacy was associated with functioning decline. Patients with delirium were six times more likely to be re-admitted to ICU.

Reasons for family involvement in elective surgical decision-making in Taiwan: a qualitative study.

AIMS AND OBJECTIVES: To inquire into the reasons for family involvement in adult patients' surgical decision-making processes from the point of view of the patients' family. BACKGROUND: Making a patient the centre of medical decision-making is essential for respecting individual's autonomy. However, in a Chinese society, family members are often deeply involved in a patient's medical decision-making. Although family involvement has long been viewed as an aspect of the Chinese culture, empirical evidence of the reasons for family involvement in medical decision-making has been lacking. DESIGN: A qualitative study. METHOD: In order to record and examine reasons for family involvement in adult patients' surgical decision-making, 12 different family members of 12 elective surgery patients were interviewed for collecting and analysing data. RESULTS: Three major reasons for family involvement emerged from the data analyses: (1) to share responsibility; (2) to ensure the correctness of medical information; and (3) to safeguard the patient's well-being. These findings also reveal that culture is not the only reason for family involvement. CONCLUSIONS: Making decision to undergo a surgery is a tough and stressful process for a patient. Family may provide the patient with timely psychological support to assist the patient to communicate with his or her physician(s) and other medical personnel to ensure their rights. It is also found that due to the imbalanced doctor-patient power relationship, a patient may be unable, unwilling to, or even dare not, tell the whole truth about his or her illness or feelings to the medical personnel. Thus, a patient would expect his or her family to undertake such a mission during the informed consent and decision-making processes. RELEVANCE TO CLINICAL PRACTICE: The results of this study may provide medical professionals with relevant insights into family involvement in adult patients' surgical decision-making.

A comparison study between two discharge planning tools.

OBJECTIVE: The objective was to compare the effectiveness between a systematic assessment tool and a traditional assessment tool for discharge planning. METHODS: This research adopted a two-group comparison study design, and convenience sampling was adopted to recruit patients requiring discharge-planning services at eight wards in a regional teaching hospital in Southern Taiwan. The postdischarge care requirements of two groups of patients were evaluated using a traditional assessment tool and a systematic assessment tool in different implementation periods, respectively. Sixty-eight patients were matched with similar age and with similar activity in daily living index scores to compare the effectiveness of the tools. RESULTS: The systematic assessment tool exhibited higher assessment integrity and placement appropriateness, as well as lower rates of rehospitalization or mortality within discharge 14 days. The two groups exhibited no significant difference in inappropriate hospital days, primary decision-makers' satisfaction, and proportion of referral professionals who meet patient care requirements. However, the differences in three items of satisfaction exhibited moderate-to-large effect sizes, which may be of clinical importance. CONCLUSIONS: To meet the needs of primary decision-makers in a family, enhance their satisfaction, and provide effective discharge-planning services, clinicians should adopt the systematic assessment tool to assess the postdischarge care requirements of a patient, and the hospital should provide relevant facilities to assist in implementing all plans.

[The Impacts of Widowhood on the Health and Life of Elderly People and R elated Nursing Care].

Widowhood, an unavoidable and stressful situation, has been associated with negative effects in elderly people during later life. This article reviews and summarizes the influences of widowhood on the health, daily life, and social life of elderly people. The influences of widowhood on elderly people may vary by gender, spousal relationship, and cohort background. In order to provide nursing care as early as possible, nurses must cooperate with professionals from social-welfare and / or community-support systems to identify high-risk widowed elderly. When nurses assess the influences of widowhood on elderly people, they should consider the interactions among gender, spousal relationship, and cohort background. Furthermore, nurses may apply various strategies based on the needs of elderly people to improve the health and quality of life of patients. Suggestions include providing appropriate nursing care, offering positive social support, adjusting daily-life routines, and arranging activity programs based on care-recipient interests and resources.

Measurement equivalence across gender and education in the WHOQOL-BREF for community-dwelling elderly Taiwanese.

BACKGROUND: The WHOQOL-BREF, a generic quality of life (QoL) instrument, has been widely used clinically and for research on older populations. However, its measurement equivalence/invariance (ME/I) has not been well examined for the elderly (≥ 65 years) across some different demographics. METHODS: The data were derived from a cross-sectional study with a convenience sampling design in Taiwan. We enrolled 244 elderly participants: men = 143 (58.6%); educational level ≤ primary school = 121 (49.6%). The ME/I was examined using multiple group confirmatory factor analysis (MGCFA) across gender and educational level. RESULTS: The fit indices were satisfactory for the configural models of gender and educational level (standardized root mean square residual [SRMR] = 0.0742 and 0.0770; root mean square error of approximation [RMSEA] = 0.0655 and 0.0686; comparative fit index [CFI] = 0.953). In addition, MGCFAs showed that ME/I was supported across gender (ΔSRMR = 0.001 to 0.019; ΔRMSEA = -0.003 to 0.001; ΔCFI = -0.003 to 0.000) and educational level (ΔSRMR = 0.002 to 0.006; ΔRMSEA = -0.002 to 0.004; ΔCFI = -0.007 to 0.000). CONCLUSION: The WHOQOL-BREF Taiwan version is appropriate for combined use and for comparisons in older people across gender and different educational levels.

Perceived exercise barriers and their associations with regular exercise across three age groups of rural women in Taiwan.

The purposes of the study were to explore the differences in perceived exercise barriers across three age groups of Taiwanese rural women (30-50, 51-70, and >70 years old) and to examine the associations between perceived exercise barriers and regular exercise behavior. A total of 227 women completed the Self-Reported Exercise Behavior and the Perceived Exercise Barrier Scale. Women older than 70 reported higher physical and psychological barriers and lower administrative barriers than did the younger group. Women who did not exercise regularly tended to have a higher perception of exercise barriers.