Objectives
This study aimed at revealing the caregiving challenges of the caregivers of people with dementia (PwD) during the COVID‐19 pandemic when daycare service was stopped as an infection ...control measure, and discussed ways to help PwD and their family caregivers to maintain their well‐being in the era of the pandemic.
Methods
Between April and May 2020, a cross‐sectional survey was conducted in 152 family caregivers of PwD who were clients of daycare service prior to the pandemic. The survey examined caregivers' stress and challenges faced during daycare service cessation, their perceived needs for continuation of daycare service, and observed changes in functional status of PwD. Regression analyses were performed to explore the associated factors of caregiving stress and preference for continuation of daycare service.
Results
Family caregivers of PwD experienced greater caregiving stress after cessation of daycare service. Infection was their main challenge in caregiving, and their physical and emotional health was adversely affected by the longer time commitment with PwD under the stay‐home policy. Older age of caregivers, greater emotional and communication problems of PwD, and more time spent with PwD were associated with greater caregiving stress. More than one‐third of the participants preferred the continuation of daycare service during the pandemic.
Conclusions
Policy makers should consider the well‐being of PwD and their caregivers when planning infection control measures. Daycare service with enhanced infection controlled measures should remain available to PwD during the COVID‐19 pandemic.
Key points
Family caregivers of PwD experienced greater caregiving stress during the COVID‐19 pandemic due to anxiety of infection and longer time commitment with PwD.
The cognitive function and mobility of PwD deteriorated after daycare service cessation because of the lack of cognitive, social, and physical activities with the stay‐home policy.
More than a third of family caregivers thought that continuation of daycare service during the COVID‐19 pandemic was important because it provided useful respite for the caregivers and a safer place for PwD to go to.
Online intervention could be an alternative form of social stimulation for PwD and may reduce caregiving stress.
Aim
To evaluate the effectiveness of a combined patient empowerment program (PEP) and cognitive training (CT) program on improving glycemic control among older subjects with diabetes and cognitive ...impairment.
Methods
A prospective single blinded, randomized controlled study was carried out in 139 older patients with diabetes aged ≥65 years with memory complaints and recent glycosylated hemoglobin level of 7–9%. They were randomly assigned to either undergo once‐weekly PEP combined with CT for 10 weeks (intervention group, N = 73) or receive no intervention (control group, N = 66). All participants were followed up at months 4 and 12 to examine the immediate and long‐term effects on glycemic control, cognition, mood and compliance to drug and diabetes self‐management.
Results
The intervention did not significantly reduce glycosylated hemoglobin. The intervention group showed significant progressive improvement in memory over 1 year and executive function improved significantly at month 12. There was no significant change in diabetes self‐management activities with the intervention.
Conclusions
Combination of PEP and CT did not improve glycemic control or self‐care activities in older patients with diabetes and memory complaints but was effective in improving cognitive function in the longer term. Geriatr Gerontol Int 2020; 20: 1164–1170.
To investigate (1) the effects of indoor incense burning upon cognition over 3 years; (2) the associations between indoor incense burning with the brain's structure and functional connectivity of the ...default mode network (DMN); and (3) the interactions between indoor incense burning and vascular disease markers upon cognitive functions. Community older adults without stroke or dementia were recruited (n = 515). Indoor incense use was self-reported as having burnt incense at home ≥ weekly basis over the past 5 years. Detailed neuropsychological battery was administered at baseline (n = 227) and the Montreal Cognitive Assessment at baseline and year 3 (n = 515). MRI structural measures and functional connectivity of the DMN were recorded at baseline. Demographic and vascular risk factors and levels of outdoor pollutants were treated as covariates. Indoor incense burning was associated with reduced performance across multiple cognitive domains at baseline and year 3 as well as decreased connectivity in the DMN. It interacted with diabetes mellitus, hyperlipidemia and white matter hyperintensities to predict poorer cognitive performance. Indoor incense burning is (1) associated with poorer cognitive performance over 3 years; (2) related to decreased brain connectivity; and (3) it interacts with vascular disease to predispose poor cognitive performance.
