E-bibliotherapy for improving the psychological well-being of informal caregivers of people with dementia: a randomized controlled trial protocol.

BACKGROUND: Providing informal care for individuals with dementia is frequently a challenging and demanding experience that can have detrimental effects on the psychological well-being of caregivers. Regrettably, community-based caregiver services often prove inadequate, highlighting the necessity for innovative approaches to support caregivers. AIM: To test the efficacy of e-bibliotherapy in improving the psychological well-being of informal caregivers of people with dementia. METHOD: The study is divided into two phases. In phase 1, the research team will co-design the e-bibliotherapy app with caregivers. In phase 2, a randomized controlled trial will be conducted among 192 informal caregivers of people with dementia in Hong Kong. Caregivers will be randomly assigned to either the e-bibliotherapy group or the control group using simple randomization. Outcome measures will encompass caregivers' psychological well-being, caregiving appraisal, mental health, saliva cortisol levels as an indicator of stress, and health-related quality of life for caregivers. Data will be collected at baseline, immediately post intervention, and 3 months and 6 months post intervention. General linear mixed model will be employed to analyze intervention effects. Qualitative interviews will be undertaken to explore caregiver experiences within this study and evaluate intervention acceptability using conventional content analysis methods. DISCUSSION: This study represents a pioneering effort in utilizing e-bibliotherapy to enhance the psychological well-being of informal caregivers of individuals with dementia, addressing the existing gap in caregiver services and facilitating knowledge dissemination within the community. TRIAL REGISTRATION: The trial has been registered on ClinicalTrial.gov (Ref: NCT05927805).

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.

Social engagement and depressive symptoms mediate the relationship between age-related hearing loss and cognitive status.

BACKGROUND AND OBJECTIVES: Age-related hearing loss (ARHL) is the third leading cause of years lived with disability. Connections among ARHL, depressive symptoms, social engagement and cognitive status are increasingly reported but the underlying mechanisms leading to these relationships are largely unknown. Exploring these mechanisms is a worthy goal, especially in older adults. This study aimed to examine the mediating effect of social engagement and depressive symptoms on the relationship between ARHL and cognitive status. METHODS: Structural equation modeling (SEM) with path analysis were performed with data from a cross-sectional study conducted in 11 community centers in 2021, which assessed older adults' intrinsic and sensory capacities using the WHO ICOPE framework. Demographic information, health profile, a binary measure of hearing capacity, depressive symptoms, social engagement, and cognitive status of participants were gathered. RESULTS: A total of 304 participants were included. ARHL was positively associated with depressive symptoms (ß = 0.18, p = 0.009) and negatively related to social engagement (ß = -0.13, p = 0.026). Social engagement was positively associated with cognitive status (ß = 0.17, p = 0.005) and negatively associated with depressive symptoms (ß = -0.23, p < 0.001). Greater depressive symptoms were negatively associated with the participants' cognition (ß = -0.13, p = 0.009). Both social engagement (ß = -0.02, p = 0.029) and depressive symptoms (ß = -0.02, p = 0.032) mediated the negative associations between ARHL and cognitive status. CONCLUSIONS: Addressing hearing loss, depressive symptoms, and enhancing social engagement should be investigated as a potential means of minimizing cognitive decline. Well-designed studies are needed to comprehensively inform the clinical practice development, particularly large prospective studies that will facilitate further elucidate possible causal mechanisms behind these observed associations.

The effect of a lifestyle intervention program using a mobile application versus the effect of a program using a booklet for adults with metabolic syndrome: A three-arm randomized controlled trial.

