Physical function mediates the effects of sensory impairment on quality of life in older adults: Cross-sectional study using propensity-score weighting.

AIMS: To investigate the effect of sensory impairment on quality of life in older adults and to assess the role of physical function as a mediator of the effect of the sensory impairment on quality of life. DESIGN: A cross-sectional study. METHODS: Older adults aged ≥65 years (N = 600) were recruited from January 2019 to May 2020. Hearing and visual function were measured with pure-tone audiometry and Snellen visual acuity tests, respectively. Quality of life (World Health Organization Quality of Life Scale Brief Version), physical function (Multidimensional Functional Assessment Questionnaire) and sociodemographic characteristics were reported by participants using interviewer-administered questionnaires. Propensity score weighting analysis was conducted based on generalized propensity scores via multinominal logistic regression for age, gender, education, income, and comorbidities. The difference in the quality of life was tested by applying a one-way analysis of variance. Multiple mediation analysis was conducted to explore the direct, indirect, and total effects of sensory impairment on quality of life through physical function. RESULTS: After propensity score weighting adjustment, when compared with participants with no sensory impairment, participants with dual sensory impairment had the worst quality of life, followed by visual impairment and then hearing impairment. Physical function statistically significantly mediated the effect of hearing impairment, visual impairment and dual sensory impairment on quality of life in older adults. CONCLUSION: Our findings demonstrated that the negative effect of the sensory impairment on quality of life in older adults was mediated through physical function. IMPACT: The convergence of an increasing ageing population and the prevalence of sensory impairment presents a significant global health burden. This study demonstrated that physical function was a mediator of quality of life in older adults. Designing appropriate physical activity interventions for older adults with sensory impairment could serve to enhance physio-psychological health and improve quality of life.

Patient willingness to undergo a two-week free trial of a telemedicine service for coronary artery disease after coronary intervention: A mixed-methods study.

AIM: To understand the factors affecting willingness to use telemedicine in patients with coronary artery disease after coronary intervention. BACKGROUND: Telemedicine is a relatively new service provided to discharged patients in Taiwan, therefore, public acceptance is low. METHOD: This mixed-methods study conducted between January and June 2014 used convenience sampling. In total, 140 patients were offered a two-week free trial of telemedicine services before hospital discharge. Participants completed structured questionnaires and answered semi-structured qualitative questions related to willingness to use telemedicine services. RESULTS: Patients' willingness to use telemedicine was not significantly correlated with experience using technology, perceived ease of use or computer self-efficacy; instead, it was based on trust in the hospital staff, opinions of the staff and ongoing support from the case manager. Reasons for their lack of willingness to use the service were mainly related to diseases, technology/equipment and environmental factors. CONCLUSION: Staff support through telephonic tracking and real-time feedback can increase willingness to use telemedicine. IMPLICATIONS FOR NURSING MANAGEMENT: Case managers can collect necessary personal information and offer the patients 24-hr services as a monitor, an instructor and a companion, thereby accommodating more patients, building value and strengthening telemedicine services.

Quality of life in older adults with sensory impairments: a systematic review.

PURPOSE: Sensory impairments are common in older adults. Hearing and visual impairments affect their physical and mental health and quality of life adversely. However, systematic reviews of the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life are scarce. The purpose of this systematic review was to determine the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life. METHODS: Searches of EMBASE, PubMed, CINAHL, MEDLINE, Cochrane Library, and Airiti Library were conducted between January 2006 and December 2017 using the keywords "quality of life," "life satisfaction," "well-being," "hearing impairment," and "visual impairment." Two authors independently assessed methodologic quality using a modified Downs and Black tool. Data were extracted by the first author and then cross-checked by the second author. RESULTS: Twenty-three studies consisting mostly of community-dwelling older adults were included in our review. Sensory impairment was found to be in significant association with quality of life, with an increase in hearing impairment or visual impairment severity resulting in a lower quality of life. Quality of life for dual sensory impairment was worse than for hearing impairment or visual impairment individually. CONCLUSIONS: A significant association was confirmed between hearing impairment, visual impairment, dual sensory impairment, and quality of life. Our review can be used to enhance health care personnel's understanding of sensory impairment in older adults and enable health care personnel to actively assess older adults' sensory functions, so that they can help alleviate the negative impact of sensory impairments on QOL in older adults.

