Journal of gerontological nursing最新文献

Purpose: To determine whether psychological distress mediates the relationship between social isolation and frailty among older people living with HIV (PLWH) in China.

Method: A quantitative cross-sectional study was conducted. A convenience sample of 342 eligible older PLWH were identified between December 2022 and October 2023. Data were collected through in-person surveys and structured questionnaires designed to collect data on sociodemographic characteristics, social isolation, frailty, and psychological distress with standard measures, including the Tilburg Frailty Indicator, Lubben Social Network Scale-6, and Distress Thermometer.

Results: Overall prevalence of major variables among participants was reported as follows: social isolation (57.3%), frailty (39.5%), and psychological distress (25.8%). Mediation analysis showed that an association between social isolation and frailty was mediated by psychological distress. Psychological distress partially mediated the relationship between social isolation and frailty, accounting for 30.4% of the total effect.

Conclusion: Higher levels of social isolation and greater levels of psychological distress may be significant risk factors for frailty among older PLWH. Levels of social isolation influence frailty directly and indirectly through a psychological distress pathway.

Purpose: Persons with dementia (PWD) often encounter challenges in effectively managing their medications, which can result in medication deviation. The objective of the current study is to provide references for enhancing the management of medication deviations among PWD.

Method: A comprehensive literature search was conducted across six databases (PubMed, ProQuest, Web of Science, CNKI, Wanfang, VIP) to identify cross-sectional and cohort studies investigating medication deviations in PWD, published between January 1, 2015, and March 1, 2025. A scoping review methodology was used to summarize and analyze the basic characteristics, assessment tools, types of medication deviations, and influencing factors of included studies.

Results: Twenty-one studies were included. Most used the Beers Criteria^® or STOPP criteria to assess medication deviations. Risk factors for deviations were categorized into three domains: individual factors (e.g., advanced age, cognitive impairment), caregiver-related factors (e.g., insufficient supervision), and medication-related factors (e.g., polypharmacy). Potentially inappropriate medications were the most prevalent type of deviation, with reported rates ranging from 12.2% to 85%.

Conclusion: Medication deviations are pervasive in dementia populations. Strengthening medication management protocols-including systematic medication reviews, caregiver education, and multidisciplinary interventions-is critical to reducing adverse drug events and preventable hospital readmissions. Future research should prioritize standardized assessment tools and context-specific strategies tailored to the neurobehavioral complexities of dementia.

Increasing efforts to improve mobility and promote exercise that facilitates healthy aging have generated new opportunities for policymakers and nurses. With the popularity of wearable devices, such as smartwatches, on the rise, governments, health systems, national organizations, and insurance payers are actively engaged in identifying use cases for these devices that help patients manage their conditions in real-world settings; however, less attention has been paid to using wearable devices to prevent the development of risk factors for chronic disease. This is particularly true regarding musculoskeletal (MSK) care, for which a growing number of digital platforms have recently been validated. Numerous pathways for policy reform to support the adoption of wearable devices in everyday living during the preventive phase of MSK disorders have been identified, each of which requires the expertise and engagement of gerontological nurses to shift the focus of aging care from disease management to prevention.

Purpose: Maintaining optimal glycemic control, as measured by hemoglobin A1c (HbA1c), is critical for preventing diabetes-related complications in older adults. The current study investigated determinants of glycemic control in older adults with diabetes in South Korea, aligning with the latest clinical guidelines from the American Diabetes Association and World Health Organization.

Method: This cross-sectional study analyzed data from the 2022 Korea National Health and Nutrition Examination Survey. A total of 372 adults aged ≥65 years with physician-diagnosed diabetes were included. Participants were categorized into well-controlled (HbA1c <7%) and poorly controlled (HbA1c ≥7%) groups. Factors influencing glycemic control, including psychological distress, physical activity, and socioeconomic variables, were assessed using binary logistic regression.

Results: Depression (Patient Health Questionnaire-9 ≥4; odds ratio [OR] = 1.986, p = 0.019), anxiety (General Anxiety Disorder-7 ≥2; OR = 1.800, p = 0.041), and insufficient strength training (<2 times/week; OR = 0.496, p = 0.025) were significant predictors of poor glycemic control. Current smoking was also associated with elevated HbA1c (OR = 2.228, p = 0.030). No significant associations were observed for demographic or socioeconomic factors.

Conclusion: Psychological distress, insufficient strength training, and smoking are key modifiable predictors of poor glycemic control in older adults with diabetes. These findings highlight the need for integrated interventions that address mental health support, lifestyle modifications, and smoking cessation in diabetes management for older adults. Further longitudinal studies are recommended to confirm causality.

Purpose: Challenging behaviors of residents with dementia represent a major concern in nursing homes (NHs). Although various studies have investigated the effects of staff training in challenging behavior management, few have explored their impact on laypeople's perceptions. However, NH professionals routinely interact with laypeople, such as current and prospective residents and their families, volunteers, and community partners. The current study examined the effect of person-centered staff training on naïve individuals' perceptions of staff competence.

