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.

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.

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.

Challenges and suggestions for exergaming program in exercise among older adults

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.

A Phase I Trial of Focal Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer

PURPOSE/OBJECTIVE(S)

Locally recurrent prostate cancer after radiotherapy (RT) is an increasingly recognized entity with no standard management. NCT03253744 was a phase I trial with a primary objective of identifying the maximally tolerated dose (MTD) of a course of image-guided, focal, salvage stereotactic body radiotherapy (SBRT) for patients with local recurrence after prior definitive RT. Additional objectives included biochemical control and imaging response on mpMRI and 18F-DCFPyL (PSMA) PET/CT.

MATERIALS/METHODS

SBRT was prescribed to three dose levels (DLs): 40Gy (DL1), 42.5Gy (DL2), and 45Gy (DL3) in 5 fractions. The prescription dose was delivered to a PTV defined by mpMRI and PSMA imaging and biopsy confirmed tumor volume. Dose escalation followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities above baseline were scored using CTCAE v5.0 criteria for two years after completion of SBRT. Escalation was halted if 2 dose limiting toxicities (DLTs) were observed. DLTs were defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT, and any grade 3 GU or grade 4 GI toxicity thereafter. Imaging response was compared between baseline and 6-months by the Wilcoxon signed rank test.

RESULTS

Between 08/2018 and 05/2022, 8 patients underwent salvage SBRT to 11 intraprostatic lesions with a median follow-up of 27 months. No DLTs were observed on DL1. Two patients were enrolled on DL2 and both experienced grade 3 GU toxicities, prompting de-escalation and expansion (n = 6) on DL1, the MTD. The most common toxicities were grade 2 GU toxicities: acute urinary urgency/frequency, acute weak urinary stream, and noninfective cystitis. One patient at DL1 had a self-limited episode of grade 2 GI toxicity (proctitis). No grade 3 GI toxicities were observed. All but two patients achieved an undetectable PSA nadir. Only one of these experienced biochemical failure (nadir + 2.0) at 33 months with suspicion of distant metastatic failure on restaging PET/CT. Imaging response was demonstrated by MRI in all lesions with heterogeneity in volumetric response (6% to 100%). A significant (p<0.01) response on PSMA PET/CT was observed for all measured parameters (SUVMax, SUVMean, GTVPSMA, Total Lesion PSMA [SUVMean × GTVPSMA]). Of the 11 lesions, 1 (9%) demonstrated a complete response (CR) by MRI and 9 (82%) by PSMA PET/CT. A single lesion increased in volume by 0.06 cc (16%) at 6-month PSMA PET/CT compared to baseline in the only patient who did not achieve an undetectable PSA nadir and did not have imaging suggestive of distant failure.

CONCLUSION

On this phase I dose escalation study of salvage SBRT for isolated intraprostatic local failure after definitive RT, the MTD was 40Gy in 5 fractions. producing a 100% 24-month bPFS, with one late failure at 33 months occurring after the 24-month study period. The most frequent clinically significant toxicity was late grade 2 GU toxicity. Imaging response was demonstrated in all lesions on MRI and PSMA PET/CT with exception of a single lesion.

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.

Research progress in the hospitalization-associated disability among elderly patients

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.

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.

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 (β = 0.015, 95% CI 0.003, 0.037) and depressive symptoms (β = 0.070, 95% CI 0.037, 0.116) separately but also through social participation and depressive symptoms sequentially (β = 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.

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.

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.

The mediating effect of skeletal muscle index on the relationship between menarcheal age and bone mineral density in premenopausal women by race/ethnicity

OBJECTIVE

To examine the contribution of skeletal mass index (SMI) as a mediator in the relationship between menarcheal age and hip/spine bone mineral density (BMD) in premenopausal women by race/ethnicity.

METHODS

The data of 4,329 participants (age ≥ 18; mean age=35.7 ± 9.5) of Whites (n = 2,543), African Americans (n = 1,236), and Asians (n = 550) enrolled from October 2011 to January 2019 from the Louisiana Osteoporosis Study were analyzed. After adjustment for physiological and behavioral factors, multivariable linear regression analyses were conducted to evaluate each component of the proposed mediation models, and mediation was verified by the bootstrapping resampling approach.

