BMC Geriatrics最新文献

Background: Namaste Care is an intervention designed to improve the quality of life for people with advanced dementia by providing individualised stimulation and personalised activities in a group setting. Current evidence indicates there may be benefits from this intervention, but there is a need to explore the practical realities of its implementation, including potential barriers, enablers, and how it is delivered within the context of nursing care homes.

Objective: To systematically assess the factors involved in implementing Namaste Care for people with advanced dementia in nursing care homes. To provide pragmatic suggestions on how Namaste Care can be delivered in the context of nursing care homes.

Design: Systematically constructed review using framework synthesis.

Data sources: Comprehensive searches were conducted in Medline, CINAHL, and PsycINFO databases for studies published between 2018 and 2024. Search concepts included "Namaste Care," "advanced dementia," and related terms.

Review methods: Studies were included if they focused on the use of Namaste Care for people with advanced dementia in nursing care homes. Data extraction and quality assessment were performed by two independent researchers using standardised forms and critical appraisal tools. A framework synthesis of the results was conducted, which involves systematically combining qualitative and quantitative data within a structured analytical framework to identify overarching themes and insights.

Findings: Twenty-five studies met the inclusion criteria. Key themes identified were: (1) Frequency and duration of Namaste sessions. (2) Namaste Care environment and personalisation of care. (3) Staff engagement and training needs. (4) Involvement of family members and volunteers.

Conclusions: Implementing Namaste Care in nursing care homes presents various challenges but also significant opportunities for enhancing the quality of life for residents with advanced dementia. Addressing key themes such as the frequency and duration of sessions, the environment and personalisation of care, staff engagement and training needs, and the involvement of family members and volunteers is crucial. Specifically, providing tailored training programmes for staff, creating dedicated Namaste Care spaces, and encouraging active family and volunteer participation can facilitate effective integration. By incorporating these pragmatic recommendations, Namaste Care can be sustainably integrated into daily care routines, leading to improved resident well-being, reduced behavioural symptoms, and enhanced caregiver-resident interactions.

Background: To identify cardiovascular (CV) risk factors in Asian elderly aged 75 years and older and subsequently develop and validate a sex-specific five-year CV risk assessment tool for this population.

Methods: This study included 12,174 patients aged ≥ 75 years without a prior history of cardiovascular disease at a single hospital in Taiwan. Electronic health records were linked to the National Health Insurance Research Database and the National Death Registry to ensure comprehensive health information. Eligible patients were randomly divided into derivation (80%) and validation (20%) cohorts. A sex-specific CV risk assessment tool was developed to predict major adverse cardiovascular events (MACE) using Cox regression modeling.

Results: During a median follow-up period of 8.6 years for men and 8.5 years for women in the derivation cohort, MACE occurred in 3.62% of men and 3.02% of women. Predictors for men comprised advanced age, smoking, non-HDL-C levels > 160 mg/dL, metastatic cancer, and aspirin usage. Predictors for women included advanced age, smoking, atrial fibrillation, cancer, dementia, osteoarthritis, systemic lupus erythematosus, use of antihypertensives, and use of oral anticoagulants. In the validation cohort, the sex-specific risk assessment tool demonstrated fair discriminative power (AUC: men, 0.64; women, 0.68). Model calibration demonstrated good performance for women but was less optimal for men.

Conclusions: This sex-specific CV risk assessment tool shows fair discriminative capability in estimating risk of cardiovascular disease among elderly Asians, potentially enabling targeted interventions in this vulnerable population.

Background: The Getting Older Adults Outdoors (GO-OUT) randomized controlled trial showed that a workshop and 10-week park-based outdoor walk group (OWG) was superior to the workshop and 10 weekly reminders (WR) with increasing walking capacity, but not outdoor walking activity, health-promoting behavior, or successful aging, among older adults with difficulty walking outdoors. The objective of this planned process evaluation was to explore participants' perceptions of mechanisms of impact of and contextual factors influencing experiences with the interventions to help explain the observed intervention effects on study outcomes.

Methods: A qualitative descriptive study involving semi-structured interviews conducted at 6-months post-baseline was conducted. A directed content analysis was undertaken.

