BackgroundFrailty and hypertension frequently coexist in older adults, posing substantial challenges to self-management and increasing the risk of adverse outcomes. Standard health education has shown limited effects in this population, and motivational interviewing may support sustained behavior change, yet evidence from randomized controlled trials remains scarce.MethodsThis prospective, single-blind, parallel-group randomized controlled trial aims to evaluate the effectiveness of a Transtheoretical Model-based motivational interviewing intervention on self-management behaviors and related clinical outcomes in community-dwelling older adults with hypertension and frailty. A total of 72 participants will be recruited in Changchun, China, and randomized 1:1 to receive a 12-week Transtheoretical Model-based motivational interviewing intervention or usual health education. The primary outcome is hypertension self-management behavior, secondary outcomes include blood pressure, frailty status, quality of life, and safety outcomes assessed at five time points over 36 weeks. Intention-to-treat analysis will serve as the primary analytical strategy.DiscussionWe hypothesize that the intervention will significantly improve self-management behaviors and produce favorable changes in blood pressure, frailty status, and quality of life. This study will provide practical guidance for self-management in older adults with hypertension and frailty, clarify the value of motivational interviewing in supporting sustained behavior change, and inform the development of more targeted intervention strategies for this population in community settings.Clinical trial registrationIdentifier ChiCTR2500114706.

Background and aims Ischemic heart disease (IHD) presents a significant global health challenge, with myocardial ischemia-reperfusion injury (MIRI) being a major pathophysiological contributor and lacking effective interventions. While aerobic exercise training (AET) enhances cardiovascular health, its protective mechanism in MIRI remains elusive. This study aims to elucidate the protective effect of AET in MIRI and its underlying mechanism. Methods A mouse model of AET and MIRI was established to evaluate basic indices, cardiac ultrasound, and myocardial injury markers. Dot Blot, qRT-PCR, and Western blot were employed to assess m6A RNA methylation levels and related protein expression in myocardial tissue. In vitro, primary cardiomyocyte culture was utilized to mimic MIRI, evaluating cell viability, mitochondrial membrane potential, etc. Finally, myocardial tissues of MIRI mice were immunoprecipitated for m6A RNA methylation and sequenced to analyze related signaling pathways. Key results AET significantly improved cardiac function and mitigated myocardial injury and fibrosis. Moreover, AET protected myocardium from MIRI by reducing m6A RNA methylation levels and modulating METTL3 expression. In vitro experiments demonstrated that the decrease in m6A RNA methylation levels and METTL3 expression conferred resistance to hypoxia/reoxygenation-induced injury. Furthermore, sequencing results indicated elevated myocardial tissue m6A RNA methylation levels during MIRI, activation of the Nrf2-related signaling pathway, and AET-mediated regulation of the Nrf2/HO-1 signaling pathway, thereby attenuating MIRI through modulation of METTL3-related m6A methylation. Conclusion and significance AET attenuates MIRI by reducing the level of METTL3-related m6A RNA methylation in cardiomyocytes and activating the Nrf2/HO-1 antioxidant signaling pathway. This finding provides a novel insight and strategy for the prevention and treatment of IHD, holding significant clinical implications.

AIM:To systematically summarise the characteristics and effectiveness of home-based interventions on health outcomes in older adults with frailty or pre-frailty. DESIGN:Systematic review and meta-analysis. METHODS:Seven databases were searched from their inception through 31st October 2024. Two reviewers independently performed study screening, selection, data extraction, and quality appraisal. Pooled effects were quantified using standardised mean differences (SMDs) with 95 % confidence intervals (CIs). Risk of bias and evidence certainty were assessed using RoB2 and GRADE, respectively. RESULTS:Twenty-four studies (20 RCTs; n = 3, 826 participants) were included. The meta-analysis demonstrated that home-based interventions significantly reduced frailty phenotype scores (SMD = -0.27, 95 % CI:0.39 to -0.15) and depressive symptoms (SMD = -0.11, 95 % CI:0.20 to -0.01), alongside marked increases in grip strength (MD = 0.84, 95 % CI: 0.26 to 1.42) and mental health-related quality of life (SMD = 0.17, 95 % CI: 0.04 to 0.30). Subgroup analyses indicated that significant improvements in physical function were observed only in supervised subgroup. No significant changes were observed for overall quality of life, or physical health-related quality of life. CONCLUSIONS:Home-based interventions are a valuable strategy for improving frailty, grip strength, and mental health outcomes in older adults with frailty or pre-frailty. Improvements in physical function appear to depend on home-based interventions delivered under professional supervision, while the unsupervised mode may pose the risk of potential iatrogenic harm and therefore necessitates caution alongside safety monitoring. REPORTING METHOD:This review followed PRISMA guidelines (PROSPERO: CRD42024604527).