RESULTS

Premenopausal women with early menarcheal age tended to have higher SMI and BMD than women with normal menarcheal age among all races/ethnicities included. Women with late menarcheal age were, however, more likely to have a lower SMI than their counterparts with normal menarcheal age (r = -0.212, 95% CI = [-0.321 to -0.103] for White women; r = -0.181, 95% CI = [-0.410 to -0.008] for African-American women; r = -0.174, 95% CI = [-0.343 to -0.006] for Asian women). Similar results were found for both spine and hip BMD. SMI fully mediated the difference in BMD due to different menarcheal ages among Whites, African Americans, and Asian women with early menarcheal age; however, no mediating effects were observed for Asian women with late menarcheal age.

CONCLUSIONS

SMI, as a full mediator, affected the relationship between menarcheal age and BMD among premenopausal women, and the mediating effects varied by race/ethnicity. To prevent or slow down the loss of hip/spine BMD and the development of osteoporosis, measures aiming at minimizing the risk for muscle mass loss should be recommended, especially for White and African-American women with late menarcheal age.

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.

Malnutrition and its associated factors among elderly Chinese with physical functional dependency

OBJECTIVE

To assess the prevalence and to identify the associated factors of malnutrition among elderly Chinese with physical functional dependency.

DESIGN

Face-to-face interviews using standardised questionnaires were conducted to collect demographic information, health-related issues and psychosocial status. Physical function was measured by the Barthel Index (BI), and nutrition status was assessed by the Mini Nutritional Assessment-Short Form. Multivariate binary logistic regression was used to assess associated factors of malnutrition.

SETTING

China.

PARTICIPANTS

A total of 2323 participants (aged ≥ 60 years) with physical functional dependency in five provinces in China were enrolled using a multistage cluster sampling scheme.

RESULTS

The prevalence of malnutrition was 17·9 % (95 % CI 16·3, 19·4). Multivariable binary logistic regression revealed the independent risk factors of poor nutrition status were being female, older age, lower educational status, poor hearing, poor physical functional status, lack of hobbies, low religious participation, poor social support, lack of social participation and changes in social participation. The study found that the most significant independent risk factor for malnutrition was complete physical functional dependence (OR 4·46, 95 % CI 2·92, 6·82).

CONCLUSIONS

The findings of the study confirm that malnutrition and the risk of malnutrition are prevalent in Chinese older adults with physical functional dependency. In addition to demographic and physical health-related factors, psychosocial factors, which are often overlooked, are independently associated with nutrition status in Chinese older adults with physical functional dependency. A holistic approach should be adopted to screen for malnutrition and develop health promotion interventions in this vulnerable population.

Effect of dietary l-arginine of broiler breeder hens on embryonic development, apparent metabolism, and immunity of offspring

