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The prevalence of frailty among older adults residing in nursing homes is high, indicating the importance of effective interventions to prevent and reduce frailty. One such intervention, VIVIFRAIL, is an exercise program that benefits older adults with frailty. The primary aim of this study was to evaluate the feasibility (recruitment, adherence, compliance, attrition, motivation and satisfaction) of the VIVIFRAIL program in an institutional setting. The secondary aim was to examine the efficacy of the VIVIFRAIL intervention in improved frailty status, reduced frailty prevalence and improving health indicators, activities of daily living (ADLs) and quality of life (QOL) in older adults. This study was a randomised-controlled, assessor-blinded, prospective trial conducted from July to September 2024 among older adults residing in nursing homes. A total of 80 participants were enrolled, and the study had recruitment, adherence and compliance rates of 100%. The attrition rate was 7.5%, and the motivation and satisfaction rates were 86% and 87%, respectively. Significant improvements were observed in frailty status (P = .002), physical performance (P = .001), cognitive function (P = .025), ADLs (P < .001) and QOL (P < .001). Bonferroni post-hoc analysis indicated significant differences across all time points for frailty status (P < .001). The VIVIFRAIL exercise program was determined to be feasible for older adults residing in nursing homes and significantly improved frailty status, health indicators, ADLs and QOL. These findings support the incorporation of structured exercise interventions as an essential component of routine care provided by health-care professionals in nursing home settings.
There is considerable evidence indicating that nursing students demonstrate inadequate knowledge and negative attitudes toward working with older adults. This suggests nursing student's unpreparedness to provide care for the expanding older adult population. Feelings of unpreparedness can negatively impact their motivation and confidence. However, limited evidence exists about how nursing students' knowledge and attitudes influence their self-efficacy in caring for older adults. Knowing this can help to identify gaps and opportunities to facilitate nursing students' confidence in caring for older adults in acute care settings. To examine nursing students' knowledge, attitudes, and self-efficacy and how these variables impact nursing student self-efficacy in caring for older adults in acute care settings in Ghana. We employed explanatory sequential mixed method approach. In Phase I, we used a cross-sectional design and collected quantitative data about students' knowledge, attitudes, and self-efficacy. Data were collected from 170 second and third-year nursing students between December 2019--March 2020. We analyzed the data using descriptive and multiple-variable linear regression. Survey results informed the selection of students for Phase II based on their scores. In Phase II, 17 nursing students were purposively selected for semi-structured interviews between November and December 2020. Interviews were transcribed and analyzed using thematic analysis. Both results were integrated and presented. Students' mean age was 21 years (SD = 3.73). Just over half were female (54%). The majority had lived with/were currently living with older adults (83.0%). Many had low knowledge scores (71%) and a majority had positive attitudes (91%) and high self-efficacy scores (97%). Nursing students' ages and attitudes were significantly positively associated with their self-efficacy. There was no significant association between students' gerontology knowledge and self-efficacy. Qualitative findings showed that low knowledge scores were due to limited attention to gerontology education in the curriculum and heavy course load. Sociocultural norms in caring for older adults influenced students' positive attitudes. This facilitated students' interactions with older adults and increased their confidence. Higher self-efficacy scores were associated with the impact of the general nursing program, students' perceived familiarity with the needs of older adults and routine procedural knowledge. Younger students perceived that their age and competencies were questioned by older adults, impacting their self-efficacy. Both datasets converged at integration. It is imperative to enhance students' knowledge and leverage their self-efficacy to advance gerontological nursing education and practice in Ghana.
