搜索结果：International journal of older people nursing

The notable and consistent evidence that musculoskeletal symptom intensity varies according to thoughts and feelings as much or more so than pathophysiologic factors has firmly established the importance of comprehensive, biopsychosocial, whole-person health strategies in orthopaedic surgery. A systematic review of existing knowledge of the role of social health factors (defined as security in relationships, roles, finances, housing, and sustenance) as sources of variation in levels of musculoskeletal discomfort and incapability could further inform the development and dissemination of comprehensive musculoskeletal health strategies, inform public health efforts, and identify areas that merit further investigation. In a systematic review of quantitative evidence regarding the relationship of social health to levels of musculoskeletal discomfort and incapability, we asked: To what degree are various aspects of social health associated with levels of musculoskeletal discomfort and incapability? A search of three databases (PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) was performed on December 4, 2023, and 5518 studies were screened after removing duplicates. We included peer-reviewed, original studies in English with participants age 18 years or older that addressed the relationship between social health and levels of musculoskeletal discomfort and incapability. Qualitative studies, case reports, preprints, and studies with < 50 participants were excluded. We did not search reference lists. Given the use of three complementary databases with broad coverage of biomedical, public health, and social research, we anticipated that additional yield from reference lists would be minimal. Two independent reviewers screened titles and abstracts, with disagreements resolved by a senior author, resulting in 226 articles eligible for a full-text secondary screen, of which 86 fit the criteria. The 86 studies included in this review, containing a total of 1,341,143 participants, were mainly observational, employing cross-sectional, longitudinal, and database designs. Study populations were diverse, representing both a variety of international settings and a mix of urban and rural communities. Overall, these studies primarily described associations between social factors and levels of musculoskeletal discomfort or incapability rather than evaluating interventions. Among studies that reported gender distribution (82 of 86), there was a median (IQR) of 56% (50% to 66%) women. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool, with scores ranging from 0 to 16 and higher scores representing better quality. The median (IQR) score was 13 (12 to 14), indicating that the studies selected were generally of moderate methodological quality with limited variability. The most common methodological limitation was lack of an a priori sample size calculation. We calculated standardized correlation size metrics (such as Cohen d, standardized &#x3b2; coefficient, &#x3b7; 2 , and Pearson correlation coefficient) based on reported values to estimate the strength of association between each social health factor and levels of musculoskeletal discomfort and incapability. The strength of association for social support outside of work was generally small (range of standardized &#x3b2; coefficient 0.14 to 0.36), and the strength of association for social deprivation was consistently small to negligible (range of Cohen d 0.10 to 0.18; range of standardized &#x3b2; coefficient 0.03 to 0.33). Other social health factors, such as limited health insurance (range of Cohen d 0.01 to 1.59), lower level or less secure employment (range of Cohen d 0.04 to 1.11; range of standardized &#x3b2; coefficient 0.19 to 1.21), and low level of education (range of Cohen d 0.03 to 1.02; range of standardized &#x3b2; coefficient 0.01 to 0.59) were generally associated with greater levels of discomfort and incapability, but showed variable strength of association. More disadvantaged occupational factors, while generally associated with greater levels of discomfort and incapability, showed less consistent and more varied direction of correlations. Combined socioeconomic factors had an inconsistent association, and in one study, household income showed a moderate association (range of standardized &#x3b2; coefficient 0.30 to 0.61). The finding that multiple aspects of social health are relatively consistently associated with levels of musculoskeletal discomfort and incapability can alert specialist clinicians to partner with patients to anticipate and identify social stressors (for instance, using screening tools and compassionate inquiry) and develop health strategies that account for their contribution to the illness (increased attunement and priority). Whereas greater levels of discomfort and incapability might traditionally trigger orthopaedic surgeons to more readily offer biomedical tests and treatments, the evidence that social factors are an important source of variation in musculoskeletal symptoms-along with the known importance of thoughts and feelings-can catalyze musculoskeletal specialty care units to develop more comprehensive biopsychosocial approaches to health and care. When disadvantaged social health is identified as a potential contributor to worse musculoskeletal health, strategies that can assist people with access to financial, food, job, or housing resources; medical-legal support; and other social supports can be considered, and in some cases prioritized, along with biomedical interventions such as medications, injections, and surgery. More widespread use of comprehensive, quantitative social health measures instead of sociodemographics may also facilitate the identification of specific social health needs, including their relative contribution to musculoskeletal health. Level III, therapeutic study.

