1
|
Kung PC, Huang HL, Hsu WC, Huang HL, Chang HJ, Shyu YIL. Coexisting with anomie: Experiences of persons living with early-stage dementia: A grounded theory study. Int J Ment Health Nurs 2024; 33:452-462. [PMID: 37985929 DOI: 10.1111/inm.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
Individuals in the early stages of dementia often endure elevated levels of stress and anxiety, which can hinder their ability to adapt to the progression of dementia. To mitigate the negative impacts of dementia more effectively, it is necessary to explore the trajectory of the adaptation process of persons living with dementia. This study aimed to construct a theoretical framework for the adaptation process of individuals in the early stages of dementia. Participants were dyads of persons diagnosed with mild dementia or mild cognitive impairment (≥ 60 years of age) and their primary family caregivers. This longitudinal study used a grounded theory approach to explore the adaptation trajectory changes in persons with mild dementia over a 3-year period. Data were collected from dyads with face-to-face interviews. Analysis of the interview data revealed the core category was 'Coexisting with anomie: Progressive disappointment and striving', which was comprised of three categories: awareness of alienation, unsettled feelings, and restorative avoidance coping. Categories changed depending on levels of cognition and constituted progressive and cyclical dynamic processes. Four contextual factors positively or negatively influenced adaptation: level of insight about dementia, personal traits, caregiving style of the caregiver, and level of social interactions. These findings provide a new perspective about the mental health of persons in early-stage dementia. Understanding coexisting with anomie and related influencing factors could facilitate the development of support interventions by mental health nursing staff, which could improve emotional safety, promote psychological well-being, and increase quality of life for persons living with dementia.
Collapse
Affiliation(s)
- Pen-Chen Kung
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Huei-Ling Huang
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Wen-Chuin Hsu
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hong-Jer Chang
- National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Dementia Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| |
Collapse
|
2
|
Lin CC, Yang CT, Su PL, Hsu JL, Shyu YIL, Hsu WC. Implementation difficulties and solutions for a smart-clothes assisted home nursing care program for older adults with dementia or recovering from hip fracture. BMC Med Inform Decis Mak 2024; 24:71. [PMID: 38475812 DOI: 10.1186/s12911-024-02468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Wearable devices have the advantage of always being with individuals, enabling easy detection of their movements. Smart clothing can provide feedback to family caregivers of older adults with disabilities who require in-home care. METHODS This study describes the process of setting up a smart technology-assisted (STA) home-nursing care program, the difficulties encountered, and strategies applied to improve the program. The STA program utilized a smart-vest, designed specifically for older persons with dementia or recovering from hip-fracture surgery. The smart-vest facilitated nurses' and family caregivers' detection of a care receiver's movements via a remote-monitoring system. Movements included getting up at night, time spent in the bathroom, duration of daytime immobility, leaving the house, and daily activity. Twelve caregivers of older adults and their care receiver participated; care receivers included persons recovering from hip fracture (n = 5) and persons living with dementia (n = 7). Data about installation of the individual STA in-home systems, monitoring, and technical difficulties encountered were obtained from researchers' reports. Qualitative data about the caregivers' and care receivers' use of the system were obtained from homecare nurses' reports, which were explored with thematic analysis. RESULTS Compiled reports from the research team identified three areas of difficulty with the system: incompatibility with the home environment, which caused extra hours of manpower and added to the cost of set-up and maintenance; interruptions in data transmissions, due to system malfunctions; and inaccuracies in data transmissions, due to sensors on the smart-vest. These difficulties contributed to frustration experienced by caregivers and care receivers. CONCLUSIONS The difficulties encountered impeded implementation of the STA home nursing care. Each of these difficulties had their own unique problems and strategies to resolve them. Our findings can provide a reference for future implementation of similar smart-home systems, which could facilitate ease-of-use for family caregivers.
Collapse
Affiliation(s)
- Chung-Chih Lin
- Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Pei-Ling Su
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Jung-Ling Hsu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.).
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (R.O.C.).
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.).
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (R.O.C.).
| | - Wen-Chuin Hsu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| |
Collapse
|
3
|
Liu HY, Kuo LM, Shyu YIL, Hsu WC. Predictors of rewarded caregiving for family caregivers of person with dementia: A longitudinal study. Res Nurs Health 2024; 47:93-103. [PMID: 38206195 DOI: 10.1002/nur.22370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The purpose of this study was to explore variables associated with rewarded caregiving for family caregivers of persons living with dementia over a 2-year follow-up. This correlational longitudinal study was comprised of 200 family caregivers of persons living with dementia from neurological clinics of a medical center was conducted. Dichotomous scoring of the Rewards of Caregiving Scale of the Family Caregiving Inventory resulted in 61 (30.5%) caregivers being assigned to the well-rewarded group and 139 (69.5%) to the poorly reward group at baseline. Variables included characteristics of family caregivers and their care receivers and assessments with validated scales of caregivers' social support and dyadic relational variables of mutuality, preparedness, and balance. Analysis at baseline showed significant predictors of well-rewarded family caregivers were being an adult child of the care receiver, having a high perceived level mutuality and having a high perceived level of preparedness. These three variables remained as significant predictors at the 1- and 2-year follow-up. Caregivers with high levels of perceived mutuality and preparedness at 2-years were seven times more likely to perceive themselves as well-rewarded. Based on the findings, developing clinical interventions that focus on promoting mutuality and preparedness for family caregivers of persons with dementia could allow caregivers to perceive their role as rewarding. Attention should also be paid to the relationship between the caregiver and care receiver to enhance the family caregiver's feelings of mutuality and preparedness.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Li-Min Kuo
- Department of Gerontological Health Care, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
4
|
Bai YL, Shyu YIL, Huang HL, Chiu YC, Hsu WC. The enrichment process for family caregivers of persons living with dementia: A grounded theory approach. J Adv Nurs 2024; 80:252-263. [PMID: 37515365 DOI: 10.1111/jan.15809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/12/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
AIM Many persons living with dementia (PLWD) reside in the community and are cared for by family members. The aim of this qualitative study was to gain an understanding the enrichment process for family caregivers of PLWD in Taiwan. DESIGN A grounded theory approach with face-to-face semi-structured interviews was conducted with family caregivers of PLWD in Taiwan. METHODS Interview data from 30 family caregivers of PLWD recruited from dementia clinics or support groups in Taiwan were obtained from the first wave of a larger study conducted from January 2018 to September 2021. Glaser's grounded theory approach with theoretical sampling was used to understand the enrichment process of family caregivers of PLWD. RESULTS Analysis indicated the core category that characterized the process of enrichment was 'holding together'. Caregivers were able to maintain their connection to the person with dementia through activities that deepened their relationship and strengthened their bond. 'Holding together' included four components: maintaining continuity, creative interactions, interacting with humour and sharing pleasurable activities. Through these components, family caregivers generated positive interactions and relationships with the person living with dementia and sustained their motivation for caregiving. Three modifying elements facilitated or impeded the process of holding together: 'previous daily interactions', 'caregiving beliefs' and 'filial piety'. CONCLUSION Through the enrichment process of 'holding together', family caregivers used different strategies to conduct pleasurable and meaningful activities with the person living with dementia to maintain and improve their relationship and enhance their happiness in life. IMPACT To facilitate the enrichment process, health care providers should encourage activities between family caregivers and PLWD that promote continuity, increase interactions, provide humour and foster pleasurable activities. REPORTING METHOD This study adhered to the COREQ guideline checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Yu-Lin Bai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- NTU BioMedical Park Hospital Zhubei Campus, Zhubei, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Huei-Ling Huang
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Geriatric and Long-Term Care Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yi-Chen Chiu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
5
|
Liu HY, Wang HP, Seak CJ, Wu CC, Hsu YH, Lee SH, Lin YE, Wang YT, Shyu YIL. Influences of Cognitive Function and Depressive Symptoms on Pain Trajectories During the First Year Following Hip Fracture Surgery: A Prospective Cohort Study. J Am Med Dir Assoc 2024; 25:104-111. [PMID: 37926427 DOI: 10.1016/j.jamda.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The purposes of this study were to explore trajectories for patterns of postoperative pain intensity during the first year following hip fracture surgery and the relationships between pain trajectory groups, cognitive impairment, and depressive symptoms. DESIGN A prospective cohort correlational study. SETTING AND PARTICIPANTS A total of 325 patients aged 60 years or older who had received hip fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020. METHODS Data were collected before hospital discharge and at 1, 3, 6, and 12 months postdischarge. Pain intensity was measured using a numeric rating scale; cognitive function was measured with the Taiwan version of the Mini-Mental State Examination; and depressive symptoms were measured by the Geriatric Depression Scale-Short Form. Patients with similar postoperative pain trajectories were categorized into groups and compared with group-based trajectory modeling. Cognitive impairment and depressive symptoms associated with each group were identified by logistic regression. RESULTS Three different pain trajectory groups were identified: drastic decline-minimum pain (47.7%), gentle decline-mild pain (45.5%), and slight decline-moderate pain (6.8%). Patients with cognitive impairment [odds ratio (OR) 11.01, 95% CI 2.99-10.51] and at risk for depression (OR 49.09, 95% CI 10.46-230.30) were more likely to be in the moderate pain group than the minimum pain group. Patients with cognitive impairment (OR 2.07, 95% CI 1.25-3.42) were more likely to be in the mild pain group than the minimum pain group. Patients at risk for depression (OR 9.68, 95% CI 3.16-29.63) were more likely to be in the moderate pain group than the mild pain group. CONCLUSIONS AND IMPLICATIONS Identifying postoperative pain trajectories can provide insight into the most appropriate pain management for older persons following hip fracture surgery. Attention should focus on assessments for cognitive impairment and risk of depression to prevent persistent postoperative pain. Future studies of older patients with clinically diagnosed cognitive impairment and depression are suggested.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Ping Wang
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; Center for Quality Management, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chi-Chuan Wu
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yi-Ting Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Neurology, Dementia Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| |
Collapse
|
6
|
Teng HC, Shyu YIL, Liang J, Teppo K. Strategies for managing group caregiving following hip-fracture surgery among family members: A grounded theory study. Int J Older People Nurs 2023:e12552. [PMID: 37291667 DOI: 10.1111/opn.12552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/02/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Family members in many countries often share caregiving responsibilities for an older relative recovering from an injury. However, few studies have examined strategies employed when multiple family members provide care for an older relative recovering from hip-fracture surgery. OBJECTIVE This study aimed to understand family group caregiving strategies when two or more family members provide caregiving for an older relative recovering from hip-fracture surgery. METHODS This study used a grounded theory design. Semistructured interviews were conducted over 1 year with 13 Taiwanese family caregivers from five families. Caregivers shared caregiving responsibilities for an older relative (62-92 years of age) recovering from hip-fracture surgery. Transcribed interviews were analysed using open, axial and selective coding. RESULTS The core category describing caregiving among family members was 'Preventive Group Management: strategies for family group caregiving'. Three strategies were employed: explicit division of labour (two stem/patriarchal families and one older two-generation/democratic family); disconnected caregiving (one nuclear/noncommunicative family) and patriarchal caregiving (one extended/traditional Chinese family). Strategies reflected family type, structure, cultural values, communication patterns and available outside support. Components of family group caregiving involved family type's division of labour, approaches to caregiving and implementation challenges and allowed family caregivers to maximise safety and stability and prevent harmful events during their relative's recovery from surgery. CONCLUSIONS There was no one-size-fits-all approach for the strategies of family group caregiving. Components of Preventive Group Management varied with family type, cultural values, communication patterns and available outside support. Healthcare professionals should be sensitive to the dynamics of family caregivers. IMPLICATIONS FOR PRACTICE Enhance group management for family caregivers by developing interventions to optimize collaboration, thereby better addressing the needs of older adults recovering from hip fracture surgery.