Participants: We interviewed 27 adults (52% male, 48% female, mean age 76 years) from the OWG (n = 13) and WR group (n = 14).

Results: We identified two themes including: "Holding Me Accountable to Walk More Frequently", and "We Walked Farther, With More Ease and Confidence, and We Felt Better". Participants in both groups described how the OWG and WR programs provided some degree of structure and accountability to others that increased their motivation to walk outdoors. Participants described how the OWG led to improved walking capacity (e.g., increased walking distance) and confidence. Interacting with people during OWG sessions led to a sense of enjoyment, and well-being.

Conclusions: Community programs that incorporate structure, accountability, and opportunities for social interaction, can help improve motivation to increase outdoor walking activity and a sense of belonging for older adults with difficulty walking outdoors. Park-based OWG programs appear to convey additional important benefits related to improved physical function and well-being.

Trial registration: ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Background: Leisure activity was associated with depression in older adults. However, the specific processes by which diet and cognition mediate the role of leisure activities and depression remain uncertain. The study aims to investigate the relationship between leisure activity and depression in older people and the underlying mechanisms involved, while constructing a comprehensive model that links these variables.

Methods: Data came from the 2018 Chinese Longitudinal Healthy Longevity Survey. Mini-Mental State Examination and CES-D-10 were used to assess cognition and depression, respectively. PROCESS macro was employed to assess the mediation effects of diet and cognition on the relationship between leisure activity and depression.

Results: Leisure activity was negatively associated with depression, with 35.90% of the total effect mediated through dietary diversity and cognitive function, of which 1.28% was from the chain-mediated effect of dietary diversity and cognition. In addition, 20.94% of the total effect mediated through a plant-based diet and cognitive function, of which 0.43% was from the chain-mediated effect of plant-based diet and cognition.

Conclusions: Leisure activities are linked to depression, with diet and cognition acting as chain-mediating factors. Public health experts recommend that older adults engage in leisure activities, ensure a broad spectrum of dietary intake, and prioritize the augmentation of plant-based diets as preventative strategies against depression.

Background: Dignity therapy is a brief, structured psychotherapeutic intervention originally designed to help last-stage cancer patients maintain their dignity. It consists of a semi-structured interview encouraging patients to talk about their lives. The recorded session are transcribed and edited, after which the patient has the opportunity to make further changes to the final document. It can be shared with whom the patient likes. We cross-culturally translated dignity therapy into Dutch and explored its feasibility of applying it to Dutch cognitively capable nursing home residents.

Method: Beaton's Guidelines for Good Clinical Practice were used to cross-culturally translate dignity therapy. Next, a pilot study was conducted with 12 nursing home residents in which the original English-language questionnaire was transculturally translated according to the method of Beaton. After the interviews were completed, feasibility was examined by open-ended questions and a five-point Likert scale questionnaire.

Results: We translated the questionnaire. The translated questions were well understood and resulted in an appropriate Dutch version of the English-language dignity therapy questions. However, the words 'dignity' and 'therapy' caused confusion. The mean number of words in the legacy document was 1078 words, which appeared shorter than in a community-based hospice setting or patients with metastatic cancer or terminally ill people. The reading aloud was much appreciated and was an emotional experience for some.

Conclusion: We successfully translated the DTQP into the Dutch language and tested it in 12 nursing home residents. The questions posed by this therapy appeared suitable and acceptable. Furthermore, participants all accepted the therapy and gave no suggestions to adapt the procedure. Follow-up research in the form of an impact study is needed to show whether and how this therapy can strengthen the sense of dignity of Dutch nursing home residents.

Background: Aspiration pneumonia, which often recurs due to dysphagia, worsens as patients move between homes, facilities, and hospitals. The impact of pre-hospital living setting on oral intake at discharge remains unclear. The purpose of this study was to identify the effects of the pre-hospital living setting on the nutritional intake route upon discharge in older patients with aspiration pneumonia.

