Fall incidents are a rising problem amongst older people and can have multiple causes. Vestibular disturbances such as benign paroxysmal positional vertigo (BPPV) are often not recognized as risk factors. The aim of our study is to determine the prevalence of BPPV in an older population referred to the geriatric falls clinic. Second, we aim to examine whether there is a reduction in the number of fall incidents and severity of fall incidents after a successful repositioning manoeuvre in patients with BPPV. Dutch adults, aged ≥ 65 years, referred to the specialised falls clinic with an increased risk of falling were included. Subjects with additional neuro-otologic disorders or with severe disability were excluded. All participants were subjected to diagnostic manoeuvres to determine whether they had BPPV. If positive, they were treated with a canalith repositioning manoeuvre and were followed up according to regular care. Participants were asked to recall the number and severity of fall incidents of the past six months at time of inclusion. During follow-up, they were asked to record every fall incident and the corresponding severity in a provided falls diary. After follow-up, fall incidents were compared between participants with and without BPPV and within participants with BPPV before and after treatment. A total of 79 (56%) out of 142 eligible subjects agreed to participate and were included. Fifty-eight (73%) were female and the median age was 82 years (± 6). We found a total of 15 subjects (19%) with BPPV of whom 7 (47%) reported no complaints of BPPV. We found no differences in the number and severity of fall incidents between the groups in the 6 months prior to inclusion. We determined a significant reduction of the number of fall incidents 6 months after treatment within the BPPV group (p = 0.04). Approximately one-fifth of geriatric patients presenting to the falls clinic appeared to have BPPV and half of these patients reported no complaints of BPPV. BPPV seems to contribute to the risk of fall incidents in older people. Since treatment is easy to perform and likely to reduce fall incidents, we think it is of great importance to routinely check for BPPV in older patients with an increased risk of falling. Approval by the medical ethics review board of Leiden University Medical Centre (September 28th 2018; trial number: P18.113) and the institutional review board of Gelre Hospitals (October 16th 2018, trial number: 18.39).
Death wishes and end-of-life legislation are increasingly relevant in ageing societies, where demographic shifts and evolving legal frameworks appear to raise complex ethical and clinical challenges. Wishes to die among older adults are complex and not limited to mental illness or terminal illness. Although depression and demoralization are common, evidence suggests that many older individuals experience these wishes in the absence of psychiatric disorders. These experiences often reflect an existential response to cumulative losses in autonomy, identity, and social embeddedness. This review organizes existing literature using a multilevel explanatory framework. At the psychological-existential and identity level, death wishes are associated with depression, demoralization, loss of meaning, and narrative disruption. At the social-relational level, loneliness, perceived burdensomeness, and social disconnection play a central role. At the structural-cultural level, ageism, societal narratives of dependency, and broader cultural meanings of ageing contribute to the emergence and interpretation of death wishes. At the legal-ethical level, medical assistance in dying (MAiD) frameworks shape how autonomy, suffering, and legitimacy of death wishes are understood in different jurisdictions. Across these levels, death wishes appear to arise from interacting psychological, relational, and societal processes rather than from a single underlying cause. Qualitative studies further highlight the deeply personal nature of these experiences, often linked to feelings of being a burden, narrative closure, or perceived loss of future meaning. Clinically, evidence indicates that a purely psychiatric or autonomy-driven approach is insufficient. Instead, effective responses require narrative competence, existential sensitivity, and awareness of contextual influences. This review synthesizes these findings into an integrated conceptual framework and outlines key implications for clinical practice in geriatrics, psychiatry, and palliative care. This review argues for a multidimensional approach that recognizes death wishes not only as clinical or legal phenomena, but as deeply human expressions of suffering, identity, and relationality in the context of ageing.
