Current Evidence of the Application of Music in Tai Chi Exercise: Scoping Review.

BACKGROUND: Music has frequently been used in movement exercises to enhance health benefits. However, scientific evidence regarding the application of music to Tai Chi practice is limited. OBJECTIVE: This scoping review aims to understand how music has been used in Tai Chi practice and whether music could be applied to Tai Chi practice to help optimize its benefits. METHODS: PubMed, CINAHL, CNKI, and Weipu databases were searched. We included studies that compare Tai Chi practice experience or health outcomes between individuals practicing Tai Chi with music and those practicing Tai Chi without music. Studies published through September 2022 were identified. Two researchers (YD and YH) independently performed study selection and data extraction. Thematic analysis was used to summarize and categorize the findings of the included studies. RESULTS: Seven studies were included in this review. All 7 included studies are experimental studies. Practicing Tai Chi with music might lead to positive perceptions of Tai Chi practice (eg, motivation, concentration, enjoyment, compliance, and performance) and higher evaluations of Tai Chi instructional quality, especially for Tai Chi beginners. The effects of incorporating music into Tai Chi practice on health outcomes are inconclusive due to the heterogeneities of the sample size, and the intervention components, lengths, and frequencies of the included studies. CONCLUSIONS: Applying music to Tai Chi practice may result in positive Tai Chi practice experience and adherence, particularly for beginners, which could help improve the dissemination and implementation of Tai Chi interventions for public health. However, whether applying music to Tai Chi practice leads to synergetic effects on health outcomes needs further investigation.

Application progress of exergames in health interventions for the elderly. / 运动游戏在老年人健康干预中的应用进展.

With the aging population in China, health issues among the elderly are becoming increasingly prominent, leading to a rapidly growing demand for health interventions for the elderly. Exergames are one of the important emerging methods in the field of health interventions for the elderly, widely used and yielding positive results. While research on exergames is well-established abroad, it is still in its infancy in China, lacking reports on the types, interaction forms, intervention content, application status, and effectiveness of exergames. Exergames are suitable for widespread use among the elderly in China, and there is a need to accelerate the development and application of exergames in the field of health interventions for the elderly in China.

Effects of Otago exercise program on physical function in older adults: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Maintaining physical function is critical for older adults to achieve healthy aging. The Otago exercise program (OEP) has been widely used to prevent falls for older adults. However, the effects of OEP on physical function remain controversial and the possible effects modifiers have not been assessed. OBJECTIVE: To evaluate the effects of OEP on physical function in older adults and to explore potential moderators underlying the effects of OEP. METHODS: We searched five electronic databases and relevant systematic reviews to identify studies. We included randomized controlled trials (RCTs) evaluating the effects of OEP as a single intervention on physical function among older adults aged 65 and over. Meta-analysis was performed using the random-effects model. Standardized mean differences (SMD) for physical function changes, pertinent to balance, strength, and mobility, were outcome measures. Subgroup analyses on exercise protocol and participants' characteristics were performed. RESULTS: Thirteen RCTs consisting of 2402 participants were included in this systematic review and meta-analysis. Results indicated a significant effect of OEP on balance (SMD = 0.59, 95 % CI: 0.22∼0.96), lower body strength (SMD = 0.93, 95 % CI: 0.31∼1.55), and mobility (SMD = -0.59, 95 % CI: -0.95∼-0.22) against control groups. No significant OEP effects were found on upper body strength (MD = 1.48, 95 % CI: -0.58∼3.55). Subgroup analysis revealed that the video-supported delivery mode was more effective for improving balance (P = 0.04) and mobility (P = 0.02) than the face-to-face mode. Session durations over 30 min was more effective on lower body strength (P < 0.001) and mobility (P < 0.001) than those 1-30 min. Program period of 13-26 weeks was more effective on mobility (P = 0.02) than those of 4-12 weeks. However, the effects of OEP on physical function were not associated with age groups, and baseline falling risks. CONCLUSION: The OEP could improve physical function including balance, lower body strength, and mobility in older adults. Implementing the OEP in video-supported, more than 30 min per session and 4-12 weeks may be the most appropriate and effective exercise protocol for improving physical function among older adults. More RCTs with rigorous design and larger scale are needed to further assess the effectiveness of diverse OEP protocols and quantify the dose-effect relationship.