The influence of renal dialysis and hip fracture sites on the 10-year mortality of elderly hip fracture patients: A nationwide population-based observational study.

Hip fractures in older people requiring dialysis are associated with high mortality. Our study primarily aimed to evaluate the specific burden of dialysis on the mortality rate following hip fracture. The secondary aim was to clarify the effect of the fracture site on mortality. A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to analyze nationwide health data regarding dialysis and non-dialysis patients ≥65 years who sustained a first fragility-related hip fracture during the period from 2001 to 2005. Each dialysis hip fracture patient was age- and sex-matched to 5 non-dialysis hip fracture patients to construct the matched cohort. Survival status of patients was followed-up until death or the end of 2011. Survival analyses using multivariate Cox proportional hazards models and the Kaplan-Meier estimator were performed to compare between-group survival and impact of hip fracture sites on mortality. A total of 61,346 hip fracture patients were included nationwide. Among them, 997 dialysis hip fracture patients were identified and matched to 4985 non-dialysis hip fracture patients. Mortality events were 155, 188, 464, and 103 in the dialysis group, and 314, 382, 1505, and 284 in the non-dialysis group, with adjusted hazard ratios (associated 95% confidence intervals) of 2.58 (2.13-3.13), 2.95 (2.48-3.51), 2.84 (2.55-3.15), and 2.39 (1.94-2.93) at 0 to 3 months, 3 months to 1 year, 1 to 6 years, and 6 to 10 years after the fracture, respectively. In the non-dialysis group, survival was consistently better for patients who sustained femoral neck fractures compared to trochanteric fractures (0-10 years' log-rank test, P < .001). In the dialysis group, survival of patients with femoral neck fractures was better than that of patients with trochanteric fractures only within the first 6 years post-fracture (0-6 years' log-rank, P < .001). Dialysis was a significant risk factor of mortality in geriatric hip fracture patients. Survival outcome was better for non-dialysis patients with femoral neck fractures compared to those with trochanteric fractures throughout 10 years. However, the survival advantage of femoral neck fractures was limited to the first 6 years postinjury among dialysis patients.

Creative approach for successful aging: A pilot study of an intergenerational health promotion program.

AIM: To develop and evaluate the effectiveness of an intergenerational health promotion program. METHODS: This was an action research project. A total of 34 participants attended the 12-week program and completed the pre-test and post-test. There were 16 middle-aged and nine older adults recruited from a district of Taipei, and nine young adults recruited from the principal investigator's university. The "Attitudes toward Aging Scale" and the "Spiritual Health Scale" were two assessment instruments used in the study. RESULTS: The results showed that there were significant improvements in the Attitudes toward Aging Scale for the young adult group (aged 18-29 years) and in the Spiritual Health Scale for the older adult group (aged 65-80 years). The evaluation showed that participants were satisfied with the program. CONCLUSIONS: The results of the present study provide future directions for successful aging and intergenerational learning. Geriatr Gerontol Int 2017; 17: 1799-1807.

Health status and quality of life of survivors of extra corporeal membrane oxygenation: a cross-sectional study.