Early chemotherapy (CTh) discontinuation in gastrointestinal (GI) cancer patients can compromise treatment effectiveness and worsen outcomes. Monitoring and addressing patient-reported symptoms may reduce early discontinuation. Yet, evidence of baseline symptoms routinely collected in standard clinical practice remains limited. This retrospective cohort study included adult patients with GI cancers who received CTh at Mass General Brigham between 01/2019 and 01/2024. The patient-reported outcome version of the Common Terminology Criteria for Adverse Events assessed 12 symptoms at CTh initiation and at visits proximal to 30, 60, and 90 days from initiation. All patients completed baseline assessment. The primary outcome was early discontinuation due to toxicity within 90 days of initiation. Using the Fine-Gray model to account for competing risks of death and progression, we examined the association between early discontinuation and number of completed assessments over time. We tested whether this association differed across prognostic groups. To address time-varying bias from disease severity, treatment, and prior completion, we applied inverse probability weighting. Among 1178 patients, the most common cancers were colorectal (35%) and pancreatic (31%), and 45% had stage IV disease. Overall, 784 (67%) completed assessments at CTh initiation and during follow-up. After adjusting for demographic and clinical covariates and time-varying bias, completing post-initiation assessments was associated with a lower cumulative risk of early discontinuation (SHR: 0.70 [95% CI: 0.44-1.12]). Results were generally consistent across prognostic groups. More frequent completion of patient-reported symptom assessment post-CTh initiation was associated with a trend toward a lower risk of early discontinuation in practice.
Metabolic syndrome (MetS) is associated with increased dementia risk, but its relationship with brain aging is unclear. The study included 27,375 UK Biobank participants aged 40 to 70 years. MetS was defined as having at least three of five components: central adiposity, hypertension, dyslipidemia, hypertriglyceridemia, and hyperglycemia. Levels of 33 plasma metabolites were measured from baseline blood samples. Brain age was estimated using a machine learning model based on 1079 phenotypes from brain magnetic resonance imaging (MRI) scans and used to calculate brain age gap (BAG, i.e., brain age minus chronological age). Participants with MetS had significantly higher BAG compared to MetS-free individuals (β = 1.13; 95% confidence interval [CI]: 0.99 to 1.27). Each individual MetS component was also associated with higher BAG. Eight metabolites significantly mediated the MetS-BAG association (mediation proportion: 2.6% to 16.5%), including apolipoproteins, fatty acids, and inflammatory markers. MetS is associated with accelerated brain aging, partly mediated by inflammation and altered lipid metabolism.
Recent advances in biotechnology and personalized medicine have driven the development of efficient clinical trial methodologies for assessing treatment efficacy across multiple populations defined by treatment effect modifiers. Within-patient comparison of different treatments is a promising approach for improving study efficiency across multiple populations by eliminating between-patient variability in treatment evaluation. This study provides a framework for evaluating treatment efficacy in multiple populations for 2 × 2 $$ 2\times 2 $$ crossover trials and evaluates the efficacy gain in comparison with the standard parallel-group analysis. Simulation experiments confirm that the crossover analysis consistently outperforms the parallel-group analysis in statistical power, especially when carryover effects are small. An application to a clinical trial in Type 2 diabetes demonstrates the efficiency advantages of the crossover analysis. These numerical results emphasize the potential of the crossover analysis for enhancing the efficiency of clinical development of personalized medicine.
Retinopathy, as a manifestation of systemic microvascular dysfunction, has been increasingly recognized as a potential indicator of cerebrovascular disease. However, evidence regarding the association between retinopathy and stroke risk remains inconsistent. This meta-analysis aimed to quantitatively evaluate the relationship between retinopathy and the risk of stroke. A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and CNKI from inception to June 12, 2025 to identify observational studies examining the association between retinopathy and stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Due to heterogeneity in retinopathy classification, only studies with comparable exposure definitions were included in the quantitative synthesis, while others were summarized qualitatively. Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist, as appropriate. A total of 23 studies were included, of which 10 were eligible for quantitative meta-analysis. The pooled results demonstrated that retinopathy was significantly associated with an increased risk of stroke (OR = 1.87, 95% CI: 1.50-2.33). Subgroup analyses indicated a graded relationship between retinopathy severity and stroke risk, with higher risks observed in more advanced stages. The association was generally consistent across subgroups stratified by country, age, and study characteristics. Sensitivity analyses confirmed the robustness of the findings. Although no significant publication bias was detected, a potential small-study effect could not be entirely excluded. This meta-analysis provides evidence that retinopathy is significantly associated with an increased risk of stroke, suggesting that retinal microvascular abnormalities may represent a promising marker associated with cerebrovascular risk. However, their predictive utility for clinical risk stratification requires further validation in prospective studies. Routine retinal assessment may aid in the early identification of high-risk individuals and inform targeted prevention strategies.
