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Background and objective: Variations in the risk factors for sarcopenia can lead to differences in the likelihood of developing sarcopenia among older adults; however, few studies have explored the interactions among the risk factors. This study examined the interactions among risk factors and identified a discriminative pathway for groups at risk of sarcopenia in community‐dwelling older adults. Methods: A cross‐sectional study was conducted between July and August 2019 to recruit 200 older adults from an outpatient department of a hospital providing care for older people. Data on various risk factors, namely demographics (age, gender, education, comorbidities, and body mass index [BMI]), dietary habits (weekly consumption of milk, coffee, and meat), lifestyle behaviours (vitamin D supplementation, smoking, drinking, and physical activity), and depression symptoms were collected. Sarcopenia was defined according to the Asian Working Group for Sarcopenia criteria. A classification and regression tree (CART) model was used to examine interactions among these factors and identify groups at risk of sarcopenia. Findings: The prevalence of sarcopenia was 38.5%. The CART model identified two end groups at differential risks of sarcopenia, with a minimum of one and a maximum of three risk factors. In the first group, low BMI (<18.5 kg/m2) was a predominant risk factor for sarcopenia among older people. In the second group, older adults with a normal BMI, aged ≥68 years, and without a regular walking habit had a higher probability of developing sarcopenia than did their counterparts. Conclusions: The interactive effects among older age, BMI, and walking may cause different probabilities of developing sarcopenia in the older population. Implications for practice: Older adults with a low or normal BMI but without a regular walking habit could be a predominant risk group for sarcopenia. The appropriate maintenance of body weight and regular walking activity is suggested to prevent sarcopenia in community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

Objectives: Health system responsiveness is a complicated issue that guides researchers in determining an efficient methodology to enhance the understanding of health care systems' perspectives. This study examined the relationship between patients' experience profiles and their satisfaction with medical outcomes. Design: The authors used 11 items from the Taiwanese Annual National Health Insurance survey and used latent class analysis (LCA) to develop experience profiles for 2012 Traditional Chinese Medicine (TCM) patients. A logistic regression model was developed to explore differences in patients' satisfaction with their treatment outcome across four groups identified using the LCA, with adjustment for demographic factors. Subjects: Patients' experiences with medical services in TCM in 2015. Outcome measures: Patients' satisfaction with their treatment outcome. Results: Participants (N = 2012) were divided into four groups. Regardless of gender and age, Group 2 (nall) held the lowest satisfaction with treatment outcome relative to those reported by the other three groups (odds ratios with p-value: Group 1 [pall]: 7.40, Group 3 [nComm]: 1.37, Group 4 [Skip]: 2.20, p < 0.001). Respondents with a more favorable patient experience reported higher satisfaction with treatment outcome. Conclusions: An increased favorable treatment experience in TCM (such as positive accessibility and better interpersonal relationships with providers) is associated with higher satisfaction with treatment outcome. The World Health Organization emphasizes that traditional medicine integrated with Western medicine can play an important role in achieving the goal of "Health for All." Health authorities should develop strategies aimed at enhancing patients' experiences in TCM to contribute to a positive care process. [ABSTRACT FROM AUTHOR]