AIMS: To understand the influential factors related to quality of life for adult patients who have undergone extra corporeal membrane oxygenation. BACKGROUND: Extracorporeal membrane oxygenation is an invasive treatment for critically ill patients requiring temporary cardiac or respiratory support. Most studies have focused on survival outcomes for patients; few have evaluated health-related quality of life. DESIGN: A cross-sectional design. METHODS: Data were collected in 2013 from a convenience sample of adult patients who had survived treatment with extracorporeal membrane oxygenation between 2009-2011. Structured questionnaires collected data about health status. The Short Form 36-item questionnaire measured quality of life. RESULTS: The 100 participants averaged 48·95 years of age. Pearson's correlation showed two measures of health status had significant correlations with quality of life: the Barthel Index and the Instrumental Activities of Daily Living; two measures had significant negative correlations: Charlson's Comorbidity Index and the Nottingham Health Profile-part II. Mean scores for the physical and mental component summaries of the Short Form-36 questionnaire were 49·25 and 48·13 respectively. These component scores had significant negative correlations with the Nottingham health profile-part II. Stepwise multiple linear regression analysis indicated the number of life areas affected on the Nottingham health profile-part II was a common factor influencing both the mental and physical component summaries scores for quality of life. CONCLUSIONS: Social participation was a common factor influencing quality of life. Examining health status and quality of life of extracorporeal membrane oxygenation survivors can help nurses determine interventions for effectively improving health-related quality of life.

Sleep Quality and Emotional Correlates in Taiwanese Coronary Artery Bypass Graft Patients 1 Week and 1 Month after Hospital Discharge: A Repeated Descriptive Correlational Study.

BACKGROUND: Poor sleep quality is a common health problem for coronary artery bypass graft patients, however few studies have evaluated sleep quality during the period immediately following hospital discharge. PURPOSE: The aim of this study was to investigate changes in sleep quality and emotional correlates in coronary artery bypass graft patients in Taiwan at 1 week and 1 month after hospital discharge. METHODS: We used a descriptive correlational design for this study. One week after discharge, 87 patients who had undergone coronary artery bypass surgery completed two structured questionnaires: the Pittsburgh Sleep Quality Index and the Hospital Anxiety and Depression Scale. Three weeks later (1 month after discharge) the patients completed the surveys again. Pearson correlations, t-tests, ANOVA and linear multiple regression analysis were used to analyze the data. RESULTS: A majority of the participants had poor sleep quality at 1 week (82.8%) and 1 month (66.7%) post-hospitalization, based on the global score of the Pittsburgh Sleep Quality Index. Despite poor sleep quality at both time-points the sleep quality at 1 month was significantly better than at 1-week post hospitalization. Poorer sleep quality correlated with older age, poorer heart function, anxiety and depression. The majority of participants had normal levels of anxiety at 1 week (69.0%) and 1 month (88.5%) as measured by the Hospital Anxiety and Depression Scale. However, some level of depression was seen at 1 week (78.1%) and 1 month (59.7%). Depression was a significant predictor of sleep quality at 1 week; at 1 month after hospital discharge both anxiety and depression were significant predictors of sleep quality. CONCLUSION: Sleep quality, anxiety and depression all significantly improved 1 month after hospital discharge. However, more than half of the participants continued to have poor sleep quality and some level of depression. Health care personnel should be encouraged to assess sleep and emotional status in patients after coronary artery bypass surgery and offer them appropriate management strategies to improve sleep and reduce anxiety and depression.

[An Investigation of the Role Responsibilities of Clinical Research Nurses in Conducting Clinical Trials].

BACKGROUND: Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. PURPOSE: This study investigates the role responsibilities of CRNs in conducting clinical trials / research. METHODS: A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. RESULTS: "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p < .05). Participants who had participated in a long-term trial-training course earned higher importance scores for "CRN four-subthemes role responsibilities" (p <.05) and lower difficulty scores for "subject protection", "research coordination and management" (p <.005) than their short-term course peers. "Recognition of overall responsibilities" and "receiving trial training" were the significant predictors of difficulty in performing CRN role responsibilities, explaining 21.9% of the total variance. CONCLUSIONS: To further promote CRN as a professional career in Taiwan, the findings of this study recommend identifying the core competences of CRNs and adding CRN-related study materials into the advanced nursing curriculum. Long-term and systematic educational training may help CRNs understand the importance of their role responsibilities, better recognize their professional role, and reflect these responsibilities in clinical practice.