Collapse
Affiliation(s)
- Hui-Chin Teng
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology and Dementia Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jieying Liang
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Health Management and Policy, School of Public Health, University of Michigan, Michigan, Ann Arbor, USA
- Department of Healthcare Management, Chang Gung University, Taoyuan, Taiwan
| | - Kröger Teppo
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
7
|
Liu HY, Shyu YIL, Chou YC, Seak CJ, Lin YC, Tsai PJ, Wang HP, Lin YE. Combined Effects of Cognitive Impairment and Nutritional Trajectories on Functional Recovery for Older Patients after Hip-Fracture Surgery. J Am Med Dir Assoc 2022; 23:1962.e15-1962.e20. [PMID: 36122599 DOI: 10.1016/j.jamda.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Malnutrition and cognitive impairment are associated with poor functional recovery in older adults following hip-fracture surgery. This study examined the combined effects of cognitive impairment and nutritional trajectories on postoperative functional recovery for older adults following hip-fracture surgery. DESIGN Prospective longitudinal correlational study. SETTING AND PARTICIPANTS This study recruited 350 older adults (≥60 years of age) who received hip-fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020. METHODS Participant data were collected over a 2-year period after surgery for nutritional and cognitive status and activities of daily living (ADLs). Participants were grouped by type of nutritional trajectory using group-based trajectory modeling. Generalized estimating equations analyzed associations between trajectory groups/cognitive status at discharge and performance of ADLs. RESULTS Nutritional trajectories best fit a 3-group trajectory model: malnourished (19%), at-risk of malnutrition (40%), and well-nourished (41%). Nutritional status for the malnourished group declined from 12 months to 24 months following surgery; nutritional status remained stable for at-risk of malnutrition and well-nourished groups. Interactions for cognitive impairment-by-nutritional status were significant: the malnourished + intact cognition subgroup had significantly better ADLs than the malnourished + cognitive impairment subgroup (b = 27.1, 95% confidence interval = 14.0-40.2; P < .001). For at-risk of malnutrition and well-nourished groups, there were no significant differences between cognitive impairment and intact cognition in ADLs. These findings suggest that nutritional status may buffer the negative effect of cognitive impairment on ADLs. CONCLUSIONS AND IMPLICATIONS Better nutritional status over time for older adults following hip fracture can protect against adverse influences of cognitive impairment on ADLs during postoperative recovery. Participants with malnutrition and cognitive impairment had the poorest ADLs. These findings suggest interventions tailored to improving nutritional status may improve recovery for older adults following hip-fracture surgery.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurology, Dementia Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; Center for Quality Management, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Yu-Chih Lin
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ping-Jui Tsai
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Ping Wang
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
8
|
Tseng MY, Liang J, Yang CT, Wang JS, Wu CC, Cheng HS, Chen CY, Lin YE, Shyu YIL. Trajectories of social support are associated with health outcomes and depressive symptoms among older Taiwanese adults with diabetes following hip-fracture surgery. Int J Geriatr Psychiatry 2022; 37. [PMID: 36371613 DOI: 10.1002/gps.5842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/29/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined trajectories of social support and their relationships with health outcomes over 2 years post hip-fracture surgery for older adults with diabetes mellitus (DM). METHODS This was a secondary analysis of data derived from a clinical trial, which included 158 hip fractured older adults with DM who had completed the Medical Outcomes Study Social Support Survey at 1-, 12-, 18-, and 24-months following hospital discharge. Health outcomes for self-care, physical and nutritional status, mental health, and depression were assessed at 3-month intervals up to 24-months after hospital discharge. Trajectories of social support were derived with latent class analysis while hierarchical linear models were employed to assess the associations of social-support trajectory with health outcomes. RESULTS Four social-support trajectories were derived for persons with DM following hip-fracture surgery: poor and declining (n = 18, 11.4%), moderate and stable (n = 29, 18.4%), high but declining (n = 34, 21.5%), and high and stable (n = 77, 48.7%). Relative to those in the poor and declining group, participants in the high and stable trajectory group performed better in Activities of Daily Living and quadriceps muscle power, had better mental Health-Related Quality of Life and nutritional status, and had fewer depressive symptoms. These differences persisted over the 2 years following hospital discharge. CONCLUSIONS These results suggest social support for persons with DM should be continually assessed following hip-fracture surgery.
Collapse
Affiliation(s)
- Ming-Yueh Tseng
- Post-Baccalaureate Program in Nursing, College of Nursing, Asia University, Taichung, Taiwan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jong-Shyan Wang
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Yen Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
9
|
Tseng MY, Liang J, Wu CC, Cheng HS, Yang CT, Chen CY, Shyu YIL. Better nutrition trajectory improves recovery following a hip fracture surgery for older persons with diabetes mellitus. Aging Clin Exp Res 2022; 34:2815-2824. [PMID: 36040680 DOI: 10.1007/s40520-022-02221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/06/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Influences of nutritional status on hip fractured persons with diabetes mellitus (DM) following surgery have not been reported. AIMS To explore the trajectory groups of nutritional status and their influences on post-operative recovery for older persons with hip fracture and DM. METHODS A total of 169 patients with DM and hip fracture from a clinical trial were included in this analysis. Mini Nutritional Assessment was used to assess the nutritional status of the participants. Outcome variables included self-care ability, muscle strength, depressive symptoms, health related quality of life, and cognitive function, which were collected before discharge and 1-, 3-, 6-, 12-, 18-, and 24-months following hospital discharge. RESULTS Among hip fractured older persons with DM, within two years following surgery there were three nutritional trajectory groups: malnourished (28.3%), at-risk of malnutrition (41.9%) and well-nourished (29.8%). A decline in nutritional status, especially for the malnourished group, was seen in the second year. A better nutritional trajectory was associated with better recovery outcomes, including self-care ability, health related quality of life, cognitive function and less depressive symptoms. DISCUSSION Close to 30% of hip fractured persons with DM were considered to have a malnourished trajectory over 2 years following surgery. A poor nutritional trajectory was associated with poor mental health and physical recovery. CONCLUSIONS Continuous nutrition assessment during the first 2 years following hip fracture surgery for older persons with DM is important. Development and implementation of interventions targeting the malnourished trajectory group are suggested.
Collapse
Affiliation(s)
- Ming-Yueh Tseng
- Post-Baccalaureate Program in Nursing, College of Nursing, Asia University, Taichung, Taiwan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yen Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, 33302, Taoyuan, Taiwan. .,Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan. .,Dementia Center, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| |
Collapse
|
10
|
Sung YL, Huang HL, Lin CC, Kröger T, Hsu WC, Hsu JL, Lin YE, Shyu YIL. Experiences of family caregivers of persons living with dementia with and without a smart- clothes assisted home nursing program during the heightened COVID-19 alert. BMC Geriatr 2022; 22:697. [PMID: 35996089 PMCID: PMC9395831 DOI: 10.1186/s12877-022-03379-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/29/2022] [Indexed: 11/12/2022] Open
Abstract
Background The COVID-19 pandemic has required restrictions of daily activities, which has been found to impact the lives of persons living with dementia (PLWDs) and their family caregivers, who have multiple care demands. The lack of relevant studies in Taiwan emphasized the need to explore the experiences of family caregivers of older PLWDs faced with the intensified restrictions to control the spread of COVID-19, and the impact of the availability of a smart-clothes home nursing program. Methods This qualitative study used semi-structured interviews with family caregivers of older PLWDs. Participants were recruited from dementia clinics of a medical center in northern Taiwan from a subset of a sample from a larger study on smart-clothes assisted home nursing care. A total of 12 family caregivers who participated in the original study were interviewed during the follow-up period; seven family caregivers of a PLWD wearing a smart-vest, which transmitted information to a home care nurse; five caregivers of a PLWD not wearing a smart-vest. Interviews were conducted by telephone because the conditions of the pandemic prevented face-to-face interviews. Recorded interviews were transcribed and analyzed using content analysis. Results Interview data showed family caregivers’ felt the care recipient’s health was compromised and functional conditions intensified as Covid-19-related pandemic restrictions increased. Specific concerns included a lack social interactions, decreased daily activity levels, loss of interest and lack of motivation for activities, increased mood and behavioral problems, a decline in physical function and an increase in health problems. Family caregivers were also impacted by these restrictions, with significant increases in severity of caregiver role strain, including feeling trapped, a lack of in-home support, profound powerlessness, and worries about the PLWD contracting the coronavirus. The smart-clothes assisted home nursing care program offered supplementary support to family caregivers by providing on-time interactions, helping them manage health problems, enhancing predictability of the care recipient’s behaviors, and providing caregivers with emotional support. Conclusions The findings of this study support alternative care such as implementation of technology-assisted home health services to meet caregiver needs to facilitate family caregiving of PLWDs during the necessary restrictions in activities implemented during the COVID-19 pandemic. Trial registration ClinicalTrials.gov Protocol Record NCT05063045.