Corrigendum: Effectiveness of a multicomponent exercise intervention in community-dwelling older Chinese people with cognitive frailty: protocol for a mixed-methods research.

[This corrects the article DOI: 10.3389/fnagi.2024.1282263.].

Barriers and facilitators to acceptance and implementation of eMental-health intervention among older adults: A qualitative systematic review.

Objective: Electronic mental health interventions are effective but not well promoted currently among older adults. This study sought to systematically review and summarize the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults. Methods: We comprehensively retrieved six electronic databases from January 2012 to September 2022: PubMed, Web of Science, Embase, Scopus, PsycINFO, and CINAHL. The JBI-QARI was used to assess the quality of the research methodology of each publication. Eligible studies underwent data coding and synthesis aligned to inductive and deductive methods. The Consolidated Framework for Implementation Research 2.0 was used as a deductive framework to guide a more structured analysis. Results: The systematic review screened 4309 articles, 17 of which were included (eight with mixed methods and nine with qualitative methods). We identified and extracted the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults: (1) innovation: technology challenges, optimized functions, and contents, security and privacy; (2) outer setting: community engagement and partnerships, financing; (3) inner setting: leadership engagement, available resources, incompatibility, intergenerational support, training and guidance; (4) individuals: perceptions, capability, motivation of older adults and healthcare providers; and (5) implementation process: recruit, external assistance, and team. Conclusion: These findings are critical to optimizing, promoting, and expanding electronic mental health interventions among older adults. The systematic review also provides a reference for better evidence-based implementation strategies in the future.

Effectiveness of a multicomponent exercise intervention in community-dwelling older Chinese people with cognitive frailty: protocol for a mixed-methods research.

Aims: To evaluate the effectiveness of a multicomponent exercise intervention and to clarify the underlying mechanisms of the program in community-dwelling older adults with cognitive frailty. Additionally, the perception of participants in the program will be explored. Design: A mixed-methods design, including a randomized controlled trial and an exploratory qualitative study, was used. Methods: Each group consists of 41 participants. The experimental group will undergo a 12-week multicomponent exercise intervention, including warm-up, exergaming aerobic exercise, elastic-band resistance exercise, and cool-down. This intervention was developed based on the Health Belief Model (HBM) and Self-Efficacy Model (SEM). The control group will not receive any intervention. Physical frailty and cognitive function will be considered as primary outcomes. Data will be collected both at baseline and at the end of the intervention period. Fisher's exact test, analysis of covariance, and generalized linear models will be conducted to compare mean changes between the two groups. Additionally, the mediation models will be used to examine whether any intervention effects are mediated through exercise self-efficacy. Discussion: The findings of this study are anticipated to provide valuable insights for healthcare providers, enabling them to learn about effective strategies to enhance exercise adherence and promote improved functionality, independence, and quality of life for older adults with cognitive frailty.Clinical trial registration: [https://clinicaltrials.gov/], identifier [ChiCTR2200058850].

Development and validation of prediction model for older adults with cognitive frailty.

OBJECTIVE: This study sought to develop and validate a 6-year risk prediction model in older adults with cognitive frailty (CF). METHODS: In the secondary analysis of Chinese Longitudinal Healthy Longevity Survey (CLHLS), participants from the 2011-2018 cohort were included to develop the prediction model. The CF was assessed by the Chinese version of Mini-Mental State Exam (CMMSE) and the modified Fried criteria. The stepwise regression was used to select predictors, and the logistic regression analysis was conducted to construct the model. The model was externally validated using the temporal validation method via the 2005-2011 cohort. The discrimination was measured by the area under the curve (AUC), and the calibration was measured by the calibration plot. A nomogram was conducted to vividly present the prediction model. RESULTS: The development dataset included 2420 participants aged 60 years or above, and 243 participants suffered from CF during a median follow-up period of 6.91 years (interquartile range 5.47-7.10 years). Six predictors, namely, age, sex, residence, body mass index (BMI), exercise, and physical disability, were finally used to develop the model. The model performed well with the AUC of 0.830 and 0.840 in the development and external validation datasets, respectively. CONCLUSION: The study could provide a practical tool to identify older adults with a high risk of CF early. Furthermore, targeting modifiable factors could prevent about half of the new-onset CF during a 6-year follow-up.