Prolonged hospital stays can increase the risk of hospital-acquired adverse events among older people, and this can give rise to increasingly complex care needs following discharge from hospital. The unique experiences of older people are important to inform effective healthcare service design. This review aims to better understand our current knowledge regarding the experiences of older people during hospital to home discharge through examining (i) the characteristics of older people included in research regarding hospital to home discharge and (ii) older people's experiences of hospital to home discharge. An overview of qualitative reviews methodology was applied. CINAHL, MEDLINE, PsycINFO and the Cochrane Library databases were systematically searched from inception to October 2024, using a combination of keywords and database specific terms and reporting followed PRISMA 2020 guidance. To estimate the extent of overlap among primary studies included in the reviews, the formula for calculated covered area (CCA) was applied. Data were extracted and analysed according to the aims of this review, and results were thematically synthesised. Six qualitative reviews reporting on 98 international primary research studies were included. Analysis revealed mixed and somewhat limited reporting of older person characteristics including age, gender, ethnicity, health conditions and reasons for hospital admission. All studies offered some insight into older persons' experiences of hospital discharge; half included the views of lay carers and healthcare practitioners. Five core themes were derived from inductive analysis: (i) wanting to be at home, (ii) working together and communication, (iii) the system versus the person, (iv) failing to meet needs and (v) role of family carers. The overarching finding was older people want to be at home but feel uninvolved in planning and therefore poorly prepared for discharge. This review exposes limited research addressing the older persons' gender, ethnicity, existing health conditions and reason for admission suggesting gaps in our understandings of the older person and their unique home context in existing research. More detailed reporting of older persons' individual characteristics and greater attention to direct reports from older persons would enrich our understanding of older persons' unique hospital to home discharge experience in different contexts. This more detailed understanding might serve to advance more bespoke strategies to enhance person-centred discharge processes and inform future research. In communicating, healthcare practitioners need to be actively 'present' to enable older people to effectively engage in discharge planning, enhance autonomy and promote shared decision making.

Fractures related to osteoporosis and low bone mineral density lead to substantial morbidity, mortality, and cost to individuals and health systems. Here we present the most up-to-date global, regional, and national estimates of the contribution of low bone mineral density to the burden of fractures from falls and additional categories of injuries from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The burden of low bone mineral density was estimated from 1990 to 2020 in terms of years lived with disability (YLDs), disability-adjusted life years (DALYs), and deaths, for individuals aged 40 years and older, using data from population-based studies from 48 countries or territories (169 unique sources). Mean standardised femoral neck bone mineral density values were estimated by GBD location, age, and sex by meta-regression. Based on a separate meta-analysis of population-based studies from nine countries (12 unique sources), we also estimated the pooled relative risk of fractures per unit decrease in bone mineral density (g/cm2). The population-attributable fraction for low bone mineral density was calculated by comparing the observed distributions of standardised femoral neck bone mineral density to an age-specific and sex-specific counterfactual distribution, defined as the 99th percentile of five rounds of the National Health and Nutrition Examination Survey in the USA, by 5-year age group and sex. Hospital and emergency department data were used to derive the incidence of fractures for six categories of injury (road injuries, other transport injuries, falls, non-venomous animal contact, exposure to mechanical forces, and physical interpersonal violence) using ICD codes. Deaths due to fractures were estimated as the proportion of in-hospital deaths due to the specified injury causes for which a fracture (nature of injury code) was more severe than the cause of injury code. YLDs and DALYs attributable to low bone mineral density by cause of injury were also determined according to previous GBD methods. In 2020, 8&#xb7;32 million (95% UI 5&#xb7;58-10&#xb7;84) YLDs, 17&#xb7;2 million (14&#xb7;1-20&#xb7;2) DALYs, and 477&#x2009;000 (411&#x2009;000-536&#x2009;000) deaths were attributable to low bone mineral density globally in individuals aged 40 years and older. Between 1990 and 2020, global YLDs, DALYs, and deaths attributable to low bone mineral density increased by 91&#xb7;8% (88&#xb7;5-95&#xb7;1), 89&#xb7;8% (81&#xb7;5-99&#xb7;0), and 127&#xb7;1% (108&#xb7;5-144&#xb7;5), respectively. Over this period, the age-standardised global rates of YLDs, DALYs, and deaths attributable to low bone mineral density showed modest decreases. In 2020, falls accounted for 76&#xb7;2% (95% UI 74&#xb7;2-78&#xb7;3) of YLDs, 65&#xb7;2% (62&#xb7;9-67&#xb7;6) of DALYs, and 71&#xb7;0% (67&#xb7;4-72&#xb7;8) of deaths attributable to low bone mineral density, and road injuries largely accounted for the remaining amount: 12&#xb7;4% (11&#xb7;1-13&#xb7;6) of YLDs, 24&#xb7;6% (22&#xb7;5-27&#xb7;1) of DALYs, and 23&#xb7;1% (21&#xb7;6-26&#xb7;2) of deaths. As a proportion of all fall-related burden, low bone mineral density accounted for 26&#xb7;6% (23&#xb7;2-28&#xb7;7) of YLDs, 25&#xb7;6% (22&#xb7;1-27&#xb7;4) of DALYs, and 40&#xb7;6% (35&#xb7;4-44&#xb7;0) of deaths in 2020. Of all road injury-related burden, 12&#xb7;6% (10&#xb7;8-13&#xb7;5) of YLDs, 6&#xb7;3% (5&#xb7;4-6&#xb7;9) of DALYs, and 8&#xb7;9% (7&#xb7;6-9&#xb7;6) of deaths were attributable to low bone mineral density. In men, road injuries accounted for the largest proportion of DALYs attributable to low bone mineral density in those aged 40-59 years and the largest proportion of deaths in those aged 40-64 years. In women, road injuries were the leading cause of DALYs attributable to low bone mineral density in those aged 40-44 years and the leading cause of deaths attributable to low bone mineral density in those aged 40-54 years. In older age groups among both men and women, falls were the leading cause of the burden attributable to low bone mineral density. Low bone mineral density is a crucial modifiable risk factor for fractures, which are an important cause of morbidity and mortality particularly in ageing populations. This analysis highlights low bone mineral density as a cause of health loss not just from falls, but also from road injuries. Gates Foundation.