Collapse
Affiliation(s)
- Ya-Li Sung
- School of Nursing, Change Gung University, Guishan District, 259 Wenhua 1st Road, Taoyuan, 33302, Taiwan, ROC
| | - Huei-Ling Huang
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC.,Geriatric and Long-Term Care Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC.,Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Teppo Kröger
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland.,Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Jung-Lung Hsu
- Department of Neurology, New Taipei Municipal Tu Cheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei City, Taiwan, ROC.,Graduate Institute of Humanities in Medicine and Research Center for Brain and Consciousness, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan, ROC
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Yea-Ing L Shyu
- School of Nursing, Change Gung University, Guishan District, 259 Wenhua 1st Road, Taoyuan, 33302, Taiwan, ROC. .,Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC. .,Dementia Center, Department of Neurology, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC. .,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan, ROC. .,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
| |
Collapse
|
11
|
Liu HY, Huang HL, Chiu YC, Tang LY, Hsu JL, Wu SM, Lin YH, Lin HY, Su IC, Shyu YIL. Perceptions of community dementia friendliness: A cross-sectional study of people with dementia, family caregivers, service providers, and the general public in Taiwan. Health Soc Care Community 2022; 30:1578-1588. [PMID: 34254381 DOI: 10.1111/hsc.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/27/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Promoting dementia-friendly communities is an important strategy for improving quality of life for people with dementia and dementia-family caregivers. The process of building dementia-friendly communities should include all people living in the community. The objective of this study was to compare perceived dementia friendliness in the community among people with dementia, family caregivers, service providers, and the general public. In Taiwan, we surveyed 60 people with dementia, 140 family caregivers, and 200 members of the general public face to face, with 200 service providers surveyed by mail. Participants completed the Perceived Community Dementia Friendliness measure, consisting of seven subscales: care services, community members, community environment, community interactions, transportation, hospitals, and stores and organisations. This measure has acceptable convergent validity, construct validity, and internal consistency reliability for use in Taiwan. Differences in perceived dementia friendliness were examined by chi-square tests/analysis of variance. Among the seven subscales, hospitals were rated with good dementia friendliness by 70% of people with dementia (n = 42); however, care services were rated poor by 23.3% of people with dementia (n = 14). Hospitals were also rated with good dementia friendliness by 39.2% of family caregivers (n = 54). Care services were rated as having good dementia friendliness by 43.5% of service providers (n = 87) and 47% of the general public (n = 86). Furthermore, community interactions were rated as good by small percentages of family caregivers (11.4%, n = 16), service providers (22.2%, n = 44), and the general public (30.9%, n = 58). Family caregivers, service providers, and the general public rated hospitals with the highest mean dementia-friendliness score and community interactions with the lowest. Perceived community-dementia friendliness among participants with dementia differed from that of participants without. People with dementia prioritised improving care services, while people without dementia rated facilitating community interactions as more vital. These differences provide vital insights into understanding the policies and administration of dementia-friendly communities.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (ROC)
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan (ROC)
| | - Yi-Chen Chiu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (ROC)
| | - Li-Yu Tang
- Taiwan Alzheimer's Disease Association, Taipei, Taiwan (ROC)
| | - Jung-Lung Hsu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (ROC)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan (ROC)
- Graduate Institute of Humanities in Medicine and Research Center for Brain and Consciousness, Taipei Medical University, New Taipei City, Taiwan (ROC)
| | - Suh-Mian Wu
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan (ROC)
| | - Yi-Hui Lin
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan (ROC)
| | - Hsin-Yi Lin
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan (ROC)
| | - I-Ching Su
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (ROC)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (ROC)
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (ROC)
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (ROC)
| |
Collapse
|
12
|
Hou YJ, Zeng SY, Lin CC, Yang CT, Huang HL, Chen MC, Tsai HH, Liang J, Shyu YIL. Smart clothes-assisted home-nursing care program for family caregivers of older persons with dementia and hip fracture: a mixed-methods study. BMC Geriatr 2022; 22:104. [PMID: 35123399 PMCID: PMC8818174 DOI: 10.1186/s12877-022-02789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this preliminary study was to explore whether a smart clothes-assisted home-nursing care program could benefit family caregivers and their care recipients.
Methods
Family caregivers in charge of a care recipient’s living situation participated in this convergent parallel, mixed methods study. We recruited older persons with dementia (n = 7) and those discharged following hip-fracture surgery (n = 6) from neurological clinics and surgical wards of a medical center, respectively, along with their family caregivers: three spouses, eight sons, one daughter, and one daughter-in-law. Care recipients were asked to wear a smart vest at least 4 days/week for 6 months, which contained a coin-size monitor hidden in an inner pocket. Sensors installed in bedrooms and living areas received signals from the smart clothing, which were transmitted to a mobile phone app of homecare nurses, who provided caregivers with transmitted information regarding activities, emergency situations and suggestions for caregiving activities. Outcomes included changes from baseline in caregivers’ preparedness and depressive symptoms collected at 1- and 3-months, which were analyzed with Friedman’s non-parametric test of repeated measures with post-hoc analysis. Transcripts of face-to-face semi-structured interview data about caregivers’ experiences were analyzed to identify descriptive, interpretative, and pattern codes.
Results
Preparedness did not change from baseline at either 1- or 3-months for family caregivers of persons with dementia. However, depressive symptoms decreased significantly at 1-month and 3-months compared with baseline, but not between 1-months and 3-months. Analysis of the interview data revealed the smart clothes program increased family caregivers’ knowledge of the care recipient’s situation and condition, informed healthcare providers of the care recipient’s physical health and cognitive status, helped homecare nurses provide timely interventions, balanced the care recipient’s exercise and safety, motivated recipients to exercise, helped family caregivers balance work and caregiving, and provided guidance for caregiving activities.
Conclusions
Experiences with the smart clothes-assisted home-nursing care program directly benefited family caregivers, which provided indirect benefits to the care recipients due to the timely interventions and caregiving guidance from homecare nurses. These benefits suggest a smart-clothes-assisted program might be beneficial for all family caregivers.
Collapse
|
13
|
Li CL, Chiu YC, Shyu YIL, Stanaway FF, Chang HY, Bai YB. Does physical activity protect older persons with frailty and cognitive impairment from excess all-cause mortality? Arch Gerontol Geriatr 2021; 97:104500. [PMID: 34388680 DOI: 10.1016/j.archger.2021.104500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The main aim of this study was to examine how physical activity in combination with physical frailty and cognitive impairment affects risk of mortality in older adults. STUDY DESIGN A national sample of community-dwelling Taiwanese aged 65 years or older (n=2678) was followed for 5 years. MAIN OUTCOME MEASURES Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. The Mini-Mental State Examination was used to assess cognitive impairment. Information on self-reported physical activity was collected at baseline. The study cohort was followed until the date of death or the end of the study period (31 December 2018). Deaths were confirmed by the computerized data files of the National Register of Deaths. RESULTS A total of 417 deaths were recorded after 12415.2 person-years of follow-up. After adjustment for other factors, compared with active participants who were physically robust with normal cognition, inactive participants who were with either frail/pre-frail or cognitively impaired had hazard ratios for mortality of 2.65 (95% CI=[1.88-3.74]) and 3.09 (95% CI=[2.08-4.59]), respectively. Inactive participants with coexisting frailty/pre-frailty and cognitive impairment had the highest hazard ratio for mortality of 3.85 (95% CI=[2.73-5.45]). Being active was associated with a mortality reduction of 31%, 38%, and 42% in physically robust participants with normal cognition, those who were frail/pre-frail only, and those with cognitive impairment only, respectively. CONCLUSIONS Having a physically active life style has beneficial effects on survival in older persons with either frailty/pre-frailty or cognitive impairment.
Collapse
Affiliation(s)
- Chia-Lin Li
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan.
| | - Yu-Chan Chiu
- Department of Bio-Industry Communication and Development, National Taiwan University, Taipei, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Fiona F Stanaway
- University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yuh-Bin Bai
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
14
|
Shyu YIL, Lin CC, Kwok YT, Shyu HY, Kuo LM. A community-based computerised cognitive training program for older persons with mild dementia: A pilot study. Australas J Ageing 2021; 41:e82-e93. [PMID: 34036705 DOI: 10.1111/ajag.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 02/19/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Computerised cognitive training programs can improve cognitive function in patients with moderate-to-severe dementia or brain injuries and healthy older adults. However, most previous studies were not randomised controlled trials and did not examine older adults with mild dementia. The current study sought to analyse the effects of a computerised cognitive training program using a randomised controlled trial. METHODS In a single-blinded randomised clinical trial, 30 older individuals with mild dementia were split into an experimental (n = 15) and a control (n = 15) group to analyse the effects of a computerised cognitive training program. Outcomes were assessed before and after each program session, and 1 and 3 months afterwards. RESULTS Participants in the experimental group had better overall subjective memory, subjective retrospective memory and global quality of life, with fewer depressive symptoms than those in the control group 3 months following the program. CONCLUSIONS Our computerised cognitive training program improved subjective memory and quality of life in patients with mild dementia and decreased their depressive symptoms. These results may be useful for health-care providers caring for people with mild dementia.
Collapse
Affiliation(s)
- Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yam-Ting Kwok
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Hann-Yeh Shyu
- Division of Neurology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Li-Min Kuo
- Department of Gerontological Health Care, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| |
Collapse
|
15
|
Li CL, Chang HY, Shyu YIL, Stanaway FF. Relative Role of Physical Frailty and Poor Cognitive Performance in Progression to Dementia. J Am Med Dir Assoc 2021; 22:1558-1559. [PMID: 33775634 DOI: 10.1016/j.jamda.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Chia-Lin Li
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan.
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Fiona F Stanaway
- University of Sydney School of Public Health, Faculty of Medicine and Health, New South Wales, Australia
| |
Collapse
|
16
|
Kung PC, Huang HL, Hsu WC, Hsu JL, Tang LY, Shyu YIL. Fluctuating interpretations: Striving to maintain a sense of self in early dementia. Geriatr Nurs 2021; 42:484-490. [PMID: 33721655 DOI: 10.1016/j.gerinurse.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022]
Abstract
This study aimed to develop a conceptual framework of the experience of persons living with the early stages of dementia. A grounded theory approach examined the experience from the perspective of the patient. Data were collected from dyads of persons with mild dementia and their family caregivers (N = 17) using face-to-face interviews at three timepoints over a one-year period. Transcribed interviews were analyzed with constant comparative analysis. The core category was "Fluctuating interpretations: striving to maintain one's sense of self." Interpretations were comprised of three subcategories: being a stranger to oneself, sense-making, and strategies for coexistence. Different situations influenced the process and affected individuals' attitudes and behaviors. Interpretations were a protective vehicle and stabilizing force that enabled persons with dementia to coexist with disease changes. Perspectives of persons with dementia during the early stages should be considered when designing intervention strategies for patient-centered care.
Collapse
Affiliation(s)
- Pen-Chen Kung
- PhD student, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Lecturer, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Geriatric and Long-Term Care Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Huei-Ling Huang
- Associate Professor, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Associate Researcher, Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Chuin Hsu
- Associate Professor & Visiting Staff, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Director, Dementia Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung-Lung Hsu
- Associate professor, Attending, Department of Neurology, New Taipei Municipal Tu Cheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei City, Taiwan; Adjunct Associate Professor, Taipei Medical University Shuang Ho Hospital, Graduate Institute of Humanities in Medicine and Research Center for Brain and Consciousness, Taipei, Taiwan
| | - Li-Yu Tang
- Secretary General, Taiwan Alzheimer's Disease Association, Taipei, Taiwan
| | - Yea-Ing L Shyu
- Lambda Beta Chapter-At-Large, Distinguished Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Professor and Group Project Leader, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Professor, Department of Gerontology and Health Care Management Chang Gung University of Science and Technology.
