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Aims and objectives: The aim of this integrative review was to investigate current literature exploring relationships between general self‐efficacy and the healthy ageing of older people. Background: Enhancing the health and well‐being of older adults, while mitigating consequences of illness and frailty are important priorities in healthy ageing. General self‐efficacy is closely associated with human behaviour and has been linked with improved health and well‐being. Design: An integrative review using the five‐stage method described by Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546). Methods: Academic databases CINAHL, MEDLINE and APA PsycInfo were searched between 2010 and 2020 for original, peer‐reviewed papers, published in English that investigated general self‐efficacy and factors associated with the healthy ageing of older people. Included papers were critically appraised using the Appraisal tool for Cross‐Sectional Studies (AXIS tool) and Critical Appraisal Skills Programme, and underwent data abstraction and synthesis via a constant comparative method. This review was also evaluated using the PRISMA checklist. Results: Twenty‐one papers were included in this review. Two main themes emerged. The first highlights positive relationships between general self‐efficacy and health and ageing perceptions, with subsequent influence on health behaviours. The second includes two sub‐themes, which explores general self‐efficacy's role in maintaining well‐being through its effects on psychological health and overcoming physical decline through adaption to changing physical and health conditions. Conclusions: Promoting general self‐efficacy has potential benefits for the healthy ageing of older people through positive effects on ageing and health perceptions, health behaviours, psychological health and overcoming physical decline. Relevance to clinical practice: Understanding how general self‐efficacy facilitates healthy ageing can guide nursing practices that reduce or mitigate consequences of illness and physical decline on the health and well‐being of older people. Strategies aimed at increasing older people's general self‐efficacy can help to facilitate subsequent positive effects on factors that promote healthy ageing. [ABSTRACT FROM AUTHOR]

Aims: To explore the nature of interactions that enable older inpatients with cognitive impairments to engage with hospital staff on falls prevention. Design: Ethnographic study. Methods: Ethnographic observations on orthopaedic and older person wards in English hospitals (251.25 h) and semi‐structured qualitative interviews with 50 staff, 28 patients and three carers. Findings were analysed using a framework approach. Results: Interactions were often informal and personalised. Staff qualities that supported engagement in falls prevention included the ability to empathise and negotiate, taking patient perspectives into account. Although registered nurses had limited time for this, families/carers and other staff, including engagement workers, did so and passed information to nurses. Conclusions: Some older inpatients with cognitive impairments engaged with staff on falls prevention. Engagement enabled them to express their needs and collaborate, to an extent, on falls prevention activities. To support this, we recommend wider adoption in hospitals of engagement workers and developing the relational skills that underpin engagement in training programmes for patient‐facing staff. Implications for Profession and Patient Care: Interactions that support cognitively impaired inpatients to engage in falls prevention can involve not only nurses, but also families/carers and non‐nursing staff, with potential to reduce pressures on busy nurses and improve patient safety. Reporting Method: The paper adheres to EQUATOR guidelines, Standards for Reporting Qualitative Research. Patient or Public Contribution: Patient/public contributors were involved in study design, evaluation and data analysis. They co‐authored this manuscript. [ABSTRACT FROM AUTHOR]

Aim: To analyse the risk factors and incidence of falls in geriatric outpatients in a university hospital ward in Hangzhou, China. Methods: From May 2020 to August 2022, 1712 geriatric outpatients in a university hospital ward in Hangzhou, China, were screened using a socio‐demographic questionnaire (e.g. gender, age, living arrangement, etc.) and assessment scales. The correlation between each factor and falls was preliminarily analysed by chi‐squared tests. Finally, binary logistic regression analysis was conducted to further analyse the risk factors of falls. The STROBE checklist was used in reporting this study. Results: Of the 1712 geriatric outpatients recruited, 1626 participants (60–79 and ≥ 80 years old) with complete questionnaire and assessment data were included. The occurrence of falls for those in the 60–79 age group was 8.4%, and for those in the ≥80 age group it was 13.4%. Age (p =.007), use of a walking assistance device (p <.001), the Stay Independent Brochure Questionnaire (SIB) (OR = 7.751, 95% CI = 5.089–11.806, p <.001), living arrangement (p =.004), timed up and go test (TUGT) (p =.007) and three diseases or above (OR = 2.496, 95% CI = 1.358–11.4.586, p =.003) reached statistical significance. Conclusions: Older people have a high incidence of falls. In this study, age, disease history, SIB scores (≥4 points), living arrangement, TUGT and walking assistance device increased the probability of falls in older Chinese adults. Personalised interventions should be carried out according to the specific situation of older people to effectively reduce their incidence of falls and improve their quality of life. Relevance to Clinical Practice: The basic characteristics and fall risk factors of the older can help nurses identify fall risk, and early intervention by caregivers can reduce fall‐related injuries, which has practical significance for promoting healthy aging. Patient or Public Contribution: The subjects of this study were older patients ≥60 years old, and the demographic characteristics and fall‐related information of patients were obtained by questionnaire. The team worked closely with a team of experts in the field of health care. Some researchers collect data and rewrite them, while other researchers analyse the information and write a paper. All authors read and approved the final manuscript. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aims to propose a self‐management clusters classification method to determine the self‐management ability of elderly patients with mild cognitive impairment (MCI) associated with diabetes mellitus (DM). Background: MCI associated with DM is a common chronic disease in old adults. Self‐management affects the disease progression of patients to a large extent. However, the comorbidity and patients' self‐management ability are heterogeneous. Design: A cross‐sectional study based on cluster analysis is designed in this paper. Method: The study included 235 participants. The diabetes self‐management scale is used to evaluate the self‐management ability of patients. SPSS 21.0 was used to analyse the data, including descriptive statistics, agglomerative hierarchical clustering with Ward's method before k‐means clustering, k‐means clustering analysis, analysis of variance and chi‐square test. Results: Three clusters of self‐management styles were classified as follows: Disease neglect type, life oriented type and medical dependence type. Among all participants, the percentages of the three clusters above are 9.78%, 32.77% and 57.45%, respectively. The difference between the six dimensions of each cluster is statistically significant. Conclusion(s): This study classified three groups of self‐management styles, and each group has its own self‐management characteristics. The characteristics of the three clusters may help to provide personalized self‐management strategies and delay the disease progression of MCI associated with DM patients. Relevance to clinical practice: Typological methods can be used to discover the characteristics of patient clusters and provide personalized care to improve the efficiency of patient self‐management to delay the progress of the disease. Patient or public contribution: In our study, we invited patients and members of the public to participate in the research survey and conducted data collection. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL. Background: Given the inherent vulnerabilities of the ageing process, the older people are an at‐risk group for both contagion of SARS‐CoV‐2 and the perpetuation of residual symptoms after infection, the so‐called long COVID or post‐COVID syndrome. Design: A cross‐sectional survey design using the STROBE checklist. Methods: Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021–March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL. Results: The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID‐19 survivors. Conclusions: Knowledge about the persistence of physical, emotional, and social symptoms of COVID‐19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society. Relevance to clinical practice: Given the novelty of long‐COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns. Patient or Public Contribution: No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection. [ABSTRACT FROM AUTHOR]

Background: Older people in the nursing home environment are much less mobile and capable of taking care of themselves as they age, and most of them face the plight of loneliness, which seriously affects the quality of life of older people in their later years. Aims: A systematic review and synthesis of older people's experiences of loneliness in nursing homes. Design: Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations. Methods: A search of PubMed, Cochrane Library, Web of Science, Embase, the Chinese biomedical literature service system, the China National Knowledge Infrastructure, the Wanfang Database and the Wipu Database for qualitative studies of older people's experiences of loneliness in nursing homes was conducted with a search time frame of March 2023. Evaluation of the quality of the literature using the Joanna Briggs Institute's Australian Centre for Evidence‐Based Health Care Quality Assessment Criteria for Qualitative Research, And the data were synthesised using Thomas and Harden's method of thematic and content analysis. Results: A total of 13 papers were included, and 36 research findings were distilled and integrated into three themes: causes of loneliness; feelings of loneliness; coping with loneliness; and seven sub‐themes: aging and loss; environmental transformation; loneliness is a pain; loneliness is a choice; participation; strengthening social ties; and diverting attention. Conclusions: Older people in nursing homes face varying degrees of loneliness, which is a subjective feeling influenced by the interplay between personal awareness and the external environment, so future care interventions should be developed in a comprehensive manner, taking into account the characteristics of the older people themselves and their external environment. No Patient or Public Contribution: This study is a meta‐synthesis and does not require relevant contributions from patients or the public. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the effectiveness of cognitive interventions after general anaesthesia to improve cognitive functioning. Background: The number of surgical procedures performed worldwide is large and growing. Postoperative cognitive dysfunction is a common complication associated with poor postoperative outcomes. A variety of cognitive interventions have been developed to maintain or improve cognitive function in one or more cognitive domains. Cognitive interventions have shown to be effective in healthy older populations, those with mild cognitive impairment, and those with heart failure. The impact of cognitive interventions in surgical patients after general anaesthesia is a relatively new focus of research and is therefore less well established. Methods: Seven bibliographic databases were searched in relation to 'surgery' and 'cognitive interventions'; no date or language limits were imposed. Studies including adult patients who were scheduled for, or who had undergone surgery under general anaesthesia, had a baseline cognitive assessment using a validated measurement, and had engaged with any cognition‐based intervention were included. Full‐text review for inclusion, quality assessment and data extraction were undertaken independently by two authors. This study is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Results: A total of 550 papers were identified for possible inclusion, of which nine met the inclusion criteria and were included in the review. The majority were randomised controlled trials (RCTs) (n = 6 [66.7%]). Four studies used computerised cognitive interventions, while five used traditional cognitive interventions. Most of the studies used multi‐domain cognitive training focusing on two or more domains (n = 7 [77.8%]) while two studies used single‐domain cognitive training. Memory (n = 7 [77.8%]) and attention (n = 5 [55.6%]) were the cognitive domains most often targeted during the intervention. Conclusions: The use of cognitive interventions demonstrated some efficacy in improving cognitive function after general anaesthesia, particularly those targeting memory. Relevance for clinical practice The findings of this review suggest that cognitive interventions show promise at improving cognitive performance in patients with POCD and could be usefully implemented in clinical practice to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aims: To investigate the change and associated factors of care needs within 6 months post‐discharge in older people with hospital‐associated disability, and the relationship between time‐varying care needs and physical function. Background: Older people with hospital‐associated disability will have various care needs post‐discharge. Understanding their care needs will help to improve their health. However, studies on this population are still limited. Design: A longitudinal study. Methods: The older people who met the inclusion and exclusion criteria were selected in 2 tertiary hospitals in Zhejiang Province, China. The questionnaire survey method was used to collect data about socio‐demographic characteristics, physical function and care needs. The data of 375 older people who completed follow‐up were analysed using logistic regression analysis, generalised estimating equations and generalised additive mixed model. We followed STROBE checklist for reporting the study. Results: The care needs of the older people with hospital‐associated disability declined unevenly, it decreased rapidly in the first three months, and then flattening out. The percentage of people with care needs in each dimension decreased over time, but daily care and rehabilitation needs were consistently more important. Socio‐demographic factors and physical function had different effects on need at different time points, the physical function was the main factor among them. There were non‐linear relationships between the physical function and different care needs with different inflection points. Conclusion: This research revealed change patterns of the care needs of older people with hospital‐associated disability post‐discharge and the non‐linear relationship between physical function and care needs. These findings may help healthcare professionals and caregivers to provide accurate care. Relevance to clinical practice: The findings can be used to identify effective approaches to address the care needs of older people with hospital‐associated disability based on the time of discharge, in conjunction with age, education, and especially physical function, which will promote the justify allocation of nursing resources. What does this paper contribute to the wider global clinical community? [ABSTRACT FROM AUTHOR]

