Multiple mediating effects of social participation and social support on the physical and mental health of the community-dwelling elderly / 中华全科医师杂志

Objective:To investigate the status and influencing factors of activities of daily living (ADL), anxiety and depression of the community-dwelling elderly, and to explore the mediating effect of social support and social participation on ADL, anxiety and depression.Methods:A questionnaire survey was conducted from July to October 2022, among 637 residents over 60 years old registered in the Community Health Service Center of Taiyuan Economic and Technological Development Zone selected by simple random sampling method. The general information questionnaire, Activities of Daily Living (ADL) scale, Anxiety Self-assessment Scale, Depression Self-assessment Scale, Social Support Scale, and Social Participation Scale were used in the survey. The dichotomous logistic regression model was used to analyze the influencing factors of disability, anxiety, and depression of the elderly. Structural equation modeling was used to verify the mediating effects of social participation and social support on the ADL and mental health status in the elderly.Results:The disability rate of the elderly in the community was 42.9%(258/602). Age( OR=2.87-4.91), acute disease attack in the last three months( OR=2.03),poor economic status( OR=2.39), impaired social participation ability( OR=4.07, 11.75) and low level of social support( OR=2.37) were risk factors for disability of the elderly in the community. The incidence of anxiety symptoms was 22.7%(137/602). The risk factors of anxiety were having more than one chronic disease ( OR=2.24), poor economic status ( OR=2.27), mild and intermediate impairment of social participation ability( OR=6.97, 180.43)and low level of social support( OR=2.04). The incidence of depressive symptoms was 19.4%(117/602). The risk factors of depression were acute disease attack in the past three months ( OR=1.90), loneliness in the past three months ( OR=2.17), impaired social participation ( OR=4.17) and low level of social support ( OR=3.90). The direct effect of ADL on mental health was 0.204 (Bootstrap 95% CI:0.081-0.330), accounting for 34.58% of the total effect. The mediating effects of social participation and social support on ADL and mental health were 0.343 (Bootstrap 95% CI:0.274-0.418) and 0.042 (Bootstrap 95% CI:0.015-0.075) respectively, accounting for 58.13% and 7.12% of the total effect. Conclusions:Social support and social participation are not only the common influencing factors of ADL, anxiety and depression of the community-dwelling elderly, but also have a mediating effect on ADL and mental health. Promoting the social participation of the community-dwelling elderly and increasing social support can improve both ADL and mental health for them.

Development, Validation and Acceptability of a Newly Developed Nutrition Resource Kit for At-Risk and Malnourished Elderly in Health Clinics Setting

@#Introduction: The elderly population is highly vulnerable to malnutrition, including those in the community. The use of nutrition education as part of nutrition intervention is able to improve their nutritional status. Hence, provision of a nutrition resource kit addressing the needs of at-risk and malnourished elderly would be advantageous. This research aimed to develop, validate and evaluate the acceptance of a newly developed nutrition resource kit, which served as an educational material among at-risk and malnourished elderly in Malaysian health clinics. Methods: This study was conducted in three phases: Phase I comprised of qualitative needs assessment to identify the types of nutrition resource kit needed; Phase II was the development and validation of the nutrition resource kit; while Phase III was acceptance evaluation, which involved individual in-depth interview and triangulation. Results: An A5-sized booklet with incorporation of an educational video in a QR code was developed. Both printed material and educational video had excellent content and face validity. Suggestions by experts and elderly from validation were considered and revision was done accordingly. Acceptance evaluation revealed four themes: 1) positive acceptance, 2) elderly-friendly, 3) valuable, and 4) individual preference. Triangulation data revealed that all elderly positively evaluated both resources. Additional suggestions given by elderly were considered for improvement. Conclusion: This newly developed nutrition resource kit, both in the printed and electronic format, was well-accepted among the at-risk and malnourished elderly. It could be used as an important reference for the elderly, especially those attending health clinics, in treating and preventing malnutrition.