AIM:To explore the relationship between sleep and cognitive frailty in older adults. DESIGN:A systematic review and meta-analysis. DATA SOURCES:The Web of Science, Cochrane Library, CINAHL, Embase, PsycINFO and PubMed databases were searched from inception to October 28, 2024. METHODS:Two investigators independently conducted literature screening, data extraction and quality assessment. The Joanna Briggs Institute Critical Appraisal Tool and Newcastle-Ottawa Scale were used to evaluate methodological quality. This review followed PRISMA guidelines. RESULTS:This review included 13 articles involving 14,223 individuals, and 10 studies included in the meta-analysis. Across 13 studies, the overall prevalence of cognitive frailty was 25%. Sleep problems were categorised into four categories; the results reported that poor sleep quality, long sleep time and insomnia were correlated with the presence of cognitive frailty. However, the relationship between short sleep time and cognitive frailty was not significant. CONCLUSIONS:This review quantitatively suggested that sleep parameters such as long sleep time, insomnia and poor sleep quality were correlated with the presence of cognitive frailty. Future research should adopt longitudinal designs and use validated instruments to measure both quantitative and qualitative aspects of sleep, thereby facilitating a thorough examination of the strength of the relationship between sleep and cognitive frailty, as well as the direction of causality. IMPACT:The review highlights the need to integrate comprehensive sleep assessments and targeted interventions into nursing care plans for older adults to enhance their sleep health. The findings will provide support for the development of effective interventions to prevent and manage cognitive frailty in the older population. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

BACKGROUND:Symptom networks offer a new approach to explore the relationships among various symptoms and provide information for optimising precise symptom management strategies. However, no previous studies have identified the central symptoms of multidimensional frailty. DESIGN:A cross-sectional study was conducted from December 2023 to March 2024 in China. SETTINGS AND PARTICIPANTS:A total of 933 community-dwelling older adults (aged 60 years or older) in China were recruited via convenience sampling. METHODS:Sociodemographic variables, clinical variables and scores on the Tilburg Frailty Indicator were assessed in all participants. The qgraph package and IsingFit package of R software were applied to construct the symptom network. Three node centrality indices (strength, betweenness and closeness) and the expected influence were calculated to identify the central symptoms of the multidimensional frailty network. All statistical analyses were performed in R. RESULTS:A total of 933 individuals were surveyed in this study, including 472 (50.6%) females. The median age of all participants was 71.0 years. A total of 408 subjects were assessed as multidimensional frailty. The prevalence of multidimensional frailty was 43.7%. The centrality indices revealed that 'difficulty in walking', 'difficulty in maintaining balance', and 'feeling down' were the symptoms with the largest strength and expected influence values. CONCLUSION:This study primarily utilised network analysis to construct a symptom network of multidimensional frailty among community-dwelling older adults. The findings revealed that difficulty in walking, difficulty in maintaining balance, and feeling down were the most central symptoms. IMPLICATIONS:This study identified the central symptoms of multidimensional frailty in older adults, which may serve as primary intervention targets. Nursing staff could incorporate targeted physical and psychological interventions into person-centred care plans. REPORTING METHODS:This study was reported in accordance with the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution was involved in this study.