Aim: Examined the evidence of low‐to‐moderate‐intensity physical activities to assess the effect in managing hypertension, diabetes mellitus and hyperlipidaemia conditions among community‐dwelling older adult. Background: Physical activity is recommended for the maintenance and improvement of health. However, high‐intensity physical activity may adversely impact exercise adherence by older adults. Design: This review was conducted with reference to methods set out in the Cochrane Handbook for Systematic Reviews of Interventions. The PRISMA statement was employed to guide the reporting of the systematic review and meta‐analyses. Data Sources: Seven electronic databases were searched to identify relevant articles that were published in English from 1 January 2000 to 31 December 2020. Review Method: This review included randomised controlled trials and cluster‐randomised controlled trials on interventions of physical activities with low‐to‐moderate intensities compared against usual care without physical activities. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias Tool. Meta‐analysis was performed using RevMan, with Cochran Q and I2 used for determining heterogeneity. The overall effect was reviewed with z scores. Results: Fifteen randomised controlled trials with 940 total participants were evaluated. Low‐to‐moderate‐intensity physical activity significantly improved systolic blood pressure [Z = 3.59, p =.0003], HbA1C [Z = 2.10, p =.04] and high‐density lipoprotein (HDL) levels [Z = 3.83, p =.0001], compared to usual care. A further subgroup analysis found no significant difference in systolic blood pressure level after three sessions a week as well as after three months. There were insufficient papers to evaluate for both HbA1C and HDL levels. Conclusion: Regular physical activity ranging from low‐to‐moderate intensity should be encouraged among older adults with chronic diseases. Relevance for clinical practice: This review suggested that low‐to‐moderate levels of physical activity could be encouraged among community‐dwelling older adults to improve their physical health. [ABSTRACT FROM AUTHOR]

Aim: To pool existing studies to assess the overall effectiveness of integrated care for older adults (ICOPE)‐based interventions in improving depressive symptoms in older adults. Design: A systematic review and meta‐analysis. Data Sources: Ten databases were systematically searched from inception to 15 July 2023 and the search was last updated on 2 September 2023. Methods: Standardized mean difference (SMD) was calculated using random effects models. RoB 2 and GRADEpro GDT were used to assess the methodological quality and confidence in the cumulative evidence. Funnel plots, egger's test and begg's test were used to analyse publication bias. Sensitivity, subgroup and meta‐regression analyses were performed to explore potential sources of heterogeneity. Results: The results of 18 studies showed ICOPE‐based interventions had a significant effect on improving depressive symptoms (SMD = −.84; 95% CI, −1.20 to −.3647; p <.001; 18 RCTs, 5010 participants; very low‐quality evidence). Subgroup analysis showed the intervention group was characterized by mean age (70–80 years old), intervention duration between 6 to 12 months, gender (female <50%), non‐frail older adults, depressed older adults and mixed integration appeared to be more effective. Sensitivity analysis found the results to be robust. Conclusion: ICOPE‐based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults. Implications for the Profession and/or Patient Care: Healthcare professionals are expected to use ICOPE as one of the interventions for depressive symptoms in older adults, and this ICOPE could provide more comprehensive care services for older adults to reduce depressive symptoms. Impact: ICOPE‐based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults.ICOPE‐based interventions had a significant effect on reducing depressive symptoms in the older adults.The intervention group characterized by mean age of older adults, intervention duration, gender ratio, health condition and integration types may influence the effect size. Reporting Method: According to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims: To identify and synthesise evidence related to ageism in older regulated nurses' practice settings. Design: A systematic review following Joanna Briggs Institute methodology. Methods: The review included empirical studies that involved older nurses as the primary study population and studies that focused on ageism in older nurses' work environments, including strategies or interventions to address ageism within the workplace. Following the initial screening, all relevant studies were critically appraised by two reviewers to ensure they were appropriate to include in the review. A synthesis without meta‐analysis reporting (SWiM) guideline was employed in the review. Data Sources: Medical Literature Analysis and Retrieval Systems Online, Scopus, Psychological Information Database and Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched to identify empirical studies and a range of academic institutional websites were accessed for master's and doctoral dissertations and theses. The search covered the period from January 2022 to May 2022, and only publications in English from 2000 onwards were considered. Results: Nineteen studies were included, ten qualitative studies, seven quantitative studies and two mixed methods secondary analyses. Our results revealed that negative perceptions and beliefs about older nurses' competencies and skills prevail in their practice settings, which influences older nurses' health and well‐being as well as their continuation of practice. Further, older nurses' continuation of practice can be facilitated by having a positive personal outlook on ageing, meaningful relationships in their practice settings and working in an environment that is age‐inclusive. Conclusion: To combat ageism in older nurses' practice settings and support their continuation of practice, effective interventions should be organisational‐led. The interventions should focus on fostering meaningful relationships between older nurses and their colleagues and managers. Further, healthcare institutions should implement initiatives to promote an age‐inclusive work environment that supports an age‐diverse nursing workforce. Implications for the profession and/or patient care: The review findings offer insights for healthcare managers, policymakers and researchers, emphasising the need for anti‐ageism policies in healthcare organisations. According to WHO (2021), educational activities such as role‐playing and simulation during in‐service training may also be effective interventions. Additionally, incorporating anti‐ageism initiatives into staff meetings and mandating anti‐ageism training could support the continuation of practice for older nurses while fostering a more age‐diverse nursing workforce. Impact: We found evidence on the presence of ageism in older nurses' workplace and the detrimental effects of ageism on older nurses' well‐being and continuation of practice. Importantly, we identified a lack of organisational initiatives to address ageism and support older nurses. These findings should encourage healthcare organisations to address ageism in older nurses' practice settings and prompt policymakers to develop age‐inclusive policies that support older nurses' continuation of practice. Reporting method: The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and Synthesis Without Meta‐analysis checklists were used to report the screening process. Trial and Protocol Registration: The PROSPERO registration number for the review was CRD42022320214 (https://www.crd.york.ac.uk/prospero/display%5frecord.php?ID=CRD42022320214). No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims: To examine how perceived balance problems are associated with self‐reported falls in the past month after controlling for known correlates of falls among older adults. Background: Approximately 30% of adults age 65 and older fall each year. Most accidental falls are preventable, and older adults' engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term 'fall risk' to describe their risk for falls. Instead, they commonly use the term 'balance problems'. Yet, commonly used fall risk assessment tools in both primary and acute care do not assess older adults' perceived balance. Design and Method: The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A retrospective, cross‐sectional secondary analysis using data from the National Health and Aging Trends Study from year 2015 was conducted. The outcome variable was self‐reported falls in the last month. Results: A subsample of independently living participants (N = 7499) was selected, and 10.3% of the sample reported a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month was 3.4 times (p <.001) greater for participants who self‐reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self‐rated health status, depression and anxiety scores were also associated with falling. Conclusion and Implications: Older adults' perceived balance problem is strongly associated with their fall risk. Perceived balance may be important to discuss with older adults to increase identification of fall risk. Older adults' perceived balance should be included in nursing fall risk assessments and fall prevention interventions. A focus on balance may increase older adults' engagement in fall prevention. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate whether a low Braden Skin Score (BSS), reflecting an increased risk of pressure injury, could predict the risk of delirium in older patients in the intensive care unit (ICU). Background: Delirium, a common acute encephalopathy syndrome in older ICU patients, is associated with prolonged hospital stay, long‐term cognitive impairment and increased mortality. However, few studies have explored the relationship between BSS and delirium. Design: Multicenter cohort study. Methods: The study included 24,123 older adults from the Medical Information Mart for Intensive Care IV (MIMIC‐IV) database and 1090 older adults from the eICU Collaborative Research Database (eICU‐CRD), all of whom had a record of BSS on admission to the ICU. We used structured query language to extract relevant data from the electronic health records. Delirium, the primary outcome, was primarily diagnosed by the Confusion Assessment Method for the ICU or the Intensive Care Delirium Screening Checklist. Logistic regression models were used to validate the association between BSS and outcome. A STROBE checklist was the reporting guide for this study. Results: The median age within the MIMIC‐IV and eICU‐CRD databases was approximately 77 and 75 years, respectively, with 11,195 (46.4%) and 524 (48.1%) being female. The median BSS at enrollment in both databases was 15 (interquartile range: 13, 17). Multivariate logistic regression showed a negative association between BSS on ICU admission and the prevalence of delirium. Similar patterns were found in the eICU‐CRD database. Conclusions: This study found a significant negative relationship between ICU admission BSS and the prevalence of delirium in older patients. Relevance to Clinical Practice: The BSS, which is simple and accessible, may reflect the health and frailty of older patients. It is recommended that BSS assessment be included as an essential component of delirium management strategies for older patients in the ICU. No Patient or Public Contribution: This is a retrospective cohort study, and no patients or the public were involved in the design and conduct of the study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To compare the effectiveness of non‐pharmacological interventions in enhancing sleep quality in older people. Background: Sleep problems in older adults have become increasingly prominent. Sleep problems not only affect the health and quality of life of older people, but also the range of chronic diseases caused by sleep problems also impose a huge burden on social services and health care. Non‐pharmacological interventions are an effective alternative to pharmacological therapies, but it is unclear which non‐pharmacological therapies are most effective in enhancing sleep quality in older adults. Design: A systematic review and network meta‐analysis based on PRISMA‐NMA. Methods: A total of seven databases were searched from the establishment of the database to March 2023. After literature screening and data extraction, the Cochrane Bias assessment tool 2.0 version of randomised controlled trials (RCTs) was used to evaluate literature quality. A network meta‐analysis was performed to evaluate the relative efficacy of the non‐pharmacological interventions on sleep quality. Results: A total of 71 RCTs involving nine non‐pharmacological interventions were included. The results of the network meta‐analysis showed that the joint intervention may be the most effective non‐pharmacological intervention to enhance sleep quality in older adults. Conclusion: This study confirms that non‐pharmacological interventions can improve sleep quality in older adults. The use of non‐pharmacological interventions can be promoted by healthcare professionals in the future to improve the quality of sleep and thus the physical and mental health of older people. Relevance to Clinical Practice: This evidence suggests that joint interventions may be most effective. Therefore, in the future, a combination of non‐pharmacological interventions could be used to maximise their effectiveness in improving sleep quality in older people and promoting healthy aging. No Patient or Public Contribution: No patient or public contribution is not applicable to this study. [ABSTRACT FROM AUTHOR]