It is unclear if adherence to healthy guidelines can modify the association between polygenic risk score (PRS) for type 2 diabetes and dementia. This study aimed to investigate interrelationships between PRS for type 2 diabetes, Life's Essential 8 (LE8) metrics, and dementia. We included 437,732 UK Biobank participants aged ≥40 years between 2006 and 2010. PRS for type 2 diabetes was calculated by summing weighted genetic variant effects. Incident all-cause and cause-specific dementias were identified using registry records up to December 2022. LE8 scores were classified as low vs. moderate-to-high levels. Cox regression and restricted cubic splines were applied. Over an average follow-up of 13.27 years (SD = 2.27), 9425 participants developed dementia. A dose-response relationship was observed between PRS and vascular dementia, with risk rising sharply beyond the 95th percentile. Individuals with low LE8 constantly showed a higher risk of all-cause dementia than those with moderate-to-high LE8 across all values of PRS for type 2 diabetes. APOE ε4 accounted for more than 35% of the population-attributable risk of dementia, whereas the PRS for type 2 diabetes contributed only 1%. The population-attributable risk of all-cause dementia could be further reduced by 5.91% to 10.46% through maintaining moderate-to-high LE8 behavioral components, even after considering APOE ε4. A dose-response relationship exists between PRS for type 2 diabetes and dementia, particularly vascular dementia. Adherence to optimal LE8 metrics, particularly behavioral components, may contribute to dementia prevention across genetic strata. These findings highlight the importance of multidomain lifestyle interventions in dementia prevention.
Aging accompanies metabolic dysregulation, wherein the liver exhibits high sensitivity to age-related changes. AMP-activated protein kinase α2 (AMPKα2), a key energy metabolism regulator, lacks investigation regarding germline knockout effects on aged liver phosphoproteins. This study investigated germline AMPKα2 knockout effects on aged mouse liver through morphological analysis, Western blot (WB), and phosphoproteomics. AMPKα2 knockout significantly exacerbated glucose-lipid metabolism dysfunction, inflammatory responses, and age-related morphological changes, with enhanced senescent phenotypes validated by WB. Data-independent acquisition (DIA) phosphoproteomic analysis identified 4,448 specific phosphopeptides, among which 316 significantly differentially modified peptides. AMPKα2 knockout enhanced phosphorylation of glucose-lipid metabolism proteins, such as acetyl-CoA carboxylase 1 (Acaca) at S118, S80, S79, S157, and S117 sites, and genomic instability proteins, such as HSP90β (Hsp90ab1) at S255. Conversely, stress response protein HSP27 (Hspb1) phosphorylation at S86 was significantly reduced, validated by WB. This study revealed novel molecular signatures of AMPKα2 knockout in exacerbating hepatic aging and metabolic dysfunction, suggesting HSP27 as a potential AMPKα2 downstream effector through site-specific phosphorylation. This work first delineated the phosphoproteomic landscape of aged liver in AMPKα2 knockout mice, establishing foundations for targeting specific protein phosphorylation sites as therapeutic targets for age-related liver diseases.
