Factor Structure and Measurement Invariance Across Gender Groups of the 15-Item Geriatric Depression Scale Among Chinese Elders

Development and validation of a nomogram for predicting anorexia of aging in older people

BACKGROUND

Anorexia of aging (AA) is a common geriatric syndrome that seriously endangers the health of older adults. Early identification of populations at risk of AAand the implementation of appropriate intervention measures hold significant public health importance. This study aimed to develop a nomogram for predicting the risk of AA among older people.

METHODS

We conducted a cross-sectional study involving 2144 community-dwelling older adults to evaluate the AA using the Simplified Nutritional Appetite Questionnaire. We utilized the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression analysis to select variables and develop a nomogram prediction model. The predictive performance of the nomogram was evaluated using the Receiver Operating Characteristic (ROC) curves, calibration curves, Decision Curve Analysis (DCA), and internal validation.

RESULTS

The prevalence of AA among Chinese older adults was 21.7% (95%CI: 20.0%-23.5%). Age, sex, family economic level, smoking status, dysphagia, loneliness, depressive symptoms, living alone, health literacy, life satisfaction, and body mass index have been identified as predictive factors for AA among older people. The nomogram constructed based on these predictive factors showed an area under the curve (AUC) of 0.766 (95%CI: 0.742-0.791), indicating good calibration and discrimination ability. Additionally, the results obtained from the 10-fold cross-validation process confirmed the nomogram's good predictive capabilities. Furthermore, the DCA results showed that the nomogram has clinical utility.

CONCLUSION

The nomogram constructed in this study serves as an effective tool for predicting anorexia of aging among community-dwelling older adults. Its implementation can help community healthcare workers evaluate the risk of AA in this population and identify high-risk groups.

A blended face-to-face and eHealth lifestyle intervention on physical activity, diet, and health outcomes in Hong Kong community-dwelling older adults: a study protocol for a randomized controlled trial

Background

Aging individuals are vulnerable to various Noncommunicable Diseases (NCDs). Different behaviors are closely related to a decreased risk of suffering from NCDs: sufficient Physical Activity (PA) (e.g., at least 150 mins Moderate-to-vigorous Physical Activity (MVPA) per week) and a healthy daily diet (e.g., at least five portions of Fruit and Vegetable Intake (FVI), 5-6 taels (189.0-226.8 g) Meat, Fish, Egg and Alternatives (MFEA)). Traditional face-to-face interventions were effective in behavior change. However, it was revealed to be resource-intensive and limited transfer due to poor self-regulation skills outside of face-to-face sessions. Thus, eHealth could be a supplement for older adults outside traditional face-to-face settings. The blended approach combining these two interventions might optimize the intervention effects on lifestyle behavior initiation and maintenance, but little research can be found among Hong Kong older adults. Therefore, the study aims to test a blended intervention to promote PA, diet, and health outcomes among Hong Kong community-dwelling older adults.

Methods

This study will adopt a 10-week three-arm randomized controlled trial. The blended group will receive weekly (1) two 60-min face-to-face sessions with one for PA and one for diet, and (2) two web-based sessions with one for PA and one for diet. The face-to-face group will receive the same intervention content as the face-to-face sessions in the blended group. The control condition will receive a biweekly telephone call. The outcomes will include MVPA (minutes/week), FVI (portions/day), MFEA consumption (taels/day), social-cognitive factors (self-efficacy, planning, social support, action control), physical health outcomes (clinical indicators, senior physical fitness), mental health outcomes (depression, loneliness) and health-related quality of life. Data collection will be implemented at the pre-test, post-test, and 3-month follow-up test.

Discussion

This is the first study evaluating a blended intervention promoting multiple health behaviors among Hong Kong community-dwelling older adults. If the effect of the blended intervention is superior to the traditional face-to-face group and the control group, it will enrich lifestyle intervention approaches and can be applied to older adults, helping them obtain health benefits. Furthermore, a better understanding of mechanisms will also have implications for theory-building.

Clinical trial registration

https://www.isrctn.com/ISRCTN32329348, ISRCTN32329348.