Psychological Distress Among Family Caregivers of Older People With Functional Impairment Are a Significant Concern. However, the Lack of Simple and Rapid Tools to Assess Psychological Distress in These Caregivers Delays Timely Intervention. The aim was to examine the convergent validity and retest reliability of the Chinese version of the Distress Thermometer (DT) and document the cut-off score in family caregivers. This was a diagnostic accuracy study and descriptive cross-sectional survey to examine the validity of the DT. The cut-off score was determined by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale (DASS-21) as the reference standard in a sample of 248 family caregivers. Good convergent validity with the DASS-21 (0.72-0.75) and good retest reliability (r&#x2009;=&#x2009;0.93) were both illustrated for the DT. At a cut-off score of five, the sensitivity, specificity, Youden index, positive predictive value and negative predictive value were most satisfactory, and area under the curve values demonstrated significantly excellent discrimination. 37.1% of participants scoring higher than the cut-off score experienced a significant number of problems. DT is a reliable tool for measuring the distress of family caregivers of older people with functional impairment. It is advisable for nurses to routinely employ DT to assess the distress of family caregivers. Healthcare professionals can use the DT as a routine screening tool to identify caregivers with psychological distress at an early stage, which facilitates the timely implementation of supportive interventions for caregivers.

This paper explores nurse educators' perceptions of nursing home placements and their experiences of supporting adult nursing students undertaking placements within them. The global population is ageing and requires the provision of skilled Registered Nurses to meet their needs. However, concerns exist that students do not view nursing homes favourably compared to hospital placements. Interpretative Phenomenological Analysis. Semi-structured interviews with eight nurse educators were conducted online between December 2020 and March 2021 and transcribed verbatim. The cross-group analysis elicited individual and shared experiences. A curriculum focussed on hospital-based technical skills can result in placement settings such as nursing homes becoming overlooked within nurse education. Participants suggested that student, faculty and nursing home nurses' negative perceptions of the value of nursing home clinical placements make it more challenging to build trusting relationships, and support everyone involved in nursing homes to recognise the potential of their skills and contribution to nurse education. There is evidence that negative perceptions of nursing home placements are apparent in the nursing faculty and those who support nursing home placements are unwittingly contributing to these negative perceptions, the Registered Nurses who work in them and the skills practised within them. Student nurses are therefore unprepared and unwilling to work in nursing homes, and nursing home staff lack confidence in supporting nursing students. Implementing Care Home Education Facilitators (CHEF) could be a first step to improving this situation. Nurse educators are challenged to ensure the nursing curriculum actively addresses the value of fundamental care throughout the nurse education programme and supports student nurses undertaking clinical placements in nursing homes. Nursing home RNs require better support in their educational roles to improve student experiences of clinical placements in these settings. While technical skills are important for students to learn, overemphasis on them within nurse education programmes can lead to a deficit in the preparation of nurses to deliver fundamental complex care to older people.

This investigation scrutinises the psychometric qualities of the Arabic version of the Older People's Quality of Life-Brief (OPQOL-brief) scale in a sample of Arabic-speaking older adults to support culturally appropriate assessment of lived experience and person-centred care in later life and to strengthen gerontological nursing assessment and evaluation across settings. A cross sectional study included 539 Arabic-speaking older Egyptians (50.3% women; 60.7% aged 65-75). Forward-backward translation and cultural adaptation procedures support linguistic and cultural equivalence. Data collection uses a mixed-mode approach (face-to-face and online) to support inclusive participation; procedures were standardised across modes to minimise measurement differences. The scale yielded a three-factor structure reflecting the multidimensional nature of quality of life in older adults. Internal consistency was high for the total score (Cronbach's alpha and McDonald's omega&#x2009;=&#x2009;0.92). Measurement properties did not differ significantly by gender, supporting cross-gender interpretability. Concurrent validity showed a strong positive correlation between Arabic OPQOL-brief and resilience scores (r&#x2009;=&#x2009;0.60, p&#x2009;<&#x2009;0.001), supporting its relevance to nursing care planning and outcome monitoring. Psychometric testing in this study includes factor structure, internal consistency reliability, concurrent validity and measurement invariance. This research closes a gap in the literature and supports the Arabic OPQOL-brief as a robust tool for assessing quality of life in Arabic-speaking older adults. The new scale can help support nurse-led person-centred assessment, care coordination and evaluation of interventions.