BACKGROUND:Age-related changes in body composition such as muscle loss can lead to sarcopenia, which is closely associated with frailty. However, the effect of body fat accumulation on frailty in old age remains unclear. In particular, the association between the combination of these two conditions, known as sarcopenic obesity, and frailty in older adults is unclear. OBJECTIVE:To synthesise the association between sarcopenic obesity and the risk of frailty and to investigate the role of obesity in the risk of frailty in old age. METHODS:Six databases were searched from inception to 29 September 2024. Two reviewers independently extracted the data and assessed the risk of bias for the included observational studies using the adapted Newcastle-Ottawa scale. The control groups consisted of robust, obese and sarcopenic individuals. Meta-analyses were performed to examine the risk of frailty due to sarcopenic obesity and the role of obesity in frailty amongst sarcopenic older adults. RESULTS:Sixteen eligible studies were included in meta-analyses from 1098 records. Compared to robust individuals, older adults with sarcopenic obesity were more vulnerable to frailty [odds ratio (OR), 3.76; 95% confidence interval (CI), 2.62 to 5.39; I2 = 79.3%; P < .0001]. Obesity was not associated with the risk of frailty (OR, 1.23; 95% CI, 0.99 to 1.53; I2 = 0.0%; P = .501) in sarcopenic older adults. CONCLUSIONS:Sarcopenic obesity is associated with a high risk of frailty. Sarcopenia and obesity may have synergistic effects on frailty in older adults.

OBJECTIVE:The aim of this project was to establish an evidence-based practice program, and examine the effect on nurses' knowledge levels, nurses' compliance and patient satisfaction. METHODS:We systematically searched six databases and five websites to summarize the best evidence. Next, we held stakeholder, EBP group and expert meetings to build the program. Finally, a noncontemporaneous controlled trial was applied. RESULTS:After the implementation of the program, the knowledge scores of nurses improved significantly. The compliance with the nine audit criteria was over 80%, and the difference was statistically significant. The satisfaction of patients in the implementation group was significantly higher than that in the comparison group. CONCLUSIONS:This was the first project of frailty screening and assessment in a clinical setting in China. The results showed that the implementation of the program could improve the knowledge level of nurses, regulate nursing behavior, and improve the satisfaction of patients.

Background Frailty is defined as a biological syndrome characterized by a decreased reserve and resistance to stressors. Frailty is closely related to lifestyle, and improving lifestyle can effectively reduce the incidence of frailty and related adverse events. Multi-component interventions were an effective mean of improving lifestyle, which has been validated in studies of other populations. This review aimed to explore the effects of multi-component interventions on the lifestyle in pre-frail or frail older adults. Methods Six databases were systematically searched as of 19 November 2024. Only randomized controlled trials were included in the analysis. The mean difference (MD) or standardized mean difference (SMD) were calculated to determine the pooled intervention effects. Methodological quality and evidence were assessed using the RoB2 tool and GRADE online tool. Results Seventeen randomized controlled trials were included in this study. The results showed that the multi-component interventions had positive effects on physical activity (SMD = 0.65, 95 %CI [0.36, 0.95]), social activity (SMD = 0.21, 95 %CI [0.04, 0.37]) and dietary nutrition (SMD = 0.78, 95 %CI [0.11, 1.44]), may reduce sedentary behavior (MD = -31.12, 95 %CI [-58.38, -3.85]). Conclusion In summary, this review analyzed existing literature and the results showed that multi-component interventions have significant benefits on the lifestyle in pre-frail or frail older adults. As the current evidence was limited, more researches were needed in the future to further enrich the evidence in the field of multi-component interventions for pre-frail or frail older adults.