A study on the relationship between frailty and nutritional status of the elderly in communities / 中华临床营养杂志

Objective:To explore the relationship between frailty and nutritional status of the elderly in communities.Method:Using the convenience sampling method, 458 elderly people in the community were investigated with the general data questionnaire, frailty phenotype, Mini-Nutritional Assessment, Mini-Mental State Examination, Self-Rating Depression Scale and Instrumental Activity of Daily Living.Results:The prevalence of frailty, pre-frailty and non-frailty in the elderly of the community was 9.2%, 60.0%, and 30.8% respectively, and 10.5% were malnourished or at risk of malnutrition. Logistic analysis showed that malnutrition increased the risk of frailty in the elderly ( OR=9.534, P=0.001). Conclusion:Malnutrition is a risk factor of frailty in the elderly in communities. Improving the nutritional status of the elderly in communities can help delay the development of frailty.

Analysis on influencing factors of the frailty of the elderly / 中华疾病控制杂志

Objective To explore influencing factors of the elderly's frailty. Methods Eight communities were randomly selected from Dalang Town, Dongguan City, and all the eligible elderly people were investigated using the self-developed frailty index. Univariate analysis was performed using the 2 test, and multivariate analysis was performed by ordinal multi-class Logistic regression. Results Univariate analysis showed that there were significant differences in the distribution of frailty conditions among different demographic characteristics, family relationships, economic situation and lifestyle (all P<0.05). Multivariate analysis showed that younger age (OR=0.13, P<0.001), male (OR=0.65, P=0.012), and daily exercise (OR=0.76, P=0.049) were protective factors for frailty of the elderly. Illiterate (OR=2.42, P<0.001), fewer times to see children per month (OR=1.82, P=0.035), pension funds as the main economic source (OR=1.59, P<0.001), low level of physical activity (OR=2.18, P<0.001) and none social participation (OR=1.41, P=0.004) were risk factors of frailty. Conclusion Age, gender, education level, times to see children per month, economic source, exercise frequency, physical activity level and social participation are the influencing factors of frailty of the elderly.

The Effects of Welfare Center's Cognitive Improvement Program on the Community Elderly Provided by Nursing Student Volunteers and Social Welfare / 의료커뮤니케이션

PURPOSE: This study was conducted to investigate effects of welfare center's cognitive improvement program on the community elderly provided by nursing student volunteers and social welfare.METHODS: A quasi-experimental with non-equivalent control group pretest-posttest design was implemented. The participants were the community elderly with or without mild cognitive impairments (experimental group: 17, control group: 15). The experimental group participated in the cognitive improvement program for four months based on the demonstration program of the special grade of dementia in long-term care insurance for the elderly.RESULTS: After the intervention, the satisfaction with perceived social support (F=9.30, p=.005) was improved statistically between the experimental group and the control group, but there was no significant difference in MMSE-K, IADL, depression, EQ-VAS, and EQ-5D variables.CONCLUSION: These results indicated that a multidisciplinary approach or a variety of manpower is needed, in order to prevent the dementia of the elderly. However, in order to provide a systematic cognitive-based intervention, it was once again recognized that the training of relevant experts and the quality planning on them were very important.

Neurocognitive profiles and related factors of subjective cognitive decline / 中华行为医学与脑科学杂志

Objective@#To investigate the neurocognitive characteristics and related factors in the elderly with subjective cognitive decline.@*Methods@#Among the 1 850 elderly volunteers aged over 50, 377 cognitive normal elderly (NC group), 234 subjective cognitive decline (SCD Group) and 291 patients with mild cognitive impairment (aMCI Group) were screened with the brief elderly cognitive screening questionnaire and the elderly rapid cognitive screening scale.They were all received clinical interview and examination and core neurocognitive test.@*Results@#(1) There were statistically significant differences in the three groups on the age, education, occupation, HAMD, low density lipoprotein and blood pressure (P<0.01). (2) The score of the picture-symbol association in SCD group(8.94±4.05)was lower than that in NC group(9.83±4.18)and higher than that in aMCI group (7.12±4.17)(all P<0.05), while the scores of the other neuropsychological tests were higher than those in aMCI group.There were no statistically significant difference between SCD group and NC group on the other neuropsychological tests(P>0.05). (3)The SCD was mainly influenced by age(β=0.063, OR=1.065, 95%CI=1.033-1.099), depression(β=0.182, OR=1.199, 95%CI=1.084-1.327)and hypertension(β=0.473, OR=1.604, 95%CI=1.185-2.171)(all P<0.01). And the aMCI was mainly influenced by age(β=0.078, OR=1.081, 95%CI=1.048-1.115), education(β=-0.174, OR=0.840, 95%CI=0.778-0.907), occupation(β=-0.406, OR=0.666, 95%CI=0.535-0.830)and low density lipoprotein(β=-0.451, OR=0.637, 95%CI=0.497-0.816)(all P<0.01 ).@*Conclusion@#Objective neurocognitive function of the elderly with subjective cognitive decline is basically normal.Age, depression and hypertension are risk factors of subjective cognitive decline.

