Background: Alzheimer's disease patients face higher risks of caregiver abuse and caregiver burden than healthy older adults,. However, the association between abuse tendency by AD caregivers and their burden remains understudied. This study aimed to investigate the association between caregivers' abusive tendencies and burden levels in Alzheimer's disease through latent class analysis. Methods: A total of 541 Alzheimer's disease caregivers from long-term care facilities in Zhejiang Province, China, were included in this cross-sectional study. Demographic characteristics、abusive tendencies and caregiver burden were assessed using scale. Heterogeneous subtypes of abusive tendencies were identified through latent class analysis, and their associations with caregiver burden were examined using multivariate regression models. Rseults: The prevalence of caregiver abuse tendency toward Alzheimer's patients in Zhejiang long-term care facilities was 39.4%, categorized into three latent classes: Class 1 ("high abuse tendency-low coping deficiency"), Class 2 ("overall low abuse tendency"), Class 3 ("high coping deficiency-low abuse tendency"). Significant differences (P<0.05) emerged among classes in marital status, chronic conditions, daily care duration, caregiving training, and patient neuropsychiatric symptoms. Compared with Class 2, caregivers in Class 1 had significantly higher odds of providing more than 12 hours of daily care (OR=0.252, P<0.001), whereas those in Class 3 had lower odds of having received Alzheimer's caregiving training (OR=0.435, P=0.002). Caregiver burden scores also differed significantly across classes (F=12.086, P<0.001). Conclusions: Caregivers for Alzheimer's patients exhibit distinct abuse tendency categories with caregiving burdens. Healthcare providers should implement targeted training programs to alleviate these burdens, reduce the incidence of abuse tendency.

Integrated Care for Older People (ICOPE), developed by the World Health Organization (WHO) with a global perspective, faces varying degrees of barriers to implementation, particularly in middle-and low-income countries. Therefore, as with other new public service interventions, we draw on established integrated care interventions to design a Theory of Change (ToC) model for ICOPE, and to propose methods and pathways for adapting community-based integrated care models for older people (OP) to specific contexts, thereby updating and enhancing the implementation of ICOPE. An initial ToC for the ICOPE was drafted based on the WHO guidelines and published literature, and synthesizing the results of semi-structured interviews, group discussions. A total of 36 healthcare stakeholder experts in geriatric nursing, geriatric care and chronic disease management, rehabilitation and quality of life, and psychiatric-mental health were recruited to participate in a 5-stage ToC group workshop conducted consecutively. Each workshop has 2–3 facilitators, and lasts from 60 to 120 min. In multiple workshops, the experts discussed the causal pathway, the interventions needed to activate it, the underlying principles and assumptions, evaluated and refined them, and finally reached consensus. The ToC design has improved the ICOPE program, identifying the resources, long-term outcomes, and impacts required for the implementation of ICOPE in a specific setting, and clarifying the specific components of the integrated care interventions, such as materials, procedures, and intervention providers. The localized, OP-centred model of integrated home care developed in our study may contribute to healthy ageing through four potential long-term outcomes: (1) reduction of unnecessary hospitalizations and increased utilization of referral services, (2) enhancement of self-care capacity to prevent, reverse, or delay the decline of intrinsic capacity in OP, (3) improvement of the quality of life of OP living at home, and (4) reduction of caregiving burdens and improvement in the level of caregiving. The ToC is effective in identifying key characteristics of resources, interventions, impact, and outcomes of integrated care for OP. Our ICOPE program has been strengthened by ToC, which forms an integrated care model for assessment, planning, implementation, and evaluation, adapted to a specific setting, and provides guidance for other areas in similar settings.

