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Background: Family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness. Methods: Concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined. Results: A 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01). Conclusion: This study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals. [ABSTRACT FROM AUTHOR]

Aims Despite the well-documented short-to-medium-term effectiveness of e-Health (electronic health) secondary prevention interventions on patients with cardiovascular disease (CVD), there is limited empirical evidence regarding long-term effectiveness. This review aims to evaluate the long-term effects of e-Health secondary prevention interventions on the health outcomes of patients with CVD. Methods and results This systematic review and meta-analysis followed Cochrane Handbook for Systematic Reviews of Interventions. EMBASE, Medline, Web of Science, and Scopus were searched from 1990 to May 2022. Randomized controlled trials investigating the effects of e-Health secondary prevention on health outcomes of CVD patients that collected endpoint data at ≥ 12 months were included. RevMan 5.3 was used for risk of bias assessment and meta-analysis. Ten trials with 1559 participants were included. Data pooling suggested that e-Health programmes have significantly reduced LDL cholesterol [ n = 6; SMD = −0.26, 95% confidence interval (CI): (−0.38, −0.14), I2 = 17%, P < 0.001]; systolic blood pressure [ n = 5; SMD = −0.46, 95% CI: (−0.84, −0.08), I2 = 90%, P = 0.02]; and re-hospitalization, reoccurrence, and mortality [risk ratio = 0.36, 95% CI: (0.17, 0.77), I2 = 0%, P = 0.009]. Effects on behavioural modification, physiological outcomes of body weight and blood glucose, and quality of life were inconclusive. Conclusion e-Health secondary prevention is effective in improving long-term management of risk factors and reducing the reoccurrence of cardiac events in patients with CVD. Results are inconclusive for behaviour modification and quality of life. Exploring, implementing, and strengthening strategies in e-Health secondary prevention programmes that focus on maintaining behaviour changes and enhancing psychosocial elements should be undertaken. Registration PROSPERO CRD42022300551. [ABSTRACT FROM AUTHOR]

The article presents the discussion on the impact of the current pandemic on people with dementia (PWD) and the caregivers. Topics include community dementia services having home-visiting services and centre-based activities being suspended leaving many community-dwelling PWD; and using as an alternative intervention during the pandemic when face-to-face group interventions cannot feasibly be carried out.

A scarcity in research assessing the palliative care (PC) educational and health care system–related issues has been reported in the Middle East region; the region comprises a wide range of economically diverse countries. Discrepancies across countries have created difficulties in adopting other countries' experiences. This study aimed to assess PC knowledge, attitude, educational needs, and health care system–related issues from physicians' and nurses' perspectives before developing PC services within the Palestinian health care system. One hundred sixty-nine professionals participated in this cross-sectional survey. Data were collected by validated instruments. Professionals had insufficient knowledge about PC, but they had positive attitudes toward end-of-life care and care of the dying. Patients'/families' avoidance of talking about issues around dying and lack of training for staff related to PC were the most 2 significant barriers to providing PC. Educational level and previous training were found to be associated significantly with knowledge and attitudes toward PC. Study conclusions support the recommendation for integration of education about PC within the health curricula and in-service training and should cover the basic and advanced principles of PC and symptom management. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine the frailty transition patterns of older adults recruited from both community and residential care settings within a 5‐year period, and to identify the physical and psychosocial factors associated with the transitions. Design: This study is a secondary data analysis of a longitudinal study for tracking the change of health status of older adults 60 years of age or older. Participants who had undergone at least two assessments during 2013–2017 were selected for analysis. Guided by the Gobben's Frailty Model, biopsychosocial predictors were comprehensively identified from the literature, and their relationship to frailty state transition was explored. Methods: We compared the baseline characteristics of participants at the frail, pre‐frail, and robust states (categorized using the Fried Frailty Index). A generalized estimating equation was used to identify factors associated with an improvement or a deterioration in frailty. The probability of transitions between frailty states was calculated. Findings: Among the 306 participants, 19% (n = 59) improved and 30% (n = 92) declined in frailty within the project period. Sleep difficulties (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.07–2.90; p =.027), better cognitive status (OR = 0.80–0.84; 95% CI: 0.66–0.98 and 0.73–2.73; p =.031 and.018), good nutritional status (OR = 0.74; 95% CI: 0.59–0.91; p =.005), slow mobility (OR = 1.03–1.13; 95% CI: 1.00–1.05 and 1.03–1.25; p =.047 and.014), hearing impairment (OR = 2.83; 95% CI: 1.00–8.01; p =.05), better quality of health—physical domain (OR = 0.95; 95% CI: 0.92–0.99; p =.006), and better functional ability (OR = 0.85–0.97; 95% CI: 0.79–0.92 and 0.96–0.99; p <.001 and p =.003) were significant associated factors in the worsening group. More physical activity (OR = 1.01; 95% CI: 1.00–1.01 and 1.01–1.02; p =.026 and p <.001), hearing impairment (OR = 0.26; 95% CI: 0.08–0.86; p =.028), and slow mobility (OR = 0.93; 95% CI: 0.87–1.00; p =.037) were significant associated factors in the improvement group. Conclusions: Frailty is a crucial global public health issue. This study provides evidence for nurses to holistically consider the associated factors and to design effective interventions to combat frailty in our ageing society. Clinical Relevance: Frailty is a transient state that can be reversed. Professional nurses working in both community and residential care settings should be able to identify older adults at risk and improve their health conditions appropriately. [ABSTRACT FROM AUTHOR]