Objective: The aims of this systematic review were to explore the pooled prevalence of multidimensional frailty assessed by the Tilburg Frailty Indicator among community-dwelling older adults. Design: A systematic review and meta-analysis. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Embase, the Cochrane Library, CINAHL and three Chinese databases. Two independent researchers selected the literatures, extracted the data and evaluated the quality. All statistical analyses were performed using STATA version 16.0. Results: There were 66 studies with a total of 40,597 individuals that were eligible for the meta-analysis. Data from the meta-analysis revealed the pooled prevalence of 42 % for multidimensional frailty (95 % CI: 38 %-45 %, I 2 = 98.9 %, T 2 = 0.024, p < 0.001). Among the six studies that provided data for different age groups, the results demonstrated an increasing trend in the prevalence of multidimensional frailty with advancing age. The results of gender-strati fied analysis proved that the pooled prevalence of multidimensional frailty in women (45 %, 95 % CI: 39 %-51 %, p < 0.001) was higher than that in men (33 %, 95 % CI: 28 %-39 %, p < 0.001). Based on different education levels, the prevalence of multidimensional frailty is highest in the primary elementary or illiterate group (41 %, 95 % CI: 30 %-52 %, p < 0.001). According to different marital status types, the pooled prevalence of multidimensional frailty in the married group was signi ficantly lower (36 %, 95 % CI: 28 %-43 %) than that in the unmarried, divorced or widowed group (51 %, 95 % CI: 37 %-65 %). Conclusions: Through a comprehensive review, we identi fied that 42 % of elderly individuals living in communities exhibit multidimensional frailty, indicating that multidimensional frailty is relatively common in this population. Strati fied analysis revealed that advanced age, female gender, lower education level and unmarried status were associated with higher rates of multidimensional frailty. (c) 2024 Elsevier Ltd. All rights reserved.

OBJECTIVES:Cognitive frailty, which is notably prevalent in nursing homes, correlates with a range of adverse health outcomes; however, interventions targeting this population are scarce, particularly those addressing activities of daily living (ADLs). The objective of this study was to evaluate the effects of virtual reality-based ADL rehabilitation training on older adults with cognitive frailty and ADL impairments. DESIGN:A 2-arm randomized controlled trial. SETTING AND PARTICIPANTS:Older adults with cognitive frailty and mild ADL impairments in a nursing home. METHODS:Sixty-six eligible participants were equally randomized into intervention and control groups. The intervention involved 45-minute sessions conducted twice weekly for 12 weeks. Outcomes evaluated included ADL performance, cognition, frailty, depression, and quality of life. Assessments were performed at baseline, 6 weeks (T1), and 12 weeks (T2). RESULTS:There was no statistically significant difference between the 2 groups at baseline. The mean age of the participants was 80.20 ± 9.14 years, and most were women (54.55%). Compared with the control group, the intervention group showed significant improvements in ADLs (T1: β = 6.33, T2: β = 12.79), basic ADLs (T1: β = 4.09, T2: β = 6.97), instrumental ADLs (T1: β = 2.24, T2: β = 4.12), cognition (T1: β = 3.67, T2: β = 4.42), frailty (T1: β = -0.76, T2: β = -1.27), and mental component summary of quality of life (T1: β = 8.49, T2: β = 16.44) at T1 and T2. By T2, significant improvements were observed in depression (T2: β = -2.06) and physical component summary of quality of life (T2: β = 8.52). CONCLUSIONS AND IMPLICATIONS:For older adults with cognitive frailty and mild ADL impairments residing in a nursing home, the virtual reality-based ADL rehabilitation program was safe and effective. Following the 12-week intervention, significant improvements were observed in ADL performance, cognition, frailty, depression, and quality of life.

Background Globally, there is an increase in the number of older people living with frailty, thus effective strategies to prevent and manage frailty are of paramount importance. The effects of nurse-led interventions on the physical and mental health of (pre) frail people have not yet been systematically reviewed. Methods We searched the PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from inception to 8 May 2024. Eligible studies included randomized controlled trials and quasi-experimental trials reporting the effects of nurse-led interventions on physical and mental health outcomes among (pre) frail people. Two researchers independently extracted trial data and assessed the risk of bias by using the risk of bias tool recommended by the Cochrane Back Review Group and the Methodological Index for Non-Randomized Studies. Results 14 randomized controlled trials and 6 quasi-experimental studies, encompassing 3943 participants, were included in the review. Nurse-led interventions included function-based care (cognitive behavioral therapy, exercise, and multi-domain intervention), personalized integrated care, and advance care planning. The reported outcomes were multiple with most results showing inconsistencies. Overall, function-based care showed more positive effects on physical outcomes (31/37, 84 %) and mental health (11/12, 92 %). However, the effectiveness of existing personalized integrated care and advance care planning might be limited. Conclusions Nurse-led interventions may effectively improve both physical and mental health among (pre) frail older adults, although effectiveness varies by intervention type. Nurses have the potential to play a leading role, both individually and within multidisciplinary teams, in alleviating the rising global burden of frailty. We need more well-designed randomized controlled trials to confirm the effectiveness of nurse-led interventions and identify the most effective type of interventions.