Methods: This prospective cohort study included patients aged ≥ 65 years who were admitted to an acute care hospital and diagnosed with aspiration pneumonia. Patients were followed up until discharge or death during hospitalisation. Patient demographic information, pre-hospital living setting (home or nursing facility), functional oral intake scale (FOIS) score, pneumonia severity index, clinical frailty scale score, history of aspiration pneumonia, and pneumonia recurrence during hospitalisation were recorded. Binary logistic regression was used to assess the impact of the pre-hospital living setting on oral intake at discharge as the primary outcome.

Results: Among the 89 included patients (52 males (58.4%); mean age, 84.8 ± 7.9 years), 39.3% (n = 35) had pneumonia recurrence during hospitalisation. The average follow-up period was 44.0 ± 36.6 days. The pre-hospital living setting was independently associated with the nutritional intake route upon discharge (odds ratio = 7.72, 95% confidence interval (95%CI) = 1.70-35.1, p = 0.008).

Conclusions: The pre-hospital living setting could serve as a good indicator of the nutritional intake route upon discharge. It is essential to optimize care in both nursing facilities and hospital settings when caring for older patients with aspiration pneumonia.

Background: Mild cognitive impairment (MCI) is a high-risk factor for dementia and dysphagia; therefore, early intervention is vital. The effectiveness of intermittent theta burst stimulation (iTBS) targeting the right dorsal lateral prefrontal cortex (rDLPFC) remains unclear.

Methods: Thirty-six participants with MCI were randomly allocated to receive real (n = 18) or sham (n = 18) iTBS. Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and executive function was evaluated with the Trail Making Test (TMT), Digital span test (DST) and Stroop color word test (SCWT). Quantitative swallowing measurements were obtained using temporal and kinetic parameters based on the videofluoroscopic swallowing study (VFSS). Resting-state functional magnetic imaging (fMRI) was performed to observe brain plasticity, functional connectivity (FC) values were calculated. All assessments were completed at baseline and two weeks after treatment. Participants received 10 sessions of daily robotic navigated iTBS.

Results: The MoCA score and the SCWT duration of the real group improved significantly compared with that of the sham group. Temporal parameters of VFSS included 5-ml oral transit time (OTT), 5-ml soft palate elevation time (SET) and 10-ml OTT showed a decreasing trend. However, there was significant improvement in 10-ml OTT when choosing patients with OTT exceeding 1000 ms. FC value between the left middle frontal gyrus and the rDLPFC increased significantly in real stimulation group (p < 0.05 with false discovery rate corrected). We found that baseline FC scores were negatively correlated with the SCWT task duration (r = -0.554, p = 0.017) and with the 10-ml OTT (rho = -0.442, p = 0.027) across all participants. Among those in the iTBS group with a pre-10-ml OTT greater than 1000 ms, we observed a positive correlation between changes in MoCA scores and changes in FC values (r = 0.789, p = 0.035). Furthermore, changes in MoCA scores were positively correlated with changes in 10-ml OTT (r = 0.648, p = 0.031), as determined by Pearson analysis.

Conclusions: Navigated iTBS over the rDLPFC has the potential to improve global cognition, response inhibition ability, and certain aspects of swallowing function for patients with MCI at high risk for dysphagia. Changes in FC between right and left DLPFC may underlie the neural mechanisms responsible for the effectiveness of iTBS targeting the right DLPFC.

Background: Physical fitness and functioning are related to better mental health in older age. However, which fitness components (body composition, strength, flexibility, coordination, and endurance) are more closely related to psychological well-being (PWB) is unclear.

Methods: This research examined how body mass index (BMI) and six indices of functional fitness (i.e., lower and upper body strength, lower and upper body flexibility, coordination [based on agility and balance], and aerobic endurance) relate to five psychological measures that could mirror PWB (i.e., resilience, mental well-being, optimism, life satisfaction, and happiness). Thirty-nine older adults (60-94 years; two-thirds female) were examined with the Fullerton Functional Fitness Test (FFFT) after completing five psychometric instruments.

Results: Data were analyzed with correlations, ordinary least squares regressions, and regularized (elastic net) regressions, calculating the Lindeman, Merenda, and Gold (LMG) indices of the relative importance of the six FFFT components separately for the five psychological measures. Results revealed that BMI, upper body strength, and upper body flexibility were the least significant predictors of PWB. In contrast, endurance, complex movement coordination, and lower body flexibility emerged as the most significant predictors. Still, lower body strength correlated moderately positively with all PWB indices, and similarly, upper body flexibility with resilience, mental well-being, and happiness.