Neurocognitive profiles and related factors of subjective cognitive decline / 中华行为医学与脑科学杂志

Objective To investigate the neurocognitive characteristics and related factors in the elderly with subjective cognitive decline. Methods Among the 1 850 elderly volunteers aged over 50,377 cognitive normal elderly (NC group),234 subjective cognitive decline ( SCD Group) and 291 patients with mild cognitive impairment (aMCI Group) were screened with the brief elderly cognitive screening question-naire and the elderly rapid cognitive screening scale. They were all received clinical interview and examina-tion and core neurocognitive test. Results ( 1) There were statistically significant differences in the three groups on the age,education,occupation,HAMD,low density lipoprotein and blood pressure (P<0. 01). (2) The score of the picture-symbol association in SCD group( 8. 94 ± 4. 05) was lower than that in NC group (9. 83±4. 18)and higher than that in aMCI group (7. 12±4. 17)(all P<0. 05),while the scores of the other neuropsychological tests were higher than those in aMCI group. There were no statistically significant differ-ence between SCD group and NC group on the other neuropsychological tests(P>0. 05). (3) The SCD was mainly influenced by age( β=0. 063, OR=1. 065,95% CI=1. 033-1. 099), depression ( β=0. 182,OR=1. 199,95%CI=1. 084-1. 327) and hypertension(β=0. 473,OR=1. 604,95% CI=1. 185-2. 171) ( all P<0. 01). And the aMCI was mainly influenced by age(β=0. 078,OR=1. 081,95%CI=1. 048-1. 115),educa-tion(β=-0. 174,OR=0. 840,95%CI=0. 778-0. 907),occupation( β=-0. 406,OR=0. 666,95%CI=0. 535-0. 830)and low density lipoprotein(β=-0. 451,OR=0. 637,95%CI=0. 497-0. 816)(all P<0. 01 ). Conclu-sion Objective neurocognitive function of the elderly with subjective cognitive decline is basically normal. Age,depression and hypertension are risk factors of subjective cognitive decline.

Sarcopenia and lower limb pain are additively related to motor function and a history of falls and fracture in community-dwelling elderly people

OBJECTIVES: To clarify the prevalence and characteristics of pain associated with sarcopenia and to verify the usefulness of evaluation of pain for sarcopenia. METHODS: In total, 759 community-dwelling people (aged 65–79 years) with or without sarcopenia and lower limb pain were classified into 4 groups (NSp, nonsarcopenia; NSpP, nonsarcopenia with pain; Sp, sarcopenia; and SpP, sarcopenia with pain). Body composition, motor function, history of fractures since age 50 years, and number of falls in the past 1 year were compared between the groups. RESULTS: Participant proportions by group were: NSp, 53.9%; NSpP, 42.8%; Sp, 1.3%; and SpP, 2.0%. Participants with lower limb pain showed low single leg standing, walking speed, and 2-step value scores and high 25-question Geriatric Locomotive Functional Scale (GLFS-25) score after adjusting for age, sex, body mass index, and presence of sarcopenia. The SpP group showed lower functional reach test and higher GLFS-25 scores than the Sp group. Regarding the history of fractures since 50 years of age and falls in past 1 year, a high retention rate of fracture was noted in the NSpP group. They also experienced significantly more falls in the past 1 year than those in the NSp group. The SpP group noted more falls and fractures although it was insignificant. CONCLUSIONS: The results indicate that participants with lower limb pain showed declining motor function and a high risk for falls and fractures. Sarcopenia could escalate this risk. Therefore, evaluating patients for both pain and sarcopenia may be useful for risk assessment and treatment.

An Investigation of the Situation of Chronic Diseases and the Effects on Quality of Life Among Different-ages Elderly in Community / 昆明医科大学学报

Objective To investigate the situation of chronic diseases and the effects on quality of life among different-aged elderly in community and provide evidence for targeted improvement quality of life.Methods During March to July 2015, the elderly who was aged 60 and over as respondents from two communities in Kunming were enrolled. Cross-sectional study and cluster sampling were used based on Activities of Daily Living scale (ADL) and Balthel index.questionnaire was designed and information of chronic disease in the elderly was colected.The effects on Balthel index in different chronic diseases and age groups were analysed.Results A total of 589 subjects were investigated, chronic disease prevalence was93.70％, and the highest prevalence is hypertension that was 27.50％.The quality of life was worse in the elderly who suffered from three kinds of chronic diseases and more older. The quality of life in different age groups elderly was statistically significant (P ＜ 0.05).Conclusion The quality of life in the community elderly is relate with age and the type of chronic diseases.In order to improve their quality of life health guidance should be strengthened.

Research on the association between sex hormone binding globulin and the risk of developing cardiovascular diseases in community elderly population / 复旦学报（医学版）

Objective To explore the correlation between sex hormone binding globulin (SHBG) and cardiovascular disease (CVD) in community elderly population.Methods In 2014,1916 elderly people (796 males,and 1 120 females) were selected from Baoshan District Friendship Community,Shanghai.We collected basic epidemiological data and fasting venous blood samples to carry out the detection of biomarkers,and then calculated their ten-year Framingham risk score.In this study,obesity,systolic blood pressure,fasting blood glucose,lipid concentration,and high-sensitive C-reactive protein were considered as CVD risk factors;Framingham risk score was considered as a CVD event prediction risk score.We analyzed the correlations of these factors with SHBG.Results SHBG mean values in the population with a history of CVD were lower than those without a history of CVD (P＜0.001).The correlation coefficient between male SHBG and waist circumference,hip circumference,BMI,systolic pressure,cholesterol,triglycerides,high density lipoprotein cholesterol,apolipoprotein A,high sensitive C-reactive protein were-0.312,-0.307,-0.266,-0.113,0.155,-0.277,0.510,0.394 and-0.130,respectively (P＜0.01).The correlation coefficient between female SHBG and waist circumference,hip circumference,BMI,fasting glucose,cholesterol,triglycerides,high density lipoprotein cholesterol,apolipoprotein A,high-sensitive C-reactive protein were-0.236,-0.248,-0.168,-0.183,0.135,-0.264,0.445,0.358 and-0.295,respectively (P＜0.001).The decrease of SHBG level was consistent with the increase of Framingham score (κ =0.062,P＜0.001).Elevated level of SHBG would reduce the risk of CVD in ten years (P＜0.01).Conclusions There was a negative correlation between baseline SHBG level and CVD risk factors,positive correlation between baseline SHBG level and CVD protection factors in community elderly population;lower SHBG level indicated higher risk of developing CVD events.

Intervention Effect of Evidence-based Nursing on Health Behavior of Elderly Patients with Hypertension in the Community / 现代医院

Objective To explore the intervention effect of evidence-based nursing on the health behavior of elderly hypertensive patients in the community.Methods 187 elderly hypertensive patients who were hospitalized in December 2015 and met the inclusive criteria were divided into observation group (n=93) and control group (n=94).The observation group received evidence-based nursing according to the evidence-based medical system evaluation while the control group was given regular nursing both for 6 months.The clinical efficacy of two nursing modes was observed and the differences between pre-intervention and pose-intervention and groups were recorded and analyzed with a self-designed questionnaire, drug compliance questionnaire and health behavior scale.Results In the observation group, the blood pressure was effectively controlled or reduced, treatment compliance was significantly increased and body mass index (BMI) was within the ideal range 6 months later.Scores of unhealthy behaviors such as those in living habits and mental stress were lower than those in the control group, which showed significant difference (P0.05).Conclusion Evidence-based nursing intervention can effectively control the hypertension, improve the treatment compliance of the community elderly hypertension patients and help lead them to a more positive and healthier life style.