Syphilis has become an increasing public health concern in recent times, with rising incidence globally. It is often referred to as the 'great imitator' due to its diverse clinical presentations across multiple stages. Neurosyphilis, a tertiary manifestation of Treponema pallidum infection, can present with neuropsychiatric features including rapid cognitive decline. It remains an important but potentially overlooked cause of cognitive impairment (CI). However, few cases document objective cognitive and functional improvement following treatment, especially within a short time frame. We describe the case of a 67-year-old man with rapid cognitive decline, displaying impairments in various cognitive domains: learning and memory, attention and executive functioning. The presence of Argyll-Robertson pupils combined with positive serological and cerebrospinal fluid testing confirmed a diagnosis of neurosyphilis. Following treatment with intravenous penicillin G, serial cognitive assessment demonstrated objective improvement in his cognition and functioning within 1 month of treatment. Our observation of such an improvement in neurosyphilis-driven CI in this time frame is a finding not commonly documented in associated literature. This case highlights the importance of thorough history taking, including a sexual history, alongside physical examination in diagnosing neurosyphilis. Additionally, it supports the importance of considering neurosyphilis when investigating patients with unexplained cognitive decline and suggests there is a degree of reversibility when treated promptly. Further research is needed to better characterise the treatability of neurosyphilis-related CI.
Radiotherapy-associated pain is among the most common and debilitating complications in head and neck cancer. Although historically viewed primarily as a treatment-related adverse effect, growing evidence suggests that pain is deeply intertwined with tumor biology, immune remodeling, and therapeutic outcomes. At the same time, recent advances in cancer neuroscience have identified sensory nerves as active components of the tumor microenvironment (TME), capable of influencing antitumor immunity through complex neuroimmune crosstalk. These observations raise the possibility that radiotherapy-associated pain is not merely a clinical symptom but also a biological indicator of dynamic changes within the tumor immune microenvironment (TIME). In this review, we outline the major clinical manifestations of radiotherapy-associated pain in head and neck cancer, including inflammatory or mucositis-related pain, neuropathic pain, and long-term chronic pain, with emphasis on their underlying biological features and potential therapeutic relevance. Given that oral mucositis is the dominant source of acute radiotherapy-associated pain in head and neck cancer, we further summarize evidence-based preventive and supportive strategies, including photobiomodulation, mucosal barrier-forming agents, anti-inflammatory mouthwashes, nutritional interventions, pain control, and multidisciplinary oral care. We further discuss how radiotherapy reshapes the TIME through mechanisms such as immunogenic cell death, activation of the cGAS-STING pathway, vascular and stromal remodeling, and regulation of lymphoid compartments, while also triggering compensatory immunosuppressive responses. Preclinical and translational studies suggest that nociceptive signaling pathways may modulate T-cell function, myeloid-cell activity, and immune-evasive programs. Through these neuroimmune interactions, radiotherapy-induced neural injury and persistent pain may contribute to the establishment of an immunosuppressive, wound-like microenvironment that ultimately affects treatment response and tumor progression. Finally, we discuss the translational significance of incorporating pain phenotyping into combined radiotherapy and immunotherapy strategies for head and neck cancer. Opioid-sparing multimodal analgesia, neuromodulation, and neuroimmune-targeted interventions may represent promising approaches to simultaneously improve symptom control and antitumor immunity. We propose that radiotherapy-associated pain may be considered a candidate neuroimmune phenotype rather than a passive adverse event, providing a new conceptual framework for precision management and translational research in head and neck cancer.
This study aimed to explore older adults' experiences of using smart devices and mHealth apps for proactive health and identify the key factors affecting their adoption and sustained engagement. The current study utilized descriptive qualitative research methodology, adopting the Technology Acceptance Model (TAM) as the theoretical framework. Purposive sampling was used to recruit older adults from a tertiary Grade A general hospital in Hangzhou. Data were collected through semi-structured interviews and analyzed using directed content analysis. A total of 20 older adults in Hangzhou were interviewed for the study. Analyses yielded two themes and eight sub-themes: perceived usefulness (enhanced health awareness and self-efficacy, real-time health data monitoring and early warning, accuracy and reliability of information and convenient communication with medical professionals), and perceived ease of use (interface simplicity and operability, learning cost and learning support, privacy concerns and information security, and technical support and experience sharing). This descriptive qualitative study explores older adults' experiences of using smart devices and mHealth apps for proactive health, highlighting that perceived usefulness and ease of use are key determinants of their technology adoption and sustained engagement. Future digital health tool development should align with research on older adults' user experiences to ensure these technologies' universality and applicability.
