搜索结果：International journal of older people nursing

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.

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.

Compassionate care is a core ethical and professional value in nursing, especially in the context of elderly care, where vulnerability, chronic illness and relational dependency are at the forefront. Despite the growing international interest in compassion and narrative medicine, there is limited empirical research examining how nurses experience, construct and sustain compassionate care for older people in everyday practice, especially in Eastern European contexts. Narrative practices offer a valuable methodological lens for capturing the experiences, moral meanings and emotional dimensions of nursing care. The aim of this study is to explore how nurses understand, experience and implement compassionate care for older people and to explore the potential of narrative practices to illuminate facilitators, barriers and professional meaning-making in gerontological nursing. A qualitative research design based on narrative inquiry and interpretive phenomenological analysis will be used. Semistructured narrative interviews will be conducted with registered nurses working with older people in institutional care settings. The interview guide is informed by international literature on compassionate care, narrative medicine, gerontological nursing and relational ethics. Data will be analysed using reflexive thematic analysis following Braun and Clarke's six-phase framework supported by NVivo software. Narrative and interpretive elements will be integrated to explore both the content of participants' stories and the meanings they attribute to their experiences. The study was approved by the Ethics Committee of the Medical University of Varna (Approval No. 17, 3 July 2025). All participants will provide informed consent and confidentiality will be assured throughout the study. Findings will be disseminated through peer-reviewed publications, academic conferences and professional forums, with the aim of informing nursing education, practice and policy related to compassionate care for older people.

To date, traditional primary care practices are often organized around the capacities of one or more physicians. New models of primary care practices involving other health professionals such as advanced practice nurses (APNs) require modified triage models for more adequate patient allocation. Therefore, a modified triage model was developed, informed by experts and reviewed by stakeholders. A convergent mixed-method design with four phases was employed. The study was conducted in Swiss primary care practices. Readiness for change of health professionals working in these primary care practices was surveyed. Triage was reviewed and modified according to expert recommendations, and its feasibility explored in two Delphi rounds with health professionals and stakeholders. Health professionals in primary care practices were interested in improving access to care. Observed triage continued to focus primarily on physicians. The modified triage model was viewed to be practicable, offering a potential way to support more systematic allocation of patients to physicians, APNs, and other health professionals depending on the reason for consultation. Drawing on international guidelines on triage in primary care practices, expert opinion on who seeks care in these practices, and review by stakeholders led to a modified triage model to include other health professionals than primary care physicians. This study did not involve patients but focused on triage in primary care practices. Hence, no trial registration was obtained. The number of people growing older and continuing to live at home with chronic and multiple diseases is increasing. However, less physicians operate in primary care practices in the community, thereby limiting necessary access to care. Among the many solutions to counteract these problems, advanced practice nurses (APNs) are installed at primary care practices. To ensure that the best health professional is made available to people with health problems, current triage needs to be modified. For this purpose, a mixed-method study was conducted with Swiss primary care practices employing APNs in Switzerland. Data were collected on interprofessional collaboration and triage in use. Data were collected on interprofessional collaboration and triage in use. Drawing on these results, a modified triage model was developed. Primary care physicians, APN, other health professionals, and stakeholders critically reviewed this modified triage model. The model may help primary care practices consider different health professionals more systematically when responding to patients’ reasons for consultation. Whether this approach improves access, waiting times, workload distribution, or quality of care requires evaluation in future implementation studies.