Trajectories of depressive symptom and its association with air pollution: evidence from the Mr. OS and Ms. OS Hong Kong cohort study

BACKGROUND

Depression is a global health priority. Maintaining and delaying depressive symptoms in older adults is a key to healthy aging. This study aimed to identify depressive symptom trajectories, predictors and mortality, while also exploring the relationship between air quality and depressive symptoms in older adults in the Hong Kong community over 14 years.

METHODS

This study is a longitudinal study in Hong Kong. The target population was community-dwelling older adults over age 65. Depressive symptoms were measured by the Geriatric Depression Scale (GDS-15). Group-based trajectory model was used to identify heterogeneity in longitudinal changes over 14 years and examine the associations between baseline variables and trajectories for different cohort members using multinomial logistic regression. The Kaplan-Meier method was employed to conduct survival analysis and explore the variations in survival probabilities over time among different trajectory group. Linear mixed model was used to explore the relationship between air quality and depressive symptoms.

RESULTS

A total of 2828 older adults were included. Three different trajectories of depressive symptoms in older people were identified: relatively stable (15.4%), late increase (67.1%) and increase (17.5%). Female, more number of chronic diseases, poor cognitive function, and poor health-related quality of life (HRQOL) were significantly associated with other less favorable trajectories compared with participants with stable levels of depressive symptoms. The late increase group had a lower mortality rate than the relatively stable and increased groups. Lower baseline ambient air pollutant exposure to NO2 over 14 years was significantly associated with fewer depressive symptoms.

CONCLUSIONS

In this study, we found that a late increase in depressive symptoms was the predominant trend in older Chinese people in Hong Kong. Poorer HRQOL was predictive of less favorable trajectories of depressive symptoms. Ambient air pollution was associated with depressive symptoms. This novel observation strengthens the epidemiological evidence of longitudinal changes in depressive symptoms and associations with late-life exposure to air pollution.

Association of Geriatric Depressive Symptoms and Government-Initiated Senior Employment Program: A Population-Based Study

OBJECTIVE

The impact of the government-initiated senior employment program (GSEP) on geriatric depressive symptoms is underexplored. Unearthing this connection could facilitate the planning of future senior employment programs and geriatric depression interventions. In the present study, we aimed to elucidate the possible association between geriatric depressive symptoms and GSEP in older adults.

METHODS

This study employed data from 9,287 participants aged 65 or older, obtained from the 2020 Living Profiles of Older People Survey. We measured depressive symptoms using the Korean version of the 15-item Geriatric Depression Scale. The principal exposure of interest was employment status and GSEP involvement. Data analysis involved multiple linear regression.

RESULTS

Employment, independent of income level, showed association with decreased depressive symptoms compared to unemployment (p<0.001). After adjustments for confounding variables, participation in GSEP jobs showed more significant reduction in depressive symptoms than non-GSEP jobs (β=-0.968, 95% confidence interval [CI]=-1.197 to -0.739, p<0.001 for GSEP jobs, β=-0.541, 95% CI=-0.681 to -0.401, p<0.001 for non-GSEP jobs). Notably, the lower income tertile in GSEP jobs showed a substantial reduction in depressive symptoms compared to all income tertiles in non-GSEP jobs.

CONCLUSION

The lower-income GSEP group experienced lower depressive symptoms and life dissatisfaction compared to non-GSEP groups regardless of income. These findings may provide essential insights for the implementation of government policies and community-based interventions.

Study protocol for a prediction model for mild cognitive impairment in older adults with diabetes mellitus and construction of a nurse-led screening system: a prospective observational study

INTRODUCTION

With an increasing number of older adults in China, the number of people with cognitive impairment is also increasing. To decrease the risk of dementia, it is necessary to timely detect mild cognitive impairment (MCI), which is the preliminary stage of dementia. The prevalence of MCI is relatively high among older adults with diabetes mellitus (DM); however, no effective screening strategy has been designed for this population. This study will construct a nurse-led screening system to detect MCI in community-dwelling older adults with DM in a timely manner.