OBJECTIVE:Conduct a systematic review of existing studies on intrinsic capacity (IC) and a meta-analysis of studies to assess the overall effectiveness of ICOPE in improving IC in older adults. METHODS:Ten databases were systematically searched from inception to November 8, 2023, and the search was last updated on January 2, 2024. Randomised controlled trials (RCTs) were included. The main outcomes were IC (cognition, psychological, sensory, vitality and locomotion). RESULTS:The results showed ICOPE had a significant effect in improving cognitive function (SMD = 0.36; 95% CI, 0.17 to 0.56, p < 0.001, 12 RCTs, 7926 participants) and depressive symptoms (SMD = -0.70; 95% CI, -0.96 to -0.43, p < 0.001, 26 RCTs, 11,034 participants), but there was no statistically significant difference in improving locomotion (SMD = 0.16; 95% CI, -0.03 to 0.34, p = 0.098, 3 RCTs, 1580 participants). Meta-regression analysis shows that intervention duration should be paid attention to when the source of heterogeneity is discussed on the cognition. CONCLUSION:The results suggest that ICOPE may be a potentially effective approach to help improve the IC in older adults, showing significant potential for improving cognitive function and reducing depressive symptoms in particular. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:ICOPE is expected to provide effective strategies to enhance issues such as IC and may be an innovative way to improve the overall health of older adults. This result provides strong support for geriatric nursing practice and encourages the adoption of ICOPE as a viable nursing approach to promote healthy ageing.

AIM:To pool existing studies to assess the overall effectiveness of integrated care for older adults (ICOPE)-based interventions in improving depressive symptoms in older adults. DESIGN:A systematic review and meta-analysis. DATA SOURCES:Ten databases were systematically searched from inception to 15 July 2023 and the search was last updated on 2 September 2023. METHODS:Standardized mean difference (SMD) was calculated using random effects models. RoB 2 and GRADEpro GDT were used to assess the methodological quality and confidence in the cumulative evidence. Funnel plots, egger's test and begg's test were used to analyse publication bias. Sensitivity, subgroup and meta-regression analyses were performed to explore potential sources of heterogeneity. RESULTS:The results of 18 studies showed ICOPE-based interventions had a significant effect on improving depressive symptoms (SMD = -.84; 95% CI, -1.20 to -.3647; p < .001; 18 RCTs, 5010 participants; very low-quality evidence). Subgroup analysis showed the intervention group was characterized by mean age (70-80 years old), intervention duration between 6 to 12 months, gender (female <50%), non-frail older adults, depressed older adults and mixed integration appeared to be more effective. Sensitivity analysis found the results to be robust. CONCLUSION:ICOPE-based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Healthcare professionals are expected to use ICOPE as one of the interventions for depressive symptoms in older adults, and this ICOPE could provide more comprehensive care services for older adults to reduce depressive symptoms. IMPACT:ICOPE-based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults. ICOPE-based interventions had a significant effect on reducing depressive symptoms in the older adults. The intervention group characterized by mean age of older adults, intervention duration, gender ratio, health condition and integration types may influence the effect size. REPORTING METHOD:According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution.