This study investigated the effects of supplemented l-arginine (l-Arg) in broiler breeder hens' diets on the embryonic development and physiological changes of offspring during the hatching period. A total of 480 35-wk-old healthy female Arbor Acres broiler breeders were randomly divided into 6 groups and fed a corn and soybean meal diet with 6 digestible Arg levels (0.96%, 1.16%, 1.35%, 1.55%, 1.74%, and 1.93%). After a 10-wk experiment, eggs were collected for incubation. At embryonic day (E) 11 to E21, eggs, embryos, and organs (liver, breast muscle, and thigh muscle) were weighed. Total protein, urea nitrogen, creatinine, cholesterol, and triglyceride in plasma, were measured. Plasma level of immunoglobulin G (IgG), immunoglobulin M (IgM), and nitric oxide synthase (NOS) were measured at E13, E17, and E21. Messenger RNA expression of carbamoyl phosphate synthase I (CPS1), ornithine transcarbamylase (OTC), and argininosuccinate synthase (ASS) in liver and breast muscle tissues was assessed at E13, E17, and E21. The results showed that 1.16% Arg in maternal diet increased egg weight (P < 0.05). The level of Arg in maternal diet has a significant effect on organ index and embryo weight of multiple embryonic days (P < 0.05). Embryonic plasma total protein concentration was significantly affected by maternal dietary Arg level (P < 0.05) and exhibited quadratic responses at E11, E15, E17, and E21 (P < 0.01). Plasma urea nitrogen, creatinine, triglyceride, and cholesterol level were also significantly affected by the level of maternal Arg at different embryonic ages (P < 0.05). Dietary digestible Arg levels quadratically influenced plasma urea nitrogen level at E21 (P < 0.05) and cholesterol concentration at E17 and E19 (P < 0.01). L-Arg supplementation in maternal diet significantly improved the IgG level at E17 and E21 (1.16%, 1.35%, 1.55%, and 1.74%; P < 0.05), the IgM level at E13 (1.35%, 1.55%, 1.74%, and 1.93%) and E17 (P < 0.05) and the NOS level at E13, E17, and E21 (P < 0.05). Maternal dietary L-Arg supplementation significantly improved the expression of CPS1 gene, OTC gene (1.16%, 1.35%, and 1.55%), and ASS gene (1.35% and 1.55%) in the liver (P < 0.05), and also enhanced the CPS1 gene (except 1.35%) and OTC gene (1.55% and 1.74%) expression in the breast muscle (P < 0.05). In conclusion, maternal Arg level affected the embryonic development of offspring and regulated the apparent metabolic programming and immunity state of the embryo. Arginine level of 1.55% in hens' diet was beneficial to the protein synthesis and immunity of the offspring in the embryonic period, and it was recommended to obtain healthy offspring.

Signatures of Ultrafast Reversal of Excitonic Order in Ta_{2}NiSe_{5}

In the presence of electron-phonon coupling, an excitonic insulator harbors two degenerate ground states described by an Ising-type order parameter. Starting from a microscopic Hamiltonian, we derive the equations of motion for the Ising order parameter in the phonon coupled excitonic insulator Ta_{2}NiSe_{5} and show that it can be controllably reversed on ultrashort timescales using appropriate laser pulse sequences. Using a combination of theory and time-resolved optical reflectivity measurements, we report evidence of such order parameter reversal in Ta_{2}NiSe_{5} based on the anomalous behavior of its coherently excited order-parameter-coupled phonons. Our Letter expands the field of ultrafast order parameter control beyond spin and charge ordered materials.

Research on the Relationship of the Organization Capacity and Job Satisfaction in Nursing Homes

Objective: To explore the occurrence of organization capacity and to examine the relationships among the organization capacity and job satisfaction in nursing homes in China. Methods: A total of 577 participants in sixteen nursing homes in Hunan province of China were enrolled using a cluster randomized controlled trial. Staff job satisfaction was measured by Minnesota Satisfaction Questionnaire(MSQ) in short form, nursing homes’ organization capacity was assessed by Shortell’s Organization and Management Survey. One-way analysis of variance examined differences between variables. The relationship and correlation of organization capability, MSQ total score and scores in each dimension was analyzed. Results: Overall score of nursing homes’ organization capacity was 99.5±8.6(level ranking, 21–105), and MSQ score was 78.2±8.2 (level ranking, 20–100). Staff job satisfaction levels were significantly different among nursing staffs with different levels of organization capability (F=9.40, P＜0.001). Correlation analysis showed that organization capability level was positively correlated with staff job satisfaction (r=0.52, P< 0.001). And Correlation analysis showed that Working conditions (r = 0.46, P < 0.001), Leaders (r = 0.46, P < 0.001), Responsibility (r = 0.51, P < 0.001) and External reward (r= 0.42, P < 0.001) were positively associated with organization capability. Conclusion: The organization capability can be improved by active staff job satisfaction. But the job satisfaction of nursing staffs was at a moderate level. Thus effective measures such as creating a supportive work conditions, appointing suitable leaders, enhancing responsibilities and providing external reward should be considered by nursing managers to promote organization capability in nursing homes.