METHODS AND ANALYSIS

A total of 642 participants with DM will be recruited (n=449 for development, n=193 for validation). The participants will be divided into MCI and none-MCI groups. The candidate predictors will include demographic variables, lifestyle factors, history of diseases, physical examinations, laboratory tests and neuropsychological tests. Univariate analysis, least absolute shrinkage and selection operator regression screening, and multivariate logistic regression analysis will be conducted to identify the outcome indicators. Based on the multivariate logistic regression equation, we will develop a traditional model as a comparison criterion for the machine learning models. The Hosmer-Lemeshow goodness-of-fit test and calibration curve will be used to evaluate the calibration. Sensitivity, specificity, area under the curves and clinical decision curve analysis will be performed for all models. We will report the sensitivity, specificity, area under the curve and decision curve analysis of the validation dataset. A prediction model with better performance will be adopted to form the nurse-led screening system.

ETHICS AND DISSEMINATION

This prospective study has received institutional approval of the Medical Ethics Committee of Qidong Hospital of TCM (QDSZYY-LL-20220621). Study results will be disseminated through conference presentations, Chinese Clinical Trial Registry and publication.

TRIAL REGISTRATION NUMBER

ChiCTR2200062855.

Social Capital and Mental Wellbeing of Older People Migrating along with Adult Children in Shenzhen, China

The phenomenon of 'older people migrating along' (OPMA) with adult children is a unique outcome of social changes that have occurred in China. These individuals generally experience different challenges and needs associated with mental wellbeing. However, there is limited research on the relationship between the social capital and mental health of OPMA in China. This study aims to examine the mental health status of OPMA and the effects of bonding social capital and bridging social capital on their mental wellbeing in China by conducting a quantitative research survey among 399 OPMA participants. We found that bonding social capital correlated to only one indicator of mental wellbeing, subjective happiness. Bridging social capital had significant relationships with four mental health indicators, namely, the 12-item General Health Questionnaire (GHQ-12), Geriatric Depression Scale (GDS), subjective happiness, and life satisfaction. Through strengthening bridging social capital, these older adults can benefit from more opportunities for participation in formal or informal organizations in their communities and improve their mental wellbeing.

Perceived Social Support Mediates the Relationship between Use of Greenspace and Geriatric Depression: A Cross-Sectional Study in a Sample of South-Italian Older Adults

A growing body of evidence is suggestive for the beneficial role of contact with greenspace (e.g., use of greenspace, visual access to greenspace, etc.) on mental health (e.g., depression, anxiety, etc.). In addition, several studies have pointed out the benefits of social support and social interaction on psychological wellbeing. Even if evidence on the association between contact with greenspace and perceived social support were mixed, it was supposed that the use of greenspace could enhance social interactions and perceived social support, especially among older adults. The present study aims to explore the effect of use of greenspace on geriatric depression in a sample of South-Italian older adults and the mediating role of perceived social support in this association. A structural equation model was tested in a sample of 454 older adults (60-90 years old) residing in the Metropolitan Area of Bari, Apulia. The fit indices revealed the goodness of fit of the model (CFI = 0.934; TLI = 0.900; IFI = 0.911; NFI = 0.935; RMSEA = 0.074; SRMR = 0.056). Results showed that the use of greenspace was inversely associated with geriatric depression through perceived social support. These findings underlined the relevance of perceived social support on the pathway linking use of greenspace and geriatric depressive symptoms. This evidence may be useful to policymakers to plan interventions for promoting physical access to greenspace and social participation in an age-friendly city framework.

