Geriatric nursing competence of clinical nursing staff at different hospital levels in Chongqing,China:A cross-sectional study

Objectives:This study aimed to survey the geriatric nursing competencies of clinical nursing staff in Chongqing City,China,and provide suggestions to enhance these competencies.Methods:This study was conducted in 204 hospitals in Southwest China from December 24,2022 to January 7,2023.The“Geriatric Nursing Competence of Clinical Nurse Investigation Tool”was used to explore factors that influence geriatric nurses’competencies via stratified sampling.The survey was conducted by distributing and collecting questionnaires through the online platform Wenjuanxing.Results:A total of 10,692 nurses answered the questionnaires.Of these questionnaires,9,442 were valid.The total geriatric nursing competence score of the clinical nursing staff was 2.29±0.81,the secondary hospital score was 2.23±0.78,and the tertiary hospital’s overall mean score was 2.33±0.83.The factors that influenced secondary hospitals included the department of medicine,age of nurses and total length of career(P<0.05).The factors that influenced tertiary hospitals included the department of medicine,age of nurses,nurses’professional title,and geriatric practical advanced nurses’certification(P<0.05).Conclusions:Geriatric nursing competence among clinical nursing staff is imbalanced at a lower-middle level and is influenced by various factors.Thefindings highlight the need for further clinical training in geriatric nursing.The training of geriatric nurses should focus on necessary clinical skills and on preparing them to adequately manage comprehensive geriatric syndromes.

老院

我们家搬出老院一晃已有十几年了。三孔半土半砖的窑洞、一个用油毡作檐的灶台、一围红土夯筑的院墙、一个两边是院墙两边用青砖泥土垒成的厕所，便是老院的所有，它们都是父母省吃俭用的成果。

The association between frailty of older stroke patients during hospitalization and one-year all-cause mortality:A multicenter survey in China

Objective:Frailty is a common geriatric syndrome defined as multiple deficits,impairing the capacity to figure out insult.Previous studies have reported a significant association between frailty and mortality in stroke patients.This study aimed to explore the association between frailty and mortality among older Chinese stroke patients.Methods:This study was a secondary analysis of a multicenter prospective cohort study conducted in older Chinese inpatients from October 2018 to February 2020,and patients with a primary diagnosis of stroke including hemorrhage and ischemia,were included in our study.Frailty of older inpatients with stroke from six hospitals was measured by the FRAIL scale,and a one-year follow-up was performed by well-trained nurses of these hospitals via telephone.Multivariable logistic regression was used to detect the association between frailty and one-year mortality.Results:A total of 530 stroke patients with an average age of 72.94(SD¼5.79)years were included in the present study.There were 37(7.0%)hemorrhagic strokes and 493(93.0%)ischemic strokes,with 228(43.0%)females in this population.The prevalence of frailty was 22.5%.In the logistic regression model with adjustment for age,sex,instrumental activities of daily living(IADL),basic activities of daily living(ADL),education,history of falls,BMI,smoking,alcohol consumption,low handgrip strength,type of stroke and polypharmacy,stroke patients with frailty had an increased risk of one-year mortality compared to those without frailty(OR¼3.38,95%CI:1.22e9.37,P¼0.019).Conclusion:Our study indicated that frailty was an independent risk factor for one-year all-cause mor-tality among older stroke patients in China.Frailty may be an essential factor for clinicians to consider before making a comprehensive treatment,and corresponding mixed interventions,including exercise training and nutritional programs,need to be conducted among older stroke patients.

Effects of a nurse-led heart failure clinic on hospital readmission and mortality in Hong Kong