Context Evidence has shown that essential nutrients are highly correlated with the occurrence of esophageal cancer (EC). However, findings from observational studies on the associations between dietary carbohydrate, salt consumption, and the risk of EC remain controversial. Objective The aim of this study was to conduct a systematic review and meta-analysis to confirm the associations of dietary carbohydrate and salt consumption with EC risk. Data Source Various electronic databases (PubMed, MEDLINE, Embase, Google Scholar, Cochrane Library, Chinese Electronic Periodical Services, and China Knowledge Resource Integrated) were searched up until January 31, 2019. Data Extraction Data related to patient characteristics and study characteristics were extracted by 2 independent reviewers. The risk ratio reported as relative risk (RR) or odds ratio (OR) was extracted, and random-effects models were performed to estimate the summary risk ratio. Results In total, 26 studies were included in this analysis, of which 12 studies, including 11 case-control studies and 1 cohort study, examined dietary carbohydrates, and 18 studies, including 16 case-control studies and 2 cohort studies, examined dietary salt. The pooled OR showed that dietary carbohydrate intake was inversely related to EC risk (OR = 0.62; 95% confidence interval [CI], 0.50–0.77), but positive correlations between dietary salt intake and the risk of EC were supported by the recruited case-control studies (OR = 1.97; 95% CI, 1.50–2.61) and cohort studies (RR = 1.04; 95% CI, 1.00–1.08). Conclusions Salt is an essential nutrient for body functions and biochemical processes. Providing health education and management regarding proper use of salt in daily foods and labeling the amount of sodium in manufactured products to reduce the risk of developing EC should be more appropriately performed in the general population. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the effects of the two‐month breathing‐based walking intervention and its follow‐up on anxiety, depression, dyspnoea and quality of life in patients with chronic obstructive pulmonary disease. Background: Mind–body‐related exercises improve bio‐psychological symptoms and quality of life in chronic diseases, but these improvements are not proven for chronic obstructive pulmonary disease. Design: This was a randomised controlled study and applied the Consolidated Standards of Reporting Trials (CONSORT) statement. Methods: Outpatients diagnosed with chronic obstructive pulmonary disease were recruited from a medical centre in Taiwan and randomly assigned to two groups. The walking group (n = 42) received breathing, meditation and walking for two months, and the control group (n = 42) did not. Data from the outcomes of anxiety, depression, dyspnoea and quality of life were collected at baseline and in Month 1, Month 2 and Month 3. Clinical trial registration was done (ClinicalTrials.gov.: NCT03388489). Findings: The results showed significant changes in anxiety, depression, dyspnoea and quality of life in the walking group across three months, compared to those in the control group and at baseline. Conclusion: This breathing‐based walking intervention is promising to achieve bio‐psychological well‐being for patients with chronic obstructive pulmonary disease. Relevance to clinical practice: This breathing‐based walking, as a mind–body exercise, could serve as an evidence‐based nursing care that contributes to improving anxiety, depression, dyspnoea and quality of life in stable chronic obstructive pulmonary disease outpatients. The feasibility and acceptability of the breathing‐based walking were met the requirement of the chronic obstructive pulmonary disease outpatients, which could be considered as home‐based exercise. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine activities of daily living trajectory groups among older residents in Taiwan, and to determine the relative risks of demographic characteristics and health status in explaining the trajectory group of activities of daily living. Background Activity of daily living is a crucial indicator of health status for institutionalised older adults. activities of daily living is a dynamic process and has differences in trajectory groups. Design This study was a 3-year longitudinal analysis of long-term care facility residents in Taiwan. Methods A total of 364 older residents completed the entire research process. We used group-based trajectory modelling and multinomial logistic models for statistical analysis. Results The result of this study revealed that three activities of daily living trajectory groups among older residents exhibited high dependency with gradually declining function (Group 1, 22.53%), low dependency with gradually declining function (Group 2, 43.13%) and persistent independent function (Group 3, 34.34%). Compared with Group 3, Group 1 was related to the following potential risk factors: older age, female, nonmainland China born and a married status. After considering resident health status in the analysis, three significant factors emerged for Group 1: the number of chronic diseases (odds ratio = 2.45), depressive symptoms (odds ratio = 1.71) and cognitive status (odds ratio = 83.11). Compared with Group 3, Group 2 was related to older age. After adding resident health status to the analysis, two significant factors of Group 2 emerged: the number of chronic diseases (odds ratio = 1.68) and depressive symptoms (odds ratio = 1.74). Conclusion The findings of this study indicated that health factors, including the number of chronic diseases, cognitive status and depressive symptoms, were more likely to contribute to the development of a decline pattern of activities of daily living. Relevance to clinical practice Appropriate exercise programmes and physical activities, according to residents' personal characteristics and activities of daily living status, is crucial for improving physical functioning, alleviating depression and cognitive defects in institutionalised older adults. [ABSTRACT FROM AUTHOR]

Purpose To explore the effect of physical health status and depressive symptoms on quality of life ( QOL) and to examine whether depressive symptoms mediate the effect of physical health status on the physical and mental components of QOL among institutionalized older adults. Design and Methods A cross-sectional study was used to assess 306 residents from 73 long-term care facilities in Taipei, Taiwan. Findings We found that depressive symptoms mediated the relationship between the number of chronic diseases and activities of daily living and physical components of QOL ( z = −2.41, p = .016; z = 3.33, p < .001) as well as between the number of chronic diseases and mental components of QOL ( z = −2.45, p = .014). Practice Implications Our findings indicate that alleviating depressive symptoms can improve the QOL of older adults in long-term care facilities. [ABSTRACT FROM AUTHOR]

Aim To identify the rate and risk factors of physical restraint in residential aged care facilities in Taiwan. Background In Taiwan, physical restraint is commonly used in aged care facilities to prevent accidents. Many are unaware of the associated risks. Restrained residents cannot move freely, increasing the risk of atrophy and leading to reduced physical functioning. Design A community-based epidemiological survey. Methods Data were collected from June-December 2007 across 178 residential aged care facilities with 5,173 residential beds in the target city of Taiwan. Twenty facilities were sampled using probability proportional to size by beds and accreditation ranking. In all, 256 primary caregivers (78 nurses and 178 care aides) and 847 residents completed the study questionnaires and tests. A multilevel analysis approach was used to identify individual- and facility-level risk factors for physical restraint and assess the variation in physical restraint at the individual- and facility-level. Results Of 847 residents, 62% (527) were restrained during the study period. The main reasons for restraint use were fall prevention and prevention of tube removal. Resident level risk factors for physical restraint included lower Barthel Index scores (more dependent) and an agreement allowing the use of physical restraint to avoid injury signed by a family member or social worker. A facility-level risk factor for physical restraint was younger primary caregivers. Conclusion To reduce the incidence of physical restraint in residential aged care facilities in Taiwan, educational programmes should target primary caregivers and families in facilities. [ABSTRACT FROM AUTHOR]