This pilot randomized controlled trial aimed to evaluate the feasibility and potential outcomes of an innovative 16-session multicomponent intervention model to improve cognitive abilities in older ...adults with mild cognitive impairment (MCI) by promoting healthy lifestyle, cognitive skills, tai chi and mindfulness practices. This study was a multicentre, randomized controlled, two-arm, parallel-group, unblinded trial in Hong Kong. 57 Chinese older adults with MCI recruited from three local elderly centers were randomly assigned to either the control or intervention group. The study results support the feasibility and efficacy of the multicomponent intervention, and recommend future larger-scale randomized control trials.
Tai Chi and walking are both moderate-intensity physical activity (PA) that can be easily practiced in daily life. The objective of the study was to determine the effects of these two PAs on weight ...loss, metabolic syndrome parameters, and bone mineral density (BMD) in Chinese adults. We randomized 374 middle-aged subjects (45.8 ± 5.3 years) into 12-week training (45 minutes per day, 5 days per week) of Tai Chi ( n = 124 ) or self-paced walking ( n = 121 ) or control group ( n = 129 ) . On average, Tai Chi and walking groups lost 0.50 and 0.76 kg of body weight and 0.47 and 0.59 kg of fat mass after intervention, respectively. The between-group difference of waist circumference (WC) and fasting blood glucose (FBG) was −3.7 cm and −0.18 mmol/L for Tai Chi versus control and −4.1 cm and −0.22 mmol/L for walking versus control. No significant differences were observed regarding lean mass, blood pressure, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, and BMD compared to control. Change in lean mass, not fat mass or total weight loss, was significantly correlated to the change in BMD. Our results suggest that both of these two PAs can produce moderate weight loss and significantly improve the WC and FBG in Hong Kong Chinese adults, with no additional effects on BMD.
Falls are a prevalent cause of injury among older people. While some wearable inertial measurement unit (IMU) sensor-based systems have been widely investigated for fall risk assessment, their ...reliability, validity, and identification ability in community-dwelling older people remain unclear. Therefore, this study evaluated the performance of a commercially available IMU sensor-based fall risk assessment system among 20 community-dwelling older recurrent fallers (with a history of ≥2 falls in the past 12 months) and 20 community-dwelling older non-fallers (no history of falls in the past 12 months), together with applying the clinical scale of the Mini-Balance Evaluation Systems Test (Mini-BESTest). The results show that the IMU sensor-based system exhibited a significant moderate to excellent test-retest reliability (ICC = 0.838,
< 0.001), an acceptable level of internal consistency reliability (Spearman's rho = 0.471,
= 0.002), an acceptable convergent validity (Cronbach's α = 0.712), and an area under the curve (AUC) value of 0.590 for the IMU sensor-based receiver-operating characteristic (ROC) curve. The findings suggest that while the evaluated IMU sensor-based system exhibited good reliability and acceptable validity, it might not be able to fully identify the recurrent fallers and non-fallers in a community-dwelling older population. Further system optimization is still needed.
Clinical risk factors to predict fracture are useful in guiding management of patients with osteoporosis or falls. Clinical predictors may however be population specific because of differences in ...lifestyle, environment and ethnicity. Four thousand community-dwelling Chinese males and females with average ages of 72.4 and 72.6 years were followed up for incident fractures, with an average of 6.5 and 8.8 years, respectively. Clinical information was collected, and bone mineral density (BMD) measurements were carried out at baseline. Stepwise Cox regression models were used to identify risk factors of nonvertebral fractures, with BMD as covariate. Areas under the receiver-operating characteristic (ROC) curve (AUC) were compared among different risk models. The incidence rates of nonvertebral fractures were 10.3 and 20.5 per 1000 person years in males and females, respectively. In males, age ≥80, history of a fall in the past year, fracture history, chronic obstructive pulmonary disease, impaired visual depth perception and low physical health-related quality of life were significant fracture risk factors, independent of BMD. In females, the significant factors were fracture history, low visual acuity and slow narrow walking speed. The clinical risk factors had a significant influence on fracture risk irrespective of osteoporosis status, even having a better risk discrimination than BMD alone, especially in males. The best risk prediction model consisted both BMD and clinical risk factors. Clinical risk factors have additive value to hip BMD in predicting nonvertebral fractures in older Chinese people and may predict them better than BMD alone in older Chinese males.
