Purpose This study aims to examine the frailty transition patterns of older adults recruited from both community and residential care settings within a 5‐year period, and to identify the physical and psychosocial factors associated with the transitions. Design This study is a secondary data analysis of a longitudinal study for tracking the change of health status of older adults 60 years of age or older. Participants who had undergone at least two assessments during 2013–2017 were selected for analysis. Guided by the Gobben’s Frailty Model, biopsychosocial predictors were comprehensively identified from the literature, and their relationship to frailty state transition was explored. Methods We compared the baseline characteristics of participants at the frail, pre‐frail, and robust states (categorized using the Fried Frailty Index). A generalized estimating equation was used to identify factors associated with an improvement or a deterioration in frailty. The probability of transitions between frailty states was calculated. Findings Among the 306 participants, 19% (n = 59) improved and 30% (n = 92) declined in frailty within the project period. Sleep difficulties (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.07–2.90; p = .027), better cognitive status (OR = 0.80–0.84; 95% CI: 0.66–0.98 and 0.73–2.73; p = .031 and .018), good nutritional status (OR = 0.74; 95% CI: 0.59–0.91; p = .005), slow mobility (OR = 1.03–1.13; 95% CI: 1.00–1.05 and 1.03–1.25; p = .047 and .014), hearing impairment (OR = 2.83; 95% CI: 1.00–8.01; p = .05), better quality of health—physical domain (OR = 0.95; 95% CI: 0.92–0.99; p = .006), and better functional ability (OR = 0.85–0.97; 95% CI: 0.79–0.92 and 0.96–0.99; p < .001 and p = .003) were significant associated factors in the worsening group. More physical activity (OR = 1.01; 95% CI: 1.00–1.01 and 1.01–1.02; p = .026 and p < .001), hearing impairment (OR = 0.26; 95% CI: 0.08–0.86; p = .028), and slow mobility (OR = 0.93; 95% CI: 0.87–1.00; p = .037) were significant associated factors in the improvement group. Conclusions Frailty is a crucial global public health issue. This study provides evidence for nurses to holistically consider the associated factors and to design effective interventions to combat frailty in our ageing society. Clinical Relevance Frailty is a transient state that can be reversed. Professional nurses working in both community and residential care settings should be able to identify older adults at risk and improve their health conditions appropriately.
Background The prevalence of fatigue and sleep disturbances is high in stroke populations. Sleep quality can be targeted by interventions to alleviate fatigue following a stroke. This study aimed to determine the prevalence of fatigue and poor sleep quality, and to quantify the contribution of sleep quality to fatigue following a stroke, in chronic (≥1 year) stroke survivors. Methods A cross-sectional design was adopted. A total of 112 stroke survivors (mean age ± standard deviation [year], 64.18 ± 5.77) at 6.08 ± 4.80 years post-stroke completed this study. All participants were assessed using the Fatigue Assessment Scale, the Pittsburgh Sleep Quality Index, the Visual Analogue Scale-Pain, the Fugl-Meyer Assessment of the upper and lower extremities, the 5-Time Sit-To-Stand Test, the Epworth Sleepiness Scale, the Frenchay Activities Index, the Life-Space Assessment, the Community Integration Measure, and the Multidimensional Scale of Perceived Social Support. Pearson and partial correlation coefficients were used to examine the correlation between fatigue and other variables. A multiple linear regression (the forced entry method) was performed to quantify the independent contribution of sleep quality to prediction of fatigue. Results Of the 112 participants, 52.7% reported experiencing fatigue and 64.3% reported poor sleep quality. Sleep quality could independently account for 5.9% of the variance in fatigue scores after a stroke. Conclusions There is a high prevalence of fatigue and poor sleep quality in Chinese stroke survivors. Sleep quality is an independent predictor of fatigue in those living in the community who have survived a stroke for a year or longer.
Background Non-pharmacological interventions are widely used to treat fatigue in clients with specific diseases but the findings may not be applicable to older adults experiencing fatigue, which also relates to the physiological changes of ageing. Non-pharmacological interventions for fatigue alleviation in older adults have not been reviewed and meta-analysed. Objective To evaluate the immediate and long-term effects of non-pharmacological interventions on fatigue in community-dwelling older adults. Methods Randomised controlled trials published from 2008 to May 2018 were searched in CINAHL, Cochrane Library, Embase, Medline, PsycINFO, PubMed and Web of Science databases. The reference lists of the publications, forward citation and clinical trial registries were also reviewed. Relevant data were extracted and meta-analysis was conducted using Cochrane Review Manager 5.3. Results Eight studies, with a total of 1093 participants, were identified. Non-pharmacological interventions included mindfulness meditation, a behavioural lifestyle programme, muscle relaxation, pet insect-assisted therapy, yoga, Tai Chi and cognitive behavioural therapy. Non-pharmacological interventions elicited significant immediate positive effects on fatigue (SMD: −0.40, 95% CI −0.62 to −0.18), although there was no lasting effect. Both physical and cognitive/mental interventions effectively alleviated fatigue. Conclusion Non-pharmacological interventions appear to be effective in alleviating fatigue at immediate post-intervention in community-dwelling older adults. More studies with robust designs and adequate sample sizes are needed in the future.
Background Integrating evidence-based music-with-movement into routine practices for people with dementia requires effective implementation strategies. The objectives of this study were to evaluate the clinical efficacy of the intervention and to examine the effectiveness of the implementation strategies in promoting home-based adoption. Methods This was a cluster randomized controlled trial adopting a clinical effectiveness-implementation hybrid design. The 12-week music-with-movement intervention aims to promote the well-being of people with dementia and their caregivers. Clinical outcomes were assessed to evaluate the efficacy of the intervention. These included the symptoms of anxiety and depression of people with dementia; caregivers’ perception of their stress and the positive aspects of caregiving; and the quality of the dyadic relationship. Caregivers, staff, and volunteers were interviewed and objective figures on reach and adoption were collected to reflect the outcomes of the implementation. Results Compared to the waitlist control, there was a significant reduction in the anxiety and the symptoms of depression of those in the intervention group. There was also a significant reduction in the perceived stress level of the caregivers. Six focus group interviews were conducted. The intervention and the appropriateness of the implementation strategies were perceived positively by the dyad participants, the staff of the centres, and volunteers. Of the collaborating centres, 57% continued to use the intervention and, after six months, served six times more people than were recruited in this study. Over half of the participating families continued to use the intervention for at least six more months. Conclusion Music-with-movement interventions showed promise for improving the well-being of people with dementia and their caregivers. Effective strategies facilitated the implementation process, such as integrating communication technology to provide instant support and involving volunteers in engaging the collaborating centres and families. This study sheds light on perceptions of the intervention, and on its scalability for a broader population. Trial Registration NCT03575026, Registered 2 July 2018.
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