Experiences of Living in the Community for Older Aboriginal Persons With Dementia Symptoms in Taiwan.

BACKGROUND AND OBJECTIVES: Improving quality of life for community-dwelling older persons with dementia symptoms (PWDS) and family caregivers requires promoting dementia-friendly communities (DFC). However, little is known regarding older Taiwanese Aboriginal PWDS' experiences of living in the community. We explored these experiences for older Atayal PWDS and their families in Taiwan. RESEARCH DESIGN AND METHODS: This grounded theory research used in-depth interviews to explore the perspectives of older PWDS (n = 4), their family members (n = 3), and key persons (n = 10) in an Atayal community in northern Taiwan. Data were analyzed using constant comparative analysis. Participants were interviewed between January and May 2015. RESULTS: Participants' experiences were captured by the overarching concept of "low dementia awareness, high family-like ambience in the community." Despite the low/absent community awareness of dementia, older Atayal PWDS functioned as freely in the community as at home due to a family-like supportive environment. Aboriginal PWDS and their families also faced environmental challenges, e.g., environmental constraints and barriers to transportation access. DISCUSSION AND IMPLICATIONS: Our results suggest that this Aboriginal community and culture offer important DFC components, and these strengths could be further studied to enhance DFC models elsewhere. Despite these strengths in supporting PWDS, environmental challenges to transportation access still cause difficulties for PWDS and their families and need improvement. The Atayal community's low dementia awareness suggests that services introduced must be culturally appropriate and nondisruptive to existing supportive helping systems. Our study can be a model for future studies to understand and identify PWDS' needs in Indigenous communities.

Diabetic neuropathies influence recovery from hip-fracture surgery in older persons with diabetes.

BACKGROUND/OBJECTIVES: To explore the impact of diabetic peripheral neuropathy (DPN) on the recovery of older persons with diabetes mellitus (DM) after hip-fracture surgery. DESIGN, SETTING, PARTICIPANTS: Secondary data for this study came from a clinical trial on the effectiveness of a DM-specific care model for 176 older persons (age ≥ 60) with DM over 2 years following hip-fracture surgery at a medical center in Taiwan. In the original trial, the experimental group (n = 88) received DM-specific care comprising diabetes care plus subacute care, and the control group (n = 88) received only usual care. MEASUREMENTS: DPN was assessed using the Michigan Neuropathy Screening Instrument. Outcomes of self-care ability in activities of daily living (ADL), health-related quality of life (HRQoL), and depressive symptoms were assessed 1, 3, 6, 12, 18, 24 months following hospital discharge using the Chinese Barthel Index and Chinese-version instrumental ADL (IADL) scale; the SF-36 Taiwan version; and the Chinese-version Geriatric Depression Scale, short form, respectively. RESULTS: After controlling for covariates, participants with DPN had 8.38 fewer points in ADL performance, 0.49 fewer points in IADL performance, and 2.33 fewer points in the physical component summary (PCS) of HRQoL than participants without DPN at 3 months following discharge. During the first year following discharge, the rate of improvement increased less for PCS (ß = -0.45, p < 0.05), but more for the mental component summary (ß = 0.49, p < 0.05) for those with DPN than for those without. During the second year, the rate of decline in physical function-related HRQoL increased slightly more for those with DPN than for those without (ß = 0.03, p < 0.05). CONCLUSION: DPN adversely affected ADL performance, IADL performance, and physical function-related health outcomes for older persons recovering from hip-fracture surgery. These results suggest that older patients with DM recovering from hip-fracture surgery should be assessed and managed for DPN.

Number of Comorbidities Negatively Influence Psychological Outcomes of the Elderly Following Hip Fracture in Taiwan.

OBJECTIVE: Hip fracture usually affects psychological functions of the elderly, and comorbidities often interfere with their recovery. However, little is known about the influence of number of comorbidities on their psychological outcomes. METHOD: Data from a previous study of 461 hip-fractured elders treated at a medical center in northern Taiwan were analyzed by the generalized estimating equation approach. Outcomes were assessed at 1, 3, 6, 12 months following discharge by the Geriatric Depression Scale (GDS), Mini-Mental State Examination, and two subscales of the Medical Outcomes Study Short Form 36: role limitations due to emotional problems, and Mental Health (MH). RESULTS: Hip-fractured elders with more comorbidities were more likely to have cognitive impairment (ß = 0.224, p = .004), higher GDS scores (ß = 0.328, p = .001), and worse MH (ß = -1.784, p = .009) during the first year following discharge. DISCUSSION: Having more comorbidities negatively influenced the psychological outcomes of elderly patients with hip fracture.