| |
Collapse
|
17
|
Liu HY, Hsu WC, Shyu YIL, Wang YN, Huang TH, Lin YE, Huang CH. Finding a balance in family caregiving for people with dementia: A correlational longitudinal study. J Adv Nurs 2021; 77:2278-2292. [PMID: 33434343 DOI: 10.1111/jan.14747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
AIMS The "Finding a Balance Point" framework was used to explore the caregiving process over time for family caregivers of people with dementia in Taiwan. This study aimed to: (a) identify Taiwanese caregivers' different balance trajectories; (b) explore predictors of trajectory group membership; and (c) examine associations of different balance trajectories with caregiving outcomes. DESIGN A correlational longitudinal design was used. METHODS Data were collected from 200 family caregivers' self-completed questionnaires and they were followed over 2 years (June 2015-May 2017). Discrete balance trajectories were identified by group-based trajectory modelling. Predictors of trajectory group membership were identified from potential predictors of caregiving characteristics and caregiving factors using multivariate logistic regression. Associations of trajectory groups with caregiving outcomes (depressive symptoms and health-related quality of life) were explored using the generalized estimating equation. RESULTS Balance trajectories best fit a two-group trajectory model (poor and good). Caregivers with a poor sense of balance between competing needs were more likely to have more depressive symptoms (b = 11.71, 95% CI [9.04, 14.38], p < .001), worse physical health (b = -6.22, 95% CI [-8.71, -3.74], p < .001), and worse mental health (b = -11.1, 95% CI [-13.58, -8.63], p < .001) than caregivers with a good sense of balance. Caregivers experiencing lower role strain (b = -1.45, SE = 0.48, p = .003) or higher predictability (b = 2.83, SE = 0.76, p < .001) were more likely to belong to the good-balance group. CONCLUSIONS Caregivers with poor balance between competing needs are more likely to have worse caregiving outcomes. Role strain and predictability significantly predicted balance trajectory groups. Family caregivers with lower caregiving task difficulty and/or better knowledge of the care receiver were more likely to be in the good balance trajectory group. IMPACT Our findings support the framework, "Finding a Balance Point," and clarify the family caregiving process for people with dementia. This framework could be used to tailor interventions for home care nurses to improve family caregivers' caregiving outcomes.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.).,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Yu-Nu Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.)
| | - Tzu-Hsin Huang
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Yueh-E Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Chun-Hsia Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| |
Collapse
|
18
|
Liu HY, Wang HP, Chen CY, Wu CC, Hua MS, Lin YE, Lin YC, Shyu YIL. Subjective memory complaints predict poorer functional recovery during the first year following hip-fracture surgery among elderly adults. Int J Geriatr Psychiatry 2020; 35:1209-1218. [PMID: 32510713 DOI: 10.1002/gps.5358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Subjective memory complaints (SMCs) in the elderly are associated with poor recovery in performing activities of daily living. This study was designed to examine SMCs and their association with recovery and health outcomes of older persons within 1 year following hospital discharge after hip-fracture surgery. METHODS Data were collected between 2012 and 2015 from 194 hip-fractured elders in northern Taiwan. SMCs were assessed by the Prospective and Retrospective Memory Questionnaire. Recovery outcomes included self-care ability (activities of daily living [ADLs] and instrumental activities of daily living [IADLs]), physical function (range of motion and maximal muscle strength), cognitive function, delirium, depressive symptoms, and health-related quality of life (HRQoL). Outcomes were assessed before discharge and 1, 3, 6, and 12 months afterwards. Associations of SMCs with participants' recovery outcomes were examined by the generalized estimating equation approach. RESULTS Participants with SMCs had significantly poorer recovery outcomes than those without SMCs. Additionally, the interaction term for time-by-SMC was significant on ADLs, IADLs, maximal strength of quadriceps muscles, maximal strength of hip abductor muscles, ankle dorsiflexion, and HRQoL, suggesting that negative associations with SMCs increased over time. Participants with SMCs were at significantly higher risk for cognitive impairment and delirium than those without SMCs. CONCLUSIONS Participants with SMCs not only had worse recovery than those without SMCs, but their rate of recovery was also slower during the first year following hip-fracture surgery. Therefore, SMCs need to be assessed to identify patients at high risk for worse recovery outcomes following hip fracture.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Ping Wang
- School of Nursing, Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan
| | - Ching-Yen Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mau-Sun Hua
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Chi Lin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| |
Collapse
|
19
|
Shen MH, Yang CT, Wu CC, Huang HL, Lin YE, Shyu YIL, Chung SC. Resuming Normal Life as a Family Caregiver During Drip-Like Recovery of Older Persons With Cognitive Impairment Recovering From Hip Surgery: A Grounded Theory. J Nurs Scholarsh 2020; 52:250-260. [PMID: 32246742 DOI: 10.1111/jnu.12554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was undertaken to develop a theoretical framework explaining family caregiving processes for older persons with cognitive impairment recovering from hip fracture surgery. DESIGN AND METHODS In this grounded theory study, data were collected in audio-recorded face-to-face interviews with 21 family caregivers. Among these caregivers, 14 cared for hip-fractured persons with cognitive impairment, and seven cared for those without cognitive impairment. Caregivers were interviewed five times after patients' discharge: at 1 week and at 1, 3, 6, and 12 months. Data were analyzed by constant comparative analysis. FINDINGS The core category explaining the family caregiving process for hip-fractured persons with cognitive impairment was "resuming normal life during drip-like recovery." This category captures the slowness of the recovery process, as slow as dripping water. During the early postoperative period, caregivers attempted to gain control of the postoperative situation, using various maintenance and improvement strategies to deal with the chaos in individuals and the family and to protect hip-fractured persons with cognitive impairment from further harm. The goal of recovery was to get back to their original life. CONCLUSIONS Family caregivers of hip-fractured older persons with cognitive impairment needed to deal with more complex chaotic situations, exerted more efforts to administer safety measures, and required more time to achieve a stable life pattern. CLINICAL RELEVANCE Since postoperative recovery was perceived as extremely slow, family caregivers of hip-fractured older persons with cognitive impairment should be patient regarding recovery and be informed before hospital discharge of different strategies to resume normal life during postoperative recovery.
Collapse
Affiliation(s)
- Mei-Hsing Shen
- Research Assistant, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Tzu Yang
- Lambda Beta Chapter-At-Large, Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Professor and Deputy Director, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huei-Ling Huang
- Associate Professor, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yueh-E Lin
- Supervisor, Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Lambda Beta Chapter-At-Large, Distinguished Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Professor and Group Project Leader, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Research Fellow, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Consultant, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Professor, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Shih-Chi Chung
- Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
20
|
Chen MC, Huang HL, Chiu YC, Yip PK, Wu SM, Hsu WC, Wang WS, Huang YF, Shyu YIL. Experiences of Living in the Community for Older Aboriginal Persons With Dementia Symptoms in Taiwan. Gerontologist 2020; 60:525-534. [PMID: 31091307 DOI: 10.1093/geront/gnz013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Improving quality of life for community-dwelling older persons with dementia symptoms (PWDS) and family caregivers requires promoting dementia-friendly communities (DFC). However, little is known regarding older Taiwanese Aboriginal PWDS' experiences of living in the community. We explored these experiences for older Atayal PWDS and their families in Taiwan. RESEARCH DESIGN AND METHODS This grounded theory research used in-depth interviews to explore the perspectives of older PWDS (n = 4), their family members (n = 3), and key persons (n = 10) in an Atayal community in northern Taiwan. Data were analyzed using constant comparative analysis. Participants were interviewed between January and May 2015. RESULTS Participants' experiences were captured by the overarching concept of "low dementia awareness, high family-like ambience in the community." Despite the low/absent community awareness of dementia, older Atayal PWDS functioned as freely in the community as at home due to a family-like supportive environment. Aboriginal PWDS and their families also faced environmental challenges, e.g., environmental constraints and barriers to transportation access. DISCUSSION AND IMPLICATIONS Our results suggest that this Aboriginal community and culture offer important DFC components, and these strengths could be further studied to enhance DFC models elsewhere. Despite these strengths in supporting PWDS, environmental challenges to transportation access still cause difficulties for PWDS and their families and need improvement. The Atayal community's low dementia awareness suggests that services introduced must be culturally appropriate and nondisruptive to existing supportive helping systems. Our study can be a model for future studies to understand and identify PWDS' needs in Indigenous communities.
Collapse
Affiliation(s)
- Mei-Chen Chen
- Department of Public Health, Taoyuan City Government, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Yi-Chen Chiu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping-Keung Yip
- Neurological Center, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Suh-Mian Wu
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Fang Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
21
|
Tseng MY, Liang J, Wang JS, Yang CT, Wu CC, Cheng HS, Chen CY, Lin YE, Wang WS, Shyu YIL. Effects of a diabetes-specific care model for hip fractured older patients with diabetes: A randomized controlled trial. Exp Gerontol 2019; 126:110689. [PMID: 31404623 DOI: 10.1016/j.exger.2019.110689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the effects of a diabetes-specific care model for hip fractured elderly with diabetes mellitus (DM). METHODS A randomized controlled trial was implemented in a 3000-bed medical center in northern Taiwan. Older adults (age ≥ 60) with DM who had hip-fracture surgery (N = 176) were recruited and randomly assigned to diabetes-specific care (n = 88) and usual care (n = 88). Usual care entailed one or two in-hospital rehabilitation sessions. Diabetes-specific care comprised an interdisciplinary care (including geriatric consultation, discharge planning, and in-home rehabilitation) and diabetes-specific care (including dietary and diabetes education, blood pressure control, dyslipidemia management, a glycemic treatment regimen, and rehabilitation exercises). Outcomes including heart rate variability; rehabilitation outcomes; activities of daily living and instrumental activities of daily living were assessed before discharge and 1, 3, 6, 12, 18, 24 months afterwards. RESULTS Patients who received diabetes-specific care had significantly higher hip-flexion range of motion (b = 5.24, p < .01), peak-force quadriceps strength of the affected limb (b = 2.13, p < .05), higher total heart rate variability in terms of the time-domain parameter for the mean squared difference between two adjacent normal R-R intervals (b = 11.35, p < .05), and frequency-domain parameters, such as low frequency (b = 42.17, p < .05), and the high frequency-to-low frequency ratio (b = 0.11, p < .01). CONCLUSIONS Our diabetes-specific care model enhanced hip-flexion range of motion, peak quadriceps strength of the affected limb, and overall heart rate variability, indicating dynamic responses to environmental changes during the 24 months following hospital discharge, above and beyond the effects of usual care.
Collapse
Affiliation(s)
- Ming-Yueh Tseng
- Department of Nursing, MeiHo University, 23 Pingguang Road, Neipu, Pingtung 91202, Taiwan.
| | - Jersey Liang
- School of Public Health, University of Michigan, 1420 Washington Heights, SPH II M3007, Ann Arbor, MI 48109, USA.
| | - Jong-Shyan Wang
- Graduate Institute of Rehabilitation Science, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Ching-Yen Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, No. 200, Lane 208, Jijin 1st Road, Anle District, Keelung 20445, Taiwan.
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan; Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Niaosng District, Kaohsiung 83301, Taiwan; Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, 261 Wenhwa 1st Road, Guishan District, Taoyuan 33303, Taiwan.
| |
Collapse
|
22
|
Kuo LM, Tsai WC, Chiu MJ, Tang LY, Lee HJ, Shyu YIL. Cognitive dysfunction predicts worse health-related quality of life for older stroke survivors: a nationwide population-based survey in Taiwan. Aging Ment Health 2019; 23:305-310. [PMID: 29266975 DOI: 10.1080/13607863.2017.1414148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study investigated the associations of cognitive status with specific/overall health-related quality of life (HRQoL) in older stroke survivors in Taiwan. METHOD A subsample of 592 older stroke survivors in a nationwide population-based survey of cognitive-dysfunction prevalencewas analyzed. HRQoL was assessed using the EuroQol five-dimension questionnaire (EQ-5D). RESULTS Stroke survivors with dementia were 5.60 times more likely to have mobility problems, 12.20 times to have self-care problems, 16.61 times to have problems in usual activities, 4.31 times to have pain/discomfort, and 3.28 times to have anxiety/depression than stroke survivors with normal cognitive function. Stroke survivors with mild cognitive dysfunction (MCD) were 2.57 times more likely to have mobility problems, 3.17 times to have self-care problems, 3.31 times to have problems in usual activities, 2.11 times to have pain/discomfort, and 2.35 times to have anxiety/depression than those with normal cognitive function. Both dementia (b = -15.13, p < .001) and MCD (b = -6.24, p < .001) significantly contributed to lower EQ-5D VAS; both dementia (b = -.15, p < .001) and MCD (b = -.10, p < .001) significantly contributed to lower EQ-5D index. CONCLUSION Dementia and MCD strongly predicted worse overall and specific HRQoL dimensions, especially self-care and usual activities for older stroke survivors.