Caregivers of people with dementia experience high stress levels. Mindfulness-based cognitive therapy has been found to be effective in reducing stress and improving the psychological well-being of several populations. To explore the feasibility and preliminary effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia. In a single-blinded, parallel-group, randomized controlled trial, 36 caregivers of people with dementia were randomized to either the intervention group, receiving the 7-session modified mindfulness-based cognitive therapy in 10 weeks; or the control group, receiving the usual family care and brief education on dementia care. The brief education sessions were similar in frequency and duration to the intervention group. Various psychological outcomes of caregivers were assessed and compared at baseline, immediately post-intervention, and at the 3-month follow-up. A focus group with eight participants from the intervention group was conducted to identify the strengths, limitations, and difficulties of the intervention. Intervention feasibility was established with a high completion rate of 83% (completing ≥5 out of the 7 sessions) and a low attrition rate of 11.1%. The duration of the average weekly home-based mindfulness practice of the caregivers was 180 minutes (S.D. = 283.8). The intervention group experienced a statistically significant decrease in stress levels (Z = -1.98, p = 0.05, Cohen's d = 0.7) and depressive symptoms (Z = -2.25, p = 0.02, Cohen's d = 0.8) at the post-test; and a decrease in stress (Z = -2.58, p = 0.01, Cohen's d = 0.9), depressive symptoms (Z = -2.20, p = 0.03, Cohen's d = 0.7), and burden (Z = - 2.74, p = 0.006, Cohen's d = 1.0), and improved quality of life (physical) (Z = -1.68, p = 0.09, Cohen's d = 0.6) at the 3-month follow-up compared to the controls. A focus group conducted immediately after the intervention revealed three major themes: Impacts on the family caregivers, Impacts on the people with dementia, and Difficulty in practicing mindfulness. The findings support the feasibility and preliminary effects of the modified mindfulness-based cognitive therapy on reducing the stress of caregivers and improving their psychological well-being. Some potential effects on people with dementia (e.g., improvements in behavioral problems) were reported by the caregivers. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the modified mindfulness-based cognitive therapy and the impacts on people with dementia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and preliminary effects of a simplified 10-step Tai-chi programme to improve the motor performance of people with dementia. Design: A two-arm, single-blinded cluster randomized controlled trial, registered with ClinicalTrials.gov (NCT03341091). Setting: Community health centres. Participants: Twenty-six dyads of people with dementia and their family caregivers were recruited, with mean (SD) ages of 82.2 (7.43) and 51.3 (18.97), respectively. Interventions: The experimental group underwent a 16 week 10-step simplified Tai-chi training programme, with additional measures to enhance engagement. The control group joined recreational activities organized by the centres. Main outcome measure(s): The feasibility assessment included recruitment, attrition, adherence to, and engagement in the Tai-chi programme. The preliminary effects were assessed by the participants' performance in mobility tests. Results: Preliminary feasibility was established, with an acceptable recruitment rate of 58% (26 out of 45 assessed dyads) and a high attendance rate of 81% (25.88 out of 32 Tai-chi sessions). There was positive engagement in the training sessions, and no adverse incidents. However, five participants withdrew from the Tai-chi group, for a high attrition rate of 38%, and the mean home practice time decreased between weeks 8 and 16. In most of the motor performance tests, a slight but insignificant improvement was observed in the Tai-chi group compared to the control group. Conclusion: A tailored Tai-chi programme for people with dementia using a dyadic approach has been found to be feasible. However, stronger support must be provided to family caregivers to improve the participants' sustained participation. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Use of physical restraints is common in nursing homes, although empirical evidence has shown it to be a hazardous measure. This article aims to understand whether there were any changes in nursing home staff's knowledge, attitudes, and practices of using physical restraints in Hong Kong, after years of deliberation on this topic. Methods: A questionnaire about the knowledge, attitude, and practice of using physical restraint was sent to all 298 staff members in four nursing homes in Hong Kong run by a nongovernmental organization. The results were compared with previous findings from 1999 using the same questionnaire. Results: Overall, the staff had satisfactory knowledge of the daily application of physical restraints, such as the operational procedure and daily assessment. Concerning the conceptual knowledge of minimizing physical restraint use, their performance in the survey was less satisfactory. For example, only 6.6% of respondents were aware that residents had a right to reject the use of physical restraints, and 70% believed that there were no good alternatives to restraints. They showed appropriate attitudes in their practice of daily use of physical restraints. Compared with the previous study in 1999, a significant improvement was found in the attitudes (p = .0014) and practice (p = .0002) of using restraints, but there was no difference in their knowledge test results (p = .29). Conclusions: The results of this study show a significant improvement among the nursing home staff in terms of their attitudes and practice of using restraints. In‐service training for nursing staff should focus more on their knowledge of ethical considerations and the hands‐on practice of using alternative devices (e.g., motion detectors or anti‐slip pads). Clinical Relevance: The findings of this study suggest that in‐service training for nursing staff should focus more on their knowledge of ethical considerations, the principles of using physical restraint, and the alternatives to restraint in order to fill the knowledge gaps of staff and improve the quality of care in nursing homes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and preliminary effects of an individualized exercise programme with and without behavioural change enhancement strategies for frail older people with fatigue. Design: A three-arm, single-blinded, quasi-experimental pilot study. Setting: Community health centres. Participants: A total of 79 frail older people with fatigue, mean age 79.32 years (±7.72). Interventions: The combined group received a 16-week combined intervention consisting of exercise training and a behavioural change enhancement programme. The exercise group received exercise training and health talks, whereas the control group received only health talks. Main outcome measure(s): Feasibility was assessed through the participants' recruitment, retention, attendance and adherence, feedback, and reports of adverse events. The preliminary effects were assessed by the participants' level of fatigue, physical endurance, self-efficacy, and self-perceived compliance with exercise. Results: Feasibility was achievable with high recruitment (87.2%) and low overall attrition (7.1%) rates. A similar reduction in fatigue was identified in all groups, but a trend of greater improvement in physical endurance was observed in the combined group than in the other two groups. The combined group also had a significantly better attendance rate [F(2,76) = 5.64, p < 0.01)] and higher self-perceived exercise compliance than the exercise group. Conclusion: The combined intervention has the potential to enhance the participants' adherence to exercise regimens by improving their attendance in training sessions and their self-perceived exercise compliance. They are important to maintaining an appropriate level of engagement in daily exercises, especially at the beginning stages of behavioural change, when the participants are establishing the habit of exercising daily. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether the implementation of the Observational Pain Management Protocol (Protocol) can improve pain management for nursing home residents with dementia. Design A two-group, single-blinded, cluster-randomized controlled trial. Setting Seventeen nursing homes. Participants Hundred and twenty eight recruited residents with advanced dementia and pain-related diagnoses were allocated to either the control or the experimental conditions based on the randomized group allocated to their home. Interventions The Protocol, which includes assessing, interpreting, and verifying the participants' observed pain scores, initiating pain-relieving interventions according to the observed pain scores, and reassessment, was implemented in the experimental homes for 12 weeks to guide the pain management of the participants. Meanwhile, the control homes continued to employ their usual pain management strategies. Measurements These included the use of pain medications (measured by the Medication Quantification Scale) and non-pharmacological pain treatments in terms of types and frequency, as well as the participants' observational pain scores (assessed by Chinese-Pain Assessment IN Advanced Dementia). Results A significant increase in the frequency (95% CI: −0.13 to −0.09, P < .01) and type (95% CI: −0.05 to −0.02, P < .01) of non-pharmacological interventions used was seen in the experimental homes in comparison with the control homes. However, no statistically significant difference in the use of pain medications was observed. A significant reduction in the observational pain score (95% CI: −0.26 to −0.17, P < .001) was obtained only in the experimental home. Conclusion This study supports the view that the Protocol is of clinical utility in enhancing the use of non-pharmacological pain-relieving interventions among residents with advanced dementia, leading to a reduction in their observational pain-related behaviors. However, the Protocol did not have any effect on the use of pain medications. [ABSTRACT FROM AUTHOR]