Background: Few reviews have addressed delirium prevention among intermediate to high‐risk older surgical patients. Aims: To map preoperative delirium prevention interventions for older surgical patients at intermediate to high risk of developing delirium, assess outcomes and identify gaps in knowledge. Design: Systematic narrative review of randomised controlled trials reported following the PRISMA checklist. Methods: A systematic search was conducted of the literature published from 1990 to October 2022 in Medline, CINAHL and Ageline and of the grey literature in Google Scholar. Randomised controlled trials were retrieved that assessed the effectiveness of preoperative delirium prevention interventions for older surgical patients at intermediate to high risk of delirium. Data were extracted using a data extraction tool, and results were tabulated. Studies were assessed for bias using the Cochrane Collaboration Risk of Bias tool. Results: Twenty‐one studies met the selection criteria including N = 5096 participants. Two studies tested cognitive training, two studies tested fascia iliaca compartment block and one study assessed femoral nerve block. Ten studies tested prophylactic medications including methylprednisolone. Five studies investigated geriatric assessment and management. One study assessed transcutaneous electrical acupoint stimulation. In the two studies testing fascia iliaca compartment block, there was a reduction in postoperative delirium for orthopaedic patients. Methylprednisolone reduced postoperative delirium in orthopaedic patients and in those undergoing gastrointestinal surgery. Results of all other interventions on the occurrence of postoperative delirium and additional outcomes including the severity and duration of delirium were inconclusive. Conclusions: Despite the promising results for fascia iliaca compartment block and methylprednisolone, there is limited knowledge regarding evidence‐based delirium prevention interventions. Most studies had small sample sizes indicating that the current evidence is exploratory. There is an urgent need for the funding and conduct of trials to test preventative interventions for older surgical patients at intermediate to high risk of developing delirium. [ABSTRACT FROM AUTHOR]

Background: The Nursing Care Continuity Report (NCCR) is a tool for evaluating the quality of nursing care during hospital admission. Aim: To explore the role of the NCCR in predicting longer length of stay (LOS) in older adults (≥65 years) admitted to a tertiary hospital and determine possible clinical differences at discharge between patients who had a short LOS (≤7 days) and a prolonged LOS (>7 days). Research Design and Setting: A retrospective cohort study was conducted including all patients with a completed NCCR admitted to the hospital between 2015 and 2019. Sociodemographic data, risk of pressure injuries, level of dependence, presence and intensity of pain, and presence and type of pressure injury were the variables registered in the NCCR. Results: A total of 41,354 patients were included in this study, with a mean age of 78 years, of whom 47% were female. At admission, 21% of patients were at potential risk of developing pressure ulcers. Age, admission to the internal or respiratory medicine unit, and having at least medium risk of developing pressure ulcers were the predictors of prolonged LOS using a random sample of 950 patients. At discharge, patients with prolonged LOS presented higher risk of pressure ulcers and a higher level of dependency and were more likely to present hospital‐acquired pressure ulcers. Conclusions: Older adults from the internal or respiratory medicine unit who exhibited higher risk of pressure ulcers were related to a prolonged LOS, a higher level of dependency, and hospital‐acquired ulcers at hospital discharge. Relevance to Clinical Practice: Identifying clinical data that have a greater relationship with LOS could be a useful tool for nursing management and for the implementation of strategies to prevent adverse events during hospitalisation. No Patient or Public Contribution: No direct patient contact was made during the data collection. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to (i) compare the prevalence of multidimensional frailty in middle‐aged and older people with stroke and to (ii) explore the relationship between multidimensional frailty and quality of life (QoL) in this patient population. Background: In recent years, stroke patients have become increasingly younger. As an important risk factor for stroke patients, frailty has gradually drawn research attention because of its multidimensional nature. Design: This study used a cross‐sectional design. Methods: The study included 234 stroke patients aged 45 and older. Multidimensional frailty was defined as a holistic condition in which a person experiences losses in one or more domains of human functioning (physical, psychological and social) based on the Tilburg Frailty Indicator, and QoL was based on the short version of the Stroke‐Specific Quality of Life Scale. Hierarchical regression was used to analyse the correlation factors of QoL. STROBE checklist guides the reporting of the manuscript. Results: A total of 128 (54.7%) participants had multidimensional frailty, 48 (44.5%) were middle aged and 80 (63.5%) were older adults. The overall QoL mean score of the participants was 47.86 ± 9.04. Multidimensional frailty was negatively correlated with QoL. Hierarchical regression analysis showed that multidimensional frailty could independently explain 14.6% of the variation in QoL in stroke patients. Conclusions: Multidimensional frailty was prevalent in middle‐aged and older people with stroke, and it was a significant factor associated with QoL in stroke patients. Relevance to Clinical Practice: This study emphasises the importance of the early identification of multidimensional frailty. And targeted interventions should be studied to prevent the occurrence of multidimensional frailty and thereby improve the QoL of patients. Patient or Public Contribution/s: There are no patient or public contributions to this study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To synthesise and appraise the evidence of the efficacy of serious games in reducing chronic pain among older adults. Background: Chronic pain in older adults generally results in a substantial handicap due to decreased mobility, exercise avoidance and various concerns that affect their overall quality of life. While serious games have been widely used as a pain management approach, no reviews have thoroughly examined their efficacy for chronic pain management in older adult populations. Design: A systematic review and meta‐analysis. Methods: The CINAHL, the Cochrane Library, Embase, Medline, PubMed and Web of Science databases were comprehensively searched to find articles published from their inception until 17 April 2023. RoB‐2 was used to assess the risk of bias in the included studies. The efficacy of serious games for pain management in older individuals was investigated using pooled standardised mean differences (SMDs) in pain reduction using a random effect model. Results: The meta‐analysis comprised nine randomised controlled trials that included 350 older adult patients with pain. Serious games effectively alleviated pain in this group (pooled SMD = −0.62; 95% confidence interval: −1.15 to −0.10), although pain‐related disability and fear require further investigation. Conclusions: Serious games tended to effectively reduce pain in this older adult group; however, due to a lack of randomised controlled trials, the analysis found lower effectiveness in reducing pain‐related disability and fear. Further studies are accordingly required to confirm these findings. Relevance to Clinical Practice: The findings of the study emphasise the importance of serious games to increase the motivation of older adults to exercise as one of the safe and extensively used pain management strategies. Serious games that effectively reduce chronic pain in older adults are characterised as consisting of diverse physical activities delivered through consoles, computer‐based activities and other technologies. Patient or Public Contributions: Serious games are recommended as being potentially useful and practical for reducing pain in older adults. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of older adults (65+) living with acquired brain injury regarding their sense of well‐being during physical rehabilitation within the Greek Healthcare System. Background: With the increasing ageing population and the life‐changing effects of acquired brain injury, there is a need to focus on care for older people and their potential to live well. Rehabilitation systems deserve greater attention, especially in improving the well‐being of those who are using them. Design: A qualitative study design with a hermeneutic phenomenological approach was used. Methods: Fourteen older adults living with acquired brain injury and undergoing physical rehabilitation in Greece were purposively sampled. Semi‐structured interviews were conducted to collect data and were thematically analysed using van Manen's and Clarke and Braun's methods. The COREQ checklist was followed. Results: Four themes emerged from the analysis: (1) Challenges of new life situation, (2) Seeking emotional and practical support through social interaction, (3) Identifying contextual processes of rehabilitation, (4) Realising the new self. Conclusions: The subjective experiences, intersubjective relations and contextual conditions influence the sense of well‐being among older adults living with acquired brain injury, thus impacting the realisation of their new self. The study makes the notion of well‐being a more tangible concept by relating it to the degree of adaptation to the new situation and the potential for older adults to create a future whilst living with acquired brain injury. Relevance for Clinical Practice: Identifying the factors that impact older adults' sense of well‐being during rehabilitation can guide healthcare professionals in enhancing the quality of care offered and providing more dignified and humanising care. Patient or Public Contribution: Older adults living with acquired brain injury were involved in the study as participants providing the research data. [ABSTRACT FROM AUTHOR]

