Development and psychometric evaluation of the Physical Resilience Instrument for Older Adults (PRIFOR)

The impact of perceived social support on chronic disease self-management among older inpatients in China: The chain-mediating roles of psychological resilience and health empowerment

BACKGROUND

Chronic disease self-management is a critical concern in public health, in which perceived social support plays an important role. However, the underlying pathways and mechanisms linking perceived social support to chronic disease self-management remained unclear. This study investigated whether psychological resilience and health empowerment mediated the relationship between perceived social support and the effectiveness of chronic disease self-management.

METHODS

A total of 368 older inpatients with chronic non-communicable diseases were recruited from three grade-A tertiary hospitals in Changsha City, China, using a convenience sampling method between January and June 2023. Data were collected using the General Information Questionnaire, the Chronic Disease Self-Management Scale, the Perceived Social Support Scale, the Connor-Davidson Resilience Scale, and the Health Empowerment Scale. Descriptive demographic analysis and Pearson correlation analysis were conducted using SPSS 26.0, and model 6 in the macro program Process 4.1 was employed to test the chain mediation effect.

RESULTS

Most older inpatients were aged 60-69 years (52.2%), followed by those aged 70-79 years (30.7%). Regression analysis revealed that perceived social support, psychological resilience, and health empowerment collectively explained 45.7% of the variance in chronic disease self-management. Mediation analysis demonstrated that perceived social support not only had a direct positive impact on chronic disease self-management (effect = 0.141, 95% CI: LL = 0.041, UL = 0.241), but also indirectly affected chronic disease self-management through three significant mediating pathways: the independent mediating effect of psychological resilience (effect = 0.102, 95% CI: LL = 0.061, UL = 0.155), the independent mediating effect of health empowerment (effect = 0.042, 95% CI: LL = 0.010, UL = 0.080), and the chain mediating effect between psychological resilience and health empowerment (effect = 0.024, 95% CI: LL = 0.006, UL = 0.047).

CONCLUSION

Perceived social support influenced chronic disease self-management directly and indirectly through psychological resilience and health empowerment. These findings offered practical guidance for developing more effective intervention strategies aimed at improving chronic disease self-management among older inpatients.

Intrinsic Capacity and Life Quality Among Taiwanese Older People: A Cross-Sectional Study

Intrinsic capacity (IC), an internal composite ability proposed by the World Health Organization, is fundamental to older people's health. The present study examined potential models explaining the association between IC and quality of life (QoL) among older people in Taiwan. Frailty, basic activities of daily living (BADL), and instrumental activities of daily living (IADL) were hypothesized to be mediators in the association between IC and QoL. Older people aged 50 years or above from community or medical center (N = 1,235; Mage = 72.63 years [SD = 7.19]; 601 males [48.7%]) completed a series of self-report and functional measures assessing IC, frailty, ADLs, and QoL. Results showed that IC was significantly associated with frailty, BADL, IADL, and QoL in the mediation models. Frailty was found to be a significant mediator in the association between IC and QoL alone or together with IADL. The findings indicate that IC is an important factor for older people to maintain good health and live a fulfilling life.

Cognitive social capital and geriatric depression: A community-based case-control study among the rural elderly people of Bangladesh

Background

Geriatric depression results in additional difficulties for older people and their residing society. The case-control study intended to assess the association between cognitive social capital and depression in rural older people.

Methods

We conducted this study from January to December 2020 among 420 rural tenants aged ≥60 years in Bangladesh. We enrolled 210 older persons with depression as cases and another 210 without depression as controls. We used a semi-structured questionnaire, the Geriatric Depression Scale (GDS-15), and a cluster sampling technique to collect data through face-to-face interviews. We performed quality control checks and followed all ethics guidelines.

Findings

Geriatric depression had a significant association with gender (p = 0.006), marital status (p < 0.001), education (p < 0.001), occupation (p = 0.001), family type (p < 0.001), family size (p < 0.001), number of family members (p < 0.001), and monthly family income (p < 0.001) of the rural older adults. Both interpersonal trust (p < 0.001) and reciprocity (p < 0.001) were significantly associated with geriatric depression. The older adults who didn't believe in interpersonal trust (OR = 6.8, p = 0.002) and who disagreed with reciprocity (OR = 31.1, p < 0.001) were more likely to have depression.

Implications

The study findings can contribute to formulating cognitive social capital policy and interventions to promote the psychological well-being of rural older people by alleviating geriatric depression.

Chinese version of the Physical Resilience Scale (PRS): reliability and validity test based on Rasch analysis

BACKGROUND

Physical resilience is known to minimize the adverse outcomes of health stressors for older people. However, validated instruments that assess physical resilience in older adults are rare. Therefore, the purpose of this study was to translate the Physical Resilience Scale (PRS) into Chinese and to validate its psychometric properties in a population of community-dwelling older adults following SARS-CoV-2 infection.