Collapse
Affiliation(s)
- Li-Min Kuo
- a Department of Gerontological Health Care, College of Nursing , National Taipei University of Nursing and Health Sciences , Taipei , Taiwan
| | - Wen-Che Tsai
- b Department of Psychiatry , College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Ming-Jang Chiu
- c Department of Neurology, National Taiwan University Hospital, College of Medicine , National Taiwan University , Taipei , Taiwan.,d Graduate Institute of Brain and Mind Sciences , National Taiwan University , Taipei , Taiwan.,e Graduate Institute of Psychology , National Taiwan University , Taipei , Taiwan.,f Graduate Institute of Biomedical Engineering and Bioinformatics , National Taiwan University , Taipei , Taiwan
| | - Li-Yu Tang
- g Taiwan Alzheimer's Disease Association , Taipei , Taiwan
| | - Huey-Jane Lee
- g Taiwan Alzheimer's Disease Association , Taipei , Taiwan
| | - Yea-Ing L Shyu
- h School of Nursing, College of Medicine , Chang Gung University , Taoyuan , Taiwan.,i Department of Orthopedic Surgery , Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,j Department of Nursing , Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan.,k Department of Gerontological Care and Management , Chang Gung University of Science and Technology , Taoyuan , Taiwan
| |
Collapse
|
23
|
Tseng MY, Huang YF, Liang J, Wang JS, Yang CT, Wu CC, Cheng HS, Chen CY, Lin YE, Wang WS, Shyu YIL. Diabetic neuropathies influence recovery from hip-fracture surgery in older persons with diabetes. Exp Gerontol 2019; 119:168-173. [PMID: 30738920 DOI: 10.1016/j.exger.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES To explore the impact of diabetic peripheral neuropathy (DPN) on the recovery of older persons with diabetes mellitus (DM) after hip-fracture surgery. DESIGN, SETTING, PARTICIPANTS Secondary data for this study came from a clinical trial on the effectiveness of a DM-specific care model for 176 older persons (age ≥ 60) with DM over 2 years following hip-fracture surgery at a medical center in Taiwan. In the original trial, the experimental group (n = 88) received DM-specific care comprising diabetes care plus subacute care, and the control group (n = 88) received only usual care. MEASUREMENTS DPN was assessed using the Michigan Neuropathy Screening Instrument. Outcomes of self-care ability in activities of daily living (ADL), health-related quality of life (HRQoL), and depressive symptoms were assessed 1, 3, 6, 12, 18, 24 months following hospital discharge using the Chinese Barthel Index and Chinese-version instrumental ADL (IADL) scale; the SF-36 Taiwan version; and the Chinese-version Geriatric Depression Scale, short form, respectively. RESULTS After controlling for covariates, participants with DPN had 8.38 fewer points in ADL performance, 0.49 fewer points in IADL performance, and 2.33 fewer points in the physical component summary (PCS) of HRQoL than participants without DPN at 3 months following discharge. During the first year following discharge, the rate of improvement increased less for PCS (β = -0.45, p < 0.05), but more for the mental component summary (β = 0.49, p < 0.05) for those with DPN than for those without. During the second year, the rate of decline in physical function-related HRQoL increased slightly more for those with DPN than for those without (β = 0.03, p < 0.05). CONCLUSION DPN adversely affected ADL performance, IADL performance, and physical function-related health outcomes for older persons recovering from hip-fracture surgery. These results suggest that older patients with DM recovering from hip-fracture surgery should be assessed and managed for DPN.
Collapse
Affiliation(s)
- Ming-Yueh Tseng
- Department of Nursing, Meiho University, 23 Pingguang Road, Neipu, Pingtung 91202, Taiwan.
| | - Yueh-Fang Huang
- Department of Nursing, Chang Gung University of Science and Technology, 261 Wenhwa 1st Road, Guishan District, Taoyuan 33303, Taiwan
| | - Jersey Liang
- School of Public Health, University of Michigan, 1420 Washington Heights, SPH II M3007, Ann Arbor, MI 48109, USA.
| | - Jong-Shyan Wang
- Graduate Institute of Rehabilitation Science, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Ching-Yen Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, No. 200, Lane 208, Jijin 1st Road, Anle District, Keelung 20445, Taiwan
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan; Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Niaosng District, Kaohsiung 83301, Taiwan; Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, 261 Wenhwa 1st Road, Guishan District, Taoyuan 33303, Taiwan.
| |
Collapse
|
24
|
Liu HY, Tsai WC, Chiu MJ, Tang LY, Lee HJ, Shyu YIL, Wang WS. Relationships Between Cognitive Dysfunction and Health-Related Quality of Life Among Older Persons in Taiwan: A Nationwide Population-Based Survey. Am J Alzheimers Dis Other Demen 2019; 34:41-48. [PMID: 30518221 PMCID: PMC10852439 DOI: 10.1177/1533317518813548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To examine the relationships between cognitive dysfunction status and quality of life. METHODS Secondary analysis of a nationwide population-based survey (≥65 years) in Taiwan. The 5-dimension EuroQoL questionnaire (EQ-5D) was completed by 10 013 participants. RESULTS Participants with mild cognitive impairment (MCI; odds ratio = 4.88), very mild dementia (VMD; 7.96), or dementia (32.85) were more likely than those with normal cognition to report self-care problems. Participants with MCI (3.86), VMD (9.26), or dementia (31.61) were more likely to have usual-activity problems, and those with MCI (3.04), VMD (3.82), or dementia (9.23) were more likely to have mobility problems. Participants with MCI (2.10 and 2.14), VMD (2.77 and 2.18), or dementia (3.04 and 3.02) were more likely to report pain/discomfort and anxiety/depression. CONCLUSION Dementia was negatively associated with EQ-5D, especially self-care, usual activities, and mobility. Mild cognitive impairment or VMD was also negatively associated, with VMD more negatively associated. Developing interventions for patients with specific cognitive dysfunctions is critical.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jang Chiu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Psychology, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Biomedical Engineering and Bioinformatics, National Taiwan University, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Yu Tang
- Taiwan Alzheimer’s Disease Association, Taipei, Taiwan
| | - Huey-Jane Lee
- Taiwan Alzheimer’s Disease Association, Taipei, Taiwan
| | - Yea-Ing L. Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
25
|
Liu HY, Tsai WC, Chiu MJ, Tang LY, Lee HJ, Shyu YIL. Mild cognitive impairment in combination with comorbid diabetes mellitus and hypertension is negatively associated with health-related quality of life among older persons in Taiwan. Qual Life Res 2019; 28:1281-1291. [PMID: 30635850 DOI: 10.1007/s11136-019-02101-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To fill the gap in knowledge about associations of health-related quality of life (HRQoL) with comorbid diabetes mellitus (DM), hypertension (HTN), and/or mild cognitive impairment (MCI) in the elderly, we explored associations of comorbid DM, HTN, and/or MCI with HRQoL. METHODS Data for this study were from a population-based cross-sectional survey of elderly Taiwanese (≥ 65 years old). Participants (N = 4,634; 47.9% male) were categorized into eight chronic-illness groups: DM only (n = 224); HTN only (n = 1226); DM and HTN (n = 365); MCI only (n = 497); DM and MCI (n = 58); HTN and MCI (n = 303); DM, HTN, and MCI (n = 101); and none (healthy; n = 1860). Associations were examined between the eight chronic-illness groups and HRQoL (measured by EQ-5D scores) using binary logistic regression analyses and generalized linear models adjusted for covariates. Index scores were calculated from EQ-5D scores using Taiwan's general population-preference weights. RESULTS Compared to the healthy group, after adjusting covariates, MCI alone or with other comorbidities was significantly, negatively associated with HRQoL. Among all chronic-illness groups, comorbid DM, HTN, and MCI exhibited the lowest HRQoL. After adjusting covariates, between-group odds ratios for index scores were significant when comparing comorbid DM and MCI to DM only, comparing comorbid HTN and MCI to HTN only and comorbid DM, comparing HTN and MCI to comorbid DM and HTN, suggesting that MCI additively affects HRQoL. CONCLUSIONS HRQoL of older Taiwanese adults was negatively associated with having MCI. Thus, clinicians managing older persons with chronic illnesses should assess their cognitive function to identify high-risk groups needing HRQoL assistance.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jang Chiu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Psychology, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Biomedical Engineering and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Li-Yu Tang
- Taiwan Alzheimer's Disease Association, Taipei, Taiwan
| | - Huey-Jane Lee
- Taiwan Alzheimer's Disease Association, Taipei, Taiwan
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan.
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| |
Collapse
|
26
|
Liu HY, Yang CT, Tseng MY, Chen CY, Wu CC, Cheng HS, Lin YE, Shyu YIL. Trajectories in postoperative recovery of elderly hip-fracture patients at risk for depression: A follow-up study. Rehabil Psychol 2018; 63:438-446. [DOI: 10.1037/rep0000130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
27
|
Abstract
Background/aims Limited research has been conducted on agitated behavior in Taiwan and dementia among community-dwelling elderly. Therefore, this study focused on community elderly with dementia and a factor analysis of an inventory of their agitated behaviors was conducted. Patients and methods Participants (N=221) completed the Chinese Cohen-Mansfield Agitation Inventory, community form. Item analysis and exploratory factor analysis assessed reliability, validity, and the underlying factor structure. Results Five factors were extracted and accounted for 44.53% of the total variance. This study classified agitated behaviors into 5 main subtypes: physically agitated behaviors, destructive behaviors, verbally agitated behaviors, handling things behavior, and aggressive behaviors. Conclusion The results indicate that differences in the agitated behavior of elderly with dementia exist with respect to cultural background and setting. This novel research and its findings serve as a reference for assessing the agitated behaviors of elderly with dementia living in their homes. Applications may exist for other countries with Chinese/Taiwanese populations.