PURPOSE: The research aimed to examine the effect of a lifestyle intervention program using mobile application versus booklet for adults with metabolic syndrome in Hong Kong. The outcomes comprised body weight (primary outcome), exercise amount, improvement of cardiometabolic risk factors, cardiovascular endurance, perceived stress scale, and exercise self-efficacy. DESIGN: A three-arm randomized controlled trial namely App group, Booklet group, and control group was adopted. METHODS: Two hundred sixty-four adults with metabolic syndrome were recruited from community centers from 2019 to December 2021. Inclusion criteria are those adults with metabolic syndrome, able to use a smart phone. All participants received a 30-min health talk. App group additionally received a mobile application, while Booklet group received a booklet, and the control group received a placebo booklet. Data were collected at baseline, Weeks 4, 12, and 24. SPSS and generalized estimating equations (GEE) model were employed for data analysis. FINDINGS: Attrition rates were minimal, ranged from 2.65% to 6.44%. Both app and booklet group showed significant improvement in outcomes (exercise amount, waist circumference) when compared to control group. However, statistically significant and superior results were observed in app group, including body weight, exercise amount, waist circumference, body mass index, and systolic blood pressure when compared to booklet group. CONCLUSION: The lifestyle intervention supported with app was found to be superior to the booklet support for reducing body weight and maintaining exercise. CLINICAL RELEVANCE: The lifestyle intervention program using mobile application support could be used widely for adults with metabolic syndrome in the community. Suggest nurses may incorporate this program in their health promotion strategies focusing on a healthy lifestyle to reduce the risk of progression to metabolic syndrome.

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.

Association between social integration and risk of dementia: A systematic review and meta-analysis of longitudinal studies.

BACKGROUND: Dementia is an emerging public health issue. Growing evidence emerged on the association between social integration and the risk of dementia. However, the magnitude of the association between different aspects of social integration and the risk of dementia is unclear. METHODS: Five databases were systematically searched. Newcastle-Ottawa scale for assessing the quality of the reporting was used for quality appraisal. Longitudinal cohort studies examining the association between social integration and the risk of dementia were analyzed using random effects model. A series of sensitivity analyses was conducted to enhance the robustness of the findings. RESULTS: Forty publications generated from 32 studies/databases were included. The meta-analysis showed that strong social engagement (overall RR = 0.81, 95% CI = 0.74-0.89, p < 0.001) and frequent social contact (overall RR = 0.86, 95% CI = 0.76-0.97, p = 0.018) were positively associated with decreased risk of dementia. The influence of social support (overall RR = 0.92, 95% CI = 0.80-1.06, p = 0.238) and close social contact (overall RR = 0.74, 95% CI = 0.48-1.13, p = 0.167) was not significant. Loneliness was significantly associated with an increased risk of dementia (overall RR = 1.42, 95% CI = 1.26-1.60, p < 0.001), whereas the influence of social isolation (overall RR = 1.58, 95% CI = 0.80-3.12, p = 0.192) was not significant. A larger social network size (RR = 0.75, 95% CI = 0.59-0.97, p = 0.028) was a promising influencing factor even though the number of studies was insufficient for a meta-analysis. However, the heterogeneity among studies was generally high even though sensitivity analysis was conducted. CONCLUSIONS: Our findings reveal that high social engagement and frequent social contact are significantly associated with a lower risk of dementia, whereas loneliness is associated with a higher risk. The promising impact of large social network size is also identified. Substantial heterogeneity appeared in most of the analysis, making the inference tentative. Nevertheless, the sensitivity analysis provided valuable implications that enhancing social engagement and reducing loneliness may prevent or delay the onset of dementia among middle-aged and older adults.

Impacts of Educational Interventions with Support of Mobile App versus Booklet for Patients with Hypertension and Metabolic Syndrome: A Secondary Data Analysis.

BACKGROUND: Hypertension comorbid with metabolic syndrome could increase the development of adverse cardiovascular events. Educational interventions were effective to improve outcomes in patients. METHODS: This was a secondary data analysis of participants with hypertension. The original randomized controlled trial aimed to examine the effect of app and booklet versus control among individuals diagnosed with metabolic syndrome living in the community. A 30-min health education was provided to each participant. In addition to the education, the app group received a mobile app while the booklet group received a booklet. Data were collected at baseline, week 4, week 12, and week 24. Intention-to-treat principle was followed, and generalized estimating equations was employed for data analysis. RESULTS: A total of 118 participants with hypertension and metabolic syndrome were extracted from the three-arm trial data. The sample size was 36, 42, and 40 in the app group, booklet group, and control group, respectively. Compared to the control group, the app group showed a significant reduction on body weight and waist circumference at week 24, while the total exercise and self-efficacy for exercise were increased at week 12 and week 24 but no significant findings were observed in the booklet group. CONCLUSIONS: The educational intervention supported with app was superior to the booklet support on the outcomes of body weight, waist circumference, total exercise, and self-efficacy for exercise among patients with hypertension and metabolic syndrome in the community.