The new Universal Health Insurance (UHI) reforms aim to improve equity and quality of healthcare delivery; however, their sustainability depends on engagement and retention of the nursing workforce. Psychological empowerment has been identified as a key factor influencing nurses' attitudes and work-related behaviors, yet the evidence on how it relates to job embeddedness among nurses working in the early phase of UHI implementation in Egypt remains underexplored. This study aimed to assess the association between psychological empowerment and job embeddedness among nurses under the umbrella of the new Universal Health Insurance in Egypt. A descriptive cross-sectional design was employed from August 2025 to November 2025. A total of 213 nurses working at Aswan Specialized Hospital, affiliated with the UHI system in Upper Egypt, were recruited. Data were collected using a demographic questionnaire, and psychological empowerment was measured using the Psychological Empowerment Scale, and job embeddedness was assessed using the Global Job Embeddedness Scale. Descriptive statistics, Pearson correlation analysis, and hierarchical linear regression were used for data analysis. Among 213 nurses, the mean score of psychological empowerment was reported at high overall levels of 5.75 (SD = 0.77), particularly in the dimensions of competence and meaning, alongside moderately high levels of job embeddedness, with a mean score of 4.76 (SD = 0.89). Psychological empowerment showed a significant positive correlation with job embeddedness (r = 0.512, p < 0.001). In hierarchical regression analysis adjusting for demographic and professional covariates, psychological empowerment emerged as a strong and independent predictor of job embeddedness (β = 0.55, 95% CI: 0.398-0.701, p < 0.001), explaining an additional 16.5% of the variance after controlling for covariates (ΔR2 = 0.165). In adjusted analyses, the covariates were not independently associated with job embeddedness. Psychological empowerment was positively associated with nurses' job embeddedness in the UHI implementation setting. Higher levels of empowerment-related factors were positively associated with greater embeddedness, suggesting their relevance to workforce engagement and retention during health system reform. Our study findings highlight that psychological empowerment plays a crucial role in fostering nurses' job embeddedness, which is critical for sustaining workforce retention and stability. Enhancing supportive leadership and nurses' involvement in decision-making is critical, especially during the early phase implementation of the universal health insurance system reform.
Continuity of care prioritizes patient-centered approaches. Effective continuity of care is essential for ensuring high-quality service delivery and benefits for patients in the end-of-life phase. Although continuity of care has been well-established, few studies have focused on promoting continuity of care in big cities. The purpose of this action research was to develop a model for continuity of care during the end-of-life phase in Bangkok. Key participants were 8 nurses involved in continuity of care services. The data collection consisted of in-depth interviews, focus group discussions, observation, and document reviews. The research process followed the action research cycle. Content analysis was employed. The 3 emerging domains of continuity of care during the end-of-life included (1) comprehensive patient information; (2) collaborative care management; and (3) technology-supported care. The participants indicated that the key factors to successful continuity of care during the end-of-life involved: (1) clear goals; (2) effective communication; (3) proactive coordination; and (4) good health care provider-client relationships. The model motivated nurses and other providers in the hospital to change practices associated with continuity of care for palliative care patients. This study's findings provide a foundation for future research to strengthen sustainable care continuity and develop palliative care networks in urban Thailand.
This study aimed to develop a scale to evaluate the reliance level on ChatGPT in learning for nursing students and then test and validate its psychometric properties. The rapid adoption of ChatGPT has raised concerns regarding reliance on ChatGPT in learning. There is significance in categorizing students by their reliance level on ChatGPT. A methodological study guided by established scale-development frameworks. A three-phase procedure was used to develop this scale and to determine its psychometric properties: (1) generating the item pool, (2) conducting a preliminary evaluation of the items and (3) analyzing its psychometric properties. The study examined the scale's face, content, construct validity; internal consistency; and temporal stability. A total of 633 students participated in testing the scale's psychometric properties, with data collection occurring between August and December 2024. The scale's content validity index was 0.89. According to principal component analysis, the scale included 29 items and four sub-dimensions and the total variance was 70.031 %. In confirmatory factor analysis, the fit indices were acceptable for this construct. Its internal consistency was good or acceptable according to reliability analysis. Test-retest showed that the scale had stability. Reliance on the ChatGPT Scale for Nursing Students is a valid and reliable instrument that can evaluate the level of reliance on ChatGPT in learning, which is useful for both researchers and educators. Future research should concentrate on longitudinal studies to evaluate how reliance on ChatGPT evolves over time and affects educational outcomes.
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 < 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.