A Qualitative Study of Family Caregiver Experiences of Managing Incontinence in Stroke Survivors.

BACKGROUND: Incontinence is a common problem faced by family caregivers that is recognized as a major burden and predictor of institutionalization. However, few studies have evaluated the experiences of family caregivers caring for stroke survivors with incontinence. PURPOSE: To describe experiences of caregivers managing incontinence in stroke survivors. DESIGN: This qualitative descriptive study employed a grounded-theory approach. METHODS: Semi-structured in-depth interviews with ten family caregivers of stroke survivors with incontinence were conducted during 2011. Audiotaped interviews were transcribed and analyzed using content analysis. FINDINGS: Data analysis identified four themes: chaos, hypervigilance, exhaustion, and creating a new life. There were nine related subcategories: fluster, dirtiness, urgency, fear of potential health-hazard, physically demanding and time-consuming, mentally draining, financial burden, learning by doing, and attitude adjustment. Together, these described a process of struggling to cope with the care of stroke survivors with urinary/fecal incontinence. Of the four categories, "creating a new life" developed gradually over time to orient caregivers to their new life, while the other three categories occurred in a chronological order. CONCLUSION: The research highlighted unique caring experiences of family caregivers of stroke patients, which focused solely on the 'incontinence issue'. Understanding these experiences may help nurses provide better support and resources for family caregivers when caring for stroke survivors with incontinence.

High short-term and long-term excess mortality in geriatric patients after hip fracture: a prospective cohort study in Taiwan.

BACKGROUND: Hip fracture has a high mortality rate, but the actual level of long-term excess mortality and its impact on population-wide mortality remains controversial. The present prospective study investigated short- and long-term excess mortality after hip fractures with adjustment of other risk factors. We calculated the population attributable risk proportion (PARP) to assess the impact of each risk factor on excess mortality. METHODS: We recruited 217 elders with hip fractures and 215 age- and sex-matched patients without fractures from the geriatric department of the same hospital. The mean follow-up time was 46.1 months (range: 35 to 57 months). We recorded data on 55 covariates, including baseline details about health, function, and bone mineral density. We used the multivariate Cox proportional hazards model to analyze hazard ratios (HRs) of short-term (<12 months follow-up) and long-term (≧ 2 months follow-up) excess mortality for each covariate and calculated their PARP. RESULTS: Patients with hip fractures had a higher short-term mortality than non-fractured patients, and the long-term excess mortality associated with hip fracture remained high. The significant risk factors for short-term mortality were hip fracture, comorbidities, and lower (below cutoff) Mini Mental State Examination score with HRs of 2.4, 2.3, and 2.3, respectively. Their PARPs were 44.7%, 38.1%, and 34.3%, respectively. The significant risk factors for long-term mortality were hip fracture (HR: 2.7; PARP: 48.0%), lower T-score (HR: 3.3; PARP: 36.2%), lower body mass index (HR: 2.5; PARP: 42.8%), comorbidities (HR: 2.1; PARP: 34.8%), difficulty in activities of daily living (HR: 1.9; PARP: 31.8%), and smoking (HR: 2.5; PARP: 19.2%). CONCLUSIONS: After comprehensive adjustment, hip fracture was a significant risk factor and contributed the most to long-term as well as short-term excess mortality. Its adequate prevention and treatment should be targeted.

Symptom distress and quality of life after stereotactic radiosurgery in patients with pituitary tumors: a questionnaire survey.