Alzheimer's disease (AD) is a multifactorial disorder involving various pathological mechanisms, such as amyloidosis, immune dysfunctions, and synaptic impairments, which are important therapeutic targets. Repurposing drugs to target these mechanisms offers a promising approach to reduce the costs and duration of drug development. Genetic studies underscore the critical role of microglial clearance of amyloid-beta (Aβ) in AD pathogenesis. Specifically, soluble ST2 (sST2)-one of the two major isoforms of the ST2 protein encoded by the IL1RL1 (interleukin-1 receptor-like 1) gene-acts as a decoy receptor isoform that interferes with IL-33/ST2 signaling and has been identified as a disease-modifying factor that impairs microglial Aβ clearance functions. In this study, we investigated drug repurposing opportunities to modulate sST2 levels and alleviate AD pathologies. Unbiased screening of commonly used medications in AD patients, followed by validation in model systems, identified trazodone-an antidepressant used to treat major depressive disorder-as a leading negative regulator of sST2. Trazodone primarily suppresses sST2 expression through its antagonistic effects on adrenergic signaling. In the APP/PS1 transgenic mouse model of AD, trazodone treatment enhanced microglial interaction with Aβ and alleviated Aβ pathology. Furthermore, trazodone reduced neurodegeneration and rescued synaptic deficits in APP/PS1 mice. Comprehensive molecular profiling of APP/PS1 mouse brains showed that trazodone restored the expression of synaptic proteins critical for synaptic integrity and plasticity. Overall, these findings demonstrate that trazodone is a promising repurposing candidate for AD that targets underlying immune dysfunctions and synaptic impairment.
Background: There are very few studies on walking recovery, its predictors and impact on survival in oldest-old patients after a hip fracture. Methods: This study is a retrospective review which included all patients older than 95 years admitted with a fragility hip fracture between December 2009 and September 2015 in a tertiary university hospital in Barcelona. Walking ability was assessed using the Functional Ambulation Classification (FAC) prior to admission and 6 months after discharge. The objective of our study is to assess walking recovery and its predictors in oldest-old patients at 6 months after discharge, and to determine whether there was a relationship with short and long-term survival. Results: One hundred and fifty-two patients were included in the study. Prior to the fracture, 78.3% of patients could walk independently, 36.8% after the fracture. A higher previous FAC score (p < 0.001, OR 3.658), absence of delirium during admission (p = 0.010, OR 3.45), and being able to carry out full weight-bearing (p = 0.026, OR 12.705) were associated with better walking recovery. The area under the ROC curve was 0.819 (p < 0.001). Mean survival after discharge was 2.24 years (SD 1.185). Patients with a post-fracture FAC ≥ 3 showed better survival. Conclusions: Predictors of walking recovery in patients with exceptional longevity were a higher previous FAC score, being able to carry out full weight-bearing, and absence of delirium. Patients able to walk unaided within six months of discharge showed better survival. These findings highlight the importance of functional outcomes when assessing prognosis in the oldest-old.
Adenocarcinoma with enteroblastic differentiation (AED) commonly develops in the stomach but rarely occurs at the lower esophagus or esophagogastric junction. This tumor may combine with another subtype such as neuroendocrine carcinoma, conventional adenocarcinoma, and so on. An 87-year-old male patient was admitted to our hospital because of anorexia. Esophagogastroduodenoscopy performed to investigate the cause of anorexia revealed a nearly circumferential elevated lesion at the lower esophagus and esophagogastric junction. Biopsy results showed AED with small foci of choriocarcinoma components. A CT scan showed multiple liver metastases. The patient died 11 days after admission due to hematemesis and hypovolemic shock. Autopsy demonstrated hemorrhage from the tumor, and 700 mL of blood had accumulated in the stomach, being a direct cause of death. As long-segment of Barrett's esophagus (LSBE) was observed in the background of the tumor, the tumor was considered to originate from LSBE. The tumor also extended along the intraesophageal and azygos veins and metastasized to the liver and lung. These results suggest that a peculiar type of carcinoma with aggressive biological behavior occurs in the LSBE.