Background: There is mounting evidence for the health benefits of aromatic scents for the older people with dementia. However, existing research has focused on indoor aromatherapy using essential oils. It is necessary to explore the health benefits of smellscapes in the outdoor environment for older people with dementia. Aims and Objectives: This scoping review aims to examine existing evidence for smellscape as a healing factor in institutional garden for older people with dementia, try to bridge the knowledge gaps between outdoor sensory garden scents and aromatherapy to develop green care techniques that incorporate outdoor activities. Methods: Seven databases (Scopus, PubMed, PsycINFO, CINAHL, MEDLINE, Embase and Web of Science) were searched with English language articles published between 1990 and 2022. The PRISMA‐ScR Checklist was used. Results: Out of 1013 articles, 11 meet the inclusion criteria. The comprehensive health outcomes include five aspects: mental health; physical health; reduced agitation behaviour; improved cognitive function; and well‐being. These aspects are part of the rehabilitation model comprising the person (older people with dementia), environment (garden smellscapes) and outdoor activities (active or passive interventions or a combination). Conclusions: The smellscape, as a healing factor in the garden, not only benefits from evidence on indoor aromatherapy but also creates a sensory environment for older people with dementia by compensating for functional impairment, activity support and environmental creation, thereby promoting enhanced health and well‐being. Relevance to Clinical Practice: The research on the healing effects of smellscapes presented in this review offers a novel environmental intervention technique for transferring evidence on essential oils to outdoor sensory gardens. This green care technique is suggested to assist in the creation of healing environments and interventions for people with dementia who cannot be cured. No Patient or Public Contribution: This scoping review did not directly involve patient or public contributions to the manuscript. [ABSTRACT FROM AUTHOR]

Aims: To synthesise and describe the combined evidence from systematic reviews of interventions using elements from the Transitional Care Model, on the content and timeframe of the interventions and the related improvement of outcomes for older patients with multiple chronic conditions. Background: The population of older patients with multiple chronic conditions is increasing worldwide and trajectories are often complicated by risk factors. The Transitional Care Model may contain elements to support transitions between hospital and home. Design: An umbrella review. Review Methods: A comprehensive search in five electronic databases was performed in April 2021 based on the search terms: 'Patients ≥60 years,' 'multi‐morbidity,' 'Transitional care model,' 'Transitional care,' and 'Systematic review.' PRISMA guidelines was used. Results: Five systematic reviews published from 2011 to 2020 comprising 62 intervention studies (59 randomised controlled trials and three quasi‐experimental trials) were included in the review. The synthesis predominantly revealed significant improvements in decreasing re‐admissions and financial costs and increasing patients' quality of life and satisfaction during discharge. Conclusion: The results of the review indicate that multiple elements from the Transitional Care Model have achieved significant improvements in older patients' transitions from hospital to home. Especially a combination of coordination, communication, collaboration and continuity of care in transitions, organised information and education for patients and pre‐arranged structured post‐discharge follow‐ups. Impact: The transition from hospital to home is a complex process for older patients with multiple chronic conditions. A specific focus on coordination, continuity, and patient education should be implemented in the discharge process. Nurses with specialised knowledge in transitional care are needed to ensure safe transitions. Patient and Public Contribution: The umbrella review is part of a larger research program which involved a patient expert advisory board, which participated in discussing the relevance of the elements within the umbrella review. [ABSTRACT FROM AUTHOR]

Aim(s): The aim of this research study is to collaboratively generate insights in the current institutional long‐term care environment for activity and mobility of older adults, and of solutions that could be used to increase the activity and improve the mobility of the older adults. Design: This research constitutes a qualitative study with a critical approach. Methods: Data were collected using photo‐elicitation in four long‐term care units in Finland during the spring of 2022. Older adults participated in individual data collection sessions which combined photographing and discussion. Staff members individually took photographs and later participated in a group discussion based on the photographs. Reflexive thematic analysis was used to analyse all data together. Results: Ten older adults and 12 staff members participated in the research study. Four themes were identified: (1) facilities should be designed and equipped for their users, (2) moving in the institutional environment, (3) passivity as a norm, and (4) nurses should act differently and have the resources to do so. Conclusion: To increase the activity and improve the mobility of older adults, improvements are needed in terms of the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources. Implications for the profession and/or patient care: Increased attention to the support of activity and mobility could benefit older adults in institutional long‐term care. Physical activity promotion should be incorporated as an integral part of nursing practice. Patient or public contribution: Directors of units were consulted when planning the study. Older adults and nurses contributed to the data collection and interpretation of data. Impact: (Addressing) What problem did the study address? ○Older adults have recurrently been reported as living inactive lives in institutional long‐term care.○There is evidence of the relationship between the environment and the activity and mobility of older adults, but there seems to be a research‐practice gap in terms of implementing activity‐ and mobility‐promoting environments.○Older adults and staff members are important in developing practice and change‐oriented knowledge that can be used to increase the activity and improve the mobility of older adults in institutional long‐term care.What were the main findings? ○Various environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long‐term care settings.○Improvements for the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources for activity support would benefit older adults' activity and mobility.Where and on whom will the research have an impact? ○Increasing the activity of older adults requires better activity promotion and mobility support by nurses in institutional care. Sufficient education and resources should be organized for activity promotion, in addition to a care and organizational culture that values activity.○Environmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities.○Policymakers and care organizers should consider evidence of the harms and benefits of different institutional living environments when making decisions on organizing care. Reporting Method: The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ). [ABSTRACT FROM AUTHOR]

Aim: To explore and gain a broader understanding of residents' viewpoints and experiences of spiritual care when living in a nursing home. Design: A qualitative hermeneutical interview study inspired by Gadamer's philosophical hermeneutics. Methods: Thirty‐eight individual interviews of 14 male and 24 female residents; of these, 24 had a dementia diagnosis. The setting was one large Norwegian nursing home providing long‐term care. FACIT‐Sp‐12 was used as a guide for the interview, in addition to two open‐ended questions about thriving and spiritual care. Findings: The older residents' voices portray a broad and diverse understanding of spiritual care, and four themes emerged: (1) Spiritual at‐homeness, (2) Spiritual awareness, (3) Philosophy of life and (4) Interconnectedness. Conclusion: Accepting one's life situation in a nursing home can foster a feeling of belonging, leading to feeling more at‐home. Spiritual well‐being, including finding purpose, spiritual awareness and beliefs, was found to be interconnected with spiritual at‐homeness in the nursing home. Implications for the Profession and/or Patient Care: This study provides insights into older nursing home residents' viewpoints on spiritual care, including persons living with dementia. Impact: The study addressed the limited evidence regarding how older residents themselves experience and express spiritual care. Listening to older nursing home residents' voices provides a unique contribution to the research field. As several individuals with dementia contributed to the findings, this study mirrors the current population of residents in nursing homes. The findings may inform healthcare provision and policymakers and impact upon spiritual care in the field of older people nursing and dementia care services. Reporting Method: The COREQ guideline. Patient or Public Contribution: Participation through interviews of nursing home residents. [ABSTRACT FROM AUTHOR]

Objective: This study examined levels of self‐reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana. Background: Dignified care has been recognised as inseparable from quality nursing care and maintaining patients' dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self‐reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa. Setting: A large teaching hospital in the northern region of Ghana. Participants: Hospitalised older adults. Methods: A cross‐sectional survey was used to gather data from a convenience sample of 270 older inpatients, using the Hospitalized Older Adults' Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist. Results: More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations. Conclusion: Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times. Relevance to clinical practice: The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender‐sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients' dignity during all hospital admissions. Patient or public contribution: Survey questionnaires were completed by hospitalised older adults at the study setting. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the epidemiological characteristics of pressure injury (PI) in older inpatients and predictive validity of the Braden scale. Design: Cross‐sectional study. Methods: Conducted in a 2600‐bed tertiary hospital in Northwestern China from January to June 2022, the study included older patients (≥60 years). The Braden scale was used for the risk assessment of PI, and the epidemiological characteristics of PI were observed. The contributing factors of PI in older inpatients were examined using univariate and multiple or multivariable logistic regression analysis. The predictive validity and optimal cut‐off value were assessed using receiver operating curve (ROC). Results: The study included 13,064 older patients, with a PI incidence of 0.20%, with the highest incidence (0.95%) in those aged ≥80. Age, BMI, Braden score and length of hospital stay were related to PI occurrence. The Braden scale showed an AUC of 0.905 for predicting PI in older inpatients, with a sensitivity of 84.6% and specificity of 86.4%. The optimal cut‐off value of 19 yielded the best predictive performance with a Yoden index of 0.710. Conclusion: PI is most likely to occur in older inpatients with older age, longer hospital stay, lower BMI and Braden score. The Braden scale demonstrated good suitability for predicting PI risk in this population, with an optimal cut‐off value of 19 showing improved predictive accuracy. Patient or Public Contribution: Throughout the investigation, patients or family members cooperated to complete all data investigation and evaluation, and nurses assisted in PI risk assessment, skin evaluation and other work. [ABSTRACT FROM AUTHOR]