BACKGROUND: Stereotactic radiosurgery (SRS) is a common treatment for recurrent or residual pituitary adenomas. The persistence of symptoms and treatment related complications may impair the patient's quality of life (QOL). PURPOSE: The purpose of this study was to examine symptom distress, QOL, and the relationship between them among patients with pituitary tumors who had undergone SRS. METHODS: This study used a cross-sectional design and purposive sampling. We enrolled patients diagnosed with pituitary tumors who had undergone SRS. Data were collected at the CyberKnife Center at a medical center in Northern Taiwan in 2012. A questionnaire survey was used for data collection. Our questionnaire consisted of 3 parts the Pituitary Tumor Symptom Distress Questionnaire, the World Health Organization Quality of Life Instrument Short-Form (WHOQOL-BREF), and a demographic questionnaire. RESULTS: Sixty patients were enrolled in the study. The most common symptoms reported by patients after SRS were memory loss, fatigue, blurred vision, headache, sleep problems, and altered libido. The highest and lowest scores for QOL were in the environmental and psychological domains, respectively. Age was positively correlated with general health and the psychological domains. Level of symptom distress was negatively correlated with overall QOL, general health, physical health, and the psychological and social relationships domains. The scores in the psychological and environmental domains were higher in males than in females. Patients with ≤6 symptoms had better overall QOL, general health, physical health, and psychological and social relationships than those with >6 symptoms. CONCLUSION: Symptom distress can affect different aspects of patient QOL. Levels of symptom distress, number of symptoms, age, and gender were variables significantly correlated with patient QOL. These results may be utilized by healthcare personnel to design educational and targeted interventional programs for symptom management to improve patient QOL.

Epidemiological study of orthopedic injuries in hemodialysis patients in Taiwan: a fixed cohort survey, 2004-2008.

BACKGROUND: The burden of chronic kidney disease (CKD) is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors. METHODS: A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004-2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury. RESULTS: A total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum (≥65 years old). In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10-3.89) for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures. CONCLUSION: The results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis.

Factors associated with low bone mass in the hemodialysis patients--a cross-sectional correlation study.

BACKGROUND: Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients. METHODS: Sixty-three subjects on hemodialysis for at least 6 months were recruited from a single center for this cross-sectional study. We collected data by questionnaire survey and medical records review. All subjects underwent a bone mineral density (BMD) assay with dual-energy x-ray absorptiometry at the lumbar spine and right hip. Data were statistically analyzed by means of descriptive analysis, independent t test and one way analysis of variance for continuous variables, Pearson product-moment correlation to explore the correlated factors of BMD, and stepwise multiple linear regression to identify the predictors of low bone mass. RESULTS: Using WHO criteria as a cutoff point, fifty-one subjects (81%) had a T-score lower than -1, of them 8 subjects (13%) had osteoporosis with the femoral neck most commonly affected. Regarding risk factors, age, serum alkaline phosphatase (ALP) level, and intact parathyroid hormone (iPTH) level had significant negative correlations with the femoral neck and lumbar spine BMD. On the other hand, serum albumin level, effective exercise time, and body weight (BW) had significant positive correlations with the femoral neck and lumbar spine BMD. Age, effective exercise time, and serum albumin level significantly predicted the femoral neck BMD (R(2) x 0.25), whereas BW and the ALP level significantly predicted the lumbar spine BMD (R(2) x 0.20). CONCLUSION: This study showed that advanced age, low BW, low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients. We suggest that regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW, and undertaking an exercise program are important to improve bone health in the patients undergoing hemodialysis.

Asthma care issues in kindergarten teachers: an evaluation on knowledge, attitudes, and self-efficacy of asthma.

As frequently there is no school nurse in a kindergarten setting, teachers receiving non-medical training take the primary roles of symptom assessment and management of young children with asthma. This article presents the knowledge, attitudes, and self-efficacy of asthma in kindergarten teachers in Taiwan. A total valid sample of 460 teachers was recruited from 70 kindergartens. Results showed most teachers understood the basic facts about asthma rather than the complex issues; they demonstrated positive attitudes toward having asthmatic children in class. Regarding self-efficacy, teachers lacked confidence in their ability to manage asthma attacks. Teachers' asthma knowledge showed a significant positive correlation with attitude (r = 0.27, p < 0.001) and self-efficacy knowledge (r = 0.23, p < 0.001). Given the need to help kindergarten teachers take care of children with asthma, the implications of kindergarten teachers' in-service education and training to asthma care are also discussed.

Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial.

The purpose of this randomized, controlled clinical trial was to preliminarily examine the effects of a three-week walking exercise program (WEP) on fatigue-related experiences of acute myelogenous leukemia (AML) patients receiving chemotherapy. Eligible AML patients were randomly assigned to either an experimental group (n=11), which received 12 minutes of WEP per day, five days per week for three consecutive weeks, or to a control group (n=11), which received standard ward care. Effects of the WEP were assessed by seven indicators: worst and average fatigue intensities, fatigue interference with patients' daily life, 12-minute walking distance, overall symptom distress, anxiety, and depressive status. All patients were evaluated four times: before chemotherapy (baseline or Day 1), Day 7, Day 14, and Day 21 of chemotherapy. Data were analyzed by Generalized Estimating Equation and revealed that AML patients in the three-week WEP group had a significantly greater increase in 12-minute walking distance than the control group. Patients in the WEP also had lower levels of fatigue intensity and interference, symptom distress, anxiety, and depressive status than the control group. Although preliminary, our results strongly suggest that three weeks of systematic walking exercise is clinically feasible for AML patients undergoing chemotherapy and can effectively improve their fatigue-related experiences.

Nutritional status and health outcomes for older people with dementia living in institutions.

AIM: This paper is a report of a study to determine changes over a 3-month period among older people with dementia living in long-term care settings, related to: (1) changes in body mass index, and (2) health outcomes and associated factors. BACKGROUND: Nutritional deficiencies are common problems among older people, but frequently unrecognized, both in long-term care settings and in the community. METHOD: A cross-sectional design with repeated measures of body weights and medical record reviews was adopted. The study was conducted in 2003 in two long-term care facilities for older people with dementia in Taiwan. Fifty-five residents participated in the study. RESULTS: Eighteen percent of the residents were under-nourished (body mass index <18.5). There was a trend toward decreasing body mass index over the 3-month study period. Residents with low body mass index tended to need assistance at mealtimes. Nineteen residents, many receiving naso-gastric tube-feeding, experienced adverse health events during the study period. Dependency in eating was the major factor differentiating residents with normal or low body mass index values, and also in distinguishing those who experienced adverse health outcomes. CONCLUSION: Assessment of eating ability, mode of feeding and measurement of body weight can be used by nurses in long-term care settings for early identification of the nutritional status of older people with dementia.

Identifying the most efficient items from the Mini-Mental State Examination for cognitive function assessment in older Taiwanese patients.

AIMS: The purpose of the study was to identify the most efficient items from the Mini-Mental State Examination for assessment of cognitive function. BACKGROUND: The Mini-Mental State Examination is the most frequently used cognitive screening instrument. However, the Mini-Mental State Examination has been criticized for insensitivity to mild cognitive dysfunction, limited memory assessment and variability in level of difficulty of the individual items. METHOD: This study used secondary data analysis. Item response theory two-parameter model was used to analyse the data from the admission assessment of mental status by the Mini-Mental State Examination for 801 patients. RESULTS: By using item response analysis, 16 items were selected from the original 30-item Mini-Mental State Examination. The 16 items included mainly the measures of orientation, recall and attention and calculation. The internal consistency of the 16-item Mini-Mental State Examination was 0.84. The proposed new cut-off point for the 16-item Mini-Mental State Examination was 11. The correct classification rate was 0.94, the sensitivity was 100% and the specificity was 97.4%, when compared with the original 30-item Mini-Mental State Examination from the cut-off point of 24. This new cut-off point was determined for the purpose of over-identifying patients at risk so as to ensure early detection of and prevention from the onset of cognitive disturbance. CONCLUSION: Only a few items are needed to describe the subject's cognitive status. Using item response theory analysis, the study found that the Mini-Mental State Examination could be simplified. RELEVANCE TO CLINICAL PRACTICE: Deleting the items with less variation makes this assessment tool not only shorter, easier to administer and less strenuous for respondents, but also enables one to maintain validity as a cognitive function test for clinical setting.