Near falls, defined as recoverable postural instability, are increasingly recognised as important experiences that can provide insight into balance and mobility in older people, yet they are often underreported and inconsistently documented. Unlike falls, which have been clearly defined and extensively investigated, the conceptual definition of near falls remains inconsistent. This concept analysis aimed to clarify the phenomenon traditionally described as 'near falls' and to establish a more precise conceptual definition in older people. This is a concept analysis using the framework by Walker and Avant. A comprehensive literature search of four databases was conducted in Medline, PubMed, Scopus and CINAHL. Data extraction and synthesis were guided by the eight-step framework of Walker and Avant. A total of 23 articles were included in the analysis. Antecedents included intrinsic and extrinsic factors. Defining attributes of near falls comprised transient loss of balance, activation of compensatory mechanisms (e.g., rapid stepping, trunk or limb adjustments) and successful prevention of a fall. Consequences involved increased fall risk, changes in physical functions and psychological impacts. Based on findings, the concept was refined and reconceptualised as 'Compensated Loss of Balance' (CLB), a more precise term emphasising recoverable postural instability through successful corrective responses. Integrating CLB into clinical screening, research frameworks and fall prevention guidelines may enhance early detection of postural instability and promote more standardised approaches to fall risk assessment and prevention.

Peripheral intravenous catheter insertion is the most frequently performed invasive procedure in healthcare. Age-related physiological factors and chronic health conditions can influence how older people experience catheter-related complications, underscoring the need for clinical practices that address diverse needs. Although peripheral intravenous catheters are widely used in hospitalised populations, research specifically exploring their use, outcomes, and associated experiences in older people remains limited. This scoping review addresses this gap by mapping the available literature on peripheral intravenous catheter use in hospitalised older people to identify the characteristics of the existing evidence and opportunities for future research. This scoping review followed the Joanna Briggs Institute methodology and was reported to have applied the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Reviews. An electronic medical database search was conducted including MEDLINE (Web of Science), CINAHL Complete (EbscoHost), PubMed (NCBI), Scopus (Elsevier), Emcare (Ovid) and the Cochrane Central Register of Controlled Trials. A systematic grey literature search was also undertaken. The review was limited to publications since the year 2000. Thirty sources from 12 different countries were included. The evidence types consisted of observational studies (n&#x2009;=&#x2009;15), experimental studies (n&#x2009;=&#x2009;2), education summaries (n&#x2009;=&#x2009;7), clinical practice guidelines (n&#x2009;=&#x2009;2), a scoping review (n&#x2009;=&#x2009;1), a bibliographic review of guidelines (n&#x2009;=&#x2009;1), a book chapter (n&#x2009;=&#x2009;1) and a letter to the editor (n&#x2009;=&#x2009;1). Most studies were observational with small sample sizes. The review identified key topics relating to older people including peripheral intravenous catheter insertion, complications, clinician practices, physiological ageing and patient experiences. Pain and satisfaction were the only two experience measures identified. Definitions of 'older people' varied, and no qualitative evidence related to experiences specific to this population was identified. Although a range of evidence types exists, substantial knowledge gaps remain. The literature is dominated by small observational studies, underscoring the need for robust experimental research. The absence of qualitative studies highlights a critical gap in understanding patient experience. Future research should employ both high-quality quantitative and qualitative methodologies to support the development of patient-centred, evidence-based peripheral intravenous catheter practices for hospitalised older people.

Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews synthesizing evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four HPSR pillars identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery, financial, and governance arrangements; and implementation strategies. This overview addresses delivery arrangements, which Cochrane EPOC defines as how health services are organized and delivered, including who provides care, how care is coordinated and managed, and where services are provided. This overview aimed to synthesize current evidence on delivery arrangements in rehabilitation from an HPSR perspective. Our series of four overviews has the following overarching objectives. &#x2022; To offer a broad synthesis of existing evidence on health policy and systems interventions' effects. &#x2022; To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. &#x2022; To identify current research gaps and set priorities for future primary HPSR. &#x2022; To pinpoint needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. We searched Epistemonikos Health Systems Evidence databases and EPOC Group systematic reviews with no language limitations to identify reviews published between 2015 and 17 November 2024. We included Cochrane systematic reviews (CSRs) and non-CSRs of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) evaluating the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to delivery arrangements as defined in the EPOC taxonomy. All four overview teams screened reviews and extracted data. We used AMSTAR 2 to critically appraise the reviews, and we analyzed the results descriptively. We included 25 systematic reviews. Three overlapped, and for 17 the AMSTAR 2 rating was low or critically low confidence. Five systematic reviews (2 CSRs and 3 non-CSRs) contributed to our synthesis. Most outcomes focused on patients, caregivers, or service use (e.g. access to rehabilitation). Equity-related outcomes were absent, and quality of care, adverse events, and our important outcomes were rarely reported. Below, we report the results of three of the five reviews judged to have moderate to high confidence for our outcomes of interest, in which authors conducted meta-analysis and assessed the certainty of the evidence. Who provides care One review analyzed advanced practice physiotherapy (APP) models, which may result in little to no difference in health-related outcomes measured by the Pain Disability Index and EuroQol 5-Dimension questionnaire after the intervention, compared with usual care in adults with spinal pain (standardized mean difference [SMD] 0.05, 95% confidence interval [CI] -0.32 to 0.42; 2 studies, 225 participants; low certainty). Information and communication technology We included two reviews in this category. One compared telerehabilitation with usual care in older adults, finding that telerehabilitation may have little or no effect on quality of life after seven to 20 weeks (SMD -0.09, 95% CI -0.23 to 0.40; 3 studies, 179 participants; low certainty). There was very low-certainty evidence on mobility after seven to 26 weeks (SMD 0.63, 95% CI -0.25 to 1.51; 5 studies, 302 participants), strength after 12 and 26 weeks (SMD 0.73, 95% CI -0.10 to 1.56; 4 studies, 226 participants), and balance after seven to 26 weeks (SMD 0.40, 95% CI -0.35 to 1.15; 3 studies, 199 participants). Another review on stroke survivors living in the community found that telerehabilitation compared with usual care probably has little or no effect on independence in activities of daily living (ADL) after 24 weeks (SMD 0.00, 95% CI -0.15 to 0.15; 2 studies, 661 participants; moderate certainty), self-reported quality of life after six to 24 weeks (SMD 0.03, 95% CI -0.14 to 0.20; 3 studies, 569 participants; moderate certainty), and depression after six to 24 weeks (SMD -0.04, 95% CI -0.19 to 0.11; 6 studies, 1145 participants; moderate certainty); and may have little or no effect on upper limb function after 12 weeks (SMD 0.33, 95% CI -0.21 to 0.87; 2 studies, 54 participants; low certainty) and mobility after six weeks (mean difference 0.01, 95% CI -0.12 to 0.14; 1 study; 144 participants; low certainty). This review also compared telerehabilitation with in-person rehabilitation and found that there may be little to no difference in independence in ADL, measured with the Modified Barthel Index at four to 12 weeks (MD 0.59, 95% CI -5.50 to 6.68; 2 studies, 75 participants; low certainty); balance, measured with the Berg Balance Scale at four to 12 weeks (MD 0.48, 95% CI -1.36 to 2.32; 3 studies, 106 participants; low certainty); and upper limb function, evaluated with the Fugl-Meyer Assessment (Upper Extremity) four weeks after intervention (MD 1.23, 95% CI -2.17 to 4.64; 3 studies, 170 participants; low certainty). Current evidence on delivery arrangements in rehabilitation is limited, mostly of low certainty, and derived from high-income countries. Reviews covered five EPOC categories, but reliable evidence for our outcomes of interest was available for only two categories. Most evidence was on telerehabilitation. Compared with usual care, APP models may have little to no effect on health outcomes in adults with spinal pain. In people with stroke, telerehabilitation compared with usual care probably has little or no effect on independence in daily living, quality of life, and depression, and may have little to no effect on upper limb function and mobility. Compared with in-person care, telerehabilitation may have little to no effect on ADL, balance, and upper limb function. Further high-quality research using well-defined frameworks is needed, especially in low- and middle-income countries, to identify effective strategies and evaluate organizational, implementation, and equity outcomes. Future Cochrane overviews in HPSR should consider a broader range of study designs, such as observational, qualitative, and mixed-design evidence, to better capture evidence on delivery arrangements in rehabilitation. PC, CK, and SN were supported and funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Protocol (2025): DOI 10.23736/S1973-9087.24.08833-6.

The aging global population has coincided with increased prevalence of chronic diseases, impacting quality of life (QOL) and life satisfaction among older people. Understanding related factors for QOL and life satisfaction is essential to develop effective interventions. This study examined the relationships between health locus of control and daily activities with QOL and life satisfaction in older people with chronic disease. This cross-sectional study used the following self-administered questionnaires: WHOQOL26, Satisfaction with Life scale, and Multidimensional Health Locus of Control scales. Data on daily activities (outings and communication with friends) and socioeconomic status were also collected. A total of 600 questionnaires were distributed to outpatients aged &#x2265;65 years with chronic diseases; 357 questionnaires were returned (response rate: 59.5%). Hierarchical multiple regression analyses were conducted to assess related factors for two outcomes (QOL and life satisfaction). After applying the eligibility criteria, 267 participants were included in the analysis. Perceptions that personal health outcomes were controlled by external factors- either by powerful others (such as doctors or nurses) or by chance-positively influenced life satisfaction but did not influence QOL score. Frequent outings were associated with higher QOL, while communication with friends was associated with increased life satisfaction. Insufficient household finances were related to both outcomes, but monthly income influenced only life satisfaction. Daily activities and perceived financial strain were associated with both quality of life and life satisfaction among older people with chronic diseases, whereas health locus of control showed differential associations with these outcomes.