Aim: To propose educational strategies to prevent delirium in older adults. Design: Integrative review. Methods: This review followed the methodology of Whittemore and Knafl (J Adv Nurs 52(5):546–553, 2005. 10.1111/j.1365‐2648.2005.03621.x). Data Sources: A literature search was performed of the PubMed, CINAHL, Embase, Cochrane Library CENTRAL, and Scopus databases on 8 July 2022. Results: Three themes of educational interventions were identified: capacity building, resource provision and enhancement of relationships, collectively termed Fa‐CARE. Educational interventions improved family caregivers' knowledge about delirium, their anxiety; depression; self‐efficacy; and attitudes. Among older adults, these interventions improved the duration, severity and incidence of delirium; functional abilities; and length of hospital stay. Conclusion: Providing education to family caregivers benefits both those caregivers and the older adults. When planning educational intervention, diverse and innovative approaches need to be considered. Implications for the profession and/or patient care: This study can guide family education regarding the care of older adults with delirium. Impact: Educational interventions positively impacted both family caregivers and older adults with delirium.Educational interventions provide family caregivers with resources, improve their capacity for delirium management, and enhance their relationships with older adults.This study suggests future directions in education for family caregivers of older adults with delirium. Reporting method: This review adhered to the EQUATOR guidelines by using the PRISMA 2020 checklist. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To conduct an in‐depth exploration of oral hydration care provided to people living with dementia in acute hospital wards, using a person‐centred care framework. Background: Oral hydration care is an important, yet rarely explored aspect of fundamental care for people with dementia admitted to acute hospitals. Using person‐centred care as a conceptual framework we investigated how oral hydration care is delivered for people living with dementia in acute hospital wards. Design: A qualitative, multiple‐case study. The cases were three acute wards in one hospital. Methods: Direct observation of care for 13 people with dementia (132 h), semistructured interviews with ward staff (n = 28), ward leaders (n = 4), organisational leaders (n = 5), people with dementia (n = 6), their relatives (n = 5), documentary analysis of clinical inpatient records (n = 26) and relevant hospital policies. Data were analysed using framework analysis. Results: Four themes were identified: (1) The acute hospital: oral hydration is obscured and not prioritised (2) Overshadowing of oral hydration at ward level (3) Siloed nature of hydration roles (4) Strategies for, and barriers to, delivering person‐centred oral hydration care. Conclusions: This study combines the concept of person‐centred care and oral hydration care for people living with dementia admitted to acute hospital wards, demonstrating that person‐centred hydration care was complex and not prioritised. Relevance to Clinical Practice: Nurses should consider means of improving prioritisation and cohesive delivery of person‐centred hydration care in acute hospital wards. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To map and synthesise the literature on loneliness at end‐of‐life and identify key knowledge gaps in loneliness research. Background: Declined health conditions, reduced social engagement, loss of social roles, and fear of death may lead to loneliness at end‐of‐life. However, systematic information about loneliness at end‐of‐life is scant. Methods: This scoping review followed the methodology proposed by Arksey and O'Malley. Nine electronic databases were searched from January 2001 to July 2022. Studies about loneliness at end‐of‐life were included. Two review authors independently screened and selected relevant studies and performed the data charting. The PAGER framework was employed to collate, summarise and report the results. The PRISMA‐ScR checklist was included. Results: A total of 23 studies were included in this review (12 qualitative, 10 quantitative, and one mixed‐methods design). There was not reliable data about the prevalence of loneliness among adults at end‐of‐life internationally. Three or 20‐item UCLA loneliness scale was frequently used to measure loneliness. Factors predisposed adults at end‐of‐life to loneliness included passive and active withdrawal from social networks, inability to share emotions and to be understood, and inadequate support on spirituality. Four strategies were identified to alleviate loneliness, yet none have been substantiated in clinical trials. Interventions facilitating spirituality, social interactions and connectedness seem effective in alleviating loneliness. Conclusions: This is the first scoping review on loneliness at end‐of‐life, synthesising evidence from qualitative, quantitative, and mixed‐methods studies. Loneliness among adults at end‐of‐life is under‐investigated and there is a prominent need to address existential loneliness at end‐of‐life. Relevance to clinical practice: All nurses should proactively assess loneliness or perceived social isolation for clients with life‐limiting conditions, regardless of social networks. Collaborative efforts (e.g., medical‐social collaborations) to promote self‐worthiness, social engagement and connectedness with significant others and social networks are needed. Patient or Public Contribution: No patient or public involvement. [ABSTRACT FROM AUTHOR]

Background: Older adults frequently suffer from postprandial hypotension, associated with an increased risk of falls, syncope, acute cardiovascular and cerebrovascular diseases, and even death. Researchers use non‐pharmacological interventions, but related literature is dispersed and lacks a latest summary. Objective: The aim of this study was to map and examine non‐pharmacological interventions currently employed to assist older adults with postprandial hypotension and lay a solid foundation for future studies. Methods: This study adhered to the JBI methodology for scoping reviews and preferred reporting items for systematic reviews and meta‐analyses extension for scoping reviews. PubMed, Web of Science, Embase, Cochrane Library, CINAHL, SCOPUS, Chinese Biomedical Journal, China National Knowledge Infrastructure, VIP and WAN FANG Data were retrieved from their inception to 1 August 2022. Results: Two randomized controlled trials and seven quasi‐experimental studies were included. Small meals, exercise interventions, fibre with meals, green tea and water therapy have been reported to prevent postprandial hypotension effectively; however, position changes have been reported to have no impact on postprandial blood pressure decrease. Additionally, the blood pressure determination methods and test meals may affect observed trial effects. Conclusion: Large samples and long‐term follow‐up studies are needed to prove the efficacy and safety of existing non‐pharmacological interventions. Future studies should develop a BP determination method based on the postprandial BP decline trajectory induced by a given test meal to improve the reliability of study results. Relevance to Clinical Practice: This review broadly summarizes existing studies on developing and validating non‐pharmacological interventions for older adults with postprandial hypotension. It also analyses special factors that may influence the trial effects. This may provide a useful reference for future research. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned readmission experiences within 30 days of discharge home and identify factors influencing these psychosocial processes. Design: Mixed methods systematic review. Data Sources: Six electronic databases (Ovid MEDLINE (R) All 1946‐present, Scopus, CINAHL, Embase, PsychINFO and Web of Science). Review Methods: Peer‐reviewed articles published between 2010 and 2021 and addressed study aims (n = 6116) were screened. Studies were categorised by method: qualitative and quantitative. Qualitative data synthesis used a meta‐synthesis approach and applied thematic analysis. Quantitative data synthesis used vote counting. Data (qualitative and quantitative) were integrated through aggregation and configuration. Results: Ten articles (n = 5 qualitative; n = 5 quantitative) were included. 'Safeguarding survival' described older persons' unplanned readmission experience. Older persons experienced three psychosocial processes: identifying missing pieces of care, reaching for lifelines and feeling unsafe. Factors influencing these psychosocial processes included chronic conditions and discharge diagnosis, increased assistance with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences. Conclusions: Older persons felt more unsafe as their symptoms increased in intensity and unmanageability. Unplanned readmission was an action older persons required to safeguard their recovery and survival. Relevance to Clinical Practice: Nurses play a critical role in assessing and addressing factors that influence older persons' unplanned readmission. Identifying older persons' knowledge about chronic conditions, discharge planning, support (caregivers and community services), changes in functional needs, intensity of symptoms and past readmission experiences may prepare older persons to cope with their return home. Focusing on their health‐care needs across the continuum of care (community, home and hospital) will mitigate the risks for unplanned readmission within 30 days of discharge. Reporting Method: PRISMA guidelines. Patient or Public Contribution: No patient or public contribution due to design. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To (1) describe the socio‐demographic and behavioural characteristics of older adults who use wearable devices for physical activity monitoring and (2) explore whether wearable device use increases the possibilities of meeting physical activity guideline recommendations among older adults and older adults with known cardiovascular disease or risk. Background: Finding ways to increase physical activity and reduce cardiovascular disease risk among older adults is a public health priority. Wearable technology has great potential for promoting physical activity among older adults. Design: A secondary analysis of the national data. Methods: A nationally representative sample of older adults aged 65 years and older (mean age = 73.79 years, N = 1484) and a subsample of older adults with known cardiovascular disease or cardiovascular disease risk (mean = 74.32 years, N = 1098) was used in the analysis. All analyses were weighted to account for the complex survey design. This study was reported according to the STROBE checklist. Results: The overall prevalence of wearable device use among older adults and older adults with cardiovascular disease risk was 16% and 14%, respectively. Older adults with higher household incomes, better self‐rated health, and greater exercise enjoyment were more likely to use wearable devices. Compared with non‐users, older adult users were more likely to meet the recommended levels of moderate (55% vs. 31%) and strengthening activity guidelines (46% vs. 25%), but not of the sedentary behaviour guideline (69% vs. 62%). Similar findings were also seen in older adults with known cardiovascular disease or risk. Conclusion: The uptake of wearable devices in older adults, particularly those with known cardiovascular disease or risk is still low. The use of wearable devices is an important facilitator of physical activity. It is critical to provide individualised support for their engagement. Relevance to Clinical Practice: Age‐friendly design and individualised support are recommended to increase older adults' adoption of wearable devices to improve their physical health. Patient or Public Contribution: No patient or public contribution was involved in this study since we used publicly available data. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio‐ecological model. Background: PA has been linked to poor long‐term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors. Design: Cohort study. Methods: We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group‐based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow‐up. A STROBE checklist was used to guide the reporting of this study. Results: Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow‐up. Conclusions: This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD. Relevance to Clinical Practice: It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA. No Patient or Public Contribution: A national cohort study was used and no patients or the public were involved in the design and implementation of this study. [ABSTRACT FROM AUTHOR]