The Impact of the Risk for Sarcopenia on Frailty Among Older Adults With Physical Functional Dependency

Objective: 1) to assess the prevalence of the risk for sarcopenia, as well as frailty among older adults with physical functional dependency in a nationally representative sample; and 2) to identify the impact of the risk for sarcopenia on frailty in this vulnerable population in China. Methods: A total of 2,323 participants (age ≥ 60 years old) with physical functional dependency in five provinces in China were enrolled using a multistage cluster sampling scheme. Physical function was measured by the Barthel Index (BI), the risk for sarcopenia was defined as “calf circumference (< 34 cm in men, < 33 cm in women)” according to the 2019 consensus proposed by the Asian Working Group for Sarcopenia, and frailty was assessed by the FRAIL scale. Multivariate binary logistic regression was used to assess the impact of the risk for sarcopenia on frailty. Results: The prevalence of the risk for sarcopenia and frailty were 41.0% and 30.9%, respectively. Logistic regression analysis shows that the risk for sarcopenia was significantly associated with frailty (odds ratio 1.51, 95% confidence interval 1.19-1.90, p = 0.001) after adjustment for demographic and psychosocial factors, as well as health-related factors. Conclusion: This study shows that the risk of sarcopenia and frailty are prevalent, and the presence of the risk of sarcopenia increased the risk of frailty in older Chinese adults with physical functional dependency. Key Words: the risk for sarcopenia; frailty; older adults; physical functional dependency.

Oral Dysphagia and Its Associations With Nutrition, Physical Functions, and Depression for the Elderly in the Community

Objectives: To explore the occurrence of oral dysphagia problems among elderly in community and to investigate whether the severity of oral dysphagia problems is associated with nutrition, physical functions and mental health. Methods: Trained nurses conducted a rigorous assessment of 679 elderly people living in communities in Zhuzhou. Basic personal information, The Short Form Mini Nutritional Assessment (MNASF), Activities of daily living (ADL), Patient Health Questionnaire-9 (PHQ-9) were used to assess each elderly. Oral dysphagia was assessed by means of a standardized questionnaire including clinically symptoms of oral dysphagia such as coughing and choking. Results: A total of 654 old people was enrolled in this study, including 250 (38.2%) developing the one or more symptoms of oral dysphagia, the most common symptoms were: drinking water choking (30.7%), followed by saliva (9.6%), dysphagia or pain (6.4%),food loss from the corner of the mouth (2.3%), foreign body sensation of the esophagus (1.8%),food residue (1.2%).The severity of oral dysphagia problems was linearly associated with nutrition, physical function, depression, education level and current care status. The higher the burden of oral symptoms, the lower the self-rated health. Conclusions: The occurrence of oral dysphagia symptom was associated in a stepwise fashion with nutrition, physical function, depression, education level and current care status. In the community, the early recognition, diagnosis and treatment of oral dysphagia is an important link of reducing the mortality and improving the rehabilitation outcome. Additionally, the psychological construction in the elderly should be taken seriously by their families and community workers.

Ultrafast Enhancement of Ferromagnetic Spin Exchange Induced by Ligand-to-Metal Charge Transfer

We theoretically predict and experimentally demonstrate a nonthermal pathway to optically enhance superexchange interaction energies in a material based on exciting ligand-to-metal charge-transfer transitions, which introduces lower-order virtual hopping contributions that are absent in the ground state. We demonstrate this effect in the layered ferromagnetic insulator CrSiTe_{3} by exciting Te-to-Cr charge-transfer transitions using ultrashort laser pulses and detecting coherent phonon oscillations that are impulsively generated by superexchange enhancement via magneto-elastic coupling. This mechanism kicks in below the temperature scale where short-range in-plane spin correlations begin to develop and disappears when the excitation energy is tuned away from the charge-transfer resonance, consistent with our predictions.

Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review

BACKGROUND

Individuals with mild cognitive impairment and dementia have impaired physical and cognitive functions, leading to a reduced quality of life compared with those without such impairment. Exergaming, which is defined as a combination of exercise and gaming, is an innovative, fun, and relatively safe way to exercise in a virtual reality or gaming environment. Therefore, exergaming may help people living with mild cognitive impairment or dementia to overcome obstacles that they may experience regarding regular exercise and activities.