Relationship between telomere shortening and early subjective depressive symptoms and cognitive complaints in older adults

Telomere length (TL) has been reported to be associated with depression and cognitive impairment in elderly. Early detection of depression and cognitive impairment is important to delay disease progression. Therefore, we aimed to identify whether TL is associated with early subjective depressive symptoms and cognitive complaints among healthy elderly subjects. This study was a multicenter, outcome assessor-blinded, 24-week, randomized controlled trial (RCT). Measurement of questionnaire and physical activity scores and blood sample analyses were performed at baseline and after six months of follow-up in all study participants. Linear regression analyses were performed to identify whether early subjective depressive symptoms, cognitive complaints, and several blood biomarkers are associated with TL. Altogether, 137 relatively healthy elderly individuals (60-79 years old) were enrolled in this prospective RCT. We observed an approximate decrease of 0.06 and 0.11-0.14 kbps of TL per one point increase in the geriatric depression scale and cognitive complaint interview scores, respectively, at baseline and after six months of follow-up. We also found an approximate decrease of 0.08-0.09 kbps of TL per one point increase in interleukin (IL)-6 levels at baseline and after six months of follow-up. Our study showed that both early subjective depressive symptoms and cognitive complaints were associated with a relatively shorter TL in relatively healthy elderly individuals. In addition, based on our findings, we believe that IL-6 plays an important role in the relationship between shortening TL and early subjective depressive symptoms and cognitive complaints.

A dual-task gait test detects mild cognitive impairment with a specificity of 91.2

Background

Mild cognitive impairment (MCI) is a valuable intervention window in the progress of senile dementia, but the question of how to easily and conveniently detect MCI in the community remains unanswered. Gait performance reflects cognitive function, but how to reliably detect MCI through gait testing is still being explored.

Objective

To develop a dual-task gait testing method that could reliably detect MCI in the community.

Methods

A cross-sectional diagnostic study was conducted in 111 older adults (mean age = 72.14 ± 6.90 years) from five communities in Wuhan, China. A novel dual-task gait testing method, walking while identifying animals in pictures (AniP-DT gait test), was developed. The participants were classified into MCI or cognitively intact based on their performance on the Montreal Cognitive Assessment Scale (MoCA). Gait performance was assessed using both single-task and the AniP-DT gait test. Multiple linear regression and binary logistic regression were used to model the association between gait speed and cognitive status, and receiver operating characteristic (ROC) curve analysis was used to assess the discrimination ability.

Results

Compared to the cognitively intact group, the gait speed of the MCI group was lower in both single-task and the AniP-DT gait tests. The gait speed of the AniP-DT gait test was significantly associated with MoCA scores after adjusting the covariates and exhibited good discrimination ability in MCI detection (AUC = 0.814), with a specificity of 91.2%. ROC analysis of the logistic models revealed better discrimination ability of dual-task gait velocity when adjusted with age and years of education (AUC = 0.862).

Conclusion

The evidence in this study suggested that the AniP-DT gait test could be an easy and reliable screening tool for MCI in community older adults.

Validation and Comparison of Three Short Depression Screening Tools Among Chinese Community-Dwelling Older Adults

The current study validated and compared three short Geriatric Depression Scales (GDS), including the GDS-5, D'Ath GDS-4, and van Marwijk GDS-4, among 917 Chinese community-dwelling older adults. The GDS-5, D'Ath GDS-4, and van Marwijk GDS-4 presented satisfactory accuracy against the GDS-15 (area under the curve [AUC] = 0.872 to 0.952), and the GDS-5 and D'Ath GDS-4 had better accuracy than the van Marwijk GDS-4. Satisfactory accuracy (AUC = 0.842 to 0.979) for the three scales was also observed across subgroups by age, sex, education, cognitive function, and multimorbidity. The GDS-5 but not D'Ath GDS-4 and van Marwijk GDS-4 retained a 2-point optimal cutoff for depressive symptoms across subgroups. The GDS-5 (average inter-item correlation coefficient [AIIC] = 0.233) and the D'Ath GDS-4 (AIIC = 0.171) but not van Marwijk GDS-4 (AIIC = 0.128) had acceptable internal consistency. Three scales had stable test-retest reliability within a 1- to 2-week interval (intraclass correlation coefficient = 0.670 to 0.885). The GDS-5 is an accurate and reliable depression screening tool with an invariable optimal cutoff among Chinese community-dwelling older adults. The variable optimal cutoffs for the D'Ath GDS-4 and van Marwijk GDS-4 across subgroups may limit their applicability in this population. [Research in Gerontological Nursing, xx(x), xx-xx.].

