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Abstract Skin injury is a growing issue among older adults, especially when admitted to an intensive care unit or long-term care facility. Skin prevention is a key point in dealing with this issue, and prompt and effective screening instruments should be used to identify risks and start preventive interventions and care. This descriptive study aimed to translate and examine the psychometric property and implement the Perineal Assessment Tool for incontinence associated dermatitis risk assessment. The English version was translated into Thai following the international guidelines from the World Health Organization by the bilinguals. From May to June 2023, 119 patients from the semi-intensive care unit were included using a consecutive sampling method. The research instruments included the demographic questionnaires, the original English version, and the translated Thai version. The Thai Version had a content validity index, an index of item-objective congruence, a Pearson correlation coefficient of percent agreement, the Pearson correlation coefficient of the interrater reliability, the Kappa coefficient of interrater reliability, the Pearson correlation coefficient of the intra-rater reliability, and the Kappa coefficient of intra-rater reliability ranked from 0.75 to 1.00. The 21.95% had a high risk of developing incontinence-associated dermatitis, which was associated with females, the length of stay in hospital and semi-intensive care unit longer than or equal to four days, receiving antibiotics, disease severity greater than or equal to 20 points, the albumin level less than 3.8 g/dl, and neuropathy and brain disorders. In conclusion, this instrument has high validity and reliability and can assess patients at risk of incontinence-associated dermatitis. This tool will help with early risk detection and guide for planning to manage various risk conditions to prevent dermatitis instead of taking care of them after the skin has already been damaged.

Abstract Acute myocardial infarction is a silent killer for people worldwide, especially older adults who often experience atypical symptoms, causing late decision-making and a high mortality rate. The unrecognition of atypical symptoms, unconcerned about their risk, and not knowing how to deal with this critical situation are the barriers to a quick decision to visit the emergency department and delaying treatment, resulting in serious adverse outcomes. Therefore, specific and effective health education among older adults is needed. This double-blinded randomized controlled trial explored the effectiveness of health education by applying a role-play promoting decision-making ability program when expecting acute myocardial infarction occurrence among community-dwelling older adults. The participants were 96 community-dwelling older adults in central northeastern Thailand. We collected data between November 2021 and April 2022. The multi-stage sampling was applied to include participants. The intervention was the role-play promoting decision-making ability program and home visit. Outcomes were measured a week before attending and after finishing the intervention. T-tests, Mann–Whitney U test, Chi-square, and Wilcoxon Signed Rank test compared the outcomes between and within groups. Moreover, adjusted analysis was also demonstrated. Results revealed that participants who attended the program improved their knowledge, belief, and decision-making; only perceived susceptibility did not show improvement. Moreover, after demonstrating an adjusted analysis, the program participants had better knowledge about symptoms, perceived benefits, barriers, self-regulation, possible calling 1669, and first action. In conclusion, a role-play promoting decision-making ability program can promote knowledge, belief, and decision-making when expecting acute myocardial infarction occurrence among community-dwelling older adults. This study proved that role-play is one strategy to promote the program's effectiveness by inducing attention before giving older adults health information. Nurses and other healthcare professionals can implement this program as part of standard practice. Clinical Trial Registration Number: TCTR20210928004 on 28/09/2021.

Abstract The changes in aging plus the pathology of diseases can influence the changes in severity levels. This study aimed to examine the changes in levels of severity in patients while waiting to see a doctor. The study was conducted at an outpatient clinic in northeastern Thailand with a total of 421 patients who were assessed twice for levels of severity using the Emergency Severity Index. The 38 triage nurses screened patients, and 18 were interviewed when severity level changes were observed. Data were collected April 1–30, 2021. Quantitative data were analyzed by Chi-square test, Fisher's exact test, and logistic regression. Qualitative data were analyzed by content analysis. Most patients were female, between 18 and 59 years old. Most patients did not change their level of severity. However, increasing levels of severity were found in older adults. Factors related to the changes in severity levels were age group, chronic disease, chief complaint, educational level, the duration of travel to the outpatient clinic, type of vehicle, aging process and comorbidity, pathology of diseases, reassessment interval, nurse's experience, bypassing the patient triage process, patient's self-preparation, management of triage nurses, and assignment of direct healthcare staff until the end of the treatment. Increased severity was more frequently found in older adults, so closely monitored during waiting times at a clinic is needed. Setting rescreening as a policy and having sensitive screening guidelines and tools specific to older adults would contribute to early detection and immediate treatment of deteriorating symptoms and illness to help reduce complications and morbidity. Trial registration: https://osf.io/fp3j2 .