Objective:The institutionalization of care for patients with dementia is becoming a trend. Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice. Therefore, this study aimed to examine the relationship between basic attributes, caring ability, and caregiver burden in employed caregivers practicing in nursing homes. Methods:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022. Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Demographic characteristics of participants, characteristics of the older patients with dementia, caring characteristics, training in dementia care, and caring abilities were collected for analysis of influencing factors. A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes. Results:The ZBI score of employed caregivers in nursing homes was 40.42 ± 10.18, representing a moderate caregiver burden. Factors such as age (U = 27.82, P < 0.001), residence (U = 7.89, P < 0.001), educational level (H = 55.81, P < 0.001), self-care of older patients with dementia (H = 85.21, P < 0.001), daily care hours (H = 73.25, P < 0.001), number of older people with dementia cared for (H = 14.56, P = 0.012) and training in dementia care (U = -9.43, P < 0.001) were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden (r = -0.22, P < 0.01). Furthermore, after controlling for demographic characteristics, the characteristics of older people with dementia, caring characteristics, training in dementia care, and caring ability explained 8.5%, 5.8%, and 4.8% of the caregiver burden, respectively. Conclusion:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors. We recommend tailored interventions, such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.

Background In the context of global population aging and the rapid development of information technology, the demand for Internet Plus Home Care Nursing (Internet+ HCN) services have been on the rise, especially in China. Internet+ HCN services have the potential to maximize existing human resources to counter the shortage of medical healthcare services. However, at present, Internet+ HCN services are difficult to scale due to the lack of standardized service quality governance. Quality indicators for service evaluation of Internet+ HCN services are under-defined. Objective To develop a quality indicator system for evaluating Internet+ HCN services, and to shed theoretical light on assessing mHealth service quality from a user experience perspective. Methods An initial quality indicator system was established based on scenarios related to Internet+ HCN services. The Delphi Method was applied to modify the indicators according to experts’ opinions, and the analytic hierarchy process (AHP) was applied to calculate the indicator weight. Finally, a quality indicator system for evaluating Internet+ HCN services was developed based on the SERVQUAL model. Results Altogether, 17 experts from relevant fields such as nursing education, clinical nursing, health management, and health informatics were consulted through email surveys. The response rates in both rounds of Delphi and the AHP were 100%. The average expert authority coefficients were 0.912 and 0.925 respectively in the two rounds of Delphi. Kendall’s W, indicating variation coefficients, ranged from 0.262 to 0.265. Finally, a quality indicator system for evaluating Internet+ HCN services, comprising five primary indicators and 15 secondary indicators, was developed. Primary indicators and their AHP generated the following weights: assurance (0.245), reliability (0.240), tangibles (0.192), responsiveness (0.190), and empathy (0.132). Conclusions By measuring the services quality gap between user expectations and perceptions, the proposed SERVQUAL model-based quality indicator system shows potential in improving the quality of Internet+ HCN services through the perspective of user experiences.

Objective:To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods:In this systematic review study, using “elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine” as the key words, the 6S evidence resource pyramid model was used to search in British Medical Journal best practice, Uptodate, World Health Organization, Guidelines International Network, National Institute for Health and Care Excellence, Chinese Medical Association, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, The Joanna Briggs Institute (JBI), New Zealand Guidelines Group, Polish Society of Gynecologists and Obstetricians, PubMed, Embase, Medline, Web of Science, SinoMed, China National Knowledge Infrastructure, WanFang Data, etc. The evidence retrieved included evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review, etc. Data were retrieved from January 1, 2017 to May 1, 2022, and collated from May 2, 2022 to May 25, 2022. Two researchers independently evaluated the quality of literature and extracted data using the AGREE Ⅱ and JBI evidence-based health care center assessment tools. The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence; and under the guidance of the evidence structure of JBI, the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results:A total of 9 articles were retrieved, including 7 guidelines and 2 systematic reviews; and 6 guidelines were classified as Grade A and 1 as grade B; both 2 systematic reviews were rated as Grade A; 84% (27/32) of the items were evaluated as “Yes”. Evidence were summarized as 34 pieces of best evidence from 6 dimensions, including “overall recommendation, evaluation of type and degree of urinary incontinence, lifestyle change, behavioral therapy, prevention of precipitating factors, intervention in special population”; the flow chart of screening, evaluation, special symptoms, life style and behavior therapy was combed, and the practical suggestions were formed.Conclusions:The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high, and the level of evidence is high. Early identification of urinary incontinence types and assessment of disease severity, lifestyle changes, avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.

Objective:To focus on the physical activity strategy to maintain the activity ability of the elderly in the community, comprehensively retrieve and integrate the best evidence, form practical suggestions with the goal of the transformation and practice of evidence, so as to provide scientific, reliable and up-to-date basis for the implementation of relevant evidence.Methods:According to the 6S pyramid model, the British Medical Journal (BMJ) Best Practice, UpToDate, DynaMed, World Health Organization, Chinese Medical Association, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, New Zealand Guidelines Group, PubMed, SinoMed and other databases were retrieved layer by layer from top to bottom. This study obtained all articles of evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review and other types related to physical activity strategies to maintain the activity ability of the elderly in the community from January 1, 2017 to March 1, 2022. According to the inclusion and exclusion criteria of the article, 2 to 4 researchers conducted independent methodological quality evaluation on different types of article according to the tool requirements, extracted and summarized the best evidence, and formed practical suggestions.Results:A total of 14 articles were included, including 2 evidence-based decision-making, 6 guidelines, 1 expert consensus, 3 systematic reviews, and 2 overviews of systematic review. Seven dimensions such as "overall advice, health benefits, diversified sports training, aerobic training, balance training, muscle strengthening/resistance training, flexibility training" and 22 best pieces of evidence were extracted and summarized, and practical suggestions were formed.Conclusions:Medical and nursing staff should adopt evidence-based methodological practical suggestions to provide management guidance and consultation for the maintenance of physical activity ability of the elderly in the community, so as to help the elderly to maintain physical activity ability and gain health benefits.

Objective:To construct a scoring system for assessing intrinsic capacity in older adults, thus to provide scientific guidance on defining the intrinsic capacity among older adults.Methods:Adopting the theoretical concepts from previous research on healthy aging, the primary set of indexes is constructed through literature analysis. And the content of intrinsic capacity evaluation index system for older adults is determined through Delphi experts consultation. The weighted values of the evaluation indexes are established by the analytic hierarchy process.Results:Eighteen experts were selected and invited for correspondence consultation. The effective recovery rates of the questionnaires were 88.89% and 93.75%, the expert authority coefficients were 0.882 and 0.900, and the Kendall harmony coefficients were 0.225 and 0.227. After a two-rounded Delphi experts consultation involving 18 experts, an intrinsic capacity evaluation index system for older adults was established, including five first level indexes and 14 secondary indexes. The weights of primary indicators were as follows: cognitive function (0.310), mobility (0.184), vision and hearing (0.183), psycho-social (0.172), and vitality (0.151). The corresponding secondary indicators of cognitive function were time and spatial orientation (0.116), memory (0.072), language ability (0.064), calculate ability (0.058). The corresponding secondary indicators of vision and hearing were visual impairment (0.091), hearing impairment (0.091).The weights of the secondary indicators corresponding to mobility were movement restriction (0.107) and fall risk (0.076). The corresponding secondary index weights of psycho-social were subjective perceived social isolation (0.067), loss of interest (0.056), and depressed (0.050). The corresponding secondary indicators of vitality were malnutrition (0.062), oral frailty (0.050), loss of appetite (0.040).Conclusion:A comprehensive evaluation index for the intrinsic capacity of the older adults was established, which provides the scheme for comprehensive evaluation of the intrinsic capacity of the older adults, and provides possibility for early intervention based on comprehensive evaluation in the older adults.

Objective:To construct a scientific and practical group activity program for senile dementia.Methods:A systematic search was conducted to identify the literature on group activities of senile dementia in the Registered Nurses Association of Ontario, guidelines from National Institute for Health and Care Excellence, JBI EBP database, Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, WanFang Data until January 1, 2022. Two researchers independently evaluated the methodological quality of the included literature. According to the retrieved literature, the first draft of group activity program was made. Two rounds of Delphi expert correspondence were conducted with experts from medical, nursing, rehabilitation and community care fields, and evaluated by expert authority coefficient and coordination coefficient, finally, the content index system of group activity program for senile dementia was established.Results:The recovery rates of the two rounds of expert consultation questionnaires were 94.44% and 94.74%, the degree of authority were 0.79 and 0.82, the coordination coefficients of importance were 0.149 and 0.184, and the coordination coefficients of feasibility were 0.130 and 0.366, all P < 0.01. Finally, the group activities program for senile dementia consists of 4 first-class indicators, 15 second-class indicators and 38 third-class indicators.Conclusion:The group activity program for senile dementia is scientific and feasible, and can be promoted and implemented within institutions with qualification and professional capabilitie at different levels.