Impact of hearing loss on cognitive function in community-dwelling older adults: serial mediation of self-rated health and depressive anxiety symptoms.

Background: Hearing loss can exacerbate cognitive decline; therefore, exploring the mechanisms through which hearing loss affects cognitive function is crucial. The current study aimed to investigate the impact of hearing loss on cognitive function and the mediating role played by self-rated health and depressive anxiety symptoms. Methods: Using stratified whole-group random sampling, the study employed a cross-sectional design and included 624 participants aged ≥65 years from three communities in Urumqi, China. Cognitive function was assessed using the Mini-Mental State Examination. Hearing function and self-rated health were determined by self-report. The 15-item Geriatric Depression Scale and the 7-item Generalized Anxiety Disorder Scale were used to assess depressive anxiety symptoms. Serial mediation analysis was performed using AMOS 26.0. Results: Hearing loss can not only negatively affect cognitive function in older adults directly (direct effect = -0.106; SE = 0.045; 95% confidence interval (CI): -0.201 to -0.016), but also indirectly affect the relationship between hearing loss and cognitive function through self-rated health and depressive anxiety symptoms. The results of the serial mediation analysis showed that the total indirect effect of self-rated health and depressive anxiety symptoms was -0.115 (95% CI: -0.168 to -0.070), and the total effect of the model was -0.221 (95% CI: -0.307 to -0.132), with the total indirect effect accounting for 52.04% of the total effect of the model. Conclusion: Our study discovered that there is a partial mediation of the relationship between hearing loss and cognitive function by self-rated health and depressive anxiety symptoms. It is suggested that by enhancing self-rated health and ensuring good mental health, the decline in cognitive function among older adults with hearing loss can be delayed.

Comparison of Exergames Versus Conventional Exercises on the Health Benefits of Older Adults: Systematic Review With Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Conventional exercises (CEs) can provide health benefits for older adults, but the long-term exercise adherence rate is low. As an emerging, stimulating, and self-motivating strategy, exergames (EGs) are defined as combinations of exercises and games that users carry out through physical actions. They can promote exercise, but the health effects of EGs versus CEs on the physical function and mental health (cognitive function, depression, and quality of life) of older adults remain controversial. OBJECTIVE: The aim of the study is to compare the health benefits of EGs versus those of CEs for the physical function and mental health of older adults. METHODS: A comprehensive search was conducted from the earliest available date to February 2023 in the following 6 databases: PubMed, Web of Science, Embase, Cochrane, CINAHL, and PsycINFO. All English-language randomized controlled trials comparing the effects of EGs versus those of CEs on the physical function and mental health of older adults, with nearly same physical activity between the 2 interventions, were included. Risk of bias was independently evaluated by 2 authors using the Cochrane risk of bias in randomized trials tool. Two authors independently extracted data. We followed the Cochrane Handbook of Systematic Reviews of Interventions to process and analyze the data for meta-analysis. Standardized mean differences (SMDs) and 95% CIs were used for continuous data, and random models were used for analyses. RESULTS: We included 12 studies consisting of 919 participants in total. Of these, 10 studies were eventually included in the meta-analysis. The results showed that EGs versus CEs exhibited no significant differences in physical (P=.13; τ2=0.31; χ26=26.6; I2=77%; SMD=0.37; 95% CI -0.11 to 0.86) or cognitive function (P=.63; τ2=0.01; χ23=3.1; I2=4%; SMD=0.09; 95% CI -0.27 to 0.44) effects. CONCLUSIONS: Our findings indicate no significant difference between EGs and CEs in improving the physical function and cognitive function of older adults. Future studies are required to compare the effects of EGs versus those of CEs on cognitive function according to cognitive status, quantify the "dose-effect" relationship between EGs and health benefits, and evaluate the effects of different types and devices of EGs with regard to the health benefits of older adults. TRIAL REGISTRATION: PROSPERO CRD42022322734; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322734.