Method: Twenty-two NH professionals completed person-centered care training in challenging behavior management and responded to a clinical vignette before and after training. Their responses were evaluated by 59 naïve assessors for relevance, confidence, and competence. In addition, two trained assessors were recruited to explore whether their informed evaluations corroborated naïve assessors' impressions.

Results: Relevance, confidence, and competence improved significantly according to naïve and trained assessors. NH professionals also reported feeling more competent.

Conclusion: Multiple measures indicate improved staff performance following training. Future studies should examine how laypeople's perceptions of staff competence influence their experiences in NHs and impact NH attractiveness.

Purpose: Digital technologies and artificial intelligence (AI) offer valuable opportunities to improve patient care, but older adults face unique challenges in adopting these innovations. The current study sought to explore the experiences of older adults with digital health technologies to inform more inclusive, accessible solutions.

Method: Ten semi-structured interviews were conducted with participants aged ≥65 years from Family Health Centers affiliated with Dokuz Eylül University, Izmir, Turkey. Data were analyzed using phenomenological thematic analysis.

Results: Five themes emerged: (1) Technology Adoption and Integration; (2) Health Care and Digital Health Services; (3) AI and Emerging Technologies; (4) Social and Emotional Impact of Technology; and (5) Trust, Privacy, and Security Concerns. Participants were open to adopting digital health tools but faced barriers, such as cognitive limitations, lack of tailored education, and trust issues. Family support was key in facilitating adoption. Privacy and ethical concerns about AI influenced engagement.

Conclusion: Addressing usability, trust, and ethical issues is essential to making technology accessible and beneficial for older adults.

Purpose: To examine the impact of sarcopenia severity on depressive symptoms and quality of life (QoL) among community-dwelling older adults with dementia, using the 2019 Asian Working Group for Sarcopenia criteria.

Method: A cross-sectional study was conducted at neurological outpatient clinics in Taiwan. Participants included 120 older adults aged ≥65 years with dementia (as determined by a Clinical Dementia Rating score ≤2). Sarcopenia severity was classified based on muscle mass, strength, and physical performance. Depressive symptoms and QoL were assessed using the Center for Epidemiologic Studies Depression Scale and Medical Outcomes Study Short Form-36, respectively.

Results: Severe sarcopenia was significantly associated with poorer QoL (p < 0.05), and no significant association was found between sarcopenia and depressive symptoms.

Conclusion: Sarcopenia severity negatively impacts QoL in older adults with dementia. Routine nursing assessments should include sarcopenia screening to guide interventions aimed at improving QoL, such as resistance training and nutritional support.

Purpose: To examine the association between market and organizational variables (financial health, market competitiveness, social capital) on health information technology (HIT) maturity levels across nursing homes.

Method: Using a national sample of HIT maturity in 525 nursing homes, we used a standard ordinary least squares regression model with robust standard errors to explore market and organizational factors associated with HIT maturity.

Results: We found four of seven financial health variables (operating income per resident day, total facility beds, occupancy percentage, chain affiliation) associated with HIT maturity. Moderately concentrated counties (market competitiveness) also exhibited higher HIT maturity. Social capital indicators were not associated with HIT maturity.

Conclusion: Facilities with greater resources can make more significant HIT investments and are associated with higher HIT maturity. These findings can assist health care leaders in strategically examining the factors that drive investments in information technology within nursing homes.

Purpose: To synthesize the pooled estimate of the overall incidence of social frailty (SF) and pre-frailty, as well as the prevalence of SF based on sex, country, participant type, and assessment tool used.

Method: This systematic review and meta-analysis incorporated data from inception to December 2021 using six databases: PubMed, Embase, MEDLINE, CINAHL Plus, PsycINFO, and Cochrane Library. In addition to using a comprehensive set of medical subject headings and text phrases in Chinese and English, additional research was manually retrieved from reference lists. Calculations of the combined incidence of SF and pre-frailty were based on a random-effects model. Sources of heterogeneity were also verified through subgroup analysis.

Results: The literature search yielded 2,371 articles, with 17 articles included in the meta-analysis. The combined incidences of SF and pre-frailty were 18.9% (95% confidence interval [CI] [13.7, 24.1]) and 46.6% (95% CI [34.4, 58.7]), respectively. After subgroup analyses of SF, the combined prevalence was 21.6% (95% CI [12.9, 30.3]) in Japan, 19.4% (95% CI [13.2, 25.5]) among females, 25.1% (95% CI [9.1, 41.1]) with Makizako's 5-item SF questionnaire, and 66.5% (95% CI [63.9, 69.1]) among older adults with heart failure.

Conclusion: SF and pre-frailty were prevalent in Asian older adults, especially in Japan, among females, with Makizako's 5-item SF questionnaire, and among older adults with heart failure.