Objective:To construct a core competency evaluation system for geriatric comprehensive assessment nurses.Methods:The core competency of geriatric comprehensive assessment nurses was determined through literature review, behavioral event interviews and semi-structured interviews, and 15 experts related to geriatric care were invited to conduct three rounds of expert inquiry to collect the experts’ revision opinions. The importance score, authority coefficients, coordination coefficient, and the coefficient of variation were calculated.Results:The authority coefficients of the three rounds of correspondence experts were 0.90, 0.93 and 0.95. In the first round, 4 out of 6 primary indicators modified, 3 out of 14 secondary indicators modified, and 23 out of 87 third-level indicators modified. After second and third rounds expert inquiry, the final established core competency evaluation system for geriatric comprehensive assessment nurses includes 6 primary indicators, 13 secondary indicators, and 72 third-level indicators with importance scores 3.93~5.00, coordinnation coefficient 0.702~0.796, and coefficient of variation 0~0.130.Conclusion:The core competency evaluation system of the elderly comprehensive evaluation is scientific and reasonable, which can provide reference for the admission, training and assessment of geriatric comprehensive assessment nurses.

目的 研究多媒体在改善医患沟通及知识不对称的应用与效果.方法 选取2019年5月—2021年5月在医院就诊的114例患者,随机分为对照组和观察组各57例,对照组采用传统方式沟通,观察组采用多媒体课件沟通,比较两组汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、知识掌握程度、自护能力(ESCA)、依从性、满意度.结果 使用多媒体技术使得观察组HAMA、HAMD评分低于对照组,ESCA评分、用药依从率及满意度高于对照组,知识掌握程度优于对照组(p<0.05).结论 多媒体技术能改善医患沟通中的知识不对称问题.

Objective:To explore the effect of medical care, elderly care and nursing management mode on self-care ability and blood pressure management in elderly patients with hypertension.Methods:From July 2018 to June 2019, 164 elderly patients with hypertension admitted into the outpatient department of the ZhejiangHospital were selected as the study objects by convenience sampling method, and randomly divided into the control group and the experimental group, 82 cases in each group. Routine hypertension management mode was given in the control group and medical care, elderly care and nursing management mode was given in the experimental group for 6 months. The Exercise of Self-Care Agency Scale (ESCA) scores and blood pressure control of the two groups were compared before and after intervention.Results:The ESCA total score and self-concept, self-care responsibility, self-care skills, and health knowledge scores of the experimental group were higher than those before intervention [(123.3±17.2) vs. (88.3±10.4) points, (26.8±3.7) vs. (20.6±3.0) points, (22.3±4.2) vs. (16.6±2.1) points, (29.3±4.1) vs. (17.6±2.4) points, (44.9±5.4) vs. (33.5±4.5) points], and higher than those of the control group [(90.0±10.2) points, (21.2±3.2) points, (16.1±2.1) points, (18.2±2.5) points, (34.5±4.2) points] (all P<0.05). The systolic blood pressure and diastolic blood pressure of the two groups after the intervention were lower than those before the intervention [control group: (142.5±7.8) vs. (161.6±8.5) mmHg (1 mmHg=0.133 kPa), (91.3±6.2) vs. (98.6±10.2) mmHg, experimental group: (132.2±8.5) vs. (160.6±8.1) mmHg, (84.2±7.4) vs. (98.1±10.3) mmHg], and the experimental group was lower than the control group (all P<0.05). The blood pressure control rate of patients in the experimental group was 88.8%, which was higher than the control group of 48.6% ( P<0.05). The satisfaction rate of quality of life in the experimental group was higher than that in the control group (28.8% vs. 18.1%), and the dissatisfaction rate was lower than in the control group (18.8% vs. 34.7%) ( P<0.05). Conclusion:The medical care, elderly care and nursing management mode can effectively improve the self-care ability and blood pressure management ability of elderly patients with hypertension.