To clarify how Ikigai and closely related meaning constructs are described in literature relevant to older people in Korea and to propose a provisional, context-informed conceptual framework for gerontological nursing. Ikigai, often glossed as "a life worth living," has been associated with well-being in later life, yet its meaning and operationalisation vary across settings. Greater conceptual clarity is needed to support culturally responsive nursing assessment and care planning. Rodgers' evolutionary method of concept analysis (Rodgers, 2000) was used to examine contemporary scholarly use of Ikigai and related concepts in 13 peer-reviewed studies (published 2002-2024; searched January 2000-June 2025), of which 10 were conducted outside Korea and three in Korea. Data were analysed to identify defining attributes, antecedent contexts, consequences and related concepts. Six defining attributes were identified: psychological equanimity, purposefulness in life, self-worth and personal value, social connectedness, cultural belonging, and reflective wisdom and self-integration. Four antecedent contexts were identified: family and intergenerational change, cultural and value transformation, health and functional challenges, and existential and social disconnection. Four consequence domains were identified: emotional stability and psychological balance, active health orientation and functional preservation, life fulfilment and satisfaction, and community integration and social engagement. In literature relevant to older people in Korea, Ikigai was not presented simply as a list of valued sources, but was provisionally interpreted as a process through which relational sources such as family roles, intergenerational continuity and everyday responsibilities may be internalised as an enduring sense of life's worth. Ikigai may be understood as a dynamic and context-dependent meaning process in later life that includes both valued sources of worth and a sense of life's worth. This review offers a provisional conceptual framework for gerontological nursing and supports further qualitative and measurement research in Korea. This framework can support gerontological nurses in assessing meaning, dignity, purpose and relational continuity alongside physical and functional indicators. Nurses may use open-ended questions and observable indicators to identify valued roles, relationships and routines that sustain older people's sense that life is worth living. Meaning-centred and culturally responsive care planning may help support participation, autonomy and continuity during later-life transitions.

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.

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.

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.

Life issues relating to identity, meaning and dignity are inherent to human existence and remain significant throughout the entire lifespan. To meet the needs of older persons residing in nursing homes, it is essential to understand their views on everyday life, particularly regarding the proximity of death, reflections on future death and dying, and the potential for meaning in everyday life. However, these views have received limited attention in research. The aim of this study was therefore to explore older persons' views regarding everyday life and reflections on their future death and dying while residing in nursing homes. A meta-ethnographic synthesis was conducted by searching CINAHL, PubMed and PsycINFO supplemented with manual searches, guided by the SPIDER tool. The synthesis focused on peer-reviewed empirical research papers published in English, between 1 January 2000 and 7 April 2025. Eighteen studies were identified and analysed based on older persons' expressed experiences and views on everyday life in nursing homes. Studies with proxy perspectives or mixed-method designs were included; however, only qualitative data representing older persons' own views were extracted and analysed, primarily from participants able to engage in interviews. Three analytic themes were formulated: Loss of the Familiar World, Trying to Maintain Personal Identity, Death as Close and Tangible. An overarching metaphor was synthesised: Maintaining and Shaping a Living Space for a Visible Future. Living in a nursing home involves an everyday life marked by losses and an ongoing awareness of future death and dying. At the same time, older persons actively strive to uphold identity, personal dignity and meaningful relationships. Understanding these processes is essential for supporting older persons in everyday nursing care. Nursing staff should make time for regular conversations about resident' lives and concerns, including thoughts about death and dying, and support activities that help them maintain their sense of self.

