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Background and Objectives Many community dementia services such as home-visiting services and center-based activities were suspended during the coronavirus 2019 pandemic. This study investigated the efficacy of a caregiver-delivered cognitive stimulation therapy (CDCST) on people with dementia during the pandemic. Research Design and Methods This was a 2-arm randomized controlled trial involving 241 patient–caregiver dyads assigned to a 15-week CDCST or control group (usual care). We hypothesized that CDCST would facilitate significant improvements among people with dementia (cognition, behavioral/psychiatric symptoms, and quality of life) and their caregivers (caregiving appraisal, attitudes, and psychological well-being) at postintervention (T1) and at the 12-week follow-up (T2). Generalized estimating equations evaluated the study outcomes. Results A total of 230 dyads completed the study, with good program adherence (93%). Participants in the CDCST showed significant improvements in cognition (p <.001), behavioral and psychiatric symptoms (p =. 027), and quality of life (p =.001) at the 3-month follow-up period. Family caregivers had improved positive aspects of caregiving (p =.008; p =.049) and decreased negative attitudes toward people with dementia (p =. 013; p <.001) at both T1 and T2. There were nonsignificant changes in the caregivers' perceived burden, distress, and psychological well-being. Discussion and Implications Family caregivers could be trained to provide cognitive stimulation at home for people with dementia, which could benefit both parties. CDCST could manage to improve the cognition, neuropsychiatric symptoms, and quality of life of people with dementia, while also improving caregiving appraisal and negative attitudes among family caregivers. Clinical Trial Registration Number NCT03803592 [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the prevalence and risk factors of undernutrition among older adults living in nonsubsidized Residential Care Homes (RCHs). Methods: Face-to-face interviews and assessments were conducted in a convenience sample of 298 older adults (aged 65 years or older) residing in nonsubsidized RCHs in Hong Kong in January 2015. Subjects who ate by mouth (with or without assistance) and who had no communication barriers were included. We employed a descriptive cross-sectional study design according to the STROBE reporting guidelines. Data were collected on participants' demographics, history of chronic illness, physical function (assessed by the 10-item Simplified Barthel Index with the self-care ability and mobility subscales), cognitive function (assessed by the 10-item Abbreviated Mental Test), and nutritional status (assessed by the 18-item Mini Nutritional Assessment). After identifying the variables associated with undernutrition, hierarchical multivariate logistic regression was used to identify salient predictors. Results: In total, 40.9% of participants had undernutrition, which was associated with a longer length of stay in RCHs and poorer physical and cognitive functions compared to adequate nutrition or being at risk of undernutrition. Hierarchical multivariate logistic regression showed that residents with better cognitive function (adjusted Odds Ratio [OR]=0.88) and self-care ability (adjusted OR=0.75) were at a lower risk of undernutrition. Conclusion: Undernutrition is prevalent among residents in RCHs in Hong Kong and poses a significant risk of cognitive impairment and poor self-care skills. To lessen the likelihood and the consequences of undernutrition, RCHs must give special consideration to residents with these risk factors. [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]

Background: Although several studies assessing the needs of advanced cancer patients have been conducted globally, most have focused on a specific type of cancer such as lung or breast cancer. The variation across studies has also created difficulties in generalizing the results and applying the findings in other countries. The aim of this study was to provide comprehensive information on the needs of Palestinian advanced cancer patients. The quality of life (QOL), distress levels, depression, anxiety, and spiritual well-being of the patients were also assessed. Methods: A hospital-based study with a cross-sectional design was conducted on a convenience sample of patients aged 18 or above who had been diagnosed with advanced-stage cancer. The unmet needs of the patients were assessed using the Short form of the Supportive Care Needs Survey (SCNS-SF34). Four instruments were utilized to examine their distress, anxiety, depression, QOL, and spirituality. A modified Supportive Care Framework was adopted to guide the design of this study. Descriptive statistics and hierarchical linear regression were utilized to analyse the data. Results: Of the 404 cancer patients invited to the study, 379 patients consented to participate and complete the questionnaire. Of them 96.8% stated that they had at least one 'moderate to high' level unmet need. The most frequent unmet needs were those in the physical aspects of daily living (Mean 58.94; SD ± 20.93) and psychological (Mean 58.84; SD ± 19.49) domains. Most of the patients (91%) were physically ill and reported experiencing physical symptoms. About 78.1% had a high level of distress. Almost 90% reported signs of depression and anxiety. Although they felt that their spiritual well-being was good, their QOL was poor. Hierarchical linear regression analyses confirmed that educational level, age, gender, marital status, cancer stage, cancer type, physical symptoms, depression, anxiety, distress, QOL, and spirituality were independently associated with unmet supportive care needs. Conclusion: Palestinian advanced cancer patients exhibit a significantly higher prevalence of unmet needs than those in other countries, indicating a need to develop a palliative care programme within the healthcare system. They have a great need for physical, emotional/psychosocial, self-management and other services, which should be made available to them, particularly in the routine delivery of cancer care. [ABSTRACT FROM AUTHOR]