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Background: Lowering low-density lipoprotein cholesterol (LDL-C) effectively reduces the risk of cardiovascular events. Therefore, we investigated LDL-C levels in geriatric patients undergoing comprehensive inpatient geriatric care. Methods: Patients aged ≥65 years who underwent inpatient comprehensive geriatric care were analyzed. Baseline, clinical, laboratory, and medical data were obtained from case records. For cardiovascular risk stratification, SCORE2, SCORE2-OP, or SMART2 was applied, and LDL-C targets for primary or secondary prevention of atherosclerotic cardiovascular disease (ASCVD) were defined. Factors associated with LDL-C values within guideline-recommended targets in the univariate analysis were entered into a logistic regression model to identify independent predictors. Results: Of 486 patients, 433 (median age 84.0 years; 67.2% female) were included in the final analysis. The majority of patients (371/433; 85.7%) had a very high cardiovascular risk profile. Lipid-lowering therapy (LLT) was identified in 222 patients (51.3%), while 205 patients (47.3%) had received LLT for ≥3 months. In 219 patients (98.7%), LLT was statin-based, either as monotherapy or in combination. The median LDL-C level in the entire cohort was 85 mg/dL (IQR: 63-114 mg/dL), whereas patients receiving LLT had a median LDL-C level of 66 mg/dL (IQR: 52-83 mg/dL). Overall, 193 patients (44.6%) achieved guideline-recommended LDL-C targets; among patients receiving LLT, 61.5% (126/205) were within target range. Intake of ≥5 medications per day was associated with pre-existing LLT (odds ratio: 3.036; 95% CI: 1.081-8.523; p = 0.035). Statin-based LLT was independently associated with achieving LDL-C targets (odds ratio: 3.383; 95% CI: 2.248-5.092; p < 0.001). Conclusions: Most patients did not achieve guideline-recommended LDL-C targets, while only half received lipid-lowering therapy, predominantly statin-based. Current risk assessment tools and approaches to polypharmacy may require adaptation for geriatric patients. Nevertheless, even the simple implementation of statin therapy alone could substantially improve cardiovascular preventive care in a large proportion of untreated older patients.
Interprofessional collaboration is proposed as an appropriate strategy to meet the increasingly complex care demands for older adults. The electronic health record (EHR) can support interprofessional teams in their daily work and quality improvement efforts. While various studies have reported on care professionals' perspectives on the EHR, to date, no study has compared the views of different care professionals on EHR use. This study aimed to investigate how different disciplines of care professionals in nursing homes view the use of EHRs. A qualitative design was adopted. Six homogeneous focus groups were organized, with certified nurse assistants, registered nurses, elderly care physicians, and students in these three professions. Conventional content analysis was used to analyze the focus groups. Forty-three (student) care professionals in the care for older adults participated in the focus groups. Analysis revealed three main themes. First, the EHR is mainly used as a communication tool, and further purposes, such as data-informed care, were pointed out as goals to be realized in the future. Second, better navigation of the EHR system necessitates skill development among EHR users and improvements in the technical functions of the EHR system. Finally, the EHR can support interprofessional collaboration in the care for older people. Yet, care professionals recognized that there is still room for improvement in such a collaboration. Different interpretations of what is considered good EHR reporting hindered effective collaboration. Proper collaboration with the EHR in the care for older adults requires increased digital literacy of care professionals, and EHR systems that are easier to use. Future studies should investigate what interprofessional teams need to better work together towards quality improvement in the care for older adults.