Nurses' ethical competence and the ethical climate of healthcare settings are critical in promoting high-quality and individualised care. However, these factors may also contribute to various stereotypes that healthcare professionals hold towards older adults, potentially hindering the recognition of patients' individuality. The aim of this study was to investigate possible associations between nurses' characteristics, ethical competence, perceived ethical climate and stereotypes towards older adults in long-term care settings. This was a cross sectional survey study. Nurses working in long-term care settings for older adults in Finland participated in the study between 2024 and 2025. The survey included three self-administered instruments: the Ethical Competence Questionnaire, [Hospital] Ethical Climate Survey and Stereotype Content and Strength Survey. The data were analysed using multiple regression models to identify associations between nurses' characteristics, ethical competence, perceived ethical climate and stereotypes regarding older adults. A total of 409 nurses participated. The participants rated their ethical competence and perceived ethical climate of their workplace as moderate or good. Both factors were statistically significantly associated with positive stereotypes towards older adults but not with negative stereotypes. Most participants (89%) held employee positions and had vocational degrees (65%). Younger age was associated with stronger stereotypes. When the independent variables of ethical competence and ethical climate were tested together, ethical competence alone no longer explained positive stereotypes, but ethical climate did, even after adjusting for age. This study confirms that nurses' ethical competence and perceived ethical climate support each other. Strengthening these elements can help alleviate stereotypes about the residents in long-term care settings. Maintaining and developing these factors can promote the delivery of high-quality, individualised care. To mitigate stereotypes regarding LTCS residents, the nurse manager can create structures that strengthen ethical competence and support an ethical climate. Further research is needed to clarify the determinants that inform nurses' assessments of stereotypes towards older adults in long-term care settings. Ethical climate is associated with the content and strength of stereotypes that nurses have towards older adults. Therefore, maintaining and developing an ethical climate is important. Every nurse can promote an ethical climate by improving their ethical competence and promoting positive relationships with different stakeholders. In addition, it is worth creating structures in organizations that strengthen nurses' ethical competence and ethical climate.

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.

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 people living with HIV (PLH) have a high multimorbidity burden that may impair quality of life (QOL). This study assessed the burden of geriatric syndromes and medical comorbidities and their association with QOL among older PLH in urban Tanzania. These results are important to understand the growing complexities of care needs in this population and inform future strategies. We conducted a cross-sectional analysis of baseline data from the Tanzania HIV and Aging Longitudinal Cohort Study (THALCS). Eligible participants (age &#x2265;50 years, on anti-retroviral therapy [ART] for &#x2265;3 years) were recruited between April and July 2024 from seven HIV care and treatment centres. Participants were excluded if pregnant or unable to consent. QOL was assessed using the WHOQOL-HIV-BREF, a 31-item tool in six domains. Domain scores were converted to a 0-100 scale, and the overall QOL score was calculated. Geriatric syndromes and medical comorbidities were assessed using standard tools. Multivariable linear regression examined the associations, adjusting for sociodemographic and HIV-related factors. Among the 400 participants (median age: 57 [IQR: 53-63] years; 50% females; ART duration: 10-19 years [60.3%]), the majority were on first-line dolutegravir-based ART (83.5%) with undetectable viral load (78.5%). The most common medical comorbidities were dyslipidaemia (80.2%), hypertension (54.5%) and overweight/obese (50.8%). Frailty (13.8%) and pre-frailty (48.3%) were observed. Median QOL score was 75.4 (IQR: 66.3-83.5), highest in physical health and spirituality domains (87.5 [IQR: 75-100] and 87.5 [IQR: 68.7-93.7]) and lowest in environmental domain 62.5 (IQR: 50-75). Males had a higher median overall QOL score than females (76.8 [IQR: 67.9-83.7] vs. 72.9 [IQR: 65.2-83.4], p = 0.036). Pre-frailty (&#x3b2; = -3.41, 95% CI: -5.64, -1.18, p = 0.003), mild depression (&#x3b2; = -7.88, 95% CI: -11.17, -4.60, p<0.001) and moderate/severe depression (&#x3b2; = -19.25, 95% CI: -24.67, -13.83, p<0.001) were associated with poorer QOL. Functional impairment showed a dose-response relationship with QOL. Increasing age (&#x3b2; = 0.18, 95% CI: 0.02, 0.34; p = 0.026) and higher income (>500,000 TZS) (&#x3b2; = 7.16, 95% CI: 3.10, 11.21; p = 0.001) were associated with better QOL. A high prevalence of geriatric syndromes and medical comorbidities was observed among older PLH in Tanzania, several of which were negatively associated with QOL. These findings underscore the need to integrate holistic care models in HIV programmes for older PLH.