METHODS

This study used a cross-sectional design and translated the Physical Resilience Scale into Chinese. A total of 426 older adults who had recovered from SARS-CoV-2 infection were chosen for assessment through convenience sampling. The measurement data were analyzed using the Rasch analysis.

RESULTS

Rasch analysis indicates that the Physical Resilience Scale demonstrates excellent reliability, validity, and unidimensionality. The Infit MNSQ and Outfit MNSQ of each entry were 0.77 ~ 1.19, and the degree of fit of each entry to the scale was good. Person and item separation reliability support the internal consistency of the studied samples and PRS items.

CONCLUSIONS

The Physical Resilience Scale has good reliability and is suitable for the assessment of physical resilience tests in older people. However, the overall difficulty of the scale is not suitable for older adults of all ability ranges, and it is possible to add higher and lower difficulty items and adjust the difficulty spacing between items in a later study.

Psychometric Properties of the Weight Loss Readiness Test in Active Duty Military Personnel Enrolled in a Weight Management Trial

INTRODUCTION

The Weight Loss Readiness Test (WLRT) was developed to encourage consideration of factors influencing readiness to engage in weight loss. The WLRT is used clinically, most notably to assess motivation before initiating Navy weight management programs, yet little is known about its psychometric properties.

MATERIALS AND METHODS

This study examined the reliability, convergent and predictive validity, and factor structure of the WLRT in a sample of active duty service members enrolling in a Navy-based weight management program (N = 178, identified as female = 61%, mean age = 29.7 years, mean baseline body mass index = 33.1 kg/m2). All procedures were approved by the respective Institutional Review Boards and research committees.

RESULTS

Exploratory factor analysis revealed a 5-factor structure explaining 52% of the variance that best fit the data with low to moderate correlations between factors: (1) Motivation, (2) Exercise-Related Confidence, (3) Non-Exercise Confidence, (4) Cues, and (5) Anticipated Satisfaction. Internal reliability of subscales was acceptable to good (α = 0.755-0.903). Generally, convergent validity was found between the identified subscales and other measures of motivation, confidence, and disinhibited eating in expected directions. No relationships were found between the subscales and predictive validity outcomes (weight change, program attendance).

CONCLUSIONS

Results indicate adequate structural and convergent validity in the WLRT, but that weight loss readiness, as measured by the WLRT, does not provide predictive validity regarding weight loss or attendance outcomes in this sample. Nonetheless, this measure offers clinical utility in fostering thoughtful conversations about weight loss. The WLRT uniquely focuses on long-term maintenance of behavior change and differentiates between exercise-related and non-exercise confidence. Future studies should further probe the utility of this measure in other populations and the contexts in which it is being used.

Development and testing of a four-item version of the physical resilience instrument for older adults (PRIFOR-4)

The 16-item Physical Resilience Instrument for Older Adults (PRIFOR) has good clinimetric properties; however, a shortened PRIFOR would greatly enhance physical resilience measurements in clinical settings. The current analysis aimed to reduce the number of PRIFOR while maintaining its clinimetric properties, emphasizing on its factor structure and convergent validity. A longitudinal study was conducted among 863 patients aged 65 years or older. Four PRIFOR items with high factor loadings were selected to generate the short version of PRIFOR (PRIFOR-4). The PRIFOR-4 was found to have a unidimensional structure (comparative fit index = 0.999; Tucker-Lewis index = 0.998 in the confirmatory factor analysis results) with good convergent validity with various external measures (absolute r = 0.109-0.597; p-values<0.01). Because the PRIFOR-4 contains only four items, the completion time for the respondents reduced three fourths from the original PRIFOR, which may have a marked reduction in the response burden. The PRIFOR-4 is thus an easy-to-use measurement that saves time for healthcare professionals in clinical practice.

The psychometric properties of the Physical Resilience Instrument for Older Adults (PRIFOR): a Rasch analysis

BACKGROUND

Prior psychometric evidence of the Physical Resilience Instrument for Older Adults (PRIFOR) showed good criterion-related validity, concurrent validity, known-group validity, predictive validity, and internal consistency. However, it is unclear whether older patients with different treatment diagnoses interpret the PRIFOR similarly.

AIMS

This study aimed to test the psychometric properties of the PRIFOR scores among different treatment diagnoses of older patients.

METHODS

We recruited 413 hospitalized older patients with a medical diagnosis and 207 with a surgical diagnosis in a 1343-bed tertiary-care medical center in Taiwan. Data analyses included Rasch models, Principal Components Analysis (PCA), and Pearson correlations.

RESULTS

The Rasch analyses showed that all PRIFOR items were embedded within their belonged constructs, reflecting good construct validity and unidimensionality. Person and item separation reliability support the internal consistency of the studied samples and PRIFOR items. However, six PRIFOR items were found to have meaningful differential item functioning (DIF) problems among treatment diagnoses.