Measurement invariance of the Multidimensional Depression Assessment Scale (MDAS) across gender and ethnic groups of Asian, Caucasian, Black, and Hispanic

BACKGROUND

Major Depressive Disorder is a severe and highly disabling mental illness. Almost all self-reported questionnaires have overlooked the interpersonal symptoms of depression which are important across gender and culture. The Multidimensional Depression Assessment Scale (MDAS) developed by Cheung and Power (2012) entails comprehensive emotional, cognitive, somatic, and interpersonal subscales. It addresses the criticism that existing self-report depression scales might not cover sufficient phenomenological heterogeneity of depression. The current study aimed to evaluate the psychometric properties of the MDAS across gender and four major ethnic groups of Caucasian, Black, Asian and Hispanic, including reliability and concurrent validity against the Centre for Epidemiological Studies Depression Scale (CESD) and Patients Health Questionnaire (PHQ-9). It also aimed to establish a stable factor structure across gender and ethnic groups and test the measurement invariance to enhance its potential for clinical use.

METHODS

A community sample of 3499 participants from four ethnic groups were recruited via online crowdsourcing sites of Qualtrics and Amazon M Turk. Each individual completed a demographic questionnaire, the MDAS, CESD and PHQ-9.

RESULTS

There was good internal consistency (Cronbach's alpha >0.90) and concurrent reliability across gender and ethnic groups. Strict measurement invariance was established for MDAS over a four-factor factor structure corresponding to the four subscales.

CONCLUSIONS

The MDAS showed good psychometric properties and measurement invariance of a four-factor structure, suggesting its potential to be used in clinical settings across gender and ethnic groups.

LIMITATIONS

Participants all answered the questionnaires in English, which could hinder cultural variations in their expression of symptoms.

Prevalence of Frailty and Associated Factors Among Hospitalized Older Adults: A Cross-Sectional Study

This study aimed to estimate the prevalence of frailty and associated factors among hospitalized older adults. It consisted of 184 hospitalized older adults recruited between October 2019 to January 2020. We used the FRAIL scale, Geriatric Depression Scale-15, and the Pittsburg Sleep Quality Index to collect data. Descriptive statistics, independent group t-test, Chi-square (χ²) tests, and logistic regression were applied to statistical analysis. It found that the prevalence of frailty among hospitalized older adults was 39.7%. Depression (Mild: OR = 5.312, 95% CI [2.384-11.833]; Moderate: OR = 6.630, 95% CI [2.077-21.160]) and low activities of daily living (ADL) (Slight dependence: OR = 5.667, 95% CI [1.308-24.557]; Moderate dependence: OR = 15.188, 95% CI [3.342-69.016]; Severe dependence: OR = 5.872, 95% CI [2.645-13.038]) were independent predictors of frailty. Future studies on the interventions to reduce depression, improve ADL and delay the progression of frailty are encouraged. We should focus more on ADL, emotional and psychological state of hospitalized older adults to prevent frailty.

Psychometric properties and modification of the 15-item geriatric depression scale among Chinese oldest-old and centenarians: a mixed-methods study

Background

The 15-item Geriatric Depression Scale (GDS-15) shows good performance in detecting depression among older persons, but its applicability has not been well studied in non-Western oldest-old adults and centenarians. This study aimed to evaluate the psychometric property of the GDS-15 and a simplified version among a large representative longevous population in China.

Methods

A total of 1624 individuals (786 oldest-old persons aged from 80 to 99 years; 838 centenarians aged 100+ years) participated in this study. Home interviews with structured questionnaires were conducted to collect sociodemographic data. Depressive symptoms were measured using the Chinese GDS-15 version. We implemented mixed methods for the psychometric evaluation of the GDS-15. Cronbach’s α coefficient and item-total correlation coefficients were used to evaluate the internal consistency. A standard expert consultation was conducted to test the content validity of each item. Multiple factor analyses were used to explore the optimal factor structure and measurement invariance.

