Factors of Influence on Diabetes Awareness in Older People With Chronic Obstructive Pulmonary Disease Comorbid With Type 2 Diabetes Mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of mortality in this population. PURPOSE: This study was designed to investigate the predictive factors of diabetes awareness (DA), including diabetes knowledge (DK), and diabetes care behaviors (DCB) among older people with both COPD and T2DM. METHODS: This was a cross-sectional descriptive correlation study. One hundred thirty-three older-age patients with COPD comorbid with T2DM receiving treatment at a chest hospital were enrolled as participants. Both DK and DCB were utilized to measure DA. The Diabetes Knowledge Questionnaire was utilized to measure DK, and the Summary of Diabetes Self-Care Activities was used to evaluate DCB. RESULTS: The average glycated hemoglobin (HbA1c) was 7.68% ( SD = 1.55%), with 74 (55.6%) participants having a level > 7%. The average DA was 46.46% ( SD = 13.34%), the average DK was 53.42% ( SD = 18.91%), and the average DCB was 39.50% ( SD = 16.66%). In terms of demographic variables, age, diabetes education, diabetes shared care, and HbA1c were all significantly associated with DA, DK, and DCB (all p s < .05). The overall variance in DA was significantly explained by diabetes education and HbA1c (all p s < .05). The overall variance in DK was significantly explained by age, diabetes education, and HbA1c. The overall variance in DCB was significantly explained by diabetes education and HbA1c (all p s < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Our study findings indicate that older adult patients with COPD comorbid with T2DM are at elevated risks of poor glycemic control and low DA. Healthcare professionals should be aware of these issues and develop appropriate DA plans to prevent poor glycemic control in this population. Providing accurate information on diabetes to older adults with COPD comorbid with T2DM is important to improving their DK and promoting better DCB.

[Application of Evidence-Based Smoking Cessation Nursing Interventions Increase the Quitting of Smoking in Hospitalized Patients].

BACKGROUND: The second-generation smoking cessation measures for inpatients in our hospital were provided primarily by physicians. Statistics from January to December 2019 showed a negative trend in the number of inpatient smoking cessation services and health education courses provided. PURPOSE: Purpose: In this study, a comprehensive systematic literature review on the application of smoking cessation interventions was conducted with the goal of helping enhance the inpatient quit rate at the author's hospital. RESOLUTION: The literature on smoking cessation interventions was reviewed, with the findings used to formulate a feasible plan for the implementation of an effective related intervention at our hospital. During the implementation process, the challenges encountered led to the formulation of strategies, including: 'conducting second-generation smoking cessation on-the-job training,' 'revising the referral process for patients taking smoking-cessation medications,' and 'adding patients who do not cease smoking to the referral process.' Data on the number of individuals attempting to quit smoking and the success rate of smoking cessation were collected. The baseline values before project implementation were compared with the values at 12 and 24-months posttest. RESULTS: The number of individuals receiving smoking cessation services increased from 85 people within 12 months to 105 people, and further increased to 125 people by the 24th month. Comparing the 3-month abstinence rates for 2019 and 2020, an increase from 31.36% before project implementation to 42.67% after implementation was observed, indicating a rise of 11.31%. Also, comparing the 6-month abstinence rates between 2019 and 2020, an increase from 27.16% before project implementation to 42.67% after implementation was observed, indicating a rise of 15.51%. The project outcomes calculated in December 2021 show a three-month abstinence rate of 44.40% and a six-month abstinence rate of 41.82%. CONCLUSIONS: The nursing interventions for smoking cessation in this project increased the abstinence rate among inpatients. Evidence-based practices, including earching for quality research evidence, utilizing the 7A framework to bridge evidence and clinical differences, and promoting the project using a collaborative cross-team approach, were the main factors contributing to the success of the project. The evidence-based application of smoking cessation strategies highlights the significant role played by nurses in enhancing the quality of care. The findings may serve as a reference for the future development of nursing project solutions.

