The Combination of Hearing Impairment and Frailty Is Associated with Cognitive Decline among Community-Dwelling Elderly in Japan

Hearing impairment and frailty are associated with cognitive decline in older people. This study aimed to investigate the effect of the interaction between hearing impairment and frailty on cognitive decline in community-dwelling older people. A mail survey of community-dwelling, older people (age ≥ 65 years) who lived independently was conducted. Cognitive decline was defined using the self-administered dementia checklist (≥18 out of 40 points). Hearing impairment was assessed using a validated self-rated questionnaire. Furthermore, frailty was assessed using the Kihon checklist, and robust, pre-frailty, and frailty groups were identified. Multivariate logistic regression analysis, adjusted for potential confounding factors, was performed to determine the association of the interaction between hearing impairment and frailty with cognitive decline. Data obtained from 464 participants were analyzed. Hearing impairment was independently associated with cognitive decline. Additionally, the interaction term of hearing impairment and frailty was significantly related to cognitive decline. For participants in the robust group, hearing impairment was not associated with cognitive decline. In contrast, for participants in the pre-frailty or frailty groups, hearing impairment was associated with cognitive decline. The association between hearing impairment and cognitive decline was affected by frailty status in community-dwelling, older people.

Relationships of Physical Activity, Depression, and Sleep with Cognitive Function in Community-Dwelling Older Adults

This cross-sectional, observational study aimed to integrate the analyses of relationships of physical activity, depression, and sleep with cognitive function in community-dwelling older adults using a single model. To this end, physical activity, sleep, depression, and cognitive function in 864 community-dwelling older adults from the Suwon Geriatric Mental Health Center were assessed using the International Physical Activity Questionnaire, Montgomery-Asberg Depression Rating Scale, Pittsburgh Sleep Quality Index, and Mini-Mental State Examination for Dementia Screening, respectively. Their sociodemographic characteristics were also recorded. After adjusting for confounders, multiple linear regression analysis was performed to investigate the effects of physical activity, sleep, and depression on cognitive function. Models 4, 5, 7, and 14 of PROCESS were applied to verify the mediating and moderating effects of all variables. Physical activity had a direct effect on cognitive function (effect = 0.97, p < 0.01) and indirect effect (effect = 0.36; confidence interval: 0.18, 0.57) through depression. Moreover, mediated moderation effects of sleep were confirmed in the pathways where physical activity affects cognitive function through depression (F-coeff = 13.37, p < 0.001). Furthermore, these relationships differed with age. Thus, the associations among physical activity, depression, and sleep are important in interventions for the cognitive function of community-dwelling older adults. Such interventions should focus on different factors depending on age.

Effects of a Nurse-Led Telehealth Self-care Promotion Program on the Quality of Life of Community-Dwelling Older Adults: Systematic Review and Meta-analysis

Background

In recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults.

Objective

This review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults.

Methods

A search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel–Haenszel test.

Results

From 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95% CI 0.03 to 0.20; P=.006; I²=21%), self-efficacy (SMD 0.19; 95% CI 0.08 to 0.30; P<.001; I²=0%), and depression level (SMD –0.22; 95% CI –0.36 to –0.08; P=.003; I²=89%).

Conclusions

This meta-analysis suggests that employing telehealth in nurse-led self-care promotion programs may have a positive impact on older adults, although more studies are needed to strengthen the evidence base, particularly regarding organization and delivery.

Trial Registration

PROSPERO (Prospective International Register of Systematic Reviews) CRD42021257299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257299

Fall prevention education to reduce fall risk among community-dwelling older persons: A systematic review

OBJECTIVES

This review aims to identify types of the existing fall prevention education (FPE) and their effectiveness in promoting fall risk awareness, knowledge and preventive fall behaviour change among community-dwelling older people.

BACKGROUND

FPE is a cost-effective and helpful tool for reducing fall occurrences.

EVALUATION

This is a systematic review study using electronic searches via EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar in March 2021. The review protocol was registered with PROSPERO (CRD42021232102). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement flow chart guided the search strategy. Articles published from January 2010 to March 2021 were included for quality appraisal using the 'Transparent Reporting of Evaluations with Non-randomised Designs' (TREND) and the 'Consolidated Standards of Reporting Trials' (CONSORT) statement for randomised controlled trial studies.

KEY ISSUES

Six FPE studies selected emphasised on personal health status, exercise and environmental risk factors. These studies reported an increase in fall risk awareness or knowledge and a positive change in fall preventive behaviours. Two studies included nurses as educators in FPE.

CONCLUSION

FPE evidently improved awareness or knowledge and preventive fall behaviour change among older adults. Nurses are in great potential in planning and providing FPE for older adults in community settings.

IMPLICATIONS FOR NURSING MANAGEMENT

Expand nurses' roles in fall prevention programmes in community settings by using high-quality and evidence-based educational tools. Highlight the nurse's role and collaborative management in FPE.