Aim To explore nursing assistants' roles during the actual process of pain management (assessment, reporting, implementation of pain-relieving interventions and re-assessment) for cognitively impaired home residents with pain. Background Nursing assistants provide most of the direct care to residents and represent the major taskforce in nursing homes. They may develop specialized knowledge of residents' pain experience that enables them to play both a pivotal role in pain assessment and possibly a supporting role in pain treatment. Currently, there is a lack of research into nursing assistants' functions in pain management. Design This is a descriptive, exploratory qualitative study. Methods Forty-nine nursing assistants were recruited from 12 nursing homes, 12 of them participating in semi-structured individual interviews and 37 in 8 semi-structured focus groups. All interviews were carried out from May to September 2010. Data collected via both data collection methods were transcribed verbatim and analysed by content analysis. Results Nursing assistants were found to play four roles in the pain management process: (1) pain assessor; (2) reporter; (3) subordinate implementing prescribed medications; and (4) instigator implementing non-pharmacological interventions. Conclusions This study highlights the importance of nursing assistants in successful pain assessment and identifies their possible supporting roles in other aspects of pain management. However, nursing assistants' scope of practice resulted in their functions in pain management being continually undervalued by other healthcare professionals. Continuous in-service training, the use of a standardized pain management protocol and strategies for building coherent work teams in nursing homes are suggested to improve this situation. [ABSTRACT FROM AUTHOR]