Research of Arithmetic and Drawing Writing in Improving Communication and Cognitive Function in Patients with Mild-to-Moderate Dementia: A Cluster Randomized Controlled Trial.

Objective: The aim of the study was to investigate the effectiveness of arithmetic and drawing writing on communication skills, quality of life, and cognitive impairment among people with mild and moderate dementia. Methods: We recruited 45 patients diagnosed with mild-to-moderate dementia into this study. The participants were randomly divided into arithmetic group (n = 14), drawing writing group (n = 16), and control group (n = 15). The arithmetic group was educated to understand the addition and subtraction formulas, then wrote down the correct answers between the number of 20 and 100. The drawing writing group was guided to name, draw, and write a given object. Both were trained by therapist for 12 weeks (40 minutes per week). Blinded assessors measured global cognitive function, communication skills, and quality of life using Mini-Mental State Examination (MMSE) scale, the subscales of Functional Assessment of Communication Skills scale and Quality of Life-Alzheimer's Disease scale at baseline and after 12 weeks' intervention. Results: After the 12-week intervention, the participants with mild-to-moderate dementia of the arithmetic writing group and the drawing writing group showed statistically significant improvement in communication skills and quality of life compared with the control group (social communication: 6.00 ± 0.69 vs. 6.06 ± 0.92 vs. 3.98 ± 1.33; basic needs communication: 6.32 ± 0.48 vs. 6.42 ± 0.53 vs. 4.25 ± 1.49; quality of life: 33.23 ± 5.34 vs. 34.07 ± 3.49 vs. 25.07 ± 2.60). In addition, MMSE scores of the arithmetic group tended to improve after the 12-week intervention (14.77 ± 3.06 vs. 17.31 ± 4.80, P < .01), but stabled in drawing writing group (14.27 ± 4.28 vs. 14.53 ± 5.26, P > .05) and significant decreased in the control group (13.73 ± 2.58 vs. 10.13 ± 3.23, P < .01). Conclusion: Arithmetic, drawing, and writing are effective in improving communication skills and quality of life; arithmetic also could delay the decline of cognitive function in people with mild-to-moderate dementia.

Characteristics and Influencing Factors of Post-Traumatic Growth: A Cross-Sectional Study of Psychiatric Nurses Suffering from Workplace Violence in Guangdong China.

Background: Workplace violence (WPV) had become an important issue that endangered the occupational safety of psychiatric nurses. A growing number of studies showed positive post-traumatic growth (PTG) resulting from coping with trauma. Objective: To investigate the characteristics of PTG in psychiatric nurses who experienced violence in the workplace and analyze its influencing factors. Methods: A total of 1202 psychiatric nurses participated in the study. From October 2022 to December 2022, this cross-sectional study collected data on psychiatric nurses from five tertiary hospitals in Guangdong Province, China. Twenty-item Chinese version post-traumatic growth inventory (PTGI), Jefferson Scale of Empathy Health Professional (JSE-HP), Confidence in Coping with Patient Aggression Instrument (CCPAI), Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Connor-Davidson Resilience Scale (CD-RISC) measured PTG level, empathy, the confidence in coping with WPV, post-traumatic stress disorder, and resilience, respectively. Bivariate analysis and multiple linear regression explored potential influencing factors of PTG. This study complies with the EQUATOR (STROBE) checklist. Results: The sample was composed of a total of 1202 psychiatric nurses suffering from WPV. The average score of PTGI in psychiatric nurses was above average (65.75 points; SD = 20.20). Linear regression analyses showed from single-child family (ß=0.052,95% CI=0.342,5.409, P<0.05), education background (ß=0.108,95% CI=1.833,5.097, P<0.001), the confidence in coping with patient aggression (ß=0.106,95% CI=1.385,4.317, P<0.001), empathy (ß=0.057,95% CI=0.312,4.374, P<0.05), and resilience (ß=0.484,95% CI=7.737,9.575, P<0.001) were associated with PTG level. Conclusion: Psychiatric nurses who were non-single child, had received higher education, had confidence in coping with patient aggression, had good resilience and strong empathy were prone to PTG after experiencing WPV. The study findings could help hospitals and nursing managers identify vulnerable individuals and take early intervention measures against such populations.

Effectiveness of nurse-delivered stepwise swallowing training on dysphagia in patients with Alzheimer's disease: A multi-center randomized controlled trial.