Prediction model for cognitive frailty in older adults: A systematic review and critical appraisal.

Background: Several prediction models for cognitive frailty (CF) in older adults have been developed. However, the existing models have varied in predictors and performances, and the methodological quality still needs to be determined. Objectives: We aimed to summarize and critically appraise the reported multivariable prediction models in older adults with CF. Methods: PubMed, Embase, Cochrane Library, Web of Science, Scopus, PsycINFO, CINAHL, China National Knowledge Infrastructure, and Wanfang Databases were searched from the inception to March 1, 2022. Included models were descriptively summarized and critically appraised by the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results: A total of 1,535 articles were screened, of which seven were included in the review, describing the development of eight models. Most models were developed in China (n = 4, 50.0%). The most common predictors were age (n = 8, 100%) and depression (n = 4, 50.0%). Seven models reported discrimination by the C-index or area under the receiver operating curve (AUC) ranging from 0.71 to 0.97, and four models reported the calibration using the Hosmer-Lemeshow test and calibration plot. All models were rated as high risk of bias. Two models were validated externally. Conclusion: There are a few prediction models for CF. As a result of methodological shortcomings, incomplete presentation, and lack of external validation, the models' usefulness still needs to be determined. In the future, models with better prediction performance and methodological quality should be developed and validated externally. Systematic review registration: www.crd.york.ac.uk/prospero, identifier CRD42022323591.

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Hospitalized patients who lose one or more activities of daily living at the time of discharge compared with 2 weeks before admission (before acute onset) are referred to as hospitalization-associated disability (HAD). The incidence of HAD is high among elderly patients, which leads to the increased readmission rates, long-term care rates, and mortality, bringing a huge burden on patients, families, and society. It is vital for doctors and nurses to identify the risk factors of HAD of the elderly patients and take targeted intervention measures to prevent and improve HAD. At present, the research on HAD in foreign countries is relatively perfect, while the research on HAD in China is still in its infancy, and there is still lack of systematic research and reports on the incidence, influencing factors, and intervention measures of HAD. Domestic clinical nursing practice can learn from foreign mature interventions, carry out cultural adjustment, create a friendly environment in the hospital for elderly patients, pay attention to the assessment of the influencing factors of HAD in elderly patients, and provide personalized and patient-centered nursing measures for hospitalized elderly patients according to the assessment results, maintain their function during hospitalization and prevent the occurrence of HAD.

Nursing assistants' knowledge, attitudes and training needs regarding urinary incontinence in nursing homes: a mixed-methods study.

BACKGROUND: Urinary incontinence is an increasingly common problem, especially among older people in nursing homes. Nursing assistants are the leading workforce in nursing homes, and their knowledge and attitudes regarding urinary incontinence have garnered considerable attention in the context of aging in China. However, most previous studies on this issue have focused on registered nurses. This study aimed to explore nursing assistants' knowledge, attitudes and training needs with regard to urinary incontinence. METHODS: We conducted a two-part mixed-methods study. After institutional manager approval, we surveyed the knowledge and attitudes of 509 nursing assistants regarding urinary incontinence. We carried out semi-structured interviews with 40 nursing assistants to elicit detailed information on training needs. RESULTS: In general, knowledge about urinary incontinence was poor (14.00 ± 4.18), although attitudes were primarily positive (35.51 ± 3.19). Most nursing assistants were very willing to learn more about urinary incontinence (93.9%, 478/509), but time constraints and low educational background may be barriers to learning motivation. The three preferred training styles among nursing assistants were face-to-face guidance from a mentor, training combining theory with practice, and online video training. CONCLUSIONS: Chinese nursing assistants had poor knowledge but positive attitudes toward urinary incontinence. Facility managers should focus on developing training and learning mechanisms regarding urinary incontinence. It is important to adopt diverse training styles according to the actual situation of nursing homes.

Relationship of hearing impairment, social participation and depressive symptoms to the incidence of frailty in a community cohort.