OBJECTIVE

The aim of this systematic review was to review studies on exergaming interventions administered to elderly individuals with mild cognitive impairment and dementia, and to summarize the results related to physical and cognitive functions such as balance, gait, executive function, and episodic memory.

METHODS

We searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, Amed, and Nursing Database for articles published from the inception of the respective databases to January 2019. We included all clinical trials of exergaming interventions in individuals with mild cognitive impairment and dementia for review. The risk of bias was independently evaluated by two reviewers using the Cochrane Collaboration and Risk of Bias in Non-randomized Studies of Interventions tools.

RESULTS

Ten studies involving 702 participants were included for review. There was consistent evidence from 7 studies with a low risk of bias showing statistically significant effects of exergaming on cognitive functioning in people with mild cognitive impairment and dementia. With respect to physical function, 3 of 5 full-scale studies found positive results, and the intensity of most games was classified as moderate.

CONCLUSIONS

Overall, exergaming is an innovative tool for improving physical and cognitive function in people with mild cognitive impairment or dementia, although there is high heterogeneity among studies in terms of the duration, frequency, and gaming platform used. The quality of the included articles was moderate to high. More high-quality studies with more accurate outcome indicators are needed for further exploration and validation of the benefits of exergaming for this population.

Effect of systemic lupus erythematosus and rheumatoid arthritis on sudden sensorineural hearing loss

OBJECTIVES

Recent reports have identified autoimmune systemic diseases as a significant risk factor for sudden sensorineural hearing loss (SSNHL). We investigated whether systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) were correlated with the hearing recovery of SSNHL.

STUDY DESIGN

A retrospective study.

METHODS

Records of 663 SSNHL patients between January 2008 and January 2019 were retrospectively reviewed, including demographic, comorbid diseases, and hearing recovery. Patients were divided into four groups (complete, partial, slight, and no recovery) according to Siegel's criteria and Chinese Medical Association of Otolaryngology (CMAO) criteria. Multinomial logistic regression was performed to evaluate the effects of onset of treatment, initial hearing threshold, audiogram pattern, diabetes mellitus, SLE, and RA on the prognosis of SSNHL according to both criteria.

RESULTS

Patients in complete recovery, partial recovery, slight recovery, and no improvement were 95 (14.3%), 183 (27.6%), 170 (25.6%), and 215 (32.4%) by Siegel's criteria, and 90 (13.6%), 152 (22.9%), 188 (28.4%), and 233 (35.1%) by CMAO criteria, respectively. Among the four groups, onset of treatment, initial hearing threshold, diabetes mellitus, SLE, RA, and profound audiogram pattern were found to be associated with recovery outcome by both Siegel's criteria and CMAO criteria (P < .05). According to analysis results, presence of SLE, RA, diabetes mellitus and higher initial hearing threshold were significantly correlated with a poor prognosis by both Siegel's criteria and CMAO criteria (P < .05).

CONCLUSION

Comorbid SLE or RA may negatively affect the prognosis of SSNHL. Lower initial hearing threshold and absence of diabetes mellitus are associated with favorable hearing recovery.

LEVEL OF EVIDENCE

4. Laryngoscope, 130:2475-2480, 2020.

Web-Based Interventions to Improve Mental Health in Home Caregivers of People With Dementia: Meta-Analysis

Background

Dementia is a major cause of disability and dependency in older adults worldwide. It is often accompanied by general psychological distress, such as depression and anxiety symptoms, among caregivers of people with dementia (PwD). The physical and mental health of the caregiver is a prerequisite and a promise to help PwD continue to live as long and as well as possible. Web-based interventions can provide convenient and efficient support and an education tool to potentially reduce the negative outcomes associated with providing care.

Objective

The aim of this study was to examine the effect of internet-based interventions on the mental health outcomes of family caregivers of PwD and to explore which components of the Web-based interventions play an important role.

Methods

A comprehensive literature search was conducted in PubMed, Excerpta Medica dataBASE, PsycINFO, Cochrane Database, and the Cumulative Index to Nursing and Allied Health Literature using relevant terms such as Web-based and caregiver as keywords, covering all studies published before June 2018. A total of 2 reviewers independently reviewed all published abstracts, according to established inclusion and exclusion criteria. We extracted information about the participants, interventions, and results and reviewed article quality in terms of the randomized trial methods, using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions.