Collapse
Affiliation(s)
- Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan, .,Nursing Department, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan, .,School of Nursing, College of Medicine & Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan, .,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan,
| | - Wen-Chuin Hsu
- Chang Gung Dementia Center, Department of Neurology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
28
|
Liu HY, Yang CT, Wang YN, Hsu WC, Huang TH, Lin YE, Liu CY, Shyu YIL. Balancing competing needs mediates the association of caregiving demand with caregiver role strain and depressive symptoms of dementia caregivers: A cross-sectional study. J Adv Nurs 2017; 73:2962-2972. [DOI: 10.1111/jan.13379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
| | - Ching-Tzu Yang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yu-Nu Wang
- Department of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Wen-Chuin Hsu
- Dementia Center; Department of Neurology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- School of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Tzu-Hsin Huang
- Department of Nursing; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Yueh-E Lin
- Department of Nursing; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chin-Yi Liu
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yea-Ing L. Shyu
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Traumatological Division; Department of Orthopedics; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Nursing; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| |
Collapse
|
29
|
Yeh HF, Shao JH, Li CL, Wu CC, Shyu YIL. Predictors of postoperative falls in the first and second postoperative years among older hip fracture patients. J Clin Nurs 2017; 26:3710-3723. [DOI: 10.1111/jocn.13743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Hsiang-Fen Yeh
- Tzu Chi University of Science and Technology; Hualien City Taiwan
- Graduate Institute of Clinical Medical Sciences; Chang Gung University; Taoyuan Taiwan
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Jung-Hua Shao
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chia-Lin Li
- Healthy Aging Research Center and Department of Health Care Management; College of Management; Chang Gung University; Taoyuan Taiwan
- Division of Endocrinology and Metabolism; Departments of Internal Medicine; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery; Chang Gung Memorial Hospital; Linkou Taoyuan Taiwan
| | - Yea-Ing L Shyu
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Healthy Aging Research Center and Department of Health Care Management; College of Management; Chang Gung University; Taoyuan Taiwan
- Traumatological Division; Department of Orthopedics; Chang Gung Memorial Hospital; Linkou Taoyuan Taiwan
- Department of Nursing; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| |
Collapse
|
30
|
Kuo LM, Huang HL, Liang J, Kwok YT, Hsu WC, Liu CY, Shyu YIL. Trajectories of health-related quality of life among family caregivers of individuals with dementia: A home-based caregiver-training program matters. Geriatr Nurs 2017; 38:124-132. [DOI: 10.1016/j.gerinurse.2016.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/21/2016] [Accepted: 08/29/2016] [Indexed: 01/07/2023]
|
31
|
Wang HP, Liang J, Kuo LM, Chen CY, Shyu YIL. Trajectories of Nutritional Status and Cognitive Impairment among Older Taiwanese with Hip Fracture. J Nutr Health Aging 2017; 21:38-45. [PMID: 27999848 DOI: 10.1007/s12603-016-0756-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This paper describes the trajectories of nutritional status and cognitive impairment and their correlation among older Taiwanese over 1 year after hip-fracture surgery. DESIGN Secondary analysis of data from a clinical trial evaluating the effects of three types of post-discharge care for 292 older hip-fracture patients (age >60 years). MEASUREMENTS Nutritional status was assessed by the Mini Nutritional Assessment before and 1, 3, 6, 12 months after hospital discharge. Cognitive function was measured by the Mini-Mental State Examination before surgery, at hospital discharge, 6 and 12 months after discharge. Trajectories of nutritional status and cognitive impairment were depicted by latent class growth modeling, whereas linkages between nutritional-status and cognitive-impairment trajectories were assessed by multinomial logistic regression. RESULTS Nutritional status in general improved significantly, particularly during the first 3 months after discharge. We identified three trajectories of nutritional status: malnourished (15.4%), at risk for malnutrition (38.9%), and well-nourished (45.7%). In contrast, cognitive changes followed four largely linear but distinct trajectories: moderately impaired (12.2%), mildly impaired (27.8%), borderline impaired (21.8%), and cognitively intact (38.2%). Trajectories of nutritional status were significantly associated with cognitive-function trajectories. For instance, relative to malnourished patients, well-nourished patients were 95% less likely (OR=0.05, CI =0.01-0.24) to be moderately cognitively impaired. CONCLUSION A good nutritional-status trajectory after hip fracture was associated with better cognitive function. To treat and care for elderly hip-fractured patients, specific interventions need to target those who are malnourished or at risk of malnutrition to decrease their risk for cognitive impairment.
Collapse
Affiliation(s)
- H P Wang
- Yea-Ing L. Shyu, Ph.D., School of Nursing, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan. Telephone: +886 3 211 8800 Ext. 5275, Fax: +886 3 211 8400, E-mail:
| | | | | | | | | |
Collapse
|
32
|
Kuo LM, Huang HL, Liang J, Kwok YT, Hsu WC, Su PL, Shyu YIL. A randomized controlled trial of a home-based training programme to decrease depression in family caregivers of persons with dementia. J Adv Nurs 2016; 73:585-598. [PMID: 27653753 DOI: 10.1111/jan.13157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 12/22/2022]
Abstract
AIMS The aim of this study was to explore distinct trajectories of caregivers' depressive symptoms and the effects of a training programme on these trajectories over 18 months after the programme. BACKGROUND Overall effects of caregiver-training programmes on family caregivers' depressive symptoms have been reported, but few studies explored distinct courses of changes in caregivers' depressive symptoms and followed up intervention effects on these distinct courses. DESIGN Randomized clinical trial. METHODS Family caregivers (n = 116) were randomly assigned into experimental (n = 57) and control (n = 59) groups. The experimental group received the training programme with telephone consultation and the control group received written educational materials and social telephone follow-ups. Caregivers' depressive symptoms were assessed from June 2009 - March 2012 by self-completed questionnaires before, at 2 weeks and 3, 6, 12 and 18 months after the intervention. Groups of individual trajectories were distinguished using group-based trajectory modelling. RESULTS Caregivers' depressive symptoms fell into three stable trajectories: non-depressed, mildly blue and depressed. After controlling for covariates, caregivers who received the caregiver-training programme were less likely than those who did not experience persistent depressive symptoms (b = -1·92, odds ratio = 0·15, P < 0·05). CONCLUSION Depressive symptoms of family caregivers of persons with dementia were relatively stable and followed three distinct courses: non-depressed, mildly blue and depressed. Therefore, caregivers' depressive symptoms should be assessed as early as possible. Caregivers in the experimental group had a lower probability of persistent depressive symptoms than caregivers in the control group. Therefore, this training programme can be used by healthcare providers for persons with dementia and their caregivers. TRIAL REGISTRATION NUMBER NCT02667951.
Collapse
Affiliation(s)
- Li-Min Kuo
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Jersey Liang
- School of Public Health and Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yam-Ting Kwok
- Division of Neurology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Ling Su
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
33
|
Kuo LM, Huang HL, Hsu WC, Wang YT, Shyu YIL. Home-based caregiver training: Benefits differ by care receivers' dementia diagnosis. Geriatr Nurs 2016; 37:376-384. [DOI: 10.1016/j.gerinurse.2016.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
|
34
|
Tseng MY, Liang J, Shyu YIL, Wu CC, Cheng HS, Chen CY, Yang SF. Effects of interventions on trajectories of health-related quality of life among older patients with hip fracture: a prospective randomized controlled trial. BMC Musculoskelet Disord 2016; 17:114. [PMID: 26936194 PMCID: PMC4776406 DOI: 10.1186/s12891-016-0958-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/19/2016] [Indexed: 11/30/2022] Open
Abstract
Background Health-related quality of life (HRQoL) has been used to assess subjects’ prognosis and recovery following hip fracture. However, evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture. The purposes of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery. Methods For this secondary analysis, data came from a randomized controlled trial of subjects with hip fracture receiving three treatment care models: interdisciplinary care (n = 97), comprehensive care (n = 91), and usual care (n = 93). Interdisciplinary care consisted of geriatric consultation, discharge planning, and 4 months of in-home rehabilitation. Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms, fall prevention, and 12 months of in-home rehabilitation. Usual care included only in-hospital rehabilitation and occasional discharge planning, without geriatric consultation and in-home rehabilitation. Mental and physical HRQoL were measured at 1, 3, 6, and 12 months after discharge by the physical component summary scale (PCS) and mental component summary scale (MCS), respectively, of the Medical Outcomes Study Short Form 36, Taiwan version. Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models. Results We identified three quadratic PCS trajectories: poor PCS (n = 103, 36.6 %), moderate PCS (n = 96, 34.2 %), and good PCS (n = 82, 29.2 %). In contrast, we found three linear MCS trajectories: poor MCS (n = 39, 13.9 %), moderate MCS (n = 84, 29.9 %), and good MCS (n = 158, 56.2 %). Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory (b = 0.99, odds ratio [OR] = 2.69, confidence interval [CI] = 7.24–1.00, p = 0.049, and b = 1.32, OR = 3.75, CI = 10.53–1.33, p = 0.012, respectively) than those who received usual care. However, neither care model improved MCS. Conclusions The interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects’ odds for following a trajectory of good physical functioning after hospitalization. Trial registration ClinicalTrials.gov (NCT01350557)
Collapse
Affiliation(s)
- Ming-Yueh Tseng
- Department of Nursing, Meiho University, 23 Pingguang Road, Neipu, Pingtung, 91202, Taiwan.
| | - Jersey Liang
- School of Public Health, University of Michigan, 1415 Washington Heights, M3007 SPH II, Ann Arbor, MI, 48109, USA. .,Institute of Gerontology, University of Michigan, 1415 Washington Heights, M3007 SPH II, Ann Arbor, MI, 48109, USA.
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan. .,Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan.
| | - Chi-Chuan Wu
- Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan.
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan.
| | - Ching-Yen Chen
- Section of General Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan.
| | - Shu-Fang Yang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan.
| |
Collapse
|
35
|
Kuo LM, Huang HL, Hsu WC, Shyu YIL. Health-related quality of life and self-efficacy of managing behavior problems for family caregivers of vascular dementia and Alzheimer's disease patients. Dement Geriatr Cogn Disord 2015; 38:310-20. [PMID: 25011490 DOI: 10.1159/000360414] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the differences in patients' behavioral problems and health outcomes of family caregivers of patients with vascular dementia (VaD) and Alzheimer's disease (AD). METHODS A secondary analysis of baseline data on a subsample of caregiver-dementia patient dyads in a randomized clinical trial. RESULTS Family caregivers of VaD patients reported higher self-efficacy than caregivers of AD patients in handling verbally nonaggressive and verbally aggressive behaviors. Caregivers of VaD patients had poorer health-related quality of life (HRQoL) than caregivers of AD patients considering role disability due to physical health problems, bodily pain, social function, and physical component summary. Greater self-efficacy was associated with better mental health-related outcomes for family caregivers of VaD patients, and better self-care ability of VaD patients was associated with better caregiver mental health-related outcomes. Caring for a patient with more severe dementia predicted poor physical health-related outcomes in role disability due to physical health problems, but better overall mental health (mental component summary) for caregivers. CONCLUSION This study is the first to examine and compare the behavioral problems of AD and VaD patients in a Chinese population, along with their family caregivers' self-efficacy and health outcomes. Family caregivers of patients with VaD might warrant specific attention to their HRQoL, with interventions developed to enhance their self-efficacy.