Background Comprehensive geriatric assessment (CGA) is performed by a multidisciplinary team and includes systematic comprehensive team assessment and treatment. Comprehensive geriatric assessment has become a fundamental component of geriatric nursing, as a multidimensional approach is necessary to achieve the best diagnosis and therapy for older adults with frailty. Objective The aim of our review was to analyze the effects of comprehensive geriatric assessment interventions on older adults with frailty in hospital settings. Methods The PubMed, Web of Science, Embase, CINAHL and Cochrane Library databases were systematically searched from inception to February 28, 2024. Only randomized controlled trials were included in the analysis. The risk ratios (RRs) or standardized mean differences (SMDs) were calculated to determine the pooled intervention effects. Sensitivity analyses and publication bias analyses were also conducted. Methodological quality and evidence were assessed using the RoB2 tool and GRADE pro online tool. Results A total of 18 randomized controlled trials were included in this study. The results showed that participants in the intervention group had a lower risk of having decreased activities of daily living than did those in the control group (RR = 0.55, 95 % CI: 0.33 to 0.92, P = 0.021, low certainty of evidence). Comprehensive geriatric assessment was associated with a reduced mortality risk (RR = 0.85, 95 % CI: 0.73 to 0.99, P = 0.038, high certainty of evidence). Conclusion In conclusion, this systematic review analyzed the available literature, and the results showed that comprehensive geriatric assessment had significant benefits in terms of increased independence and was associated with a reduced mortality risk for older adults with frailty in hospital settings. However, the evidence was limited. Thus, more research is needed in the future to further enrich the evidence in the field of comprehensive geriatric assessment interventions for older adults with frailty.

Adverse childhood experiences represent a critical public health concern that warrants urgent attention and cannot be overlooked. The evidence regarding the relationship between adverse childhood experiences and mortality has been insufficient and inconsistent. To address this gap, we conducted a systematic review and meta-analysis to explore the association between adverse childhood experiences, including their subtypes, and various mortality outcomes. We systematically searched PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from inception to 9 March 2024. Ultimately, 49 studies were included. Among them, 46 studies involving 24,276,424 participants investigated the association between adverse childhood experiences and mortality. The results showed adverse childhood experiences were significantly associated with overall mortality (OR, 1.64; 95% CI, 1.51 to 1.78; P<0.001), external cause mortality (OR, 1.91; 95% CI, 1.7 to 2.15; P<0.001), and internal cause mortality (OR, 1.3; 95% CI, 1.17 to 1.44; P<0.001). Among women and men, the effect sizes were 1.39 (95%CI, 1.25 to 1.54; P<0.001) and 1.4 (95%CI, 1.22 to 1.6; P<0.001), respectively. Increased mortality risk was also observed for those exposed to maltreatment (OR, 1.95; 95%CI, 1.65 to 2.3; P<0.001), household dysfunction (OR, 1.36; 95%CI, 1.22 to 1.51; P<0.001), low socioeconomic status (OR, 1.25; 95%CI, 1.09 to 1.43; P=0.002), or out-of-home care (OR, 2.87; 95%CI, 2.12 to 3.9; P<0.001). Gender differences were not statistically significant, except for minor variations within the low socioeconomic status. This study underscores the profound impact of adverse childhood experiences on mortality risk, highlighting the need for targeted public health interventions and policies.

Objective: To synthesize the pooled mortality risk estimate and determine whether cognitive frailty is a predictor of mortality. Design: A systematic review and meta-analysis.Setting and Participants: The participants were community-dwelling older adults aged >= 60 years.Methods: PubMed, Web of Science, Embase, CINAHL, and the Cochrane Library databases were systematically searched. Two researchers independently screened potentially eligible literature, evaluated the quality of the included studies, and then extracted the data. We used STATA, version 15.0 to perform the all data.Results: Nineteen studies were included. The association between cognitive frailty and a higher risk of death was statistically significant [hazard ratio (HR), 2.01; 95% CI, 1.84-2.19; P < .001]. The outcomes indicated that cognitive frailty was a critical risk factor for predicting mortality (OR, 4.82; 95% CI, 1.59-14.57; P < .01). Based on different models of cognitive frailty, the results of subgroup analyses revealed that the risk of mortality was the highest in the Frail thorn mild cognitive impairment group (HR, 2.35; 95% CI, 2.05-2.70; P < .001). The subgroup analyses by region demonstrated that mortality risk was lowest in the European group (HR, 1.63; 95% CI, 1.4-1.87; P < .001). Conclusions and Implications: This study quantitatively portrays the pooled mortality risk estimate of cognitive frailty. The results suggest that in older adults, cognitive frailty can be a predictor of mortality. The findings could alert health care providers to pay more attention to cognitive frailty.(c) 2023 AMDA -The Society for Post-Acute and Long-Term Care Medicine.