Influence of dementia literacy and caregiving appraisal on the psychological wellbeing of informal caregivers of people with dementia: A cross-sectional study.

Background: Dementia informal caregiving is a global phenomenon. It is well documented that caregivers' psychological health is often affected by busy caregiving schedules. Lawton's two-factor model indicates that caregivers' psychological wellbeing is influenced by caregiving appraisal and other caregiver factors. Our review also identified the significance of dementia literacy, which was an essential caregiver factor. However, it is imperative for a clear understanding of the mechanism of how psychological wellbeing is influenced by them. Objectives: To explore the association among dementia literacy, caregiving appraisal, and psychological wellbeing and the influencing mechanisms between them. Methods: Two hundred and twenty-three informal caregivers of people with dementia were involved in this cross-sectional study. Dementia literacy was measured by the Alzheimer's Disease Knowledge Scale and Dementia Attitude Scale. Caregiving appraisal and psychological wellbeing were measured with the Caregiving Appraisal Scale and Ryff's Psychological wellbeing Scale, respectively. Descriptive statistics were used to describe the characteristics of participants and key outcome variables. Pearson's correlation analysis was used to analyze the correlation among the variables. Structural equation modeling was used to examine the hypothetical mediating role of caregiving appraisal in the relationship between dementia literacy (i.e., knowledge of dementia and attitude toward dementia) and caregivers' psychological wellbeing. Results: The hypotheses were partially confirmed. Attitude toward dementia was significantly associated with caregiving appraisal (r = 0.312, p < 0.01) and psychological wellbeing (r = 0.311, p < 0.01). However, knowledge of dementia was only significantly associated with psychological wellbeing (r = 0.136, p < 0.05). The structural equation modeling fitted well (p = 0.078, CFI = 0.987, RMSEA = 0.038). In the fitted model, caregiving appraisal partially mediated the association between attitude toward dementia and psychological wellbeing. In contrast, attitude toward dementia and caregiving appraisal fully mediated the association between knowledge of dementia and psychological wellbeing. Conclusion: Efforts can be exerted to improve dementia caregivers' caregiving appraisal and attitude toward dementia to improve their psychological wellbeing.

Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial.

Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment's feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants' experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.

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.

The Development of an Evidence-Based Telephone-Coached Bibliotherapy Protocol for Improving Dementia Caregiving Appraisal.

Caregiving appraisal is the caregivers' cognitive evaluation of caregiving stressors. It determines the caregiving outcomes and caregiver health. Dementia caregivers have shown relatively negative caregiving appraisals. However, there is a lack of interventions to improve caregiving appraisal. This study describes the multi-phase process of developing and validating an evidence-based bibliotherapy protocol for improving the caregiving appraisal of informal caregivers of people with dementia. Two phases were included in the development: In Phase 1, a series of reviews of theory and evidence were conducted to identify the theoretical underpinnings, the core components, the dosage, and the mode of delivery of evidence-based bibliotherapy. In Phase 2, focus groups consisting of an expert panel of 16 clinicians and academics were used to validate the intervention protocol. Evidence synthesis was used in Phase 1 to formulate a draft intervention protocol. Content analysis was used in Phase 2 to work out the principles to revise the intervention protocol. The validated evidence-based bibliotherapy protocol included eight weekly sessions, and each session targeted improving one aspect of the essential factors that influence caregiving appraisal. This study provided a culturally sensitive and contextually appropriate evidence-based bibliotherapy protocol ready to be tested in a clinical trial.

Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia.