BACKGROUND: Although swallowing exercises are a fundamental treatment for dysphagia, few studies have evaluated the effectiveness of swallowing training in patients with Alzheimer's disease. METHODS: We recruited 93 patients with Alzheimer's disease from three hospitals in Guangdong, China. This was a parallel armed randomized controlled trial that randomly assigned patients to intervention (n = 48) and control (n = 45) groups. The intervention group adopted systematic stepwise swallowing training for four weeks based on routine dysphagia care. The control group implemented routine dysphagia care, including diet and posture management and health education about swallowing dysfunction. The swallowing function was the primary outcome, which was assessed using the Water Swallowing Test and Standard Swallowing Assessment. An abnormal eating behavior questionnaire was used to assess the incidence of aberrant eating behavior in patients with Alzheimer's disease. The Mini-Nutritional Assessment Short Form and Barthel index were adopted to evaluate the nutritional status and ability to carry out daily activities between groups. SPSS software was used to perform the chi-square test, t-test, and generalized estimation equation for data analysis. RESULTS: We analyzed the effects of the stepwise swallowing training program using the generalized estimating equation method. The intervention group exhibited greater improvements in their swallowing function (Water Swallowing Test: ß = -3.133, 95 % CI: -4.113, -2.154, P < 0.001; Standard Swallowing Assessment: ß = -5.813, 95 % CI: -7.782, -3.844, P < 0.001), abnormal eating behaviors (abnormal eating behavior questionnaire: ß = -13.324, 95 % CI: -21.643, -5.005, P = 0.002), daily function (Barthel index: ß = 11.280, 95 % CI: 4.021, 18.540, P = 0.002), and nutritional status (Mini-Nutritional Assessment Short Form: ß = 2.402, 95 % CI: 1.313, 3.490, P < 0.001) over time than the routine-care group in the fourth week. CONCLUSIONS: Stepwise swallowing training is a safe and effective intervention for managing dysphagia and other related symptoms in patients with Alzheimer's disease.

Physical condition and activity of daily living among aging inpatients with mental disorders in Guangzhou, China: a cross-sectional study.

BACKGROUND: The number of elderly with mental disorders is increasing, but few studies have been concerned with the physical condition and activities of daily living (ADL) of these patients. This study aims to describe the physical condition and ADL of patients with mental illnesses (PMI) from different age groups, which provides evidence to improve mental health services for PMI. METHODS: In this prospective cross-sectional study, the samples were divided into three groups of less than 60 years old (group 1), 60-74 years old (group 2), and over 75 years old (group 3) for comparison. Participants' ADL and physical condition were measure by Barthel Index (BI), Functional Activities Questionnaire (FAQ), Standardised swallowing assessment (SSA) and Short Form of Mini Nutrition Assessment (MNA-SF). The Brief Psychiatric Rating Scale (BPRS) and the Mini-Mental State Examination (MMSE) were used to measure psychological condition. RESULTS: Totally, 392 participants had been recruited, meanwhile 86% of them were diagnosed with at least one physical disease. There were statistically significant differences in the three groups of participants in BI (F = 50.603, P < 0.001), FAQ (F = 40.332, P < 0.001), SSA (F = 28.574, P < 0.001), and MNA-SF (F = 18.366, P < 0.001). Group 2 and group 3 had significantly lower scores in BI and FAQ than group 1, and the SSA scores were significantly higher than the participants in group 1. In the negative symptoms subscale of BPRS, the mean score of group 3 was significantly higher than groups 1 and 2. Negative symptom subscale has different degrees of correlation with BI (r = -0.537), FAQ (r = 0.643), SSA (r = 0.480), MNA (r = -0.325) and MMSE (r = 0.607). In addition, the participants with comorbidities were related to BI (r = -0.364). CONCLUSION: Somatic comorbidities play a pivotal role in the clinical characteristics of elderly patients with mental illness, thus greater effort should be paid to elderly patients suffering from mental illness with dysphagia, malnutrition, and cognitive decline. Further, the negative symptoms of elderly patients with mental disorders also deserve attention.

Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes.

Objectives: To investigate differences in behavioral and psychological symptoms of dementia (BPSD) and caregiver distress caused between older adults with dementia living in the community and in nursing homes. Design: A comparative cross-sectional study. Setting and Participants: Participants were recruited from outpatient clinics of a tertiary psychiatric hospital and dementia units of a nursing home in Guangzhou, China. Methods: Neuropsychiatric Inventory was used to assess symptoms and caregiver distress. Dementia severity was determined using the Clinical Dementia Rating. Results: This study included 157 community and 112 nursing home residents with dementia. Clinically significant symptoms (item score ≥ 4) were found in 88.5% of the former and 75% of the latter. Caregivers of 79.6% of the former and 26.8% of the latter reported that at least one of these caused them moderate-to-severe distress (distress score ≥ 3). Among the community patients, anxiety was the most frequent "very severe" symptom, while sleep disorders and agitation caused the most frequent "very severe" caregiver distress. After controlling for dementia severity and medication use, family caregiving remained an independent risk predictor for clinically significant symptoms and moderate-to-severe caregiver distress. The prediction of caregiver distress based on symptom scores varied across caregiver types and individual symptoms (R2 0.36-0.82). Group differences in clinically significant symptoms and moderate-to-severe caregiver distress showed at the stage of moderate-to-severe dementia. Conclusions and Implications: Tailored management strategies to relieve family caregivers' BPSD-induced distress are needed, especially at the stage of moderate-to-severe dementia. An effective service system should be established for supporting family caregivers to cope with BPSD.