Results

The α coefficient of the GDS-15 was 0.745, while two items impaired the overall consistency reliability. Nineteen experts rated the applicability for each item and provided removal suggestion. Five items with less validity were removed, and a simplified 10-item GDS model with three-factor structure was proposed as an optimal solution. The GDS-10 model showed factorial equivalence across age, sex, residence, and education in multi-group confirmatory factor analyses.

Conclusions

The original GDS-15 has acceptable internal reliability, known-group validity, and concurrent validity among Chinese community-dwelling oldest-old and centenarians; however we provided preliminary evidence indicating that individual items related to somatic function or social activities may not be applicable for this population. The modified GDS-10 can be proposed as a potentially more practical and comprehensible instrument for depression screening.

Self-Efficacy Beliefs of University Students: Examining Factor Validity and Measurement Invariance of the New Academic Self-Efficacy Scale

Academic self-efficacy beliefs influence students' academic and career choices, as well as motivational factors and learning strategies promoting effective academic success. Nevertheless, few studies have focused on the academic self-efficacy of university students in comparison to students at other levels. Furthermore, extant measures present several limitations. The first aim of this study was to develop a reliable and valid scale assessing university students' self-efficacy beliefs in managing academic tasks. The second aim was to investigate differences in academic self-efficacy due to gender, years of enrollment, and student status. The study involved 831 students (age M = 21.09 years; SD = 1.34 years; 66.3% women) enrolled in undergraduate programs. Indicators of academic experiences and performance (i.e., number of exams passed and average exam rating) were collected. A new scale measuring students' academic self-efficacy beliefs was administered. Results from a preliminary Exploratory Factor Analysis were consistently supported by findings from a Confirmatory Factor Analysis. Multigroup CFA supported the presence of measurement invariance. Analyses revealed that the new scale has eight factors: "Planning Academic Activities," "Learning Strategies," "Information Retrieval," "Working in Groups," "Management of Relationships with Teachers," "Managing Lessons," "Stress Management," and "Thesis Work." Self-efficacy dimensions showed significant relations with academic experiences and students' performance indicators, as well as differences due to gender, years of enrollment, and student status. Findings are discussed in terms of practical implications for the implementation of intervention programs aimed at fostering self-efficacy beliefs and academic success.

Apathy is associated with white matter network disruption and specific cognitive deficits in Parkinson's disease

BACKGROUND

Apathy is common in Parkinson's disease (PD) but its underlying white matter (WM) architecture is not well understood. Moreover, how apathy affects cognitive functions in PD remains unclear. We investigated apathy-related WM network alterations and the impact of apathy on cognition in the context of PD.

METHODS

Apathetic PD patients (aPD), non-apathetic PD patients (naPD), and matched healthy controls (HCs) underwent brain scans and clinical assessment. Graph-theoretical and network-based analyses were used for group comparisons of WM features derived from diffusion spectrum imaging (DSI). Path analysis was used to determine the direct and indirect effects of apathy and other correlates on different cognitive functions.

RESULTS

The aPD group was impaired on neural integration measured by global efficiency (p = 0.009) and characteristic path length (p = 0.04), executive function (p < 0.001), episodic memory (p < 0.001) and visuospatial ability (p = 0.02), and had reduced connectivity between the bilateral parietal lobes and between the putamen and temporal regions (p < 0.05). In PD, executive function was directly impacted by apathy and motor severity and indirectly influenced by depression; episodic memory was directly and indirectly impacted by apathy and depression, respectively; conversely, visuospatial ability was not related to any of these factors. Neural integration, though being marginally correlated with apathy, was not associated with cognition.

CONCLUSIONS

Our results suggest compromised neural integration and reduced structural connectivity in aPD. Apathy, depression, and motor severity showed distinct impacts on different cognitive functions with apathy being the most influential determinant of cognition in PD.

Otago exercise programme for physical function and mental health among older adults with cognitive frailty during COVID-19: A randomised controlled trial

AIMS AND OBJECTIVES

Quarantine during the COVID-19 pandemic resulted in longer-term sedentary behaviours and mental health problems. Our study aimed to evaluate the impact of the Otago exercise programme (OEP) on physical function and mental health among elderly with cognitive frailty during COVID-19.