During the COVID-19 pandemic, there is a growing interest in online information about coronavirus worldwide. This study aimed to investigate the digital health literacy (DHL) level, information-seeking behaviour, and satisfaction of information on COVID-19 among East and South-East Asia university students. This cross-sectional web-based study was conducted between April to June 2020 by recruiting students from universities in China, Malaysia, and the Philippines. University students who have Internet access were invited to participate in the study. Items on sociodemographic variables, DHL, information-seeking behaviour, and information satisfaction were included in the questionnaire. Descriptive statistics and logistic regression analysis were conducted. A total of 5302 university students responded to the survey. The overall mean score across the four DHL subscales was 2.89 (SD: 0.42). Search engines (e.g., Google, Bing, Yahoo) (92.0%) and social media (88.4%) were highly utilized by the students, whereas Websites of doctors or health insurance companies were of lower utilization (64.7%). Across the domains (i.e., adding self-generated content, determining relevance, evaluating reliability, and protecting privacy) higher DHL was positively associated with higher usage of trustworthy resources. Providing online information on COVID-19 at official university websites and conducting health talks or web-based information dissemination about the strategies for mental health challenges during pandemic could be beneficial to the students. Strengthening DHL among university students will enhance their critical thinking and evaluation of online resources, which could direct them to the quality and trustworthy information sources on COVID-19.

"Am I entitled to take a break in caregiving?": Perceptions of leisure activities of family caregivers of loved ones with dementia in China.

Leisure activities are essential for family caregivers of loved ones with dementia living in the community, yet these caregivers tend not to engage in them, especially in China, wherein it may have a negative impact on their physical and psychological health. To date, limited knowledge exists regarding underlying reasons that deter these family caregivers from doing leisure activities. This study aims to explore perceptions of family caregivers of people living with dementia and their engagement in leisure activities. A qualitative descriptive research design was used with semi-structured, face-to-face, individual in-depth interviews. The data were collected in Shijiazhuang, China between October and November 2019. Content analysis was used to develop categories. Results of 20 family caregivers (5 men and 15 women, mean age = 55.6±12.7) reported their perceptions under four main categories: (i) "the condition of leisure life," (ii) "needs for leisure activities," (iii) "reasons for the reluctance to do leisure activities," and (iv) "motivations supporting the implementation of leisure activities." In addition to the heavy caregiving workload and lack of support, traditional Chinese beliefs including filial commitment and "fatalistic voluntarism" were the reasons that prevented Chinese family caregivers of people living with dementia from doing leisure activities. However, engaging their loved ones in leisure activities, like doing exercise together, could motivate family caregivers themselves to participate in leisure activities. These findings encourage healthcare professionals to consider the influence of culture on family caregivers' engagement in leisure activities which is one of the ways to reduce stress. Family caregivers may benefit from the leisure activities by learning how to better cope with and balance caregiving tasks with their leisure pursuits in the community.

Effectiveness of a Nurse-Led Support Programme Using a Mobile Application versus Phone Advice on Patients at Risk of Coronary Heart Disease - A Pilot Randomized Controlled Trial.

Purpose: Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally. This study aimed to examine the preliminary effect of a nurse-led support programme using a mobile application versus nursing telephone advice on patients at risk of CHD living in the community. Patients and Methods: A prospective randomized controlled trial was adopted. Sixty eligible CHD participants were randomized into the app group (App) or the nursing telephone advice (NTA) group to support their own health care and exercise. Data were collected at baseline (T0), 1 month (T1), and 3 months (T2). Outcomes were total amount of exercise, self-efficacy of chronic disease management, total time of exercise, blood pressure, and lipid concentrations. Data were analyzed using the generalized estimating equation models. Results: Ninety-two individuals were screened for eligibility and 60 were randomized into the app group (n = 30) or NTA group (n = 30). The mean age of the participants was 60.92. The total attrition rate at T2 was 1.66%. The app group showed a moderate effect (Cohen's d =0.43) in significant increase in exercise amount, and reduction of lipid concentration (total cholesterol d=-0.43, triglyceride d=-0.39) respectively. Other outcomes showed improvement trend but non-significant between group. Conclusion: The CHD app is effective to motivate CHD patients for maintaining exercise amount which will be beneficial to their lipid control.

Mix-and-Match or Mismatch? Exploring the Perspectives of Older Adults About Zumba Dance and Its Potential Utilization for Dual-Task Training.