Predictors of everyday functional impairment in older patients with schizophrenia: A cross-sectional study.

Objective: This study investigates the prevalence of everyday functional impairment among older adults with schizophrenia and builds a predictive model of functional decline. Methods: A total of 113 hospitalized older patients enrolled in this study. Functional impairment is defined according to the Functional Activities Questionnaire (FAQ). Patients who scored <9 could function independently daily, while those who scored ≥9 had problems in everyday functional activities. Data collected include sociodemographic characteristics, depressive symptoms, social support, and physical comorbidities, which were classified according to the eight anatomical systems of the human body. Results: The sample comprised 75% female participants with a mean age of 63.74 ± 7.42 years old. A total of 33.6% had a functional impairment, while cognitive impairment was present in 63.7%. Independent participants had better urinary system and respiratory system health (P < 0.05). After adjusting for the potential confounders of age, disease course, physical comorbidities, psychiatric symptoms, the ability to independently carry out daily activities, and cognitive function, we found that impaired everyday function is associated with poor cognition, depressive symptoms, first admission, psychiatric symptoms (especially positive symptoms), ADL, and respiratory and urinary system diseases. Conclusion: Everyday functional capacity is predicted by disease course, admission time, cognition, depressive symptoms, severity of psychosis, ability to carry out daily activities, and respiratory and urinary system health status. Urinary system diseases contribute significantly to the prediction of impaired function. Future studies should focus on health status, drug use, and everyday functional recovery in older patients with schizophrenia.

Validation of the Chinese version of the abnormal eating behavior questionnaire in people with dementia.

Abnormal eating behaviors are common in patients with dementia. To comprehensively assess and understand these issues, we validated the Chinese version of the Abnormal Eating Behaviour Questionnaire. Data for psychometric property evaluation were obtained from 129 patients with dementia. Internal consistency, test-retest reliability, dimensionality, and concurrent validity of the instrument were tested. The instrument showed acceptable internal consistency (Cronbach's alpha 0.73), time stability (Intra-class correlation coefficient 0.88, 95% CI: 0.77-0.94), and concurrent validity (ρ = 0.60, P < 0.001). Six factors (eigenvalues > 1, factor loading ≥ 0.3) explaining 55.1% of the variance were obtained through exploratory factor analysis. Overall, 86.8% of the participants showed at least one abnormal eating behavior. The instrument is reliable and valid for assessing abnormal eating behaviors in patients with dementia. Patients with dementia had a high prevalence of abnormal eating behaviors.

Conversion between Mini-Mental State Examination and Montreal Cognitive Assessment scores in older adults undergoing selective surgery using Rasch analysis.

AIMS: To develop and validate a conversion table between the MMSE and the MoCA using Rasch analysis in older adults undergoing selective surgery and examine its diagnostic accuracy in detecting cognitive impairment. DESIGN: Cross-sectional study. METHODS: Older patients [N = 129; age 66.0 (4.6) years, education 7.7 (3.5) years] undergoing elective surgery were recruited from December 2017 to June 2018. All participants completed the MMSE and MoCA and 113 of them completed a battery of neuropsychological tests. Common person linking based on Rasch analysis was performed to develop the conversion table. The conversions were validated by calculating the intraclass correlation coefficient (ICC), score differences between actual and converted scores, and root mean squared error of the difference (RMSE). The diagnostic accuracy of the conversions for detecting cognitive impairment was also tested. RESULTS: The MoCA [person measure: 1.3 (1.1) logits] was better targeted to the patients than the MMSE [person measure: 3.2 (1.3) logits]. Conversion from MoCA to MMSE scores (ICC 0.84, 95% CI 0.77-0.88; RMSE 1.36) was more precise than conversion from MMSE to MoCA (ICC 0.82, 95% CI 0.75-0.87; RMSE 2.56). Conversion from MoCA to MMSE demonstrated better diagnostic accuracy in detecting cognitive impairment than the actual MMSE, whereas conversion from MMSE to MoCA exhibited the opposite pattern. CONCLUSION: Conversion from MoCA to MMSE was more precise and had better diagnostic accuracy in detecting pre-operative cognitive impairment in older patients undergoing selective surgery than conversion from MMSE into MoCA. IMPACT: The finding is useful for interpreting, comparing, and integrating cognitive measurements in surgical settings and clinical research. Statistically sound conversion between MoCA and MMSE based on Rasch analysis is now possible for surgical setting and clinical research.