Cardiopulmonary Endurance of Hospitalized Older Adults With Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) could lead to poor cardiopulmonary endurance, which affects quality of life and increases the risk of rehospitalization or mortality. However, studies investigating associated factors of cardiopulmonary endurance for COPD inpatients are scant. OBJECTIVE: The aim of the study was to investigate whether and how age, gender, COPD severity, body composition, dyspnea, respiratory muscle strength, and lower limb muscle strength and endurance were related to cardiopulmonary endurance in elderly inpatients with COPD. METHODS: This was a cross-sectional study using a systematic sampling of older inpatients. Data of demographic characteristics such as age, gender, and disease severity were collected, and body mass index was calculated. Degrees of dyspnea were assessed by the modified Medical Research Council Dyspnea Scale. Respiratory muscle strength was reflected by the maximal inspiratory pressure and the maximal expiratory pressure. Lower limb muscle strength and endurance were assessed by a handheld dynamometer and a 30-second sit-to-stand test, respectively. Finally, cardiopulmonary endurance was assessed by a 6-minute walk test. RESULTS: A total of 83 older COPD inpatients participated. The mean age was 74.01 ± 6.93 years. Cardiopulmonary endurance was associated with age, COPD severity, dyspnea, respiratory muscle strength, lower limb muscle strength, and endurance. Predictors of cardiopulmonary endurance were disease severity, dyspnea, and lower limb muscle endurance. These predictors explained 53% of the variance in cardiopulmonary endurance in older inpatients with COPD. DISCUSSION: Cardiopulmonary endurance of hospitalized older adults with COPD should be strengthened by improving conditions of disease severity, dyspnea, and lower limb muscle endurance.

Inhaled corticosteroids and the risks of low-energy fractures in patients with chronic airway diseases: A propensity score matched study.

BACKGROUND AND AIMS: Inhaled corticosteroids (ICSs) are crucial anti-inflammatory medications for chronic airway diseases. Studies investigating the relationship between ICSs and fractures in Asian populations are scant. We investigated whether ICSs increased the risk of low-energy fractures in patients with chronic airway diseases. METHODS: We used the Longitudinal Health Insurance Database to select patients aged 20 years and older with chronic airway diseases (asthma and COPD) between 2000 and 2011 as the base cohort. We identified ICS users and ICS non-users matched by propensity score method at 1:1 ratio. Cox proportional hazard regression models were used to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for factors associated with the risk of fracture. RESULTS: A total of 1,182 ICS users and 1,182 controls were enrolled. After adjustment for age, gender, annual exacerbation number of acute respiratory events, comorbidity and medications, the risk of fracture was 1.10 for ICS users (aHR = 1.20; 95% CI = 1.10-1.31) compared with ICS non-users. The ICS users exhibited significantly 1.63-fold risk of hip fracture and 1.24-fold risk of ulna and radius fracture than did the ICS non-users. Patients with medium and high doses of ICS use were associated with significantly increased risks of fracture (aHR = 1.48, 95% CI = 1.25-1.76 for medium dose and aHR = 1.55, 95% CI = 1.39-1.72 for high dose) compared with those in ICS non-users. CONCLUSIONS: Patients with medium and high doses of ICS use are associated with an increased risk of fracture.

Free radicals and antioxidant enzymes in older adults after regular senior elastic band exercising: an experimental randomized controlled pilot study.

AIM: The aim of this study was to pilot test the effects of regular senior elastic band exercises on the generation of free radicals and antioxidant enzyme activities in older adults. BACKGROUND: Long-term regular exercises have positive health promotion outcomes. On the contrary, high-intensity, high-speed and short-term exercises in older adults may increase free radicals and cause chronic disease and ageing effect. DESIGN: A prospective randomized controlled pilot study. METHODS: Data were collected during 2012. Twenty-five older adults were recruited from a community care centre, southern Taiwan and were randomly assigned to either an experimental or control group. Twenty-two participants completed the study: experimental group (n = 10) and control group (n = 12). The experimental group performed 6-month senior elastic band exercises while the control group kept regular daily routines. Both groups received blood tests (thiobarbituric acid-reacting substances and glutathione peroxidase) 30 minutes before the study began and 1 hour after the final intervention treatment. RESULTS: At the end of the 6-month senior elastic band exercises, no statistically significant differences in thiobarbituric acid-reacting substances and glutathione peroxidase values between the experimental and control groups. No significant differences existed in both thiobarbituric acid-reacting substances and glutathione peroxidase values before and after the 6-month senior elastic band exercises either. CONCLUSIONS: Regular senior elastic band exercises did not increase the generation of free radicals and antioxidant enzyme activities. Senior elastic band exercises have the potential to be promoted among older adults in the community as an exercise option without adverse effects on free radicals and have potential for mitigating ageing and increasing disease control.

Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial.

CLINICAL TRIALS IDENTIFIER: NCT02329873. BACKGROUND: Acute exacerbation (AE) of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed. OBJECTIVE: To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD. METHODS: A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10-30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration) were assessed at the baseline and at the end of the fourth day. RESULTS: All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all P<0.05). Within-group comparisons revealed that the dyspnea, cough, and exercise tolerance significantly improved in the experimental group by the end of the fourth day (all P<0.05). CONCLUSION: Results of this study suggest that the respiratory rehabilitation exercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD.