Cognitive frailty and its association with disability among Chinese community-dwelling older adults: a cross-sectional study.

BACKGROUND: There are a variety of determinants that are key to functional disability of older adults. However, little is known regarding the relationship between cognitive frailty and disability among older people. The aims of this study were to examine the associations between cognitive frailty and its six components with instrumental activities of daily living (IADL) functioning in community-dwelling older adults. METHODS: A total of 313 community-dwelling older adults (aged ≥ 65 years) were recruited from eight community centers in central China. Cognitive frailty was operationalized using the Mini-Mental State Examination for the evaluation of cognitive status and the Fried criteria for the evaluation of physical frailty. The outcome was functional disability assessed by the IADL scale. The association between cognitive frailty, as well as its components, and IADL limitations was identified by conducting binary logistic regression analysis. RESULTS: The prevalence of cognitive frailty was 8.9% in this study. The results showed that cognitive frailty (OR = 22.86) and frailty without cognitive impairment (OR = 8.15) were associated with IADL limitations. Subdimensions of cognitive frailty, exhaustion, weakness, low physical activity and cognitive impairment components were independently associated with IADL limitations. CONCLUSION: Cognitive frailty was associated with a higher prevalence of disability. Interventions for improving cognitive frailty should be developed to prevent IADL disability among community-dwelling older adults in China.

To validate the integral conceptual model of frailty among community-dwelling older adults in China: a cross-sectional study.

PURPOSE: The integral conceptual model of frailty (ICFM) integrates physical, psychological, social aspects of individuals and stresses that frailty is a dynamic state evolving over time. This study aimed to validate the ICMF among community-dwelling older adults in China. METHODS: The study recruited 341 older community-dwelling adults by convenient sampling method between June 1 and August 30, 2019 in Hubei province, China. The data was collected by questionnaire-based survey. Frailty was assessed by the Chinese version of the Tilburg Frailty Index. Participants were assessed for life-course determinants, disease and adverse health outcomes. Hierarchical regression analyses, Bootstrap method and the structural equation model were conducted in data analysis. RESULTS: Both linear and logistic hierarchical regression models were statistically significant. Life-course determinants, disease, and three domains of frailty together explained 35.6% to 50.6% of the variance of disability and all domains of quality of life. The mediation effect of frailty between disease and all adverse outcomes was significant, excluding hospitalization. The structural equation model guided by the ICMF fits the data well. CONCLUSIONS: The ICMF is valid among community-dwelling older adults in China. Therefore, the multidimensional concept of frailty should be widely used in Chinese communities.

Effects of flipped classroom on nursing psychomotor skill instruction for active and passive learners: A mixed methods study.

BACKGROUND: Psychomotor skill instruction is a critical component of nursing education. For now, the optimal teaching method to help students acquire psychomotor skills remains elusive. A few studies have explored the effects of flipped classroom on skill instruction, but yield a mixed conclusion. Furthermore, little knowledge was eligible if flipped classroom was beneficial to all learners with different learning styles. PURPOSE: This study aimed to investigate the effects of flipped classroom on nursing psychomotor skill instruction for students with different learning styles. METHODS: The sequential explanatory mixed-methods design was used. In the quantitative study, students in the control group and the intervention group were instructed by traditional laboratory class and flipped classroom respectively. Self-report questionnaires evaluated students' satisfaction and perceived stress before and after the project. Students' skill performance was videotaped and graded by a nursing teacher. Independent sample t-test and paired sample t-test were used to study differences within and between two groups. In the qualitative component, a multiple case study was implemented to investigate the learning experience of flipped classroom among students with different learning styles. RESULTS: The quantitative study results showed that flipped classroom was more effective in improving student performance than traditional laboratory class, for both active and passive learner. However, after flipped classroom intervention, the learning satisfaction of passive learners decreased significantly (P < 0.05), while the learning satisfaction of active learners showed an opposite increasing trend (P = 0.07). Furthermore, compared with traditional laboratory class, the stress perception of passive learners in flipped classroom also increased significantly (p < 0.001). The qualitative study analysis obtained similar results, although active students hold a more positive attitude toward flipped classroom, passive learners expressed more dissatisfaction and stress perception than their peers. CONCLUSIONS: In terms of skill performance, learning satisfaction and stress perception of students, flipped classroom maybe more suitable for active learners rather than passive learners. Therefore, evaluating the learning styles of students is necessary before the implementation of flipped classroom.

Association of insomnia and multidimensional frailty in community-dwelling older adults: A cross-sectional survey.

OBJECTIVE: To evaluate the relationship between insomnia and multidimensional frailty. BACKGROUND: Frailty has major implications on adverse health outcomes of older adults. In recent years, multidimensional nature of frailty has been increasingly recognised. Many frail older adults also suffer from insomnia. METHODS: This was a cross-sectional observational study including 454 community-dwelling adults aged 60 and older. Insomnia was defined as a subjective experience of inadequate sleep duration or quality that affects social functioning during the day, based on the Athens Insomnia Scale (AIS), and multidimensional frailty was based on Tilburg Frailty Indicator (TFI). The STROBE checklist was used to guide the submission. RESULTS: Mean age was 69.1 years old, 211 (46.5%) of participants suffered from insomnia, and 185 (40.7%) of participants were frail. There was a significant relationship between insomnia and multidimensional frailty (physical, psychological and social dimensions). Insomnia was associated with frailty, adjusting for sociodemographic characteristics and comorbidity OR of 6.863 (95% CI: 4.237-11.116). CONCLUSION: Frailty was independently predicted by insomnia. Future researches should determine whether there is a causal relationship between insomnia and multidimensional frailty, with the ultimate goal of providing interventions to reverse or prevent frailty. RELEVANCE TO CLINICAL PRACTICE: This study emphasises the importance of assessment and treatment of insomnia, potentially contributing to the reversion and prevention of frailty in community-dwelling older adults.

Predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes: a cross-sectional survey.

OBJECTIVES: To assess the prevalence of frailty and identify predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes. DESIGN: A cross-sectional design. SETTING: Two community health centres in central China. PARTICIPANTS: 291 community-dwelling older adults aged ≥65 years with type 2 diabetes. MAIN OUTCOME MEASURES: Data were collected via face-to-face interviews, anthropometric measurements, laboratory tests and community health files. The main outcome measure was frailty, as assessed by the frailty phenotype criteria. The multivariate logistic regression model was used to identify the predictors of frailty. RESULTS: The prevalence of prefrailty and frailty were 51.5% and 19.2%, respectively. The significant predictors of frailty included alcohol drinking (ex-drinker) (OR 4.461, 95% CI 1.079 to 18.438), glycated haemoglobin (OR 1.434, 95% CI 1.045 to 1.968), nutritional status (malnutrition risk/malnutrition) (OR 8.062, 95% CI 2.470 to 26.317), depressive symptoms (OR 1.438, 95% CI 1.166 to 1.773) and exercise behaviour (OR 0.796, 95% CI 0.716 to 0.884). CONCLUSIONS: A high prevalence of frailty was found among older adults with type 2 diabetes in the Chinese community. Frailty identification and multifaceted interventions should be developed for this population, taking into consideration proper glycaemic control, nutritional instruction, depressive symptoms improvement and enhancement of self-care behaviours.

A Large Scale of Nurses Participated in Beating down COVID-19 in China: The Physical and Psychological Distress.

The outbreak of coronavirus disease 2019 (COVID-19) posed an unprecedented threat to health care providers (HCPs) in Wuhan, China, especially for nurses who were frequently exposed to infected or suspected patients. Limited information was available about the working experience of nurses in fighting against the pandemic. To learn the physical and psychological responses of nurses during the pandemic and explore the potential determinants, we conducted a large-scale survey in Wuhan. This multicenter cross-sectional study enrolled 5521 nurses who worked in designated hospitals, mobile cabins, or shelters during the pandemic. A structured online questionnaire was distributed to assess the physical discomforts, emotional distress and cognitive reactions of nurses at work, and the log-binomial regression analysis was performed to explore potential determinants. A considerable proportion of nurses had symptoms of physical discomforts [3677 (66.6%)] and emotional distress [4721 (85.5%)]. Nurses who were directly involved in the care of patients (i.e., care for severe patients: RR, 2.35; 95% CI, 1.95-2.84), with irregular work schedules (RR, 2.36; 95% CI, 1.95-2.87), and working overtime (RR, 1.34; 95% CI, 1.08-1.65) were at a higher risk for physical discomforts. Nurses who were directly involved in the care of patients (i.e., care for severe patients: RR, 1.78; 95% CI, 1.40-2.29), with irregular work schedules (RR, 3.39; 95% CI, 2.43-4.73), and working overtime (RR, 1.51; 95% CI, 1.12-2.04) were at a higher risk for emotional distress. Therefore, formulating reasonable work schedules and improving workforce systems are necessary to alleviate the physical and emotional distress of nurses during the pandemic.

Personal Growth and Associated Factors Among Patients with Chronic Obstructive Pulmonary Disease in China: A Cross-Sectional Study.

Purpose: This cross-sectional study aimed to describe personal growth and to analyze its associated factors among patients with chronic obstructive pulmonary disease (COPD) in China. Patients and Methods: A total of 364 Chinese COPD hospitalized patients were included in the study between November 2016 and April 2018. Participants provided demographic information and completed the Growth Through Uncertainty Scale (GTUS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the modified Medical Research Council dyspnoea scale (mMRC). Results: The mean total score on the GTUS was 142.34 (SD = 7.61). The multiple linear regression analysis showed that factors including educational level, average monthly income, social support, and breathlessness can influence personal growth (R2 = 0.427, F = 44.420, p < 0.001), explaining 42.7% of the variance. Conclusion: COPD patients tend to report a moderate level of personal growth in China. Educational level, average monthly income, social support, and breathlessness were significant factors associated with personal growth. Medical workers should be aware of the level of personal growth among COPD patients and make tailored interventions to facilitate COPD patients' personal growth, such as increasing social support and decrease breathlessness.

Chinese Medical Students' Attitudes toward Older Adults and Willingness To Consider a Career in Geriatric Medicine: A Cross-Sectional Survey.

Phenomenon: Ageism is a significant social issue, especially in China. Ageism adversely affects willingness to consider a career in geriatric medicine. However, few studies have examined this topic among Chinese medical students. This study aimed to investigate attitudes toward older people among medical students in China, examine the factors related to these attitudes, and determine the relationships between attitudes and willingness to consider geriatric medicine as a career after graduation. Approach: Responses from 1,022 Chinese medical students were included in the analyses. Students provided demographic information and completed the Fraboni Scale of Ageism (FSA). The data were analyzed using the Statistical Package for Social Sciences, version 24.0 (IBM SPSS Corp). Findings: The mean score of the FSA was 64.42 ± 6.58. Multiple regression analysis showed that the significant predictors of ageism were being male, longer years of training in medical school, and no caregiving experiences with older adults during clinical practice (R 2 = .038, F = 13.520, p < .001). Students who had higher FSA scores were more unwilling to consider a career in geriatric medicine after graduation (t = 4.281, p < .001, Cohen's d = .268). Insights: Chinese medical students have fewer positive attitudes toward older adults than what has been reported in other countries. Future studies should examine the determinants of ageism among medical students in various cultures to guide the development, implementation, and assessment of interventions designed to nurture a more positive attitude toward older adults and increase willingness to consider a career in geriatric medicine.

Psychometric properties of a Chinese version of the Fraboni scale of ageism: evidence from medical students sample.

BACKGROUND: The increasing of older adults has led to enormous demand for medical care. However, as a group with unique needs and characteristics, older adults are often discriminated against in the medical field. In this paper, we aimed to translate the Fraboni Scale of Ageism (FSA) into Chinese and examine its construct validity, content validity, and reliability in Chinese mainland medical students. In order to evaluate the prevalence of ageism in Chinese medical students and prompt medical college to adopt necessary teaching methods to mitigate ageism in medical students. METHODS: By Brislin's translation guidelines, FSA was translated to Chinese. The convenient sampling method was used to select samples for this survey, including 1,974 students from two medical schools in central and north China. Construct validity was verified by the exploratory and confirmatory factor analysis. The content validity index (CVI) was used to assess content validity. The Cronbach's alpha coefficients and intraclass correlation coefficient (ICC) were used to estimate reliability. RESULTS: The alpha coefficients for FSA (Chinese version) was 0.81 and ICC was 0.87. The CVI was 0.93. Three factors were identified by exploratory factor analysis explaining 34.84% of the total variance and a three-factor model was confirmed to fit by confirmatory factor analysis. CONCLUSIONS: FSA (Chinese version) is a reliable and valid scale for measuring discrimination degree against older adults in Chinese medical students.

NF-κB controls Il2 and Csf2 expression during T cell development and activation process.

Aging and dysregulation of immune responds are closely associated through a complicated but unclear mechanism. Although many theories have been proposed as overall dysregulation involved in aging, mechanisms such as efficiency of DNA repairing, over-expression of transcription factors (such as NF-κB family), and shift of cell types, are among many factors that contribute to and affect aging process. It is of great interests to understand the possible mechanism that is involved in aging immune system. Here, we report that the inducible genes Il2 and Csf2 are increased as T cells undergo activation and aging. Of particular note were the findings that the relative composition of the circulating CD4(+) T cell population changes as animals mature with an increased percentage of the population being memory/effector type cells. In addition, mRNA levels of NF-κB family genes that are essential elements for cytokine activation in adult mice and activated T cells are significantly increased. We have demonstrated that the expression of inducible genes is accompanied by increased memory/effector type cells and by increased expression level of NF-κB family genes during cell activation and development.