To examine the association between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and depressive symptoms among rural older adults in South Korea and explore implications for gerontological nursing. The current cross-sectional study used 2022 national survey data from 456 rural adults aged ≥65 years. Depressive symptoms, measured using the Patient Health Questionnaire-9 (PHQ-9), and vitamin D status (<20 ng/mL vs. ≥20 ng/mL) were analyzed using adjusted logistic and linear regression. Vitamin D deficiency was significantly associated with greater odds of depressive symptoms (odds ratio = 2.59, p < .001), and lower serum 25(OH)D3 levels were independently associated with higher PHQ-9 scores (β = -0.177, p < .001). Female sex was also a significant predictor. Vitamin D deficiency may be a modifiable factor in depression screening. Including vitamin D assessment in gerontological nursing practice may support early identification and prevention in rural older adults.
To describe older adults' lived experience with a chronic wound in a long-term care (LTC) facility, with the ultimate goal of enhancing well-being and overall quality of life (QoL). A descriptive phenomenological design guided by Colaizzi's method was used. Seven cognitively intact LTC residents with chronic wounds were interviewed using a semi-structured guide. Interviews were analyzed inductively through multiple coding cycles, consensus-building, and member checking. Four interrelated themes were constructed: Lack of Independence, Confinement and Limitations, Interruptions to Daily Life, and Emotional Sequelae. Participants described physical and emotional burdens, a reliance on staff, and disruptions to routines and relationships. Despite challenges, most expressed appreciation for the wound care received in the facility. Chronic wounds deeply affect quality of life and identity. Clinicians should recognize the emotional and social dimensions of wound care. Results can help guide clinicians in LTC facilities to improve residents' wound healing and promote overall QoL.
We have developed a quality indicator for long-term care (LTC) that can be applied across various care settings, advancing the "Visualizing Effectiveness of Nursing & Long-term Care (VENUS) indicators." This study assessed the feasibility and reliability of the VENUS indicators in LTC hospitals and revised the evaluation forms and guides based on these findings. This study included 24 nurses and 12 care workers employed in two LTC hospitals in the Tokyo metropolitan area. Each group, consisting of two nurses and one care worker, was asked to evaluate VENUS indicators for the same patient. The missing data rate and inter-rater reliability between the two nurses and between the nurses and care workers were calculated. Interviews were conducted to gather feedback on the use of VENUS indicators, followed by revisions to the evaluation forms and guides. The revised forms were re-evaluated, and opinions on re-evaluation were collected. The average missing data rate for evaluations was 20.0%, with particularly high missing rates for the following indicators: "Poor family wellbeing," "Neglecting the client's desired way of life," "Lack of social interaction," and "Social isolation." On the other hand, the inter-rater reliability was high, with an average of 89.4% between nurses and 92.0% between nurses and care workers. After the revision of the evaluation forms and guides, it was reported that the criteria for evaluating patients with communication difficulties and their families were clarified, making it easier for them to evaluate. In LTC hospitals, the VENUS indicators showed high overall feasibility and reliability, although there were challenges in the feasibility of some items. The revision of the evaluation forms and guides allowed for clearer criteria based on which patients' conditions could be assessed. This research has the potential to contribute to maintaining consistency in quality evaluation across various LTC settings and to improve the quality of LTC.
Older adults hospitalized in an intensive care unit (ICU) frequently experience adverse outcomes, including delirium, functional decline, medication-related harm, and goal-discordant care. Despite the availability of evidence-based interventions to address these risks, adoption and sustained implementation remain limited. The Age-Friendly Health Systems 4Ms Framework offers a policy-aligned structure for advancing adoption and sustainability of gerontological nursing interventions in the ICU. The Centers for Medicare & Medicaid Services announcement of the 2025 Age-Friendly Hospital Measure marks a turning point: hospitals will be incentivized to deliver care integrated with the 4Ms (What Matters, Medication, Mentation, and Mobility) to older adults. The introduction of this new measure presents a timely opportunity to align innovative gerontological nursing interventions with institutional quality goals. Grounding interventions in the 4Ms will facilitate engagement with key stakeholders, including frontline health care providers and hospital leadership, who are essential to the adoption and sustainability of age-friendly critical care for older adult patients in the ICU.