Aims: To assess the incidence density of local complications of peripheral venous catheters in patients aged 70 years and older, to identify risk factors for local complications of peripheral venous catheters, to describe microbiological epidemiology and to assess the impact of complications on patient outcomes. Design: Prospective, observational, single‐centre study. Methods: Patients 70 years and older admitted to the geriatric department of a teaching hospital in France between December 2019 and May 2020 were considered for inclusion if they had a peripheral venous catheter during their stay. Nurses checked the catheter insertion site three times a day for local complications; physicians ensured the follow‐up of complications. The STROBE checklist was used in this prospective observational study. Results: A total of 322 patients were included, with 849 peripheral venous catheters; the median age was 88 years and 182 (56.5%) were women. The incidence density of local complications was 50.5/1000 peripheral venous catheter‐days. Risk factors for local complications on multivariate analysis were dressing replacement (OR 1.18), furosemide (OR 1.11) and vancomycin (OR 1.60) infusion, urinary continence (OR 1.09) and hematoma at the catheter insertion site (OR 1.15). Thirteen cellulitis and three abscesses were diagnosed. Occurrence of a local complication was associated with a 3‐day increased duration of hospital stay (17 vs. 14 days). Conclusion: Risk factors for peripheral venous catheter local complications include urinary continence, furosemide or vancomycin infusion, hematoma at the peripheral venous catheter insertion site or dressing replacement. Implication for the Patient Care: Closer clinical monitoring may help reduce the occurrence of local peripheral venous catheters complication in patients 70 years and older. Relevance to Clinical Practice: Patients at greater risk of peripheral venous catheter local complications deserve closer clinical monitoring or improved preventive measures, which may be beneficial to reduce the length of hospital stay. No Patient or Public Contribution: The study was designed to describe risk factors for local complications of peripheral venous catheters in order to reinforce surveillance in this specific population by nurses and medical staffs. Patients had their peripheral venous catheter insertion site checked thrice a day by the nurse in charge as part of usual care. They, as service users, caregivers or members of the public, were not solicited for data collection, analysis, interpretation or preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Background: Changed behaviours in residential aged care facilities (RACF) are frequently reported in the literature. How RACF staff routinely respond to these observed changed behaviours represents a significant gap. Objective: To analyse the frequency of changed behaviour reported within RACF behavioural report logs and to ascertain how staff typically manage these behaviours. Methods: Residents (N = 25) with varying levels of cognitive function were recruited from a 160 bed RACF in Queensland, Australia. A retrospective analysis of behavioural report logs was conducted to elucidate prevalence of reported changed behaviours as categorised by RACF staff. Thematic analysis of staff recorded behavioural mitigation strategies was used to categorise staff actions. A case analysis was also conducted to highlight the challenges faced by RACF staff managing persistent acute changed behaviours using identified common mitigation strategies. The STROBE guidelines were followed for reporting. Results: There were 395 behaviours recorded in a two‐month period. Physical agitation, interfering while wandering, trying to get to inappropriate places, verbal refusal of care, physical aggression, and verbal disruption were most frequently reported by staff. Management strategies included redirection, PRN psychotropic medication, reassurance, routine care practices, offering of beverages, repositioning, and rarely analgesia. A 24‐h case analysis highlighted how staff utilised redirection and multiple doses of a PRN benzodiazepine with limited effectiveness. Conclusion: This study reveals current mitigation strategies employed by RACF staff in response to acute changed behaviours often associated with dementia. Agitation and wandering are prevalent and are difficult for staff to manage effectively. Relevance to clinical practice: This study highlights that careful consideration should be taken to avoid overuse of PRN benzodiazepines in management of changed behaviours. Short‐term mitigation strategies, such as redirection, may not be effective if underlying causes such as pain, physiological, mental, emotional, or social needs are not met. Patient and public contribution: A RACF participated in project design and review. [ABSTRACT FROM AUTHOR]

Aims and objectives: To reduce the likelihood of preventable readmissions, the aim was to investigate how older people (with their family members) managed their chronic health conditions at home following hospital discharge. The objectives explored older people and their family members' perspectives on how discharge plans assisted self‐management of their chronic conditions, their recognition of deterioration and when to seek treatment/re‐attend hospital. Background: Chronic conditions have challenged older adults' self‐management, particularly after hospital discharge and can impact on preventable readmission. Few studies have examined patients' and their family members' perspectives on the management of their conditions at home after hospitalisation. Design: A qualitative exploratory design known as Interpretive Description was utilised. Methods: Purposeful sampling involved 27 community‐dwelling older adults; nineteen were discharged patients with one or more chronic health conditions. Eight nominated family members were also recruited to enhance understanding of the older persons' self‐management at home. Interviews were undertaken and thematic data analysis followed the COREQ guidelines. Results: Five themes emerged: (1) Post‐Discharge Advice; (2) Managing at Home; (3) Recognition and Response to Deterioration; (4) Community Care and Support; and (5) The "Burden" on Others of Post‐Discharge Care. Conclusion: Older people sought a clear plan for self‐management at home prior to discharge. This plan should contain potential signs of deterioration and guidance on future action. We found that support given to older people from family and friends was critical to prevent readmission. In addition, their local General Practitioner and Pharmacist played an essential part in the support of their care. For some, social support services were also important. Nurse telephone follow‐up in the week following discharge was mostly absent. However, this strategy would be strongly recommended. Relevance to clinical practice: To mitigate against preventable readmission, we recommend the above strategies to assist the older person at home with self‐management of their chronic conditions. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To enhance knowledge of how older people with heart failure, living at home, manage their illness with the support of their family caregivers and home care nursing services. Background: Heart failure monitoring and self‐care have been important means of reducing the serious impact of heart failure. Drawing on theories of practice as enacted and conceptualising service users and their family caregivers as active, the idea of attunement was used to explore how home care nurses work in supporting them. Design: Ethnographic case study. Method: Data collection involved home visits and interviews (10 home care users, 10 caregivers, five home care team leaders). Data were field‐notes and transcribed interviews. Themes were deductively developed from the findings, informed by the theoretical background, using content analysis. The COREQ checklist was used. Findings Three themes were developed from the data: (1) Practices of attunement in relations, (2) Becoming among difficulties and (3) Off track—difficult to attune around self‐care. Conclusions: The findings reflect the complexity of heart failure monitoring at home, showing how, in addition to self‐care measures, users are supported by an array of informal and formal care. The caregiving situation is shaped by relations among participants and involves making oneself available to the situation. We suggest a stance of attunement for home care nurses, which demands tact and calls for interest, engagement and openness. Relevance to Clinical Practice: Study findings caution against limiting heart failure monitoring to circumscribed tasks, instead calling for a holistic understanding of what may be helpful for users. Home care nurses need time to attune with users living with heart failure and their caregivers to prevent exacerbations and promote well‐being. No Patient or Public Contribution: Although patients were not formally involved in study design ethnography favours their voice. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To evaluate the influence of an ageing simulation intervention on qualified acute care nurses' empathy towards older people. Background: Life expectancy is increasing globally with an increased incidence of older people accessing healthcare services. As such, it is essential for qualified nurses within hospital settings to connect with older people by establishing healthful relationships. Empathy is an essential component of healthful nurse‐patient relationships. Fortunately, empathy can be taught through education. Design: A convergent mixed‐methods design was utilised. Methods: Nurses (N = 95) undertook an 8‐hour ageing simulation intervention. Data were collected from April 2019 to May 2020 across three time points: before the intervention (T0); immediately after (T1) and at three months follow‐up (T2). A mix of convenience (intervention) and purposeful (follow‐up) sampling techniques were utilised. Quantitative data were collected via the Interpersonal Reactivity Index survey (n = 86) and analysed using repeat measures ANOVA to compare mean scores across time points. Qualitative data were collected via debriefing discussions (N = 95) and focus groups (n = 38), and analysed using a systematic thematic analysis method. Data convergence occurred during the interpretation phase. Study reported with the TREND checklist. Results: Primarily, when quantitative and qualitative findings were merged they confirmed each others' empathy outcomes. Quantitative results showed a statistically significant increase in affective and cognitive empathy levels among nurses post‐intervention. Qualitative findings expanded on quantitative results and revealed an increase in nurses' affective, cognitive and behavioural empathy represented in themes 'enhancing my empathy', 'impact of ageing', 'from self to others' and 'person‐centred moments'. Conclusions: This study adds empirical evidence how a mixed‐methods design can be used to evaluate the influence of an ageing simulation intervention on nurses' empathy levels. Relevance to clinical practice: Ageing simulation interventions are a suitable experiential educational approach to improve acute care nurses' affective, cognitive and behavioural empathy towards older people. [ABSTRACT FROM AUTHOR]