Conclusions: These findings should stimulate research on the mechanism connecting functional fitness with PWB in older adults. Further, apart from their novelty, the findings could be valuable in providing directions for physical fitness intervention programs targeting mental and physical health for older people.

Background: Physical activity and exercise are promoted worldwide as effective interventions for healthy ageing. Various exercise initiatives have been developed and evaluated for their efficacy and effectiveness among older populations. However, a deeper understanding of participants' experiences with these initiatives is crucial to foster long-term activity and exercise among older persons.

Methods: A constructivist grounded theory study was conducted to explore the experiences of older persons participating in a supervised group supramaximal high-intensity training (HIT) programme. Four focus groups were held, involving 28 persons aged 65 to 78. The focus groups were analysed inductively, followed by an iterative process of abstraction, abduction, and theory generation using a constant comparative method. A conceptual framework comprising three theoretical concepts-stereotype embodiment, ageist practices, and self-efficacy-was employed during the abductive phase as an analytical lens.

Results: The core category of our grounded theory, Negotiating a physically active life in tune with ageing, encapsulates the complex processes and actions influencing older persons as they engage in physical activities in their daily lives and in relation to HIT. This core category was created from the conceptual framework and the four categories: Grit in the moment and overall life, Empowered by the training group, Navigating one's physically active self, and Committing to exercise for duty and pleasure. Participants reported feeling invigorated by the exercise, enjoying the challenge, and valuing the group setup for its social connectedness and structure. The generated theory illustrates how participants' engagement with physical activity and exercise is shaped by various perspectives accumulated over their lifespan. The findings provide a plausible explanation of how participation in HIT groups can challenge negative age stereotypes and ageist practices while enhancing self-efficacy for high-intensity exercise.

Conclusions: Our grounded theory underscores that physical activity and exercise should be regarded as multifaceted processes, which must be considered when promoting physical activity initiatives for older persons. By considering the older person and societal norms and values, we can gather knowledge to design physical exercise interventions that are not only effective but also enjoyable and capable of transforming how individuals perceive themselves as exercising persons.

Background: Over the past decades, self-directed models of care have been implemented throughout the world to support older people, including those with dementia, to live at home. However, there is limited information about how self-directed home care is experienced by older people with cognitive impairment and dementia, and how their thinking informs their care choices and quality of life.

Methods: We used the ASCOT-Easy Read, a staggered reveal method, talk aloud techniques, probing questions, and physical assistance to support users of self-directed home care in Australia with cognitive impairment and dementia to discuss their Social Care Related Quality of Life (SCRQoL). Interviews were recorded, transcribed and analysed thematically in NVivo. Demographic, functional, cognitive and SCRQoL scores were analysed in Excel and SPSS. Analysis of both the quantitative and qualitative data for each participant allowed us to examine consistency or discordance between ratings and participants' comments about their experiences within each domain.

Results: Twenty six older people with cognitive impairment and/or dementia completed an interview. Ratings of SCRQoL were more favourable in lower order domains (e.g. food and drink, personal cleanliness, accommodation comfort and cleanliness and safety) than in the higher order domains (e.g. occupation and social participation). Overall SCRQOL also varied significantly from 0.40 to 0.97. Despite variable ratings, all participants described unmet needs associated with limitations in personal function and mobility, transport and the amount and flexibility of home care services they received. Qualitative comments suggest many experienced more significant limitations than some of their ratings may imply. This was attributed to adaptation and acceptance of limitations as a normal part of aging. The choice to remain living in one's own home was perceived as the most important outcome.

Conclusions: Some older people living at home with cognitive impairment and/or dementia adapt and accept their limitations as a normal part of the aging process. This affects expectations about their lives at home and their support. Rather than relying on self-direction, supports to live well at home could be enhanced by a greater emphasis on comprehensive needs assessment and more supports to promote reablement and enhance personal and community level participation.