Health status, care needs, and assessment for beneficiaries with or without dementia in a public long-term care insurance pilot in Guangzhou, China.

BACKGROUND: Chinese government launched a pilot study on public long-term care insurance (LTCI) recently. Guangzhou is one of the fifteen pilot cities, officially started providing LTCI in August 2017. An in-depth analysis of experimental data from the pilot city may provide suggestions for developing a fair and effective LTCI system. This study aimed to evaluate the LTCI pilot by exploring the characteristics and care needs of claimants, and performance of the assessment tool. METHODS: A retrospective cross-sectional study in which claims data between July 2018 and March 2019 in the Guangzhou pilot was analyzed. LTCI claimants during the study period were included. The care needs were determined based on claimants' physical function assessed by the Barthel Index and their medical conditions. Rasch analysis was used to explore the performance of the Barthel Index. RESULTS: Among 4810 claimants included, 4582 (95.3%) obtained LTCI benefits. Of these beneficiaries, 4357 (95.1%) were ≧ 60 years old, and 791 (17.3%) had dementia. Among 228 (4.7%) unsuccessful claimants, 22 (0.5%) had dementia. The prevalence of stroke was high in beneficiaries with (38.1%) or without dementia (56.6%), as well as in unsuccessful claimants with (40.9%) or without dementia (52.4%). Beneficiaries without dementia needed more support for basic activities of daily living and nursing care than those with dementia, while beneficiaries with dementia were more likely to be institutionalized. Five (22.7%) unsuccessful claimants with dementia and 48 (23.3%) unsuccessful claimants without dementia were disabled in at least two basic self-care activities. Regarding Barthel Index, Rasch analysis showed threshold disordering in "mobility" and "climbing stairs", and the narrow interval was observed between all the adjacent categories of the ten items (< 1.4 logits). CONCLUSIONS: Stroke and dementia were two common reasons for needing long-term care in LTCI claimants. The Barthel Index is not suitable for assessing and dividing LTCI claimants, because of inappropriate items and narrow category responses. A comprehensive assessment and grading system is required, together with needs-led care services. The eligibility should be expanded gradually based on balance finance solutions.

Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia?

OBJECTIVES: To evaluate application of the Barthel Index (BI) in assessing basic activities of daily living (ADL) of patients with dementia using Rasch analysis. DESIGN: A multi-country cross-sectional study. SETTING AND PARTICIPANTS: Nineteen long-term care facilities located in China, Japan, South Korea, and Thailand. A total of 644 patients with dementia were included. METHODS: Unidimensionality, global and item fit, local dependence, person-item targeting, threshold disordering, and differential item functioning (DIF) were examined. Negative correlations between scores for DIF items and Neuropsychiatric Inventory Nursing Home version (NPI-NH) were evaluated. RESULTS: Item reliability (1.0) and person reliability (.88) were acceptable. The Rasch dimension explained 72.9% of the variance (Eigenvalue = 27), while the first contrast explained 6.6% (Eigenvalue = 2.4). The "mobility" was misfitting to the Rasch model (infit mean square = 1.86). The overall difficulty of the BI exceeded patients' ability (person location = -2.27 logits). The "stairs climbing" and "mobility" showed narrow category thresholds (< 1.4 logits). The location of "controlling bladder" and "toilet use" overlapped. Removing "stairs climbing", collapsing categories with narrow threshold widths in "mobility", and combining "controlling bowel" and "controlling bladder" into one item, improved unidimensionality, and item fit of the scale. Only three items ("grooming", "dressing", and "toilet use") were free from DIF across countries. The scores for "feeding" were negatively related to scores for "disinhibition" (r = -0.46, P < 0.01), and scores for "controlling bowel" were negatively related to scores for "disinhibition" (r = -0.44, P < 0.01), "agitation" (r = -0.32, P < 0.05), and "aggression" (r = -0.27, P < 0.01) in Japanese samples. CONCLUSIONS AND IMPLICATIONS: The performance of the BI for assessing patients with dementia might be compromised by misfit items, person-item mistargeting, measurement gaps, redundant items, narrow threshold width, and item bias. Mobility ability might not be helpful for determining capability of basic ADL in the patients. Comparisons of BI scores between countries should be undertaken with caution due to item bias. Neuropsychiatric symptoms might interact with basic ADL abilities of the patients. We will not suggest using the instrument in patients with dementia, without future refining to improve its performance.