With the aging of the population, frailty has attracted much attention, and the social dimension of frailty, namely social frailty, has also attracted attention. Studies have shown that social frailty can bring some adverse effects to the elderly, such as physical and cognitive function. To explore the risk of adverse health outcomes in older adults with social frailty compared with older adults with non-social frailty. Five databases were systematically searched from inception to February 28, 2023. Screening, data extraction and quality assessment were conducted independently by two researchers. The included studies were longitudinal studies of adverse outcomes in community-dwelling socially frail older adults, and the quality of each study was assessed using the Newcastle‒Ottawa Scale. A total of 15 studies were included based on the inclusion criteria, of which 4 were subjected to meta-analysis. The mean age of the included population ranged from 66.3 to 86.5 years. According to existing research, social frailty was predictive of some adverse outcomes, such as incident disability, depressive symptoms, and reduced neuropsychological function. The meta-analysis showed that social frailty had a significant predictive effect on mortality among older adults [HR = 2.27, (95

Background: Virtual reality has gradually been applied to nursing education, with many advantages.Methods: A quasi-experimental, pretest-posttest study was conducted to verify the teaching effective-ness of a virtual reality-based cognitive assessment and rehabilitation simulation course. The Chinese version of the Critical Thinking Disposition Inventory was used to measure the critical thinking abilities of participants. The teaching evaluation included the evaluation of the virtual system, course, teaching, and students themselves.Results: The difference between the pre-and post-tests was statistically significant for the dimensions of truth seeking, open mindedness, systematicity, self-confidence, inquisitiveness, maturity, and the total score of critical thinking ability ( p < .05). Conclusion: The course can significantly improve the critical thinking ability of nursing undergraduates and provide an effective teaching method.

Objective: The aim of this systematic review and meta-analysis was to investigate the pooled prevalence of cognitive frailty among community-dwelling older adults and provide evidence-based support for policy makers planning health and social care policies. Design: A systematic review and meta-analysis. Methods: PubMed, Web of Science, Embase and the Cochrane Library were systematically searched from their inception to December 10, 2020. Descriptive studies (cross-sectional studies or population-based longitudinal studies) and cohort studies were available. Participants were community-dwelling older adults aged 60 years and above. Two researchers independently screened the literature, extracted the data and evaluated the quality of the included studies. All statistical analyses were conducted using Stata 15.0. Results: We screened 2815 records, among which 24 studies met the inclusion criteria and were included in the review. The pooled prevalence of cognitive frailty was 9% (95% CI: 8%-11%, I 2 = 99.3%). The results of the subgroup analysis showed that the pooled prevalence of cognitive frailty was 11% (95% CI: 9%-14%) in men and 15% (95% CI: 11%-19%) in women. The pooled prevalence of cognitive frailty based on the descriptive studies and cohort studies was 7% (95% CI: 5%-9%) and 17% (95% CI: 11%-22%), respectively. The pooled estimates of cognitive frailty prevalence were 6% (95% CI: 4%-8%) from 2012 to 2017 and 11% (95% CI: 9%-14%) from 2018 to 2020. Conclusions: This systematic review analyzed the available literature and revealed that the pooled prevalence of cognitive frailty among community-dwelling older adults was 9%. The stratified analysis showed that the prevalence of cognitive frailty was higher in older women. In addition, the prevalence has increased in recent years, which has important implications for adapting health and social care systems. (c) 2021 Elsevier Ltd. All rights reserved.