The impact of sleep duration on recovery post-hip fracture among older diabetic adults in Taiwan.

This study explored postoperative changes in sleep duration and physical activity and their relationships with physical function recovery, the muscular strength of the affected side and blood glucose control in elderly adults (n = 41) with diabetes mellitus (DM) who underwent surgery for hip fracture. Thirty-two participants (78.0%) had abnormal sleep durations for at least two time points, and they all had low physical activity levels (an average of 1348.2 kcal/day for the first month, 1377.9 kcal/day for the third month, and 1389.1 kcal/day for the sixth month) during the six months post-hip fracture. The participants with normal sleep durations showed greater femoral muscle improvement on the affected side (adduction: ß = 3.70, p = 0.029; abduction: ß = 7.25, p = 0.016) and better blood glucose control before meals (ß = -73.29, p < 0.001) and after meals (ß = -47.90, p = 0.007) compared with those with abnormal sleep durations. Those with higher physical activity levels had better physical function recovery.

Ageism perceived by the elderly in Taiwan following hip fracture.

This qualitative, longitudinal study explored the feelings about and responses to discrimination experiences related to perceived ageism of older persons following hip fracture. Five male and six female hip-fractured elderly patients were sampled from a medical center in northern Taiwan. Semi-structured questionnaires were used to explore participants' experiences of and responses to ageism-related experiences. Data were collected in face-to-face interviews during home visits at 1, 3, 6, and 12 months after discharge from hospital, between June 2007 and December 2008. Textual data of participants' responses were analyzed by directed content analysis. All participants experienced ageism. In first 3 months after discharge, participants' main perceived ageism was positive because of their dependency and feeling overprotected by others. From 3 months to 1 year after discharge, other ageism experiences emerged: isolated because of physical restrictions and neglected. Furthermore, participants' responses were divided into two categories: disregard and tolerance of ageism, or becoming more independent because of ageism. The elderly participants considered that the influences of positive ageism in the early months after discharge reduced their autonomy and deprived them of power. This response to ageism was temporary; over time the participants tried to regain autonomy by overcoming their dependency and improving their physical functioning.

Diabetes and health outcomes among older Taiwanese with hip fracture.

OBJECTIVE: Hip fracture tremendously impacts functional abilities for the elderly with high morbidity and mortality; recovery is compromised by co-morbidities. Diabetes mellitus is a common co-morbidity for the aging population, but little is known about the influence of diabetes on outcomes of the Asian elderly with hip fracture. RESEARCH DESIGN AND METHODS: This study was a secondary analysis of data on 242 community-dwelling elders with hip fracture from three previous longitudinal studies. Sixty-one cases (25.2%) had diabetes. Outcomes were measured by the Chinese Barthel Index, Medical Outcomes Study Short Form-36 Taiwan version, and analyzed by the generalized estimating equation approach to examine how diabetes influenced hip-fractured elders' mortality, service utilization, mobility, daily activities, and health-related quality of life during the first 12 months after postsurgical discharge in Taiwan. RESULTS: Hip-fractured elderly with diabetes had a significantly higher mortality rate (22.6% vs. 10.3%, p=0.03) during the first year following discharge, and significantly higher readmission rate (10.0% vs. 2.5%, p=0.04) from the first to third month following discharge than those without diabetes. After controlling for covariates, elderly participants without diabetes had an overall 2.2 times (confidence interval [CI]=1.15-4.21) greater odds of recovery in walking ability and better reported general health (ß=9.33; p=0.01) and physical functioning (ß=7.26; p=0.02) than those with diabetes during the first year after discharge. CONCLUSIONS: Diabetes negatively influenced outcomes of elderly patients with hip fracture. The results may provide a reference for developing interventions for hip-fractured elders with diabetes.

A communication platform for diabetes surveillance.

Diabetes mellitus is a common and precarious chronic disease, which affects cellular metabolism and energy production. The condition is divided into types I and II; the most common form is type II diabetes, which is an adult-onset disease. Blood glucose testing is crucial to diabetes control, and it is effective in reducing the risk of complications and improving life quality. Unfortunately, both elderly patients and their caregivers find it difficult to monitor glucose levels long term. This study developed a communication platform for diabetes surveillance. The developed system prompts diabetics to measure their blood glucose regularly at home, and provides remote care persons with complete information about the patient's measurement. This aids in the improvement in diabetes control, thereby increasing the social activities and life quality of diabetics.