Background Heart failure （HF） is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce the hospital readmission of HF patients. This study evaluates the effects of a nurse-led HF clinic on the hospital readmission and mortality rates among older HF patients in Hong Kong. Methods This study is a retrospective data analysis that compares HF patient in a nurse-led HF clinic in Hong Kong compared with HF patients who did not attend the clinic. The nurses of this clinic provide education on lifestyle modification and symptom monitoring, as well as titrate the medications and measure biochemical markers by following established protocols. This analysis used the socio-demographic and clinical data of HF patients who were aged 〉 65 years old and stayed in the clinic over a six-month period. Results The data of a total of 78 HF patients were included in this data analysis. The mean age of the patients was 77.38 ± 6.80 years. Approximately half of the HF patients were male （51.3%）, almost half were smokers （46.2%）, and the majority received 〈 six years of formal education. Most of the HF patients （87.2%） belonged to classes II and III of the New York Heart Association Functional Classification, with a mean ejection fraction of 47.15± 20.31 mL. The HF patients who attended the clinic （n = 38, 75.13 ± 5.89 years） were significantly younger than those who did not attend the clinic （n = 40, 79.53 ± 6.96 years） （P = 0.04）, and had lower recorded blood pressure. No other statistically significant difference existed between the socio-demographic and clinical characteristics of the two groups. The HF patients who did not attend the nurse-led HF clinic demonstrated a significantly higher risk of hospital readmission [odd ratio （OR）： 7.40; P 〈 0.01] than those who attended after adjusting for the effect of age and blood pressure. In addition, HF patients who attended the clinic had lower mortality （n = 4） than those who did not attend （n = 14）. However, such a difference did not reach statistical significance when the effects of age and blood pressure were adjusted. A signifi- cant reduction in systolic blood pressure IF （2, 94） = 3.39, P = 0.04] and diastolic blood pressure [F （2, 94） = 8.48, P 〈 0.01] was observed among the HF patients who attended the clinic during the six-month period. Conclusions The finding of this study suggests the important role of nurse-led HF clinics in reducing healthcare burden and improving patient outcomes among HF patients in Hong Kong.

老院人物纪事

时常梦见小时候的老院，仿佛又回到了三十几年前那个潮湿阴暗窄小的空间，梦里总是带着某种恐怖、压抑，儿时的经历铭刻在我的记忆深处，挥之不去，难以忘怀。

Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital

Background Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. There still a paucity of data on the proportional distribution of precipitating factors specifically in elderly patients. The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in elderly patients with heart failure in our community hospital. Methods We evaluate elderly patients who need admissions for decompensate heart failure. All patients were reviewed daily by the study investigators at the first 24 h and closely followed-up. Decompensation was defined as the worsening in clinical NYHA class associated with the need for an increase in medical treatment （at minimum intravenously diuretics）. Results We included 102 patients （mean age 79 ± 12 years）. Precipitating factors were identified in 88.5%. The decompensation was sudden in 35% of the cases. Noncompliance with diet was identified in 52% of the patients, lack of adherence to the prescribed medications amounted to 30%. Others precipitating factors were infections （29%）, arrhythmias （25%）, acute coronary ischemia （22%）, and uncontrolled hypertension （15%）, miscellaneous causes were detected in 18% of the cases （progression of renal disease 60%, anemia 30% and iatrogenic factors 10%）. Concomitant cause was not recognizable in 11.5%. Conclusions Large proportion heart failure hospitalizations are associated with preventable precipitating factors. Knowledge of potential precipitating factors may help to optimize treatment and provide guidance for patients with heart failure. The presence of potential precipitating factors should be routinely evaluated in patients presenting chronic heart failure.

The Effect of Signs Design of Wayfinding to Elders in Hospital： Take National Taiwan University College of Medicine for Example

Taiwan had officially entered aging society in 1993, and meantime the birthrate reaches its lowest point again and again. The constitution of population dramatically turns into an elder and low-birthrate society. Therefore, the ratio of elders living along is increasing yearly. When the elders need to deal the illness and go to hospital along, decays come from degeneration might have affect on their activity in accessible environment in hospital. Signs is a vital tool for delivering and communicating information in the road sign system. Whether the elders can identify the signs in hospital clearly becomes an important issue in the current research. To understand the affect of signs design in hospital to elders, the research reviewed and gained insight of degeneration in both physical and psychological of elders and the proper principal of signs design for elders. The research surveys in Taipei City, which has densest medical center, and mainly focus on National Taiwan University College of Medicine, which has hundred years of history （founded in 1895）. The research conducts field survey in both old and new buildings of National Taiwan University College of Medicine in August, 2015. The survey includes five types of signs design： Public Facilities, Prohibition, Safety, Warning, and Commercial Facilities. The result from article review indicates the most salient psychological degenerations includes the change in cognitive function, decay of memory, and deceleration of information processing; physical degenerations includes the decay of vision. As a result, the following properties should be taken into consideration when designing sings for elders： （1） The proper ratio of graphic and text. （2） Avoid using colors or matches difficult to identify by elders, like purple, blue, and green. （3） Take the visibility, legibility, identity, attention, and memory into consideration, there should be 70% differentiation in contrast between text of sign and background. （4） Avoid using multi-meaning graphic, keep the design simple. The result from the survey of National Yaiwan University College of Medicine indicates： （1） Using mainly on graphic and text as subsidiary, part of the sign design using both Chinese and English, and make sure the appropriateness of ratio between graphic and text. Use more of sans-serif font, which has better legibility. （2） Match the color mainly as yellow background with black graphic, blue background with white graphic, white background with black graphic, white background with blue graphic, a strong contrast between background and graphic on brightness and chroma matches the principle of visibility, legibility, and identity. （3） Simplify the signs design may safeguard its visibility. When elder need to handle illness comes from degeneration alone and go to large and complex hospitals frequently, the decay of their mental and physical might have a huge negative affect. Therefore, the signs design in hospital should understand their properties and design signs that match their requirement, to safeguard their live independency.