Aim and objectives: To identify determinants for using a new screening tool to identify older patients eligible for targeted nurse‐led intervention, as perceived by healthcare professionals implementing the tool, and to examine how these perceptions changed over time. Design: A cross‐sectoral longitudinal qualitative study based on semi‐structured interviews with healthcare professionals in a Danish hospital and two collaborating municipalities. Methods: In three focus groups, seven single interviews and a workshop, we examined the healthcare professionals' perceptions of and attitudes towards the new screening tool before, during and after the implementation. The Theoretical Domains Framework was used to identify the healthcare professionals' perception of barriers and facilitators, followed by content analysis. The results were further discussed using the COM‐B system as an analytic framework. This qualitative study is reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. Results: 'Professional role', 'Goals' and 'Environmental context' were the domains most talked about by the healthcare professionals across the three time points. The content analysis identified four determinants for using the new screening tool:Making time for the project, External motivation and management, Expectations and reality, and Professional identity. The healthcare professionals' perception of the determinants changed during the implementation, influencing their behaviour and, consequently, the implementation's sustainability. Conclusion: Perception of barriers and facilitators to the interventions were time‐ and context‐sensitive. Beliefs and motivational factors changed during the project, which points out the importance of following implementation processes systematically to understand the outcome of an intervention. Relevance for clinical practice Perceptions and attitudes towards a new initiative may change over time, emphasising the importance of following barriers and facilitators during the implementation of an intervention and working with an implementation plan that can be adapted along the way. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the serial mediating effect of executive function and attentional bias in the relationship between frailty and depressive symptoms. Background: Although the role of frailty in predicting depression has been well documented, the underlying mechanisms remain unclear. Design: A cross‐sectional study was conducted with 667 older inpatients aged 60–90 years in the internal medicine wards of a hospital in China. Methods: Attentional bias, frailty and depressive symptoms were assessed using the Attention to Positive and Negative Information Scale, the Physical Frailty Phenotype and the 5‐item Geriatric Depression Scale. Executive function was measured using 3 tests, including digital backward, category Verbal Fluency Test and Trail Making Test. The study followed the STROBE guideline. Results: The latent profile analysis (LPA) identified four patterns of attentional bias, namely "no positive bias & no negative bias" (class 1, 9.3%), "minor positive bias & no negative bias" (class 2, 48.0%), "major positive bias & minor negative bias" (class 3, 25.6%) and "major positive bias & no negative bias" (class 4, 17.1%). Regression analysis found that frailty was associated with depressive symptoms. Frailty was also negatively associated with executive function, which was a protective factor for attentional bias class 1, 2 and 3 with reference to class 4. Attentional bias class 1 and 2 but not class 3 was associated with depressive symptoms with reference to class 4. The joint significance test confirmed executive function and attentional bias as serial mediators linking frailty to depressive symptoms. Discussion: Unlike robust older adults who have the age‐related positivity effect, frail older adults have attentional bias deficits due to executive dysfunction, and consequently experience clinically relevant depressive symptoms. Relevance to clinical practice: Healthcare providers should take executive function training and attentional bias regulation into consideration to reduce the detrimental effects of frailty on emotional well‐being. [ABSTRACT FROM AUTHOR]

Objective: To identify the flow charts and discriminators of the Manchester Triage System that are most likely to identify the onset of delirium in older people. Background: Delirium is an underdiagnosed geriatric syndrome, and up to 80% of all cases of delirium go undetected in emergency departments. Patient triage seeks to manage clinical risk with a view to safely and appropriately managing patient flows. Design: A case–control study was performed according to the STROBE checklist. Setting: The emergency department of a secondary hospital. Participants: Older adults aged ≥65 years and admitted from 1 January to 31 December 2020. Methods: Older patients were identified from the emergency department research database. Cases were defined as patients diagnosed with delirium (n = 128), excluding cases of delirium due to alcohol or substance abuse. Controls were randomised from the remaining patients (n = 128). Results: A total of 29.35% of the subjects admitted to the emergency department were older adults with an incidence of delirium of 0.7%. The flow charts with the highest probability of delirium were 'unwell adult' [OR = 3.04 (95%CI:1.82–5.1)] and 'behaving strangely' [OR = 16.06 (95%CI:3.72–69.29)], and the discriminators were 'rapid onset' [OR = 3.3 (95%CI:1.85–5.88)] and 'new neurological deficit less than 24 h old' [OR = 4.76 (95%%CI:1.01–22.5). The area under the curve for 'unwell adult' in the presence of dementia, previous stroke and fall in the previous 30 days was 0.73 (95%CI: 0.67–0.79), and that for 'behaving strangely' in the presence of diabetes was 0.75 (95%CI: 0.69–0.81). Conclusions: Knowing which flow charts, discriminators and risk factors are most likely to predict delirium allows the identification of the older population at risk for triage screening in emergency departments. Relevance to clinical practice: Risk factors such as diabetes, dementia, previous stroke and recent fall among 'unwell adult' or 'behaving strangely' triaged older persons should be assessed for the probable presence of delirium. [ABSTRACT FROM AUTHOR]

Background: Delirium is defined as a sudden onset of confusion due to disruption in normal brain functioning. Although it is highly prevalent in post‐operative patients, most significantly the older adult population, limited information exists explaining why its onset occurs. Purpose: This integrative review aimed to synthesise specific comorbidities that can contribute to the development of post‐operative delirium in older adult cardiac surgical patients. Methods: PRISMA statement was used to report the identification, selection, appraisal and synthesis of articles and the PRISMA diagram reports the selection process. The Johns Hopkins Evidence‐Based Practice Tools were used as guide in literature review, critical analysis, levelling of evidence and quality rating. PubMed, ProQuest, CINAHL plus, EMBASE, MEDLINE, Ovid Nursing Collection and Cochrane databases were searched from 2015 to 2020. Results: The initial search yielded 1529 articles. Following the removal of duplicates and screening, 14 articles were included for this review. The following comorbidities were identified in the studies: Diabetes mellitus, atrial fibrillation, depression, impaired olfaction, pre‐existing cerebrovascular disease, pre‐existing cardiovascular disease, insomnia and frailty. Conclusion: There was a strong indication of the development of post‐operative delirium among older adult cardiac surgical patients with comorbidities. Relevance to clinical practice: Awareness of the impact of comorbidities in developing post‐operative delirium may help healthcare providers to plan and implement proper care management among older adult cardiac surgical patients with comorbidities. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study investigated the relationship between frailty and diabetes complicated with comorbidities. Background: Frailty is a common geriatric syndrome, and older adults with diabetes are prone to frailty. Patients with diabetes and comorbidities might be at increased risk of developing frailty. Design: A multicenter cross‐sectional study. Methods: A cross‐sectional study was conducted to identify older patients with diabetes and comorbidities in the internal medicine departments of five tertiary general hospitals in Sichuan Province, China, from March 2020 to June 2021. We used the FRAIL scale to identify frailty, and multinomial logistic regression was used to compare sociodemographic characteristics and comorbidities of frail or pre‐frail participants with robust participants. The STROBE checklist was used for this cross‐sectional study. Results: A total of 1652 patients (883 males, 53.5%) were included, and the prevalence of frailty was 26.5%. Multinomial logistic regression analysis revealed that compared with robust patients, diabetic patients with hypertension, coronary heart disease, chronic cardiac failure, COPD, cerebrovascular diseases, osteoarticular diseases, chronic renal diseases, chronic gastrointestinal diseases and cancer were more likely to be frail. In addition, patients who engaged in less exercise, presented more comorbidities, were older and had lower education levels, were more prone to frailty. Conclusion: There was a clear correlation between diabetes complicated with comorbidities and the development of frailty. Appropriate personalised care levels for patients with diabetes and comorbidities, and early screening for frailty might reduce the prevalence of frailty in these patients. Relevance to clinical practice: This study provided information for healthcare providers to identify circumstances that increase the risk of frailty and more effectively support patients with diabetes and comorbidities. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the association between sedentary behaviour (SB), physical activity (PA), and frailty and frailty subdomains in community‐dwelling older women. Background: Frailty is associated with numerous adverse health outcomes in older people, and women had a higher prevalence than men. However, older adults may face different health risks due to different combinations of frailty subdomains; therefore, specific studies on frailty subdomains are needed. Design: A cross‐sectional study guided by the STROBE. Methods: In total, 1099 community‐dwelling older Chinese women (60–70 years) were included. SB and PA were objectively obtained using a validated triaxial accelerometer. Frailty was defined using the Fried Phenotype (FP) Model. Results: After adjusting for confounders, a significant association was found between SB, PA and the prevalence of frailty. The optimal cut‐off values of total SB time, light PA (LPA) time, and moderate‐to‐vigorous PA (MVPA) time to discriminate between frailty and non‐frailty were 625.4 min/day, 379.3 min/day and 20.1 min/day, respectively. For frailty subdomains, total SB time was positively associated with low PA. When it comes to total LPA time, the association with low PA was negative. Total MVPA time was significantly and negatively associated with exhaustion, weakness, slowness and low PA, and the optimal cutoff value was 24.4 min/day, 26 min/day, 29.5 min/day and 20.8 min/day, respectively. Conclusions: Effective management of frailty requires consideration of different combinations of frailty subdomains. Increasing MVPA and limiting SB may help deal with frailty for community‐dwelling older Chinese women. Additional research is needed to determine whether PA are useful for prevention of frailty. Relevance to clinical practice: The results of this study could help caregivers provide professional and specific physical activity guidance for order women, who are on a risk of or already suffered frailty. [ABSTRACT FROM AUTHOR]