Research in influence of group intervention on quality of life of community elderly population with depression tendency / 中国实用护理杂志

Objective To explore a new type community nursing mode which can improve the life quality of community elderly population with depression tendency.Methods In the chosen community of Jilin City,we used Geriatric Depression Scale (GDS) to identify the elderly population with depression tendency.78 elderly people with depression tendency who met the conditions of study were assigned to the intervention group and the control group with 39 people in each group randomly.8-week group-intervention was given to the intervention group,and no intervention was given to the control group.For the intervention group,the total intervention time was 8 weeks,once a week for continuous 8 times together and intervention time was 90 minutes for each time.The Geriatric Depression Scale (GDS) and the world health organization quality of life (WHOQOL-BREF) were used to measure the quality of life of the two groups.Results After intervention,the total scores of the intervention group were significantly lower than those of the control group,the difference was statistically significant.Average scores of each dimension in the life quality of the intervention group were obviously higher than those of the control group.Conclusions Group intervention mode for the community elderly population with depression tendency was feasible,effective,and reasonable.It can be applied to mental health care of community elderly people,and can also provides basis for early discovery and early intervention of the community elderly people with depression.

The Prevalence of Urinary Incontinence among the Elderly in a Rural Community in Selangor

Background: Urinary incontinence is a common but poorly understood problem in the elderly population. The aim of this study was to determine the prevalence of urinary incontinence and its associated factors among the elderly in a community setting. Methods: A cross-sectional study design was used. Stratified cluster sampling was used in this study. All elderly residents aged 60 years old and above who fulfilled the selection criteria were included as respondents. The translated Malay version of the Barthel’s Index (BI) was used to identify the presence of urinary incontinence. Results: The prevalence of urinary incontinence was 9.9% among the elderly respondents. Urinary incontinence among the elderly was significantly associated with age, gender, depression, functional dependence, and diabetes mellitus (P < 0.05).

Multilevel analysis on influencing factors regarding blood level among elderly hypertensive patients at the community level / 中华流行病学杂志

Objective To explore the factors affecting blood level of elderly hypertensive patients, using a multilevel analysis model. Methods 927 elderly hypertensive patients from 23 communities were studied, through a multi-stage random sampling method. The influencing factors on systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed through a two-level linear multilevel model, respectively. Results The average blood pressure of subjects appeared as: SBP (139.2±11.7) mm Hg ( 1 mm Hg=0.133 kPa), DBP (85.6±8.6) mm Hg. Ratio of physician versus patients was the factor affecting blood level of subjects from the community level. SBP and DBP of the subjects from the higher physician/patient ratio communities were 3.86 mm Hg and 2.51 mm Hg, lower than the subjects in the lower ratio communities, after controlling the other related factors. Age, gender,overweight/obesity were the individual risk factors of hypertension, while factors as regularl medicine taking, reducing salt intake and related self-efficacy to manage disease could reduce the blood pressure.Reducing salt intake could lower the SBP for 2.44 mm Hg and DBP for 2.03 mm Hg, after controlling the other factors. Conclusion Multilevel analysis model could effectively analyze the hierarchically structured data while both factors from the community and individual levels could affect the blood level among elderly patients with hypertension.

Comparison of Instrumental Activities of Daily Living and Cognitive Functions Among the Elderly Attending Senior Community Centers According to the Presence of Depressive Symptoms / 신경정신의학

OBJECTIVES: The aim of this study was to evaluate whether or not depressive symptoms were related to differences in the abilities of daily living activities and cognitive functions among the elderly attending senior community centers. METHODS: A total of 304 respondents over 65 years of age completed a set of interviews, which included clinical evaluation, neuropsychological batteries, Short Geriatric Depression Scale (S-GDS), and Instrumental Activities of Daily Living (IADL). RESULTS: Depression was observed in 34.2% respondents (n=105). The depressed group significantly decreased the sum of IADL than that of the non-depressed group (t=3.8, p=0.0002). With logistic analysis, they indicated significant impairment in six items of IADL associated with cognitions, but not in other items with physical functions. The depressed group scored significantly lower in MMSE-K (F=8.56, p<0.01) and delayed recall assessment (F=10.53, p<0.01) despite they showed no difference in immediate memory, compared with the non-depressed group. Among the sociodemographic variables, gender was not a significant risk factor in the depressed elderly, whereas lower income was the only risk factor after adjusting for other variables. CONCLUSION: The depressed elderly attending senior community centers showed impaired functions in their usual daily activities and cognitions. Furthermore, they revealed impairment in cognitive IADLs, whereas they preserved functions in physical IADLs.