Systematic reviews bring together all the evidence on a health topic in an organised and careful way. The People's Review aims to help the public understand what systematic reviews are and why they matter by designing and conducting their own systematic review. The question chosen for The People's Review is: Does resistance training make a difference to quality of life and/or heart health for older adults compared to aerobic exercise? This paper outlines how we will carry out this review. This is a systematic review involving the public throughout. This review will search for, include and summarise: randomised controlled trials, with older adults (50&#x2009;+&#x2009;years), that compare resistance training (such as lifting weights) with aerobic exercise (such as walking or running), and measure quality of life or heart health. First, the technical team will search research databases to find possible studies. The public will look at summaries of these to find studies that might be relevant. Then, two members of the technical team will read the full studies and decide which ones to include. Next, the public will help collect some of the key information from the included studies. The technical team will record the rest. The public and the technical team will work together to check for biases (or flaws in how the studies were done) in the studies. Finally, if possible, the team will combine the study results using a method called meta-analysis (a way of pooling numbers together). If we can't combine the numbers, we will write a summary of what the studies found. This review will summarise all the available evidence that addresses the review question. This review could support the public to make decisions about what type of exercise to engage in as they age, and influence exercise guidelines, clinical practice and future research.

Older adults living in institutional long-term care benefit from engaging in physical activity adapted to their functioning. Despite evidence of solutions to promote physical activity, recurrent evidence shows that older adults spend their time sedentary. More in-depth knowledge is needed about the current state of promoting the physical activity of older adults in institutional long-term care for improved practice in the future. We aimed to increase the understanding of older adults' physical activity promotion in institutional long-term care by investigating how, how much and by whom older adults' physical activity is promoted. This is a concurrent mixed-method case study using data from a larger research project performed in an institutional, full-time, long-term care unit in Finland. Thirteen older adults and 12 staff members participated. Data were collected through focus groups, interviews, patient record transcripts and actigraphy between May and October 2023. A mixed-method analysis was conducted using the framework 'Following a thread'. Separate analyses of datasets were conducted, including analyses of qualitative and quantitative data using reflexive thematic analysis and descriptive statistics. Analytical questions were identified and further explored using all datasets to synthesise findings. Four themes were developed: (1) lack of physical activity, (2) plans for physical activity promotion, (3) nurses' role in activity promotion and (4) accessibility and freedom of movement. Current activity promotion is not sufficient for older adults to achieve the benefits of physical activity for their health and functioning. Improvements are needed in delivering sufficient physical activities. Nurses' role in activity promotion should be developed to include care-integrated activities, spontaneous and organised activities and instrumental activities of daily living for older adults. Interprofessional work to promote activity could be used more. Stimulating elements in the physical environment and increasing freedom of movement could produce improvements in physical activity. Improvements in activity promotion can potentially be achieved with simple strategies and low additional costs.

Most older adults with disabilities in China and across Eastern Asian prefer to age in place, relying on home- and community-based care. Their family caregivers frequently encounter significant challenges, including a pronounced lack of knowledge and skills for providing daily living assistance, highlighting a critical need for accessible, practical training. Furthermore, existing community-based support programmes for caregivers often fail to incorporate an integrated family perspective. This oversight neglects the crucial dynamics and internal interactions within the family unit, which are fundamental to the overall adaptation and resilience of the entire family system. This study aims to develop a nurse-led, family-oriented resilience intervention programme for caregivers of older adults with disabilities. The programme is designed to enhance caregivers' practical competencies and to strengthen overall family adaptation within the context of Chinese community settings. We followed the Medical Research Council (MRC) framework for developing and evaluating complex interventions to guide the development process. This involved integrating empirical evidence from our prior studies, identifying relevant theories of family resilience, and validating the preliminary intervention content. We employed a two-round Delphi method with an expert panel to validate the initial programme draft. For each proposed activity, we calculated the coefficient of variation (CV) and Kendall's coefficient of concordance (Kendall's W) to assess expert consensus. The two-round Delphi consultation yielded high positive and authority coefficients. In the first round, the mean importance scores for items ranged from 4.19 to 4.96 (overall mean 4.77&#x2009;&#xb1;&#x2009;0.21), with a coefficient of variation (CV) between 0.04 and 0.16 and Kendall's W was statistically significant (p&#x2009;<&#x2009;0.01). In the second round, scores ranged from 4.16 to 4.96 (overall mean 4.82&#x2009;&#xb1;&#x2009;0.19), with a CV between 0.04 and 0.15, and a significant Kendall's W (p&#x2009;<&#x2009;0.01). Based on this expert feedback, we refined the intervention into an 8-week programme, delivered via weekly home visits, integrating two core components: caregiving skill and family resilience. The weekly themes are (1) Getting to know each other; (2) I am not fighting alone (cleaning care and coping, social support for caregivers); (3) Thank you, embrace you (family resilience and internal support); (4) Love flows through communication (dietary care and coping, family communication and coping); (5) Riding the wind and waves together (excretion care and coping, social support for peers); (6) Community with me (mobile care and coping, social support for community); (7) Supplementing energy (safety protection and basic first aid, social support for external systems); and (8) Radiating the caregiver's radiance (individual self-resilience and self-support). Guided by the MRC framework, we developed a theory-driven, culturally appropriate, nurse-led and family-oriented resilience intervention for caregivers of older adults with disabilities. The program's flexible delivery allows adaptation to local resources and caregiver needs, help caregivers overcome practical challenges and enhance family resilience. Future research should utilize a three-arm randomized controlled trial to evaluate the feasibility, acceptability and preliminary effectiveness of this complex intervention. This nurse-led, family-oriented resilience intervention offers a practical, home-based training programme that equips family caregivers of older adults with disabilities with essential caregiving skills and strategies to strengthen family adaptation, thereby supporting the implementation of community-based aged care services in China and similar Eastern Asian contexts.