Abstract Older adults have limitations from their aging process and chronic disease, so developed interventions must pay attention and concern to their aging degeneration and needs. This study aims to study the effects of a symptom management program on selected health outcomes among older people with chronic obstructive pulmonary disease. The quasi-experimental research included the 15 older patients in the control group receiving routine nursing care, while the other 15 in the experimental group received a 4-week symptom management program. First, the general information was analyzed using descriptive statistics. Next, the average health outcomes were analyzed using independent and dependent t-tests, Mann–Whitney U Test, and Wilcoxon Signed Ranks Test. In addition, the readmission rate was compared using Fisher’s Exact Test. Results revealed that most of the older patients were men (96.7%), aged 60–88 years (Mean = 71.57, SD = 7.75), with a smoking history (93.3%). The improvements were found in dyspnea (p

Abstract The older adult is an influential group experiencing acute myocardial infarction, delaying treatment and causing a high mortality rate. Factors related to their delay differ from other age groups, and their specific characteristics are barriers to recognizing their symptoms and learning new information. Therefore, specific innovative methods related to their limitations and needs should be considered when developing interventions promoting on-time treatment. This study aims to review intervention details and their effects on knowledge, belief, decision-making, rate of calling 911, and mortality among community-dwelling older adults at risk or after a first myocardial infarction compared to receiving usual care or no intervention. The 12 databases were searched unlimitedly until July 30, 2022. The two researchers independently reviewed the articles, and the third reviewer broke the tight when disagreement was found. Data were extracted, kinds of interventions were grouped, and intervention details were summarized narratively. Finally, the selected outcomes were analyzed by meta-analysis using a fixed and a random-effects model. Eleven articles were for final review. Interventions were categorized into eight groups: direct mail, community-based, multi-group health education, innovation methods, tailored education, structured education, tricked intervention promoting memory and concern, and nurse-based case management. Finally, the meta-analysis found that only innovative methods could increase the rate of calling 911 and taking aspirin (Odd ratio = 2.55; 95% CI = 1.01-6.44). In contrast, there were no statistically significant differences in the rate of affecting time to first unplanned readmission or death and time delay to the emergency room. Results recommended that effective and specific interventions must be developed and strengthened to promote older adults surviving acute myocardial infarction. Clinical Trial Registration Number: PROSPERO CRD42021247136.

Background Postoperative cardiac surgery patients often experience appetite loss. Although nutritional status is known to be associated with time of recovery, functional status, and length of stay, less is known about factors related to patient’s loss of appetite after cardiac surgery. This review aimed to identify and understand factors related to loss of appetite in postoperative cardiac surgery patients, systematic review with narrative summary design was applied. Data sources including CINAHL, SCOPUS, PubMed, ProQuest, ScienceDirect, ThaiLIS, ThaiJo, and E-Thesis were searched without restriction on publication year through August 2020. Methods We conducted the review following the Joanna Briggs Institute methodology, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist to categorize methodological quality and the PRISMA flow diagram to record the studies’ factors. Results Six studies reported one or more of 16 factors related to loss of appetite: older age, sex (female), illiteracy, history of chronic disease, not knowing someone in health field, pain score ≥ 7, pain medications containing codeine, constipation, depression, heart-lung machine ≥ 120 minutes, preoperative serum creatinine levels ≥ 179 µmol/L, emergency surgery, perfusion pressure ≤ 40 mmHg, low cardiac output syndrome, mechanical ventilation ≥ 96 hours, and a New York Heart Association class III and IV. Conclusion The small number of publications restrict our conclusions. Future research should focus on multiple factors related to appetite loss in postoperative cardiac surgery patients. Additional research will provide a foundation for evidence-based interventions to reduce appetite loss and improve patient nutritional status after cardiac surgery. Nurses and other health professionals should assess postoperative cardiac surgery patients for the presence of the 16 significant factors. To promote patients’ nutritional status, there should be evidence-based practice guidelines on the management of postoperative symptoms such as pain management, treatment of constipation, and reduction of emotional stress and depression.