Collapse
Affiliation(s)
- Li-Min Kuo
- School of Nursing, Hsin Sheng College of Medical Care and Management, Longtan, Taiwan, ROC
| | | | | | | |
Collapse
|
36
|
Tseng MY, Shyu YIL, Liang J, Tsai WC. Interdisciplinary intervention reduced the risk of being persistently depressive among older patients with hip fracture. Geriatr Gerontol Int 2015; 16:1145-1152. [PMID: 26492971 DOI: 10.1111/ggi.12617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 12/20/2022]
Abstract
AIM To assess the effects of an interdisciplinary intervention on the trajectories of depressive symptoms among older patients during 2 years after hip fracture surgery. METHODS A secondary analysis of data from a randomized controlled trial that contrasted usual care with an interdisciplinary program. Whereas usual care (n = 77) entailed only in-hospital rehabilitation and occasional discharge planning, the interdisciplinary program (n = 76) consisted of geriatric consultation, in-hospital rehabilitation, discharge planning and rehabilitation at home for 3 months after hospitalization. Depressive symptoms were assessed by using the Chinese version of the Geriatric Depression Scale short-form, before discharge, and 1, 3, 6, 12, 18 and 24 months after discharge. Covariates included demographic attributes, pre-fracture performance of activities of daily living (Chinese Barthel Index) and cognitive functioning (Mini-Mental State Examination). RESULTS Changes in depressive symptoms can be characterized by three trajectory groups, including a non-depressive group (n = 58, 37.8%), a marginally depressive group (n = 46, 30.7%) and a persistently depressive group (n = 49, 31.5%). Relative to those who received usual care, participants in the interdisciplinary program had a significantly lower risk of being in the persistently depressive group (odds ratio 0.23, P < 0.05). In addition, women and those physically and cognitively more impaired were more likely to be in the marginally and persistently depressive groups. CONCLUSIONS Our interdisciplinary intervention reduced older persons' likelihood of having persistent depressive symptoms after hip fracture surgery. Geriatr Gerontol Int 2016; 16: 1145-1152.
Collapse
Affiliation(s)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Jersey Liang
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA. .,Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
37
|
Liu HY, Yang CT, Cheng HS, Wu CC, Chen CY, Shyu YIL. Family caregivers' mental health is associated with postoperative recovery of elderly patients with hip fracture: a sample in Taiwan. J Psychosom Res 2015; 78:452-458. [PMID: 25703043 DOI: 10.1016/j.jpsychores.2015.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study investigated the relationship between family caregivers' mental health and postoperative recovery for elderly patients with hip fracture in Taiwan. METHODS This study is a secondary analysis of data from a randomized controlled trial with 12-month follow-up on 276 family caregiver-patient dyads. Categories of caregiver mental-health trajectory groups were identified by latent-class finite-mixture modeling. Differences in these groups were explored using the generalized estimating equation approach for effects on patients' postoperative recovery, including pain intensity, range of motion, maximum muscle strength, recovery of self-care ability, mobility, re-hospitalization, and health-related quality of life. RESULTS The patterns of family caregivers' mental health best fit a three-group trajectory model (poor, moderate, and good). Compared to patients with caregivers in the "poor" mental health group, patients with caregivers in the "good" group had better trajectories in physical functional recovery, including mobility, muscle strength, hip flexion and extension, and ankle extension. These patients were also less likely to be hospitalized, experienced less pain, and had better physical and mental health. Patients with caregivers in the "moderate" group likewise performed better than those in the "poor" group. CONCLUSION During the first year following discharge, postoperative recovery of patients after hip fracture was associated with their family caregivers' mental health. When a family caregiver's mental health was "poor," the patient recovering after hip-fracture surgery was more likely to recover poorly. These results suggest that health care providers could consider family caregivers' mental well-being while estimating recovery times and health outcomes of patients following hip fracture.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Yen Chen
- Section of General Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
38
|
Abstract
PURPOSE The purpose of this study was to explore family caregivers' role-implementation experiences at different stages of dementia. PATIENTS AND METHODS For this cross-sectional, exploratory study, 176 dyads of family caregivers and their community-dwelling elderly relatives with dementia were recruited from the neurological clinics of a medical center in Taiwan. The Family Caregiving Inventory was used to assess family caregivers for caregiving activities, role strain, role preparation, and help from others at different stages of care receivers' dementia. RESULTS Family caregivers' caregiving activities were related to patients' stages of dementia. For patients with mild dementia, caregivers provided more assistance in transportation and housekeeping. In addition to these two activities, family caregivers of patients with moderate dementia provided more assistance with mobility and protection. For patients with severe dementia, family caregivers provided more assistance with personal care, mobility and protection, transportation, and housekeeping. Overall, family caregivers reported having some preparation to provide care; the most difficult caregiving activity was identified as managing behavioral problems. CONCLUSION This study's results provide a knowledge base for designing dementia stage-specific interventions in clinical practice and developing community-based, long-term care systems for families of patients with dementia.
Collapse
Affiliation(s)
- Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan ; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Min-Chi Chen
- Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sien-Tsong Chen
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chuin Hsu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan ; Chang Gung Dementia Center, Taoyuan, Taiwan
| |
Collapse
|
39
|
Liu HY, Wang YN, Huang HL, Hsu WC, Lin YE, Huang TH, Shyu YIL. Psychometric Properties of the Finding a Balance Scale for Family Caregivers of Elders with Dementia in Taiwan. Res Nurs Health 2014; 37:336-46. [DOI: 10.1002/nur.21603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Hsin-Yun Liu
- Postdoctoral Fellow, Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
| | - Yu-Nu Wang
- Instructor, Department of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Huei-Ling Huang
- Associate Professor, Department of Gerontological Care and Management; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Wen-Chuin Hsu
- Assistant Professor and Visiting Staff, Department of Neurology; Chang Gung University and Memorial Hospital; Taoyuan Taiwan
| | - Yueh-E Lin
- Supervisor, Department of Nursing; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Tza-Hsin Huang
- Director, Department of Nursing; Taoyuan Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Yea-Ing L. Shyu
- Professor, School of Nursing; and Healthy Aging Research Center; Chang Gung University; 259 Wen-Hwa 1st Road, Kwei-Shan Taoyuan 33302 Taiwan
| |
Collapse
|
40
|
Liu HY, Tseng MY, Li HJ, Wu CC, Cheng HS, Yang CT, Chou SW, Chen CY, Shyu YIL. Comprehensive Care Improves Physical Recovery of Hip-Fractured Elderly Taiwanese Patients With Poor Nutritional Status. J Am Med Dir Assoc 2014; 15:416-22. [DOI: 10.1016/j.jamda.2014.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/09/2013] [Accepted: 01/14/2014] [Indexed: 11/28/2022]
|
41
|
Shyu YIL, Tseng MY, Liang J, Tsai WC, Wu CC, Cheng HS. Interdisciplinary intervention decreases cognitive impairment for older Taiwanese with hip fracture: 2-year follow-up. Int J Geriatr Psychiatry 2013; 28:1222-31. [PMID: 23504666 DOI: 10.1002/gps.3945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 01/22/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Few studies describe the trajectories of cognitive function for hip-fracture patients following hospital discharge and the treatment effects of interdisciplinary intervention on cognitive outcomes. The purpose of this study was to explore the 2-year postoperative trajectory for cognitive function of older hip-fracture patients and cognitive effects of an interdisciplinary intervention. METHODS Of 160 subjects randomly assigned to groups, 29 (35.8%) in the control group (n = 81) and 30 (38.0%) in the intervention group (n = 79) were cognitively impaired at admission. The intervention group received geriatric consultation, continuous rehabilitation, and discharge planning. Subjects' cognitive function was measured using the mini mental state examination Taiwan version at admission, 6, 12, 18, and 24 months after discharge and analyzed using hierarchical generalized linear models. RESULTS Patients who received the intervention program had 75% less likelihood of being cognitively impaired 6 months following discharge than those who received routine care (odds ratio = 0.25, p < 0.001). The difference between the control and intervention groups was small at admission, peaked at 18 months, and decreased from 18 to 24 months following discharge. CONCLUSIONS Our interdisciplinary intervention improved the long-term postoperative cognitive functioning of older persons with hip fracture in Taiwan.
Collapse
Affiliation(s)
- Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | | | | | | | | | | |
Collapse
|
42
|
Huang HL, Kuo LM, Chen YS, Liang J, Huang HL, Chiu YC, Chen ST, Sun Y, Hsu WC, Shyu YIL. A home-based training program improves caregivers' skills and dementia patients' aggressive behaviors: a randomized controlled trial. Am J Geriatr Psychiatry 2013; 21:1060-70. [PMID: 23933422 DOI: 10.1016/j.jagp.2012.09.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 08/28/2012] [Accepted: 09/26/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of an individualized, home-based caregiver-training program for caregivers of elderly patients with dementia and behavioral problems. METHODS Using a randomized clinical trial in the neurologic clinics of two hospitals and a community care management center in northern Taiwan, we tested an individualized home-based caregiver-training program for managing behavioral problems, with referrals to community services and telephone consultation. Participants were patients with dementia and their caregivers (N = 129): 63 in the intervention group and 66 in the control group. The control group received only written instructions and social telephone follow-ups. Behavioral problems of elderly dementia patients were assessed by the Chinese version of the Cohen-Mansfield Agitation Inventory, community form. Family caregivers' outcomes were measured by the Agitation Management Self-efficacy Scale and the Preparedness and Competence Scales. These instruments were administered before the program and 2 weeks, 3 months, and 6 months afterward. RESULTS Family caregivers who received the individualized home-based training program had better preparedness (t = 2.72, df = 127, p <0.01), competence (t = 4.77, df = 126, p <0.001), and overall self-efficacy (t = 3.81, df = 127, p <0.001) at 3 months than those in the control group. Moreover, the growth rate by treatment interaction effect was significant for caregiver competence (t = 2.25, df = 127, p <0.05) and overall self-efficacy for managing behavioral problems (t = 2.16, df = 127, p <0.05). The probability of physically aggressive behavior for patients in the intervention group decreased from 0.27 to 0.12. CONCLUSION Our individualized home-based caregiver-training program improved caregivers' preparedness, competence, and self-efficacy for managing problematic behaviors and decreased physical aggressiveness of elderly patients with dementia.
Collapse
Affiliation(s)
- Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Kuo LM, Huang HL, Huang HL, Liang J, Chiu YC, Chen ST, Kwok YT, Hsu WC, Shyu YIL. A home-based training program improves Taiwanese family caregivers' quality of life and decreases their risk for depression: a randomized controlled trial. Int J Geriatr Psychiatry 2013; 28:504-13. [PMID: 22778053 DOI: 10.1002/gps.3853] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 06/08/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Little is known about the longitudinal effects of training programs on family caregivers' health-related quality of life (HRQoL) and depressive symptoms over time. Therefore, the purpose of this study was to examine the effects of a home-based caregiver training program on HRQoL and depressive symptoms for family caregivers of older persons with dementia. METHODS Outcomes (caregivers' HRQoL and depressive symptoms) were assessed before the training program (baseline), and at 2 weeks, 3 months, and 6 months afterwards. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey, Taiwan version. Depressive symptoms were measured using the Chinese version Center for Epidemiologic Studies Depression Scale. RESULTS Family caregivers who received the individualized home-based training program had better health outcomes in bodily pain (b = 12.37, p < 0.013), role disability due to emotional problems (b = 17.74, p < 0.013), vitality (b = 12.40, p < 0.001), better mental summary score (b = 5.14, p < 0.003), and decreased risk for depression (odds ratio = 0.15, confidence interval = 0.04-0.65, p < 0.013) than those in the control group during the 6 months following the training program. CONCLUSION Our home-based caregiver training program improved caregivers' HRQoL, especially role limitations due to emotional problems, and decreased their risk for depression.