When older patients are intubated, their older spouses often play an important role in making difficult decisions to assist them. Therefore, this study was conducted to understand how older spouses experienced making decisions on intubation for older patients. A descriptive qualitative design. Fifteen participants were recruited using purposive sampling. Face-to-face semi-structured interviews were employed to interview participants. Data were analysed using the content analysis method. Four themes identified were as follows: (1) Reasons for making decisions-believing in doctors' recommendation, enhancing the survival of older patients without suffering and performing intubation because of their love for, and attachment to, their spouse; (2) Consequences of decision-making-worry about the survival of older patients and effects of prolonged intubation, fear of signs of deterioration and complication, but happiness to see spouses' survival; (3) Requiring assistance-they required assistance from physicians, nurses and family members in decision-making for spouses with regards to intubation; and (4) Selected treatment-they selected treatments for older patients with utmost treatment, symptomatic treatment and avoidance of suffering. Spouses of older patients were often eager to help choose treatments, including intubation, for them. However, they faced both positive and negative consequences in decision-making, which highlighted their need for assistance from healthcare professionals. These challenges resulted from a lack of knowledge and experience. To address these challenges, basic information can be utilised to create a decision-making program that supports spouses of older patients in their choices in managing intubation for them.

Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2&#xb7;50 million (95% uncertainty interval [UI] 2&#xb7;24-2&#xb7;81) deaths and 98&#xb7;7 million (87&#xb7;7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33&#xb7;4% (10&#xb7;4-47&#xb7;4) since 2010, with a global mortality rate of 94&#xb7;8 (75&#xb7;6-116&#xb7;4) per 100&#x2009;000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100&#x2009;000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634&#x2009;000 [95% UI 565&#x2009;000-721&#x2009;000] deaths or 25&#xb7;3% [24&#xb7;5-26&#xb7;1] of all LRI deaths), followed by Staphylococcus aureus (271&#x2009;000 [243&#x2009;000-298&#x2009;000] deaths or 10&#xb7;9% [10&#xb7;3-11&#xb7;3]), and Klebsiella pneumoniae (228&#x2009;000 [204&#x2009;000-261&#x2009;000] deaths or 9&#xb7;1% [8&#xb7;8-9&#xb7;5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177&#x2009;000 [95% UI 155&#x2009;000-201&#x2009;000] deaths) and Aspergillus spp (responsible for 67&#x2009;800 [59&#x2009;900-75&#x2009;900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.

Nursing homes care for a significant proportion of individuals with advanced dementia, yet timely hospice referrals remain a challenge. The Advanced Dementia Prognostic Tool (ADEPT) is a mortality risk score instrument that holds promise for improving care planning by providing a standardised, accessible method for identifying residents at risk of death within 6 months. To describe current nursing home processes for identifying residents with dementia for hospice referral and gather stakeholder input on integrating ADEPT into routine assessment practices. A qualitative descriptive design guided by the Consolidated Framework for Implementation Research (CFIR) was employed. Data were gathered through online surveys and individual interviews (n&#x2009;=&#x2009;5) as well as a focus group (n&#x2009;=&#x2009;4) with interdisciplinary staff from six Florida nursing homes. Analysis involved deductive coding using a CFIR-based codebook and thematic synthesis. The Standards for Reporting Qualitative Research (SRQR) checklist was followed. Current processes for identifying hospice-eligible residents rely on regular assessments and interdisciplinary collaboration but reveal significant gaps, including delays in referrals and inconsistent practices. Participants viewed ADEPT as a promising tool to complement goals-of-care conversations and enhance care planning, rather than exclusively triggering hospice initiation. Implementation barriers included the need for electronic system integration, regulatory compliance and staff education, while facilitators encompassed strong leadership support, interdisciplinary coordination and alignment with existing workflows. ADEPT has the potential to improve hospice referral processes in nursing homes by providing a structured, accessible framework to support care planning and interdisciplinary discussions. Addressing barriers through targeted training, leadership engagement and pilot testing is essential to optimise its implementation and impact. ADEPT could support end-of-life care in nursing homes by fostering timely, goal-directed care planning for residents with dementia, ultimately enhancing both care quality and staff decision-making processes.