BACKGROUND

Lockdowns and restrictions during the COVID-19 pandemic result in longer-term sedentary behaviours related disease and mental problem. Older people with cognitive frailty are more vulnerable to be influenced. Timely intervention may achieve better outcomes, OEP exercise was designed as a balance and muscle-strengthening programme for elderly people.

DESIGN

A parallel-group, assessor-blinded randomised controlled trial was performed according to CONSORT guidelines.

METHODS

This study was conducted from July 2020 to October 2020 among 62 elderly people with cognitive frailty from a nursing home. Participants were randomly divided into an OEP group (n = 31) or a control group (n = 31). Both groups received sleep- and diet-related health education. The OEP group also received a 12-week group exercise programme. The Five Times Sit to Stand Test (FTSST), Berg Balance Scale (BBS), and Timed Up and Go Test (TUGT) were used to assess physical function. The Geriatric Depression Scale-15 (GDS-15) and the 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) were used to assess mental health. Outcomes were measured at 6 and 12 weeks.

RESULTS

Physical function and mental health were similar in the two groups at baseline. At 12 weeks, the OEP group (difference in change from baseline: FTSST, -2.78; TUGT, -3.73; BBS, 2.17; GDS-15, -0.72; SF-12 MCS, 2.58; all p < .001) exhibited significantly greater improvements than the control group (difference in change from baseline: FTSST, 1.55; TUGT, 1.66; BBS, -0.10; GDS-15, 1.07; SF-12 MCS, -5.95; all p < .001).

CONCLUSION

Our findings showed the OEP group had better physical function and mental health outcomes than the control group. OEP can be used to improve the physical and mental function among elderly people with cognitive frailty during the COVID-19 pandemic.

RELEVANCE TO CLINICAL PRACTICE

Otago exercise program intervention programmes should be implemented to improve physical function for cognitive frailty elderly to reduce the harm of longer-term sedentary behaviours, and to ruduce depression symptom and improve mental health, particularly during COVID-19 pandemic period.

An empowerment-psycho-behavioral program on neuropsychiatric symptoms in persons with mild cognitive impairment: Study protocol of a randomized controlled trial

AIMS

Neuropsychiatric symptoms (NPS) are highly prevalent among persons with mild cognitive impairment (PwMCI). However, the mainstay of treatments only focuses on cognitive training. This study develops an empowerment-psycho-behavioural programme to improve the NPS and other health outcomes of this preclinical cohort. The empirical effects and the participants' perception and experience of the programme will be explored.

DESIGN

This sequential mixed-method study comprises a single-blind randomized controlled trial and a qualitative study.

METHODS

This study will recruit 250 PwMCI from the community and randomize them to either the intervention group to receive a 13-week empowerment-psycho-behavioural programme which focuses on promoting cognitive coping and stress adaptation, or the control group to receive a health education programme which serves as an attention placebo with content unrelated to dementia. The primary outcome is NPS, and the secondary outcomes include cognitive function, subjective memory complaints and health-related quality of life. These outcomes will be measured at baseline, upon completing the programme and 4 weeks thereafter. A purposive sample of 30 participants from the intervention group will be interviewed for their engagement experience in the programme. This study received funding support in July 2020.

DISCUSSION

Given the high prevalence and detrimental effects of NPS on disease progression, effective management is yet to be determined. Underpinned by the Progressively Lowered Stress Threshold (PLST) Model, the empowerment-psycho-behavioural programme is designed. Results on the outcome-based evaluation and the patients' experience can advance the science in this under-addressed area.

IMPACT

This study enhances our understanding of the PLST Model in explaining the manifestations of NPS by the stress-coping disequilibrium at the early disease stage. It will shed important insight into the care management of MCI to attend both cognition function and psychological well-being in research and clinical context.

TRIAL REGISTRATION

This study is registered in the ClinicalTrials.gov (NCT04723667) and the HKU Clinical Trials Registry (HKUCTR-2915).