Predicting post-surgical cognitive disturbance in older Taiwanese patients.

The purpose of this study was to test a theoretical model to understand the influences of six predicting variables in post-surgical cognitive disturbance in older Taiwanese patients after elective surgery. The data were collected in a medical center in Taipei, Taiwan. Ninety-three patients were included in the final analysis. The findings showed that cognitive function at admission (beta=0.50, p<0.001), physical function at admission (beta=-0.34, p<0.001), and physiological stability (beta=-0.21, p<0.01) had direct effects on post-surgical cognitive disturbance. Physical function and cognitive function at admission also affected post-surgical cognitive disturbance indirectly through physiological stability. These variables accounted for 67% of the total variance of post-surgical cognitive disturbance. The findings from this study suggest that a careful and systematic assessment of the patient's condition at the time of admission is important. It is necessary to monitor and correct these variables at admission or before surgery to prevent or reduce the impact of post-operative delirium. It is also necessary to monitor these variables during the hospital stay to help nurses to distinguish the etiology of delirium. In each case, knowing when confusion is more likely to occur can assist in focusing more appropriate and effective efforts at detection, thereby reducing the consequences associated with confusion.

Postoperative cognitive changes among older Taiwanese patients.

The purpose of the study was to describe variations in cognitive/behavioural changes during the course of delirium among older Taiwanese patients after elective surgery. A total of 106 patients assessed four times (admission, onset of delirium, delirium day 3 and delirium day 5) by the Mini Mental State Examination (MMSE) were included in the analysis to understand the neurocognitive/behaviour change during the course of delirium. Repeated measures anova was used to analyse within-subject differences across these four time points for those who became delirious and those who did not. The findings showed that patients who experienced delirium had significantly (P < 0.01) lower MMSE scores than non-delirious patients. Scores for the delirious group were also significantly different across the four assessments (P < 0.01) within the group. The subscales of orientation to time, orientation to place, registration and recall were the major changes from time 1 (admission assessment) to time 2 (onset of delirium) for delirious patients. When scores for time 4 (delirium day 5) and time 1 (admission assessment) were compared, the subscales of orientation to time, orientation to place and visual construction showed the least improvement among the subscales at time 4. The findings of the study suggest that mental status assessments are important during the patient's admission and hospital stay. The repeated assessments can be incorporated into routine nursing care so that problems can be detected and appropriate nursing care implemented.

Functional recovery after hip fracture: six months' follow-up of patients in a multidisciplinary rehabilitation program.

BACKGROUND AND PURPOSE: Hip fracture is a major source of disability among the elderly. The purpose of this study was to evaluate the effects of an in-hospital multidisciplinary rehabilitation program (MRP) on basic activities of daily living (BADL) and mobility 6 months after hospital discharge in patients with hip fractures. METHODS: A before and after quasi-experimental design was used. Subjects were recruited in a large teaching hospital in Taipei, Taiwan. The first 44 consecutive patients recruited received conventional care (control group). The next 50 consecutive patients received physical therapy, nursing-supervised practice of exercise, and discharge planning (intervention group). The 94 patients recruited were aged 60 years or older and were hospitalized to receive open reduction and internal fixation or arthroplasty. Subjects were assessed at admission, on the fourth operative day, on the day of discharge, and 6 months after discharge. RESULTS: On average, subjects did not regain their prefracture functional score for BADL and mobility 6 months after discharge. The intervention versus control group had a lower incidence of functional decline in BADL (16.0% vs. 34.1%; p = 0.01) and mobility (48.0% vs. 75.0%; p = 0.01) 6 months after discharge. Subjects who were independent before fracture (odds ratio [OR], 12.24), did not receive MRP intervention (OR, 4.63), or who were female (OR, 5.24), were more likely to have a decline in function 6 months after discharge. CONCLUSION: An MRP had a continuous positive effect on hip-fracture patients, thus facilitating improved recovery in BADL and mobility 6 months after discharge.