Collapse
Affiliation(s)
- Li-Min Kuo
- School of Nursing, Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Shyu YIL, Liang J, Tseng MY, Li HJ, Wu CC, Cheng HS, Chou SW, Chen CY, Yang CT. Comprehensive and subacute care interventions improve health-related quality of life for older patients after surgery for hip fracture: a randomised controlled trial. Int J Nurs Stud 2012; 50:1013-24. [PMID: 23245454 DOI: 10.1016/j.ijnurstu.2012.11.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 11/14/2012] [Accepted: 11/24/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elderly patients with hip fracture have been found to benefit from subacute care interventions that usually comprise usual care with added geriatric intervention, early rehabilitation, and supported discharge. However, no studies were found on the effects of combining subacute care and health-maintenance interventions on health outcomes for elders with hip fracture. OBJECTIVES To compare the effects of an interdisciplinary comprehensive care programme with those of subacute care and usual care programmes on health-related quality of life (HRQoL) for elderly patients with hip fracture. DESIGN Randomised controlled trial. SETTINGS A 3000-bed medical centre in northern Taiwan. PARTICIPANTS Patients with hip fracture (N=299) were randomised into three groups: subacute care (n=101), comprehensive care (n=99), and usual care (n=99). METHODS Subacute care included geriatric consultation, continuous rehabilitation, and discharge planning. Comprehensive care consisted of subacute care plus health-maintenance interventions to manage depressive symptoms, manage malnutrition, and prevent falls. Usual care included only 1-2 in-hospital rehabilitation sessions, discharge planning without environmental assessment, no geriatric consultation, and no in-home rehabilitation. HRQoL was measured using the Medical Outcomes Study Short-Form 36 Taiwan version at 1, 3, 6, and 12 months after discharge. RESULTS Participants in the comprehensive care group improved more in physical function, role physical, general health and mental health than those in the usual care group. The subacute care group had greater improvement in physical function, role physical, vitality, and social function than the usual care group. The intervention effects for both comprehensive and subacute care increased over time, specifically from 6 months after hip fracture onward, and reached a maximum at 12 months following discharge. CONCLUSIONS Both comprehensive care and subacute care programmes may improve health outcomes of elders with hip fracture. Our results may provide a reference for health care providers in countries using similar programmes with Chinese/Taiwanese immigrant populations.
Collapse
Affiliation(s)
- Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Huang YF, Shyu YIL, Liang J, Chen MC, Cheng HS, Wu CC. Diabetes and Health Outcomes Among Older Taiwanese with Hip Fracture. Rejuvenation Res 2012; 15:476-82. [DOI: 10.1089/rej.2011.1308] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yueh-Fang Huang
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Graduate Institute of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L. Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Min-Chi Chen
- Department of Public Health & Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
46
|
Shyu YIL, Liang J, Tseng MY, Li HJ, Wu CC, Cheng HS, Yang CT, Chou SW, Chen CY. Comprehensive Care Improves Health Outcomes Among Elderly Taiwanese Patients With Hip Fracture. ACTA ACUST UNITED AC 2012; 68:188-97. [DOI: 10.1093/gerona/gls164] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
47
|
Shyu YIL, Tsai WC, Chen MC, Liang J, Cheng HS, Wu CC, Su JY, Chou SW. Two-year effects of an interdisciplinary intervention on recovery following hip fracture in older Taiwanese with cognitive impairment. Int J Geriatr Psychiatry 2012; 27:529-38. [PMID: 21732418 DOI: 10.1002/gps.2750] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 05/09/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article aims to evaluate the long-term effects of an interdisciplinary intervention program on cognitively impaired older persons after hip fracture in Taiwan. METHODS Of 160 subjects randomly assigned to control (n = 81) and intervention (n = 79) groups, 24 (29.6%) and 27 (34.2%) were cognitively impaired in the control and intervention groups, respectively, and outcomes were followed for 2 years after discharge. RESULTS Among cognitively impaired subjects, more in the intervention group recovered their previous walking ability (odds ratio [OR] =3.49; confidence interval [CI] = 1.64 to 7.42), activities of daily life performance (β = 18.59; p = 0.0002), and more were readmitted to the hospital (OR = 4.44, CI = 1.53 to 12.89) than those in the control group during the first 2 years following discharge. Among subjects without cognitive impairment, more in the intervention group recovered their previous walking ability (OR = 2.6; CI = 1.33 to 5.07), had fewer falls (OR = 0.47; CI = 0.25 to 0.86), and made fewer emergency room visits (OR = 0.33; CI = 0.11 to 0.97) during the first 2 years following discharge than those in the control group. CONCLUSIONS Cognitively impaired individuals benefited from our interdisciplinary intervention by improving their walking ability and physical function during the first 2 years following discharge. Specific strategies on fall prevention following hip fracture need to be further developed for cognitively impaired individuals.
Collapse
Affiliation(s)
- Yea-Ing L Shyu
- School of Nursing, Chang Gung University, Taoyuan, Taiwan.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Li CL, Chang HY, Shyu YIL. The excess mortality risk of diabetes associated with functional decline in older adults: results from a 7-year follow-up of a nationwide cohort in Taiwan. BMC Public Health 2011; 11:953. [PMID: 22196153 PMCID: PMC3275554 DOI: 10.1186/1471-2458-11-953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 12/23/2011] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Diabetes is associated with an increased risk of functional decline in older adults. Few studies have investigated the contribution of functional decline to excess mortality risk in older people with diabetes. The aim of this study was to examine how diabetes in combination with different levels of functional decline affects 7-year mortality in older adults. METHODS We analyzed data from a nationally representative sample of people aged 65 years and over, participating in the 2001 National Health Interview Survey in Taiwan. A total of 1873 participants were followed through 2002-2008, of whom 286 (15.3%) had a history of diabetes confirmed by a medical professional. Participants were divided into three functional status groups: (1) high functioning-no limitations involving activities of daily living (ADLs), instrumental activities of daily living (IADLs), or physical functioning; (2) low functioning-limitations in one or more ADLs; (3) middle functioning-all participants in between groups 1 and 2. RESULTS The crude mortality rate was 52.7 per 1,000 person-years in those with diabetes and 34.1 per 1,000 person-years in those without diabetes. After adjustment for other factors, diabetes alone was not associated with an increased mortality risk in those with high functioning. However, diabetes alone had a hazard ratio (HR) for mortality of 1.90 (95%CI = [1.02-3.53]) in those with middle functioning and 3.67 (95%CI = [1.55-8.69]) in those with low functioning. The presence of diabetes and one or more other chronic conditions was associated with a HR for mortality of 2.46 (95%CI = [1.61-3.77]) in those with middle functioning and 4.03 (95%CI = [2.31-7.03]) in those with low functioning. CONCLUSIONS Our results indicate that diabetes is not associated with increased mortality in those with high functioning. There was a gradient effect of functional decline on mortality in individuals with diabetes. Additionally, among participants with other chronic conditions, functional decline was associated with a greater burden of mortality in older adults with diabetes. These findings highlight the critical importance of the prevention of cardiovascular disease morbidity and the maintenance of functional abilities in order to reduce mortality risk in older adults with diabetes.
Collapse
Affiliation(s)
- Chia-Lin Li
- Department of Health Care Management, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | | | | |
Collapse
|
49
|
Abstract
AIM The aim of this study was to investigate the association between care activities and pain and restraint and pain in residents with dementia. BACKGROUND If pain in people with dementia is not identified or alleviated in a timely manner, it could lead to an adverse effect on their physical, mental, social health and quality of life. Care activities and restraint might cause pain, but little is known as to whether they are true risk-factors of pain in people with dementia. DESIGN A cross-sectional research design was employed. METHODS One hundred and twelve people with dementia were chosen from two nursing homes located in northern Taiwan. The demographic and clinical data collected included diagnoses, analgesics, restraints, recent falls, etc. The severity of dementia was assessed using the Clinical Dementia Rating Scale. The researchers observed every participant immediately following instances of routine care and then recorded the level of pain using the Chinese version of the Pain Assessment in Advanced Dementia scale. RESULTS About 36·6% of the participants had a Chinese version of the Pain Assessment in Advanced Dementia scale score above two points and an overall mean score of 1·50 (SD 1·81) with a range from 0-8. Only one resident with dementia received regular analgesic. Pain level in residents with dementia that needed assisted care was higher than in residents who were able to move about freely. It showed a positive correlation between level of pain and the severity of dementia among residents. The major predictors for pain in residents with dementia included restraint, assisted bathing and assisted transfer. CONCLUSION The findings confirm the association between care activities and pain and between restraint and pain in residents with dementia. RELEVANCE TO CLINICAL PRACTICE Formal caregivers need to minimise the triggering of pain when they assist residents' daily activities and avoid unnecessary restraints, while offering personalised, conventional nursing care to residents with late-stage dementia.
Collapse
Affiliation(s)
- Pei-Chao Lin
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | |
Collapse
|
50
|
Shyu YIL, Liang J, Wu CC, Cheng HS, Chen MC. An interdisciplinary intervention for older Taiwanese patients after surgery for hip fracture improves health-related quality of life. BMC Musculoskelet Disord 2010; 11:225. [PMID: 20920220 PMCID: PMC3161401 DOI: 10.1186/1471-2474-11-225] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 09/29/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The effects of intervention programs on health-related quality of life (HRQOL) of patients with hip fracture have not been well studied. We hypothesized that older patients with hip fracture who received our interdisciplinary intervention program would have better HRQOL than those who did not. METHODS A randomized experimental design was used. Older patients with hip fracture (N = 162), 60 to 98 years old, from a medical center in northern Taiwan were randomly assigned to an experimental (n = 80) or control (n = 82) group. HRQOL was measured by the SF-36 Taiwan version at 1, 3, 6, and 12 months after discharge. RESULTS The experimental group had significantly better overall outcomes in bodily pain (β = 9.38, p = 0.002), vitality (β = 9.40, p < 0.001), mental health (β = 8.16, p = 0.004), physical function (β = 16.01, p < 0.001), and role physical (β = 22.66, p < 0.001) than the control group at any time point during the first year after discharge. Physical-related health outcomes (physical functioning, role physical, and vitality) had larger treatment effects than emotional/mental- and social functioning-related health outcomes. CONCLUSIONS This interdisciplinary intervention program may improve health outcomes of elders with hip fracture. Our results may provide a reference for health care providers in countries using similar programs with Chinese/Taiwanese immigrant populations. TRIAL REGISTRATION NCT01052636.
Collapse
Affiliation(s)
- Yea-Ing L Shyu
- School of Nursing, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Taoyuan 333, Taiwan
| | - Jersey Liang
- School of Public Health, University of Michigan, 1420 Washington Heights, M3234, SPH II, Ann Arbor, MI 48109-2029, USA
- Institute of Gerontology, University of Michigan, 300 North Ingalls, 9th Floor, Ann Arbor, MI 48109-2007, USA
| | - Chi-Chuan Wu
- Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kwei-Shan, Taoyuan 333, Taiwan
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kwei-Shan, Taoyuan 333, Taiwan
| | - Min-Chi Chen
- Department of Public Health & Biostatistics Consulting Center, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Taoyuan 333, Taiwan
| |
Collapse
|