BACKGROUND: The mediating effect of social participation and depressive symptoms on the relationship between hearing impairment and frailty remains unclear. METHODS: A total of 3981 participants from three waves of the China Health and Retirement Longitudinal Study (CHARLS) were included. The outcome was incidental frailty. Hearing impairment, social participation, and depressive symptoms were the main variables. Cox regression models and structural equation models were adopted to examine the relationship between hearing impairment, social participation, depressive symptoms, and the incidence of frailty, with adjustments for demographic characteristics and lifestyle variables at baseline. RESULTS: Hearing impairment (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.12, 1.74), social participation (HR 0.72, 95% CI 0.55, 0.94), and depressive symptoms (HR 1.78, 95% CI 1.37, 2.30) were associated with the incidence of frailty. Hearing impairment was associated with frailty not only through social participation (ß = 0.015, 95% CI 0.003, 0.037) and depressive symptoms (ß = 0.070, 95% CI 0.037, 0.116) separately but also through social participation and depressive symptoms sequentially (ß = 0.002, 95% CI 0.001, 0.004). Furthermore, the effect of social participation on frailty occurred in participants with hearing impairment, while the effect of depressive symptoms on frailty occurred in participants with normal hearing status. CONCLUSIONS: Hearing impairment is associated with frailty, in which social participation and depressive symptoms partly mediate the association. The effect of social participation and depressive symptoms on frailty varies across hearing statuses. Integrated and comprehensive intervention measures, including hearing screenings, promoting social participation, and improving depressive symptoms, are suggested to prevent frailty.

Challenges and suggestions for exergaming program in exercise among older adults. / 运动游戏在老年人运动锻炼中面临的挑战及对策.

Engaging in physical activity and exercise is one of the important ways for health promotion. However, older adults are often physically inactive or have a sedentary lifestyle and have poor compliance with physical activity. Exergaming program with their unique advantages could make physical activity a more joyful experience and motivate older adults to participate in physical activity. Promoting older adults' health through engagement in exergaming programs is still in the early stage, and still faces many challenges. Analyzing the challenges and difficulties faced by exergaming program for older adults and exploring in-depth strategies to promote the implementation of exergaming program for older adults are of great significance for the design and implementation of sports games for older adults.

Older adults' experiences of implementing exergaming programs: a systematic review and qualitative meta-synthesis.

OBJECTIVE: this study sought to systematically review and synthesize qualitative data to explore older adult exergame experiences and perceptions. METHODS: a comprehensive search was conducted in seven databases from the earliest available date to May 2022. All qualitative and mixed-method studies available in English and explored exergame experiences in older adults were included. Tools from the Joanna Briggs Institute were used for data extraction and synthesis. Data were extracted using the Capability, Opportunity and Motivation Model of Behaviour (COM-B model) as a guide, and a pragmatic meta-aggregative approach was applied to synthesize the findings. RESULTS: this systematic review identified 128 findings and aggregated 9 categories from the 10 qualitative research articles included, and three synthesized findings were: older adult capability, opportunities in the exergaming program and motivation in the exergaming program. Capability consisted of attitude toward exergames, age- or health-related impairments and exergame knowledge and skills. Opportunities included older adult-friendly exergame design and social influence. Motivation included self-efficacy, support, instruction and feedback, health benefits, as well as unpleasant exergaming experiences. CONCLUSIONS: it is crucial to tailor the exergaming program to suit the older population. We identified barriers and facilitators of implementing exergaming in older adults and found most barriers are surmountable. The results of the current systematic review could provide evidence for the design and implementation of exergaming programs among older adults. The ConQual score of the synthesized findings was assessed as low. Dependability and credibility should be accounted for in future studies to increase confidence.

Longitudinal impact of metabolic syndrome and depressive symptoms on subsequent functional disability among middle-aged and older adults in China.