Background and Objectives Family caregivers of people with dementia (PWD) experience high levels of stress resulting from caregiving. This study aimed to investigate the effects of a modified of Mindfulness-Based Cognitive Therapy (MBCT) for dementia caregiving. Research Design and Methods 113 family caregivers of PWD were randomized to either the intervention group, receiving the 7-session modified MBCT for a period of 10 weeks with telephone follow-up or the control group, receiving the brief education on dementia care and usual care. The caregiving stress (primary outcome) and various psychological outcomes of caregivers and the behavioral and psychological symptoms of dementia (BPSD) in the care recipients were assessed and compared at baseline (T0), postintervention (T1), and at the 6-month follow-up (T2). Results At both T1 and T2, the intervention group had a statistically greater improvement in stress (p =.02 and.03), depression (p =.001 and.04), anxiety (p =.007 and.03), and BPSD-related caregivers' distress (p =.003 and p =.04). A significant greater improvement was also demonstrated in mental health-related quality of life at T2 (p =.001) and BPSD of the care recipients at T1 (p =.04). The increased caregivers' level of mindfulness was significantly correlated with the improvement of various psychological outcomes at T1 and T2 with a correlation coefficient −0.64 to 0.43. Discussion and Implications The modified MBCT enhanced the level of mindfulness in the caregivers and was effective to reduce the caregivers' stress and promote their psychological well-being during a 6-month follow-up. Future research is recommended to further examine its effects on the varieties of psychological and behavioral outcomes of both caregivers and care recipients and their dyadic relationships, as well as explore its mechanism of action in facilitating dementia caregiving. Clinical Trials Registration Number NCT03354819 [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]

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]

Aims and objectives To identify the prevalence and risk factors for fear of falling among robust community-dwelling older people. Background Different models including various risk factors emerged when previous studies attempted to explore the factors' multivariate associations with fear of falling. Attempting to detect fear of falling by a single question in some previous studies may not have been sufficiently sensitive, particularly in a robust population. Although some studies used a validated instrument to detect participants' fear of falling, their self-perceived efficacy in performing various activities was seldom reported. Information to provide an insight into the planning of well-targeted interventions to reduce fear of falling has been lacking. Design A cross-sectional study of 445 robust community-dwelling older people aged ≥65. Methods Besides their demographic and fall-related background, participants' fear of falling level was assessed using the Chinese Fall Efficacy Scale-International. Other instruments included the timed up and go test, the Chinese Geriatric Depression Scale-Short Form, the Chinese Anxiety Disorder Scale, the Chinese Lubben Social Network Scale and the Chinese Personal Wellbeing Index, which were used to assess different variables that may be associated with fear of falling. Results Of the 64·73% of participants who had fear of falling, 65·63% had no history of fall but still had fear of falling. This result was higher than in most previous studies. Participants' main concerns were walking on slippery/uneven surfaces, in crowded places and up/down a slope. Multivariate analyses showed that being female, suffering from poor vision and arthritis, poor performance in the timed up and go test, expressing more depressive and anxiety symptoms and low self-perceived well-being are multiply associated with fear of falling. Conclusion Fear of falling is prevalent among robust community-dwelling older people regardless of their fall history. They showed lack of self-perceived efficacy in performing various outdoor activities. Relevance to clinical practice The findings can assist in developing multidimensional strategies for reducing fear of falling in robust community-dwelling older people. [ABSTRACT FROM AUTHOR]

The article discusses a research study on the acceptance of the use of Pain Behaviour Observational Methods (PBOM) by nursing home staff. The success of pain management in cognitively impaired older people (CIOP) is observed to be affected by the inability to verbally report pain. The use of PBOM by frontline nurses is said to be dependent on their willingness to use them with CIOP. It concludes that nurses are willing to use PBOM in daily routine but are concerned with time and effort required with regular use of PBOM.

The article discusses a study which reported the development and implementation of an Observational Pain Assessment Protocol in a nursing home in Hong Kong, China and its impact on pain management for cognitively impaired home residents (CIHRs). The study also reported the opinions of the nursing home staff, including nurse assistants, nurses and physiotherapist, about the protocol. It observed improved communication among various rank of staff in the nursing home with the use of the protocol.

Background Family intervention for psychotic disorders is an integral part of psychiatric treatment with positive effects on patients’ mental state and relapse rate. However, the effect of such family-based intervention on caregivers’ psychological distress and well-being, especially in non-Western countries, has received comparatively much less attention. Objectives To test the effects of guided problem-solving-based manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis over a 6-month period of follow-up, when compared with those in usual family support service. Design A single-centre randomised controlled trial, which was registered at ClinicalTrials.gov ( NCT02391649 ), with a repeated-measures, two-arm (parallel-group) design. Settings One main psychiatric outpatient clinic in the New Territories of Hong Kong. Participants A random sample of 116 family caregiverss of adult outpatients with recent-onset psychosis. Methods Following pre-test measurement, caregivers were assigned randomly to one of two study groups: a 5-month self-help, problem-solving-based manual-guided self-learning (or bibliotherapy) programme (in addition to usual care), or usual family support service only. Varieties of patient and caregiver health outcomes were assessed and compared at baseline and at 1-week and 6-month post-intervention. Results One hundred and eleven (96%) caregivers completed the 6-month follow-up (two post-tests); 55 of them (95%) completed ≥4 modules and attended ≥2 review sessions (i.e., 75% of the intervention). The family participants’ mean age was about 38 years and over 64% of them were female and patient's parent or spouse. Multivariate analyses of variance indicated that the manual-guided self-learning group reported significantly greater improvements than the usual care group in family burden [ F (1,110) = 6.21, p = 0.006] and caregiving experience [ F (1,110) = 6.88, p = 0.0004], and patients’ psychotic symptoms [ F (1,110) = 6.25, p = 0.0003], functioning [ F (1,110) = 7.01, p = 0.0005] and number of hospitalisations [ F (1,110) = 5.71, p = 0.005] over 6-month follow-up. Conclusions Problem-solving-based, manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis can be an effective self-help programme and provide medium-term benefits to patients’ and caregivers’ mental health and duration of patients’ re-hospitalisations. [ABSTRACT FROM AUTHOR]