Aims and objectives: The objectives of this study were to assess the benefits of a caregiver training programme on the cognitive and functional status of older adults, and to compare the effects of this programme according to type of caregiver (professional vs. family caregiver). Background: Due to demographic changes that have resulted in an aging population, the role of caregiver of an older adult has become very important in recent years. Design and Methods: The sample was composed of 160 older adults: (a) 100 received care from caregivers who had taken the three‐month training programme (treatment group), of which 60 were professional caregivers and 40 were family caregivers, and (b) 60 received care from caregivers who had not taken the programme (control group). In order to evaluate programme effects on cognitive and functional status, we used both direct measures answered by the older adults (MMSE, CAPE and EuroQol) and caregiver reports (Barthel and RMPBC). We used a quasi‐experimental, pre‐post design. We followed SQUIRE 2.0 guidelines for reporting. Results: The results showed that older adults who were cared for by caregivers that had participated in the training programme showed gains in quality of life and cognitive ability and maintenance of functional ability. Within the treatment group, although everyone significantly improved their scores, the older adults cared for by family caregivers improved in more of the cognitive sub‐items than did their peers in the professional caregiver group. Conclusions: The data obtained show that a caregiver training programme based on cognitive stimulation produces cognitive, functional and health‐related quality‐of‐life benefits in older adults. Furthermore, the caregivers reported increased satisfaction with their work. Relevance to clinical practice: The improvements obtained in the older adults and in caregivers show the relevance of this type of intervention when working in the clinical field of caregiving. [ABSTRACT FROM AUTHOR]

Background: Hip fracture is a major burden on health care systems worldwide and requires hospitalisation for a long period. Objective: The aim was to evaluate the effectiveness of multicomponent home‐based rehabilitation compared with different control interventions (in‐hospital rehabilitation, active control or usual care) in older patients after hip fracture surgery. Design: Systematic review and meta‐analysis of randomised controlled studies. Data sources: We searched three electronic databases, including Ovid‐MEDLINE, Ovid‐Embase, CINAHL and the Cochrane Library for relevant articles up to March 2020. Review methods: Two investigators independently extracted data and assessed study quality using the risk of bias. Data were analysed using Review Manager 5.3. The current review employs the PRISMA procedure. Results: Out of 2996 studies, 22 articles were relevant for this review and meta‐analysis. Among them, five compared the multicomponent home‐based rehabilitation with in‐hospital rehabilitation, one compared it with active control, six with usual care and ten compared the home exercise only with usual care. There was no significant difference in activities of daily living (ADL) between multicomponent home‐based rehabilitation and in‐hospital rehabilitation, while multicomponent home‐based rehabilitation significantly increased in ADL when compared to usual care. Home exercises also had significant effects on ADL, quality of life(QoL), balance, gait and muscle strength of the knee extensor compared with usual care (p <.05). Conclusions: Multicomponent home‐based rehabilitation is comparable to in‐hospital rehabilitation regarding improvements in muscle strength, gait speed, balance, ADL and QoL. Relevant to clinical practice: Multicomponent home‐based rehabilitation is comparable to in‐hospital rehabilitation regarding improvements in muscle strength, gait speed, balance, ADL and QoL. Also, high adherence to home exercise may be associated with better clinical outcomes. Therefore, more compliance‐oriented multicomponent home‐based rehabilitation programmes for older patients after hip fracture must be developed by health care professionals, including physical therapist, to ensure optimum home‐based rehabilitation. [ABSTRACT FROM AUTHOR]

Aims: To investigate the efficacy of applying auricular acupuncture (AA) treatment in improving dry mouth in institution‐dwelling older adults. Background: Dry mouth (xerostomia) is a common distressing problem in older populations, especially for institution‐dwelling older adults that can affect oral health and quality of life. Design: A randomised controlled trial was conducted from December 2020 to March 2021 and performed according to STRICTA guidelines extended from the CONSORT statement. Methods: Older adults aged more than 65 years were randomly allocated to an AA group (n = 37) with an 8‐week actual auricular points treatment or a control group (n = 38) receiving sham auricular point acupuncture. Measurements comprised a subjective assessment of the level of dry mouth as assessed by a visual analogue scale in a xerostomia questionnaire, and an objective assessment of the physiological wetness of the lingual mucosa measured with a moisture‐checking device. A generalised estimating equation model was used for data analyses. Results: After completing an 8‐week AA intervention stimulating the Shenmen, Point Zero and Salivary Gland 2‐prime points, the AA group exhibited significantly improved subjective symptoms of dry mouth comprised of difficulty speaking (B = −6.47, p <.001), difficulty swallowing (B = −6.73, p <.001), the amount of oral saliva (B = −5.38, p <.001), a dry throat (B = −7.53, p <.001) and thirst (B = −8.06, p <.001) compared with the control group. Moreover, the AA group had higher objective oral saliva flow than the control group (B = 4.73, p <.001). Conclusion: AA is an effective non‐pharmacological method for improving subjective symptoms of dry mouth and objective saliva secretion in older populations living in nursing homes. Relevant to clinical practice: Performing regular AA on the Shenmen, Point Zero and Salivary Gland 2‐prime auricular points can be considered an alternative treatment approach to improve dry mouth in institution‐dwelling older adults. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study investigated: (a) the usage patterns of paracetamol, and (b) the association between paracetamol use and patient outcomes such as liver and kidney functions among older people. Background: Paracetamol is a well‐known analgesic and antipyretic drug, with an excellent safety profile when used within its recommended dose. It is a commonly used drug by people aged over 65 years to treat chronic pain. Prolonged use of paracetamol in the elderly is poorly understood. As such, there is a genuine risk among older people of unintentional overdose. Methods: A retrospective analysis of medical records in rehabilitation wards was undertaken from 1 July 2016 to 30 June 2017. Patients' paracetamol use, prescribing patterns and biochemical results were analysed to assess for differences in admission and discharge biochemistry results. The TREND Statement was utilised to guide study reporting (Enhancing the QUAlity and Transparency Of health Research, 2021). Results: A total of 1119 patients were admitted for seven or more days in a metropolitan tertiary hospital in Melbourne. Almost three‐quarters (74%) of patients were administered paracetamol; 76.1% received 'Immediate‐Release Paracetamol' (IRP), and 23.9% were given 'Sustained‐Release Paracetamol' (SRP). A proportion (4.5%) of patients in both the IRP and SRP groups received more than the daily recommended dose. There were limited statistically significant differences between patients' admission and discharge biochemistry results; group or time differences were observed, which were indicative of improvements within the paracetamol group. Conclusion: Paracetamol was a commonly used medication among long‐stay elderly patients. Precaution to ensure paracetamol use does not exceed recommended daily doses is required. This study suggests that paracetamol used at a therapeutic level in older patients had limited, negative associations with liver and kidney function. Relevance to clinical practice: The clinical practice regarding prolonged use of paracetamol is ambitious. The increased risk of paracetamol toxicity among the frail elderly is a concern. Optimising the dose adjustment in the elderly is important to avoid adverse outcomes. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to construct a model for oral assessment using deep learning image recognition technology and to verify its accuracy. Background: The effects of oral care on older people are significant, and the Oral Assessment Guide has been used internationally as an effective oral assessment tool in clinical practice. However, additional training, education, development of user manuals and continuous support from a dental hygienist are needed to improve the inter‐rater reliability of the Oral Assessment Guide. Design: A retrospective observational study. Methods: A total of 3,201 oral images of 114 older people aged >65 years were collected from five dental‐related facilities. These images were divided into six categories (lips, tongue, saliva, mucosa, gingiva, and teeth or dentures) that were evaluated by images, out of the total eight items that comprise components of the Oral Assessment Guide. Each item was classified into a rating of 1, 2 or 3. A convolutional neural network, which is a deep learning method used for image recognition, was used to construct the image recognition model. The study methods comply with the STROBE checklist. Results: We constructed models with a classification accuracy of 98.8% for lips, 94.3% for tongue, 92.8% for saliva, 78.6% for mucous membranes, 93.0% for gingiva and 93.6% for teeth or dentures. Conclusions: Highly accurate diagnostic imaging models using convolutional neural networks were constructed for six items of the Oral Assessment Guide and validated. In particular, for the five items of lips, tongue, saliva, gingiva, and teeth or dentures, models with a high accuracy of over 90% were obtained. Relevance to Clinical Practice: The model built in this study has the potential to contribute to obtain reproducibility and reliability of the ratings, to shorten the time for assessment, to collaborate with dental professionals and to be used as an educational tool. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed. Background: Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls. Design: An integrative review. Methods: An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review. Results: Twenty‐two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk. Conclusions: Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates. Relevance to clinical practice: Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To systematically determine the effectiveness of horticultural therapy (HT) on the physical functioning and psychological health of older people. Background: With advancing age and increased chronic diseases, older adults are vulnerable to physical deterioration and psychological problems. There is evidence that horticultural therapy (HT) has positive effect among older adults. However, less attention has been devoted to systematically evaluating the physical functioning and psychological health effects of HT in older adults. Design: Systematic review and meta‐analysis were conducted based on the checklist for PRISMA. Methods: The searches were conducted in PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, China Network Knowledge Infrastructure, Wan Fang, and China Science and Technology Journal Database, from their inception until June 2021. Randomised controlled trials published in either English or Chinese were reviewed. The Review Manager 5.4 software was used for meta‐analyses. The quality of included studies was evaluated using the Cochrane risk of bias tool by two independent researchers. Results: Ten studies involving 884 participants were included. Compared with the control group, HT can significantly improve upper body flexibility and aerobic endurance in older adults with cancer. Besides, HT was found to be more effective for promoting emotional functioning and well‐being, subjective social functioning, and quality of life among the elderly. The attendance rate for HT was 66%–100%, and no negative events were found. Conclusion: Horticultural therapy has potentially positive effects on the physical functioning and psychological health of older adults. However, more rigorous randomised controlled trials with larger populations are required to confirm the findings. Relevance to clinical practice: As a safe and promising nonpharmacological intervention, healthcare professionals may consider the HT intervention when caring for older adults with cancer, dementia and frailty. [ABSTRACT FROM AUTHOR]