Background: Postoperative cardiac surgery patients often experience appetite loss. Although nutritional status is known to be associated with time of recovery, functional status, and length of stay, less is known about factors related to patient’s loss of appetite after cardiac surgery. This review aimed to identify and understand factors related to loss of appetite in postoperative cardiac surgery patients , systematic review with narrative summary design was applied. Data sources including CINAHL, SCOPUS, PubMed, ProQuest, ScienceDirect, ThaiLIS, ThaiJo, and E-Thesis were searched without restriction on publication year through August 2020. Methods: We conducted the review following the Joanna Briggs Institute methodology, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist to categorize methodological quality and the PRISMA flow diagram to record the studies’ factors. Results: Six studies reported one or more of 16 factors related to loss of appetite: older age, sex (female), illiteracy, history of chronic disease, not knowing someone in health field, pain score ≥ 7, pain medications containing codeine, constipation, depression, heart-lung machine ≥ 120 minutes, preoperative serum creatinine levels ≥ 179 µmol/L, emergency surgery, perfusion pressure ≤ 40 mmHg, low cardiac output syndrome, mechanical ventilation ≥ 96 hours, and a New York Heart Association class III and IV. Conclusion: The small number of publications restrict our conclusions. Future research should focus on multiple factors related to appetite loss in postoperative cardiac surgery patients. Additional research will provide a foundation for evidence-based interventions to reduce appetite loss and improve patient nutritional status after cardiac surgery. Nurses and other health professionals should assess postoperative cardiac surgery patients for the presence of the 16 significant factors. To promote patients’ nutritional status, there should be evidence-based practice guidelines on the management of postoperative symptoms such as pain management, treatment of constipation, and reduction of emotional stress and depression.

Acute myocardial infarction is a significant world-wide problem, especially among older adults. More than 50% of older adults who experience this die before arriving at the hospital because of delaying seeking treatment. The aim of this integrative review was to describe factors related to a delay in seeking treatment among older adults with acute myocardial infarction. Studies published up to 2019 were extracted from the literature that dealt with a delay in treatment for acute myocardial infarction. These needed to be published in peer reviewed English or Thai journals or thesis/dissertations; and involved studies where at least 75% of participants were over 55 years. However, studies without comparisons about factors related to delay treatment were excluded. A total of 23 papers were selected for final review following standard methods for an integrative review. Results revealed three phases related to delays in seeking treatment: patient/bystander recognition action, transportation, and hospital action phases. Most older adults spent the longest average of time delaying in the first phase. Factors associated with delay seeking treatment were in four categories: socio-demographic (advanced age, female, non-white, single/widowed/separated, low education, and low income) ; physiological and environmental (using private car, living alone, experiencing symptoms at home/weekday/night, and living in impoverished/rural area); psychological and behavioral (feelings and thoughts hesitancy/ambiguity/bother and self-management); and clinical (lack of cardiac history, positive history of diabetes mellitus, hypertension, stroke, heart failure, angina pectoris, smoking, and symptoms mismatch/low intensity/atypical symptoms). Findings suggest that nurses need to educate older populations about the early recognition of acute myocardial infarction symptoms and tailor interventions to improve understanding of symptoms and need for emergency treatment. [ABSTRACT FROM AUTHOR]

Lack of knowledge of acute myocardial infarction symptoms and coronary artery disease risk factors is associated with delayed treatments and significant comorbidities. Calling an emergency medical service (i.e., in the USA calling 9-1-1) is the most appropriate first decision to survive this critical situation. This study explored public knowledge and determined socio-demographic variables related to knowledge of coronary artery disease risk factors, acute myocardial infarction symptoms, and first decision-making in acute myocardial infarction situation. This cross-sectional study involved collecting data from 345 lay people from the Midwestern United States. The research team used t-tests to compare cardiovascular disease knowledge in relation to socio-demographic variables. Associations between first decision-making and demographic characteristics were tested using Chi-squared testing. We found that participants recognized classic acute myocardial infarction symptoms more readily than atypical symptoms. Participants who were younger, college educated, had higher household income and health insurance had greater knowledge of symptoms. Older adults were less informed about acute myocardial infarction symptoms. Approximately half of the participants misidentified specific typical coronary artery disease risk factors, especially diabetes mellitus. Over 90% of respondents indicated "Calling 9-1-1" for their first decision in an acute myocardial infarction situation. Older adults and people with lower income and education displayed the greatest lack of knowledge. Nurses should provide health education programs about atypical cardiovascular symptomology and promote calling emergency medical services when experiencing acute myocardial infarction to address the concerning lack of knowledge and awareness in this population. [ABSTRACT FROM AUTHOR]