To describe a systematic process for developing an art making intervention, guided by a previously developed theoretical framework outlining its proposed mechanism of action as a potential pain management strategy for older adults. A multi-method approach that combined a descriptive qualitative study and survey methodology was used. Initially, a qualitative study with 11 older adults experiencing various chronic pain conditions provided insights into their perspectives on the preliminary intervention. Participants described the intervention, which included drawing, painting, and craft activities, as generally appropriate but in need of revisions to instructional details and difficulty levels. Based on this feedback, we created six independent intervention books featuring activities at three levels of difficulty. A quantitative survey was conducted with five content experts and three experiential experts to collect formative evaluations of the revised intervention. The eight experts rated the revised intervention highly overall but recommended improving the organization of the written and visual instructions and ensuring the use of age-appropriate language. The final intervention offers 20 art making activities delivered in a home-based, individual format using an art making activity book and YouTube channel. By using a multi-method design, we tailored the intervention to the unique needs of older adults while grounding it in our theoretical framework describing its proposed mechanism of action for chronic pain management. Future studies are needed to rigorously test our hypotheses and evaluate the intervention's efficacy in reducing pain intensity among older adults.
This study evaluated the feasibility and acceptability of Ōura, a finger-worn sensor used to monitor heart rate variability (HRV) as a digital biomarker of stress among Korean-American home care workers caring for Korean-American individuals with dementia. This prospective, single-cohort study included 15 home care workers who wore Ōura for 21 days, with HRV data collected over a 14-day analysis period. Feasibility and acceptability were evaluated through quantitative and qualitative approaches. All participants were female, with a median age of 61 years, and each cared for a median of 1 Korean-American individual with dementia (range: 1 to 3 care recipients). We achieved an 88.24% retention rate and a 100% completion rate. Of the 210 potential daily HRV data points, 94.2% were valid. Participants reported high ease of use and comfort wearing the ring. Qualitative findings revealed themes of enhanced health awareness, variability in comfort and fit, and a need for more information about the health data provided by the ring application. The findings demonstrate the feasibility and acceptability of using a finger-worn sensor in Korean-American home care workers. Future studies should address data validity issues and explore the clinical utility of HRV monitoring via finger-worn sensors for stress management in this understudied population.
Social support networks are essential for maintaining quality of life among older adults, particularly in nursing homes where loneliness and isolation are common. The current study analyzed the perceived impact of formal and informal social support networks on emotional well-being and evaluated recreational activities as factors promoting social connections among older adult residents in Spain. A qualitative study was conducted using semi-structured interviews with seven nursing home residents. Data were analyzed thematically to identify key aspects of social support and well-being. Participants highlighted the importance of family visits, peer relationships, and nursing staff support in enhancing emotional well-being. Although many reported satisfaction with their social environment, some expressed a need for more diverse recreational activities to foster social interaction. Maintaining external connections was also deemed essential. Strengthening social support networks and increasing opportunities for meaningful social engagement can significantly improve the emotional well-being of older adults residing in long-term care facilities.
The Age-Friendly Health Systems (AFHS) is a national initiative that ensures evidence-based care for older adults. To facilitate implementation, direct care providers created a questionnaire for older adults to complete before a clinic visit. The current mixed methods study evaluated the questionnaire's acceptability using the Theoretical Framework of Acceptability and explored provider perceptions of the questionnaire. In 2022, the questionnaire was sent to 1,100 retail health clinics. After 4 weeks of use, an online survey was sent to 3,300 direct care providers (e.g., nurse practitioners, physician assistants) at these clinics. Higher-than-average acceptability of the questionnaire in most of the Theoretical Framework of Acceptability domains was reported and self-reported implementation, completion, and documentation of all AFHS 4Ms improved. In open-ended responses, direct care providers described how the questionnaire was user-friendly and improved clinic visit efficiency. Direct care provider innovations help overcome real-world challenges, improving the effective implementation and delivery of evidence-based practices in a retail health clinic setting.