Geriatric rehabilitation (GR) is a key component of integrated care for older persons with multimorbidity, yet its fundamental care process and core components that enable effective GR remain poorly defined and highly variable. We conducted a systematic review (Registration ID: PROSPERO 2025 CRD42025642761) to identify and synthesise evidence on core components of the GR care process. Medline, CINAHL, Cochrane and Embase were searched to 31 January 2025. Randomised controlled trials (RCTs) and controlled prospective cohort studies involving multimorbid geriatric patients undergoing multidisciplinary GR programmes were included. Study quality was assessed using the JBI critical appraisal tool. Thirty-six studies (31 RCTs and 5 controlled prospective cohort studies), comprising 10,647 patients, met the inclusion criteria. Studies represented a broad range of GR service types. Substantial heterogeneity was observed in reported care processes, including terminology, team composition, workflow, contextual factors, and assessment methods, with over 90 different tools used. Comprehensive geriatric assessment (CGA) was rarely reported, patients with moderate to severe dementia were frequently excluded, and no study described the entire GR care process in a holistic manner. Current evidence shows substantial heterogeneity and fragmentation in the description and implementation of the GR care process, with variable depth of implementation, team structures and assessments. The lack of reproducible process structures and clearly defined core components limits comparability, implementation, and evaluation. Future research should adopt study designs spanning the full GR pathway across settings, incorporate standardised process indicators, a toolbox of CGA and goal-setting instruments and evaluate outcomes aligned with the biopsychosocial principles of the ICF.
Care partners of people living with dementia (PLWD) report significantly higher levels of stress, anxiety, and depression than non-care partners. Mindfulness-based programs improve overall well-being, but little research has evaluated the impact of emotional resilience programs for care partners of PLWD. This study reports the design and implementation of a pilot emotional resilience training initiative for care partners of PLWD. Three sessions were held at a monthly care partner support group. Emotional regulation skills were assessed using self-recorded emotional shifts before and after resilience practices. The feasibility and acceptability of the program was assessed using feedback collected through a post-survey and focus session. After participating in resilience practices, 82% of participants reported experiencing increased positive emotion. Most participants plan to use the program tools in the future and agree that their overall well-being improved after the training. Participants also noted that this program would be impactful for other care partners. The findings of this pilot study provide evidence that emotional resilience training may be a beneficial support strategy for care partners of PLWD.
Despite the broad impact of sleep in injury-related recovery, there is limited literature investigating how sleep may impact patients after anterior cruciate ligament reconstruction (ACLR). It is unclear whether patients perceive sleep changes as a result of ACLR and whether they perceive these changes to influence their health-related outcomes (eg, physical recovery, psychological functioning) in the early postoperative ACLR recovery phase. This qualitative study aimed to capture patient perceptions of sleep after ACLR as well as how they perceived the impact of sleep on their ACLR recovery within the first 3 months postoperatively. We aimed to better understand patients' subjective experiences regarding the role of sleep in recovery and to identify any barriers or facilitators to achieving optimal sleep when undergoing acute stages of ACLR rehabilitation. Qualitative study. Research university. Twelve participants aged 18 to 35 years and 1 to 3 months post-ACLR completed semistructured interviews via a videoconferencing platform. Audio and video recordings of each interview were transcribed verbatim to prepare for thematic coding. Transcriptions were anonymized with pseudonyms. Data were interpreted through thematic analysis using an inductive approach. Coding and thematic analysis was carried out by 2 independent reviewers. Three major themes were found relating to participants' perception of their sleep and ACLR experience early in the rehabilitation process: (1) sleep disturbances experienced, (2) repercussions of sleep disturbances, and (3) prior knowledge of sleep hygiene. The most important finding of this study was that patients after ACLR in this sample did perceive significant sleep disturbances leading to poor sleep quality, and these led to perceived negative impacts to health outcomes. Future researchers should focus on integrating lifestyle factors, such as sleep, into ACLR rehabilitation protocols as improving sleep may improve ACLR-specific recovery outcomes and quality of life.