Background: Caregivers of people with chronic conditions are more likely than non-caregivers to have depression and emotional problems. Few studies have examined the effectiveness of ...mindfulness-based stress reduction (MBSR) in improving their mental well-being. Methods: Caregivers of persons with chronic conditions who scored 7 or above in the Caregiver Strain Index were randomly assigned to the 8-week MBSR group (n = 70) or the self-help control group (n = 71). Validated instruments were used to assess the changes in depressive and anxiety symptoms, quality of life, self-efficacy, self-compassion and mindfulness. Assessments were conducted at baseline, post-intervention and at the 3-month follow-up. Results: Compared to the participants in the control group, participants in the MBSR group had a significantly greater decrease in depressive symptoms at post-intervention and at 3 months post-intervention (p < 0.01). The improvement in state anxiety symptoms was significantly greater among participants in the MBSR group than those of the control group at post-intervention (p = 0.007), although this difference was not statistically significant at 3 months post-intervention (p = 0.084). There was also a statistically significant larger increase in self-efficacy (controlling negative thoughts; p = 0.041) and mindfulness (p = 0.001) among participants in the MBSR group at the 3-month follow-up compared to the participants in the control group. No statistically significant group effects (MBSR vs. control) were found in perceived stress, quality of life or self-compassion. Conclusions: MBSR appears to be a feasible and acceptable intervention to improve mental health among family caregivers with significant care burden, although further studies that include an active control group are needed to make the findings more conclusive.
Highlights • This 3-arm cluster randomized controlled trial provided evidence that, under the same frequency and duration of 12-week practices, both Tai Chi and self-paced brisk walking had ...significant effects on improving aerobic capacity, body composition, and self-perceived physical health. • Tai Chi had higher effect than walking on improving rest oxygen consumption and kilocalorie expenditure. • Taichi had significant effect on improving self-perceived mental health compared with control. • Practicing Tai Chi consumed a smaller amount of energy than walking. Thus, Tai Chi may be a better choice for individuals who are concerned about exercise intensity and safety, particularly those who are less able to perform more vigorous exercises.
Physical restraints have been widely applied as a means to prevent accidents among care home residents with cognitive impairment.
Evidence has shown the risks and harms of physical restraints to the ...physical and psychosocial health of care home residents. Research on reducing restraint use has been sporadic with inconclusive results.
Can a multicomponent program reduce inappropriate use of physical restraints in care home settings?
A pretest–post-test study was conducted in two care homes in Hong Kong. The multicomponent program comprised staff education, case conferences, and consultation. Data were triangulated using self-administered questionnaires, observations of restraint use practice, and documentary reviews. The following study outcomes were evaluated at baseline and 12-month follow-up: care home staff's use of restraints, knowledge of physical restraints, and perceived competence in dementia care.
Restraint use was reduced by 30.9% in 12 months (p < .001), but no significant difference in the mean scores of knowledge of physical restraints and perceived competence in dementia care was noted among care home staff between baseline and the 12-month follow-up (p = .387 and p = .287, respectively).
The findings suggest that our multicomponent program, underpinned by organisational support, was instrumental in reducing the use of physical restraints in care home settings, but its effects on care home staff and residents remain unclear.
This study suggests the feasibility and preliminary effects of using a multicomponent program to reduce restraint use in care homes. A more robust study design is needed to evaluate the sustained effects of our multicomponent program and also its effects on the outcomes of care home staff and residents.
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