Despite the popularity of Zumba dancing, research is scarce about its impact on older adults. Meanwhile, the integration of cognitive tasks with physical exercises, also known as dual tasking, is an evolving strategy to facilitate activities for older adults. This study investigated the perceptions of persons aged ≥55 years on Zumba and its potential to be incorporated into a dual-task program. We conducted a descriptive-qualitative study involving 44 Filipino older adults. Using content analysis, four themes were identified: moving toward match or mismatch, balancing benefits with burdens, dual tasking as innovative yet potentially challenging, and overcoming barriers with enablers. Although Zumba was perceived as an inclusive and beneficial activity, individual and contextual limitations could hinder its suitability. Moreover, dual tasking in Zumba was considered an innovative approach, although challenges should be addressed to promote its feasibility. Several strategies could enable the design and implementation of age-appropriate Zumba and dual-tasking programs for older adults.

Sense of coherence mediates the relationship between digital health literacy and anxiety about the future in aging population during the COVID-19 pandemic: a path analysis.

Objectives: During the COVID-19 pandemic, older adults experience various challenges, including information uncertainties, financial pressure, and visit restrictions, which may lead to anxiety about the future. As a protective factor, sense of coherence (SOC) may play a role to reduce some psychological discomfort. This study aimed to analyze the relationships of SOC with anxiety, digital health literacy (DHL), information, and financial satisfaction among older adults during the outbreak.Methods: This is part of a large-scale DHL study with a cross-sectional survey across 41 countries. This study extracted data from three Asian countries (China, the Philippines, and Singapore) and included people aged ≥60. Structural equation modeling with path analysis was utilized to examine the relationships of SOC with anxiety about the future and other variables.Results: A total of 266 older adults were included, with 43.2% expressed anxiety about the future. DHL (ß=-0.13, p < 0.05) and SOC (ß=-0.26, p = 0.01) were negatively associated with anxiety, while financial and information satisfaction were not. However, financial satisfaction (ß = 0.34, p < 0.01) and DHL (ß = 0.32, p = 0.01) were positively associated with SOC. Higher SOC further mediated the negative relationships of DHL (ß= -0.11, p = 0.004) and financial satisfaction (ß= -0.12, p = 0.004) on anxiety of older adults.Conclusions: SOC had direct negative effect on anxiety and mediated the relationships between anxiety and DHL/financial satisfaction. Strategies should be developed to enhance SOC and DHL among older adults, as these capacities may help to manage anxiety during the pandemic.

Nurses' Attitudes Toward the Importance of Families in Nursing Care: A Multinational Comparative Study.

The aim of this study was to examine nurses' attitudes about the importance of family in nursing care from an international perspective. We used a cross-sectional design. Data were collected online using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire from a convenience sample of 740 registered nurses across health care sectors from Sweden, Ontario, Canada, and Hong Kong, China. Mean levels of attitudes were compared across countries using analysis of variance (ANOVA). Multiple regression was used to identify factors associated with nurses' attitudes and to test for interactions by country. Factors associated with nurse attitudes included country, age, gender, and several practice areas. On average, nurses working in Hong Kong had less positive attitudes compared with Canada and Sweden. The effects of predictors on nurses' attitudes did not vary by country. Knowledge of nurses' attitudes could lead to the development of tailored interventions that facilitate nurse-family partnerships in care.

Pilot testing of Dual-task Zumba Gold (DTZ) for community-dwelling people with mild cognitive impairment: A mixed-methods study.

Dual-tasking (e.g., enrichment of physical activities with mental exercises) is an innovative strategy to enhance older adults' cognition. Meanwhile, Zumba is a popular dance program, but research is limited about its utility on older people or those with mild cognitive impairment (MCI). This study assessed the feasibility of a new intervention called dual-task Zumba Gold (DTZ) for people with MCI. A mixed-methods feasibility study involving ten people aged ≥55 years with MCI was conducted from December 2020 to March 2021. Nine participants completed the study (90%) with high intervention acceptability. Program adherence (90.3%) and implementation fidelity (92.2%) were high. Participants also expressed the program's benefits, challenges, and facilitators. Moreover, pilot test results suggested improvements in global cognition (Z=-2.680; p=0.007), quality of life (Z=-2.688; p=0.008), and mobility (Z=-2.333; p=0.020). Hence, DTZ is feasible and acceptable for people with MCI, offering potential multidomain effects. Future randomized controlled studies should confirm these outcomes.