Introduction/ObjectivesLower urinary tract symptoms (LUTS) are prevalent and represent prominent health issues among community-dwelling older people globally. This study aimed to examine the association among psychological adaptation, socio-economic status (SES), symptom types, and quality of life in community-dwelling older women with LUTS.MethodsA cross-sectional study was conducted among 150 older women residing in communities in central Thailand, who were recruited using purposive sampling criteria. Data collection was conducted through structured interviews and questionnaires, including the Personal Information Questionnaire, the Thai Geriatric Depression Scale-15, the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms, and the King's Health Questionnaire. Descriptive statistics and multiple logistic regression analyses were performed.ResultsParticipants presented with multiple urinary tract symptoms; filling symptoms were found in 99.3% of participants, followed by incontinence (70%), and voiding symptoms (30%). For psychosocial adaptations, 23.3% suggested mild-moderate depressive symptoms, and 2.7% were classified as having moderate-severe depressive symptoms. Regarding SES, the majority of participants had completed primary school (73.3%), earned an average monthly income of 500-1,000 baht (52.7%), and were unemployed (56.7%). For quality of life, the mean total quality of life score was 16.45 &#xb1; 11.32. Participants with more than one lower urinary tract symptom were 3.81 times more likely to report poor quality of life than those with only filling symptoms (OR: 3.81, 95% CI: 1.53-9.47, p = 0.004).ConclusionThe findings from this study provide essential insights for healthcare personnel, particularly geriatric nurse practitioners, about the impact of LUTS on the quality of life of community-dwelling older women. Implementing systematic screening for LUTS may facilitate timely intervention, potentially delaying symptom progression, mitigating complications, and thereby enhancing the quality of life among this population.

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.

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.

The purpose of this study was to compare the efficacy of different non-pharmacological multicomponent interventions in community-dwelling older adults with frailty or prefrailty and to determine the most effective non-pharmacological multicomponent interventions. Frailty or prefrailty is highly prevalent among community-dwelling older adults and contributes to significant distress among older adults and increases the caregiver burden. Non-pharmacological multicomponent interventions are recommended for first-line management; however, the comparative efficacy among interventions remains unclear. A systematic electronic literature search was performed in the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Wanfang, VIP and Sinomed databases up to July 1, 2025. Randomized controlled trials (RCTs) evaluating the efficacy of non-pharmacological multicomponent interventions compared with routine care or other interventions in community-dwelling older adults with frailty or prefrailty were included. A random effects model based on restricted maximum likelihood (REML) estimation was used for the network meta-analysis. Efficacy was assessed via standardized mean differences with 95% credible intervals, and interventions were ranked via surface under the cumulative ranking curve (SUCRA) probabilities. Twenty-two RCTs were included in the analysis. For overall frailty level, exercise + cognitive intervention achieved the highest rank (SUCRA&#x2009;=&#x2009;84.7%), followed by exercise + cognitive + social support intervention (SUCRA&#x2009;=&#x2009;83%) and exercise + nutritional intervention (SUCRA&#x2009;=&#x2009;72%). With respect to motor ability, exercise + nutrition + psychological intervention was the most effective intervention (SUCRA&#x2009;=&#x2009;77.1%). Non-pharmacological multicomponent interventions have a positive effect on improving the physical condition of community-dwelling older adults with frailty or prefrailty. Nurses and care managers should actively prioritize the integration of the above two interventions into personalized frailty or prefrailty care plans, maximizing the efficacy of non-pharmacological management. Exercise + cognitive intervention is likely the most effective non-pharmacological multicomponent intervention for reducing the frailty level, and exercise + nutrition + psychological intervention is likely the most effective non-pharmacological multicomponent intervention for improving motor ability in community-dwelling older adults with frailty or prefrailty. The study identified the best non-pharmacological multicomponent interventions to improve frailty or prefrailty in community-dwelling older adults, providing a basis for the development of practical interventions in later gerontological nursing practice. PROSPERO: CRD420251115805.