A novel construct of anhedonia revealed in a Chinese sample via the Revised Physical and Social Anhedonia Scales

BACKGROUND

Anhedonia is a core clinical symptom of mental disorders. The Revised Physical Anhedonia Scale (RPAS) and the Revised Social Anhedonia Scale (RSAS) have been applied in clinical and non-clinical samples since 1980s. However, the construct of a unified RPAS&RSAS for comprehensive measurement of anhedonia has never been explored. Therefore, the purpose of our study was to examine the factor structure of the unified RPAS&RSAS among undergraduates and clinical patients.

METHODS

A total of 3435 undergraduates from two universities and 294 clinical patients with mental disorders had completed the Chinese version of the RPAS and the RSAS. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were each conducted to reveal the constructs of the RPAS and the RSAS. CFA was used to evaluate first- and second-order models for the unified RPAS&RSAS in undergraduates and clinical patients. The internal consistency and test-retest reliability of the RPAS and the RSAS were also evaluated.

RESULTS

EFA and CFA indicated 2-factor structures for RPAS and RSAS, with the factors being defined as anticipatory anhedonia and consummatory anhedonia. The second-order model of the unified RPAS&RSAS in the undergraduates and clinical patients both had satisfactory fit index values (Undergraduate sample: CFI = 0.901, TLI = 0.899, RMSEA = 0.055, SRMR = 0.086; Clinical sample: CFI = 0.922, TLI = 0.911, RMSEA = 0.052, SRMR = 0.078). The psychometric robustness of the RPAS&RSAS were confirmed by high internal consistency and test-retest reliability values.

CONCLUSIONS

The unified RPAS&RSAS with a second-order structure was confirmed in both undergraduates and clinical samples in Chinese. The construct of anhedonia was refreshed as covering physical and social domains, and each of them includes both anticipatory and consummatory components.

Associations Between Nutritional Status, Sociodemographic Characteristics, and Health-Related Variables and Health-Related Quality of Life Among Chinese Elderly Patients: A Multicenter Prospective Study

Background: Studies that explore the nutritional status, sociodemographic factors, mental health variables, and physical health variables that affect the health-related quality of life (HRQoL) of elderly patients are scarce in China. Objective: This study aimed to examine the association between health-related quality of life (HRQoL) and nutritional status, sociodemographic characteristics, and health-related variables among Chinese elderly patients. Materials and Methods: Participants were recruited from six tertiary-level hospitals in six provinces or municipalities/cities throughout China from October 2018 to February 2019: a total of 9,996 participants aged 65 years and older were enrolled. The nutritional status and HRQoL were measured using the Mini Nutritional Assessment-Short Form (MNA-SF) and the EuroQoL Five-Dimension Visual Analog Scale, respectively. BMI was taken using standard measurement protocols. Sociodemographic characteristics included age, sex, education, marital status, ethnicity, smoking, alcohol drinking, and current residence. Mental and physical health variables such as frailty and depression were assessed using validated tested instruments. Multiple linear regression analysis was used to analyze whether the nutritional status, sociodemographic characteristics, and health-related variables were associated with HRQoL. Results: According to the MNA-SF scores at the 30- and 90-day follow-up, 9.7% and 9.1% of participants were malnourished, respectively. Higher MNA-SF scores were related to higher HRQoL scores in older patients (regression coefficient; 95% confidence interval) both at the 30-day (0.660; 0.499-0.821) and 90-day (0.622; 0.434-0.809) follow-up. However, there were no significant associations between the body mass index values and HRQoL. Sociodemographic characteristics (such as age, smoking, and current residence), physical health variables (frailty, urinary function, defecation function, sleeping condition, and falling accidents in the past 12 months), and mental health variables (depression) were the main factors influencing HRQoL in this group. Conclusion: There are several factors associated with HRQoL among the population derived from this investigation of a representative sample of the Chinese hospitalized elderly population in tertiary hospitals. These findings could have major importance for the planning of "active aging" policies and programs. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800017682, registered August 9, 2018.