The Analysis of＂House-for-Pension＂ in China

As China has entered the aging society, the social and family are facing an increasing pressure in pension system. To explore diversified pension model for China has become the key to solve this problem. In 2013 the state council issued an document named Opinions to Speed Up the Derelopment of Pension Services, which clearly put forward that the government should promote the elderly housing reverse mortgage endowment insurance pilot ＂. ＂To implement housing endowment＂, practiced successfully in European and American countries, has proved a good way to solve the problem of lack of pension. This paper makes a analysis of the model, including the necessity,some practice and restricting factors promoting in our country, so as to explore countermeasures and Suggestions of the feasibility.

A Study on Developing College English Teachers＇ Ability of Integrating Academic from the Perspective of Self-efficacy

This article consists of the following parts： First, explains what the teacher efficacy is. Second, analyzes current situation of College English teachers integrating academic ability. Third, talks about the relationship between the efficacy level of College English teachers and the ability to improve the integration of academic from four aspects. Finally, analyzes College English teachers＇ training about integrating academic ability under the efficacy perspective from college English teachers, colleges and social aspects.

Research on service arrangement of taking senior citizens to hospital based on Customers＇ Satisfaction

In the transportation service, customers＇ specially ordered time window is not always strictly obeyed and deviation of service time from customer-ordered time window determine customers＇ satisfaction degree, which can be quantified by satisfactory function. And improved saving algorithm is proposed to solve the multi-objective model. A case study is also presented to verify effectiveness of the proposed algorithm.

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

Objective To investigate the status of vitamin B 12 deficiency in elderly inpatients in the department of neurology. Methods A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B 12 during the previous 3 months before the detection. The levels of serum vitamin B 12, folate and homocysteine （Hcy） were evaluated. The patients with vitamin B 12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B 12 deficiency. Results Vitamin B 12 deficiency was found in 163 patients （19.71% of the total patients）, and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B 12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B 12 deficient patients had megaloblastic anemia. Symptoms of vitamin B 12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson＇s disease （Parkinsonism）, diabetes mellitus and coronary heart disease. Most of the vitamin B 12 deficient patients had neuroelectricphysiological abnormalities. Conclusion Vitamin B 12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.

Effects of five-element music therapy on elderly people with seasonal affective disorder in a Chinese nursing home

OBJECTIVE: To explore the effects of five-element music therapy on elderly patients with seasonal affective disorder in a Chinese nursing home.METHODS: The patients(n=50) were recruited from a Shijingshan district nursing home in Beijing,China. They were randomly assigned to two groups, a treatment group and a control group,with 25 participants in each group. The patients received music therapy for 1-2 h each week over an8-week period. The music therapy involved four phases: introduction, activities, listening to the Chinese five-element music, and a concluding phase.The participants in the control group did not listen to the five-element music. This study consisted of two parts:(a) a qualitative study that used focus groups to understand the feelings of the patients with seasonal affective disorder;(b) a quantitative study that involved administration of the self-rating depression scale(SDS) and Hamilton depression scale(HAMD) before and after treatment.RESULTS:(a) Qualitative analysis results: strength derived from the five-element group music therapy and emotional adjustment. The five-element group music therapy can reduce patients' psychological distress and let them feel inner peace and enhance their life satisfaction.(b) No significant difference in SDS and HAMD scores was found between the two groups(P>0.05) prior to treatment. After treatment,the mean SDS score of the control group was 49.9±18.8, while the treatment group's score was 40.2±18.1. The HAMD score of the control group was11.2±3.1, and the treatment group's score was 8.8±4.9. Following 8 weeks of music therapy, the SDS and HAMD scores of the treatment group were significantly lower than those for the control group(P<0.05).CONCLUSION: Five-element music therapy alleviated the symptoms of seasonal affective disorder in the elderly patients.