The rising global incidence of dementia is an escalating public health issue. In 2021, the rate of dementia cases in Indonesia had already risen to 27.9%. Dementia literacy, which refers to the ability to acquire, assess, and apply knowledge about dementia, is crucial for increasing public awareness and improving dementia care. However, obstacles persist in advancing dementia literacy owing to difficulties in obtaining information and a lack of awareness regarding the importance of dementia knowledge. Addressing these challenges is essential to enhance dementia care at a societal level. This study was implemented to translate and adapt the Consumer Access, Appraisal, and Application of Services and Information on Dementia (CAAASI-Dem) instrument into Indonesian (CAAASI-Dem-INA) and to evaluate its psychometric properties to ensure it is a valid and reliable tool for assessing dementia literacy in Indonesia. In this cross-sectional study, a two-stage translation procedure followed by psychometric testing was used. A sample of 319 older adults aged 60 years or older was recruited from Semarang, Central Java, Indonesia, using a convenience sampling method. Data were analyzed using descriptive statistics and confirmatory factor analysis (CFA) to assess the validity and reliability of the translated instrument. The results of the psychometric evaluation indicate that CAAASI-Dem-INA offers satisfactory validity and reliability. Moreover, the good model fit obtained in the CFA confirms the construct validity, while the Cronbach alphas obtained demonstrate strong internal consistency (.934), and composite reliability (.744-.930), further supporting the reliability of this tool. The CAAASI-Dem-INA is a valid and reliable tool for measuring dementia literacy among older adults in Indonesia. Thus, it represents an important addition to existing dementia literacy assessment tools and may be used to gain a comprehensive understanding of dementia literacy levels in Indonesia. As a tool to help assess and promote improvements in dementia literacy, the CAAASI-Dem-INA can contribute to improving care and support for the growing number of people affected by dementia in Indonesia.

Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24&#x2008;025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60&#xb7;1 million (95% UI 59&#xb7;0-61&#xb7;1) deaths occurred globally, of which 4&#xb7;67 million (4&#xb7;59-4&#xb7;75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35&#xb7;2% (32&#xb7;2-38&#xb7;4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66&#xb7;6% (65&#xb7;8-67&#xb7;3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67&#xb7;7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11&#xb7;5%, 31&#xb7;7%, and 49&#xb7;9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53&#xb7;9% and 40&#xb7;1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87&#xb7;3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61&#xb7;2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13&#xb7;2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51&#xb7;2 (50&#xb7;6-51&#xb7;7) years for females and 47&#xb7;9 (47&#xb7;4-48&#xb7;4) years for males in 1950 to 76&#xb7;3 (76&#xb7;2-76&#xb7;4) years for females and 71&#xb7;4 (71&#xb7;3-71&#xb7;5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74&#xb7;7 (74&#xb7;6-74&#xb7;8) years for females and 69&#xb7;3 (69&#xb7;2-69&#xb7;4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76&#xb7;3 [76&#xb7;0-76&#xb7;6] years for females and 71&#xb7;5 [71&#xb7;2-71&#xb7;8] years for males). 194 (95&#xb7;1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61&#xb7;8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.

Understanding nursing students' attitudes toward older adults is important as these attitudes influence their career choices and the quality of future gerontological care for older adults. The aim of this study was to explore and compare attitudes toward older adults among nursing students in Finland and Japan. A cross-sectional comparative design was employed. Data were collected in 2024 using a structured questionnaire, which included demographic variables and Kogan's Attitude toward Old People Scale (KAOP). The participants consisted of 65 nursing students from Finland and 74 nursing students from Japan. Data were analysed using descriptive and comparative methods, and regression analysis to examine associations between KAOP scores and background factors. Japanese nursing students had more positive attitudes and greater score variability (KAOP mean 127.0, SD 10.9) than Finnish nursing students (KAOP mean 115.9, SD 5.9). The mean difference of 11.1 (95% CI: 8.2-14.0) was statistically highly significant p&#x2009;<&#x2009;0.001, with a large Cohen's d effect size (1.27). The observed differences may be influenced by the cultural and structural contexts of aged care in Finland and Japan.