Results

A total of 815 caregivers participated in 6 studies, with 4 of the studies using depression as an outcome. The analysis found that depression scores dropped an average of 0.23 (95% CI −0.38 to −0.07; P<.01) after Web-based interventions. In 2 studies of caregivers who were experiencing anxiety symptoms, the average score for anxiety dropped by 0.32 points (95% CI −0.50 to −0.14; P<.01). However, in terms of coping, pain, and stress, the Web-based interventions showed a poor effect. On the whole, the addition of professional psychological support on the basis of education can improve caregivers’ mental health.

Conclusions

Internet-based interventions were generally effective at reducing anxiety and depression in dementia caregivers, although negative results were found in some studies. As for burden and stress, further research is required.

Baseline concentration of misfolded α-synuclein aggregates in cerebrospinal fluid predicts risk of cognitive decline in Parkinson's disease

BACKGROUND

The prognostic significance of misfolded α-synuclein (α-Syn) aggregates in Parkinson's disease (PD) has not been well investigated. The aim of this study was to reveal the relationship between misfolded α-Syn aggregate concentration in cerebrospinal fluid (CSF) and cognitive decline risk in PD.

METHODS

A total of 278 patients with PD were retrospectively included. They were diagnosed between 2011 and 2013. The end-point was 2016, and the follow-up period was 54.3 ± 10.0 months. Cognitive decline was defined as a 4-point decrease in the Mini-Mental State Examination score during follow-up. Misfolded α-Syn aggregate concentration in baseline CSF was measured using the protein misfolding cyclic amplification (PMCA) technique. Time to reach 50% of the maximum fluorescence value was recorded.

RESULTS

The PMCA technique successfully detected the level of misfolded α-Syn aggregates in CSF with a sensitivity of 85.3% and a specificity of 91.4%. The time to reach 50% of the maximum fluorescence value was shorter in the patients with cognitive decline than in the patients without cognitive decline (190.7 ± 40.1 h vs. 240.8 ± 45.6 h, P < 0.001). Multifactorial Cox regression analysis revealed that reaching 50% of the maximum fluorescence value in ≤219 h at baseline was associated with increased risk of cognitive decline during the follow-up (HR: 4.90, 95% CI: 2.75-8.74, P < 0.001).

CONCLUSION

Baseline concentration of misfolded α-Syn aggregates in CSF measured by the PMCA technique predicts risk of cognitive decline in PD.

Rap1 is indispensable for TRF2 function in etoposide-induced DNA damage response in gastric cancer cell line

The telomeric protein TRF2, involving in telomeric and extratelomeric DNA damage response, has been previously reported to facilitate multidrug resistance (MDR) in gastric cancer cells by interfering ATM-dependent DNA damage response induced by anticancer drugs. Rap1 is the TRF2-interacting protein in the shelterin complex. Complex formation between Rap1 and TRF2 is essential for their function in telomere and end protection. Here we focus on the effects of Rap1 on TRF2 function in DNA damage response induced by anticancer drugs. Both Rap1 and TRF2 expression were upregulated in SGC7901 and its MDR variant SGC7901/VCR after etoposide treatment, which was more marked in SGC7901/VCR than in SGC7901. Rap1 silencing by siRNA in SGC7901/VCR partially reversed the etoposide resistance. And Rap1 silencing partially reversed the TRF2-mediated resistance to etoposide in SGC7901. Rap1 silencing did not affect the TRF2 upregulation induced by etoposide, but eliminated the inhibition effect of TRF2 on ATM expression and ATM phosphorylation at serine 1981 (ATM pS1981). Furthermore, phosphorylation of ATM targets, including γH2AX and serine 15 (S15) on p53, were increased in Rap1 silencing cells in response to etoposide. Thus, we confirm that Rap1, interacting with TRF2 in the shelterin complex, also has an important role in TRF2-mediated DNA damage response in gastric cancer cells treated by etoposide.