BACKGROUND: Few studies examining the impact of metabolic syndrome and depressive symptoms on subsequent functional disability are available. OBJECTIVES: To determine the impact of baseline metabolic syndrome and depressive symptoms on subsequent functional disability. METHODS: This study used data from the 2011 baseline and 2013, 2015 and 2018 follow-up waves of the China Health and Retirement Longitudinal Study (CHARLS). Functional status was assessed by activities of daily living (ADLs) and instrumental ADLs (IADLs). Analyses were restricted to middle-aged and older adults (≥50 years) free of functional disability at baseline. Metabolic syndrome, depressive symptoms, and covariates were measured at baseline. New-onset ADL and IADL disability were obtained in follow-up measurements. Competitive risks based on survival analysis were conducted to examine the impact of baseline metabolic syndrome and depressive symptoms on subsequent functional disability after covariates were controlled. RESULTS: Baseline depressive symptoms significantly predicted functional disability over a 7-year follow-up after adjusting for covariates (Hazard ratio [HR] = 1.54, 95% confidence intervals [CI] = 1.40-1.70 for ADL disability; HR=1.36, 95% CI=1.25-1.48 for IADL disability). Metabolic syndrome significantly predicted ADL disability (HR=1.25, 95% CI=1.14-1.38) but not IADL disability (HR=1.02, 95% CI=0.94-1.10). No significant additive interaction between metabolic syndrome and depressive symptoms on functional disability was found. CONCLUSION: The current study found that baseline depressive symptoms were significantly associated with both ADL and IADL disabilities, while metabolic syndrome significantly predicted ADL disability. In addition, some indications showed that the effect in those with both conditions was greater than the sum of the effects separately.

Impact of Pain and Psychosocial Factors on Frailty Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study.

AIMS: The objective of this study was to determine the prevalence of frailty and pain among older adults with physical functional limitations in China. We also assessed the impact of pain and psychosocial determinants on frailty among this vulnerable population. DESIGN: This study was a cross-sectional study. SETTING AND PARTICIPANTS: Totally, 2,323 Chinese elders with physical functional limitation were enrolled. METHODS: Physical functioning was assessed by the Barthel Index, participants who reported "often troubled with pain" were further asked about the intensity of their pain using a 1-10 numeric rating scale, and frailty was assessed by the Assessment of frailty FRAIL scale. The impact of pain and psychosocial factors on frailty was assessed by multivariable binary logistic regression. RESULTS: The prevalence of frailty and pain were 30.9% and 46.1%, respectively. Compared with subjects who reported no pain, those who reported mild (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.31), moderate (OR = 2.10, 95% CI = 1.53-2.82), or severe pain (OR = 2.31, 95% CI = 1.56-3.40) tended to be more vulnerable to frailty. Furthermore, compared with participants with positive psychosocial determinants, those with negative psychosocial determinants seemed more likely to be frail. CONCLUSIONS: These findings suggest that the incidence of pain, negative psychosocial status, and frailty were prevalent, and the presence of pain and negative psychosocial factors increased the risk of frailty among older adults with physical functional limitation.

Enablers and barriers to implementing care quality improvement program in nursing homes in China.

OBJECTIVE: To explore the perspectives of key stakeholders on necessary factors to implement care quality improvement program. METHODS: We conducted qualitative descriptive research in eight nursing homes in four major prefecture-level cities of Changsha, Xiangtan, Zhuzhou, and Yueyang. Data of 50 clinical nurses and 64 nurse assistants were included and analyzed. Ethical approval was given by the medical ethics committee of Chinese Clinical Trial Registry (No. ChiCTR-IOC-17013109, https://www.chictr.org.cn/index.aspx ). One-to-one interviews were used with the nursing managers, and separate focus group discussions were used with the clinical nurses and nurse assistants. All of the interviews were audio recorded and later transcribed verbatim. In addition, the first author documented the responses of every participant in the field notes during the interviews and focus groups. RESULTS: The participants' perspectives were characterized by two main themes: (1) enablers, with four subthemes of "organizational support", "the evidence-based practice ability", "proactivity", "nursing supervision and feedback;" and (2) barriers, with five sub-themes of "low educational background", "the limitations of self-role orientation", "resistance to change", "lack of job motivation", and "organizational constraints". CONCLUSION: These findings recognize factors at the organizational level, staff level and societal level that are necessary to implement effective mentoring. The results of this study can provide reference for nursing home in improving nursing management quality, formulating, implementing and revising training policies.