To investigate the prevalence of and factors associated with subjective cognitive decline (SCD) in middle-aged adults. The current cross-sectional study used convenience sampling to recruit community-dwelling adults aged 50 to 64 years. Data collected included demographics, disease characteristics, frailty, depression, sleep quality, and social support. A logistic regression model identified significant risk factors related to SCD. In total, 200 middle-aged adults participated in the study, with a 15% prevalence of SCD. Multiple logistic regression models revealed that chronic diseases, smoking, and poor sleep quality were significantly associated with increased SCD. Specifically, participants with chronic diseases (odds ratio [OR] = 2.99, 95% confidence interval [CI] [1.27, 7.04]), those who smoked (OR = 3.51, 95% CI [1.23, 10.02]), and those reporting poor sleep quality (OR = 3.18, 95% CI [1.36, 7.49]) had significantly higher likelihoods of experiencing SCD compared to their counterparts. This study identified significant associations among chronic disease status, smoking, and poor sleep quality and the presence of SCD among middle-aged adults. Although causal relationships cannot be established, findings highlight the need for greater attention to cognitive health in individuals with these risk profiles. Further longitudinal research is warranted to clarify temporal relationships and assess the potential value of targeted monitoring strategies in at-risk populations.
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Dietary supplements are commonly used by older adults for concerns such as memory loss or to slow the progression of Alzheimer's disease. However, these agents are not regulated by the U.S. Food and Drug Administration. Furthermore, there are limited long-term studies evaluating safety and efficacy, especially in older adults. The intent of the current article is to review the recent literature on commonly used dietary supplements in older adults to reduce the risk of cognitive decline and dementia. Systematic reviews and/or meta-analyses published within the past 10 years were reviewed to provide recommendations on the use of dietary supplements for brain health. There is limited evidence supporting the efficacy of commonly used dietary supplements but there are germane safety concerns that need to be considered by the interprofessional team. Future research should prioritize standardized dosing, diverse older adult populations, and long-term outcomes focusing on efficacy and safety.
This scoping review evaluates the effectiveness of community-based interventions addressing frailty's multidimensional impacts (physical, nutritional, and psychosocial) in older adults, emphasizing nurses' roles in crisis-responsive care during pandemics. A scoping review was conducted using Arksey & O'Malley's framework and PRISMA-ScR guidelines. Thirty-one studies were from 2019 to 2023, sourced from PubMed and Scopus, spanning five continents. Study quality was assessed with the Newcastle-Ottawa Scale; outcomes included frailty reduction and quality-of-life metrics. Interventions included physical rehabilitation (e.g., Otago Exercise Program), nutritional optimization, psychosocial support, technology-enhanced models (e.g., telemedicine), and social engagement. Multicomponent interventions outperformed single-domain approaches, improving gait speed, reducing frailty progression, and mitigating depression. Telemedicine maintained 78% care continuity during lockdowns. Asian family-centered models excelled, but 84% of evidence came from high-income countries, highlighting low- and middle-income country (LMIC) gaps. Gerontological nurses are pivotal in delivering culturally adapted care by coordinating interprofessional home-based teams, integrating gerotechnology in resource-limited settings, and advocating for policy reforms to bridge urban-rural disparities. These findings underscore nursing's role in equitable, resilient frailty management.
To examine fall-related medications and fall risk as predictors of fall-related hospitalizations among a cohort of community-dwelling older adults in the southern tier of New York State. Participants comprised 8,499 patients from 14 primary care practices within a large community hospital system. Bivariate and multivariate analyses were conducted to examine associations between fall-related medications and fall risk, and their interactions as predictors of fall-related hospitalizations. There was a statistically significant association between fall risk and Fall Risk Medication Score (FRMS) with a cut-point ≥6 (χ2 = 85.145, p < .001), with a weak but significant positive correlation (φ = 0.100, p < .001). Older adults who had fall risk were 1.738 times more likely to have a FRMS ≥6 (95% confidence interval [CI] [1.544, 1.956]). Similarly, there was a statistically significant association between fall risk and FRMS with a cut-point ≥10 (χ2 = 68.953, p < .001), with a weak but significant positive correlation (φ = 0.090, p < .001). Older adults who had fall risk were 2.348 times more likely to have a FRMS ≥10 (95% CI [1.909, 2.887]). In logistic regression analyses, the interaction between fall risk and FRMS was a significant predictor of hospitalization when controlling for age and sex (p < .001); however, FRMS did not significantly improve the model over fall risk alone. Current tools for assessing and weighing the personal, environmental, and pharmacological factors that influence the likelihood of falls among older adults could be significantly improved through larger cohort studies using significant endpoints, such as fall-related hospitalizations.