CONCLUSIONS

The PRIFOR is a solid measurement and can be used for monitoring the status of older adults' physical resilience. However, because six items were found to have meaningful DIF among treatment diagnosis groups, future studies should consider designing specific items for different patient populations to assess their needs in physical resilience.

Minimal short-term decline in functional performance and quality of life predicts better long-term outcomes for both in older Taiwanese adults after hip fracture surgery: a prospective study

BACKGROUND

Hip fracture can lead to long-term loss of mobility and self-care ability in older adults. Despite initial decreases in functional performance after hip fracture surgery, patients tend to gradually recover. However, recovery can vary, with some regaining their abilities quickly while others becoming functionally dependent. In this study, we investigated whether the level of short-term postoperative decline in activity of daily living (ADL) performance and quality of life (QoL) can predict the 1-year outcomes for both following hip fracture surgery in older Taiwanese adults.

METHODS

This prospective cohort study included 427 older adults (≥ 60 years) who underwent hip fracture surgery at a single tertiary medical center in Taiwan between November 2017 and March 2021. We collected pre-fracture data, including the patients' demographics, Charlson comorbidity index (CCI) scores, and responses to a questionnaire (Short Portable Mental State Questionnaire [SPMSQ]) for dementia screening. Moreover, their scores on the EuroQol-5D questionnaire (for evaluating QoL) and the Barthel Index (for assessing ADL performance) were collected at pre-fracture status and at 3- and 12-months following surgery. Changes in ADL and QoL three months post-surgery compared to pre-fracture status were evaluated, and the associations of these parameters (and other potential factors) with 1-year outcomes for ADL and QoL were investigated.

RESULTS

We analyzed the data of 318 patients with hip fracture and complete follow-up data regarding ADL performance and QoL at 3- and 12-months post-surgery. After adjusting for covariates, multivariate linear regression revealed that changes in ADL and QoL at 3 months post-surgery from pre-fracture status were positively and significantly associated with 1-year outcomes for both (p < .001 for both). Furthermore, pre-fracture CCI and SPMSQ scores were independent predictive factors associated with 1-year ADL outcomes (p = .042 and < .001, respectively).

CONCLUSIONS

Patients who exhibit a smaller decline in functional performance and quality of life three months after hip fracture surgery from pre-fracture status are likely to have improved long-term ADL and QoL.

TRIAL REGISTRATION

TMU-JIRB N201709053.

The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an instrument to screen substance-use-related health risks. However, little is known whether the ASSIST could be further shortened while remaining psychometrically sound across different countries, languages, gender identities, and sexual-orientation-based groups. The study aimed to validate a shortened 11-item ASSIST (ASSIST-11). Using the International Sex Survey data, 82,243 participants (M age = 32.39 years) across 42 countries and 26 languages completed questions from the ASSIST-11 regarding gender identity, sexual orientation, and other information. Confirmatory factor analysis (CFA) and multigroup CFA (MGCFA) evaluated the ASSIST-11's structure and tested measurement invariance across groups. Cronbach's α and McDonald's ω were used to examine the internal consistency. Cohen's d and independent t-tests were used to examine known-group validity. The ASSIST-11 was unidimensional across countries, languages, age groups, gender identities (i.e., men, women, and gender-diverse individuals), and sexual orientations (i.e., heterosexual and sexual minority individuals). Cronbach's α was 0.63 and McDonald's ω was 0.68 for the ASSIST-11. Known-group validity was supported by Cohen's d (range between 0.23 and 0.40) with significant differences (p-values<0.001). The ASSIST-11 is a modified instrument with a unidimensional factor structure across different languages, age groups, countries, gender identities, and sexual orientations. The low internal consistency of the ASSIST-11 might be acceptable as it assesses a broad concept (i.e., use of several different substances). Healthcare providers and researchers may use the ASSIST-11 to quickly assess substance-use information from general populations and evaluate the need to follow up with more detailed questions about substance use.

Psychometrics of the Physical Resilience Scale in Older Adults Living with Dementia: Proxy Responses

Objectives: The purpose of this study was to determine if proxies can complete the Physical Resilience Scale for older adults living with dementia. Methods: This was a descriptive study using Rasch analysis and baseline data from the Function Focused Care for Acute Care Using the Evidence Integration Triangle trial. The first 240 patients living with dementia were included in this analysis. Results: There was evidence of reliability based on person and item separation index. There was no evidence of Differential Item Functioning (DIF) between genders and a DIF by race on Item 7. Validity was supported based on items fitting the model with the exception of one item, and a significant relationship between physical resilience and pain and function. Discussion: There is some evidence that the Physical Resilience Scale is reliable and valid when completed by proxy reports. Future use should remove one of the items due to redundancy.