Background: Traditional statistics in longitudinal data analysis are likely to be insufficient in nursing studies, in which the time varying characteristics of explanatory variables and cumulative effects require additional consideration. Objectives: The aims of this study were to introduce alternative longitudinal approaches for incorporating time-varying variables and cumulative effects, to discuss their strengths, and to highlight key issues that nursing researchers should recognize before and while undertaking such analyses. Results: The three alternative models provide differing analytical outcomes based on the research focus. The baseline tracking model was used to estimate the stability effect of an intervention program, detecting risk factors early. The temporal sequence of potential cause and effect was incorporated further in the time-dependent model. The cumulative model was used to explore whether cumulative intervention effects existed. Conclusion: Nurse researchers should incorporate alternative methods into the longitudinal data analysis tools they commonly use when facing explanatory variables with time variations or cumulative effects on the variable being measured. [ABSTRACT FROM AUTHOR]

This study used community-based cohort data to explore the trajectory stability (tracking coefficient or stability coefficient) and its influencing factors on the longitudinal age-related change in physical performance among older populations. An integrated statistical method with generalized estimating equations was applied to study trajectory stability. The study particularly demonstrated a mixed representation regarding the significant trajectories of intact and reduced physical performance over time. It is important to note that the trajectory stability of reduced physical performance was higher in females (odds ratio [OR] = 7.76; 95% confidence interval [CI]: 5.04-11.93) than in males (OR = 5.65; 95% CI: 4.09-7.79). However, for intact physical performance, the coefficient was 3.52 (95% CI: 2.76-4.48) in males and 2.55 (95% CI: 1.91-3.41) in females. There are further gender differences based on the influence of demographic, psychological, lifestyle, and biological variables in relation to the trajectories of physical performance. The authors conclude that an understanding of trajectory stability, as well as the factors affecting these trajectories in physical performance, is essential to the development of prevention programs tailored to maintaining functional ability or preventing the loss of physical function among older people. [ABSTRACT FROM AUTHOR]

Esophagectomy is the primary surgical treatment for esophageal cancer. However, patients often experience a decrease in physical activity, poor nutrition, and a reduction in quality of life following surgery. The aim of this study was to examine the effects of an exercise and nursing education health informatics program on quality of life, exercise capacity, and nutrition among patients following esophagectomy for esophageal cancer. A randomized controlled trial. Patients who had undergone an esophagectomy for cancer were recruited by purposive sampling from a medical center in Taiwan. Patients who met inclusion criteria and agreed to participate (N = 88) were randomly assigned to an exercise informatics program (intervention group, n = 44) or usual post-surgery care (control group, n = 44). Quality of life was assessed at baseline and 1, 3, and 6 months after discharge. Secondary outcomes of nutrition (albumin, body mass index), and exercise capacity (maximal oxygen uptake, the six-minute walking test) were conducted at baseline and 3 months following discharge. Differences in quality of life, nutrition and exercise capacity between the two groups were analyzed using generalized estimating equations. Analysis demonstrated significant improvements in outcome measures following hospital discharge for the intervention group compared to controls. Measures of quality of life were significantly better for the intervention group and varied with time following discharge. Functional scores for physical (1 and 3 months), role (1, 3, and 6 months), emotional (1 month), social (3 months) and global health (3 months) were significantly higher than controls. Cancer-related subscales improved for insomnia (1 and 3 months) and nausea/vomiting (3 and 6 months). Esophageal cancer-specific symptoms improved for dry mouth (1 month), dysphagia (3 months), and loss of taste (1 and 6 months). Three months following discharge, levels of albumin were significantly higher for the intervention group compared to controls (β =0.32, 95% CI 0.09, 0.54, p <.01); body mass index did not differ between groups. Exercise capacity was also significantly better; the intervention group had higher maximal oxygen consumption (β =2.61, 95% CI 1.54, 3.69, p <.001) and greater distance on the six-minute walking test (β =83.30, 95% CI 52.60, 113.99, p <.001). The intervention group experienced significant improvements in nutrition, exercise capacity, and variables related to quality of life. These findings suggest a nurse-led exercise and health education informatics program should be implemented for survivors of esophagectomy prior to hospital discharge. [ABSTRACT FROM AUTHOR]