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To analyse how refined living arrangements, in the context of digital access, affect elderly healthcare resource utilisation and satisfaction with healthcare needs.
A prospective cohort study. The study reporting is conformed to the STROBE checklist.
This longitudinal study utilised data from the 2018–2020 waves of the United States-based Health and Retirement Study and the 2013–2015 waves of the China Health and Retirement Longitudinal Study.
Baseline living arrangement was categorised into living alone, intergenerational living, living with spouse, nuclear living and proximate residence. Unmet healthcare needs at follow-up waves (i.e., 2020 wave of Health and Retirement Study and 2015 wave of China Health and Retirement Longitudinal Study) were classified into unmet clinical care needs and unmet preventive care needs, which were measured using three measurements on whether the participant had disorders, whether the participants use any clinical care, and whether the participants use any preventive care. Digital exclusion was assessed using a single question about internet access at baseline.
A total of 7116 participants from the China Health and Retirement Longitudinal Study cohort (female: 48.6%, mean age: 57.4 years) and 7266 from the Health and Retirement Study cohort (female: 64.9%, mean age: 65.1 years) were included. Compared with older adults living a nuclear arrangement, those living an inter-generational arrangement with digital exclusion had higher clinical care utilisation, but not necessarily lower risk of unmet clinical needs; they also had lower preventive care utilisation in the Health and Retirement Study cohort, while living with spouse led to higher preventive care utilisation in the China Health and Retirement Longitudinal Study cohort.
Living arrangements can affect older adults' healthcare utilisation and unmet healthcare needs, which can be moderated by digital exposure.
These findings suggest that healthcare providers should tailor care strategies by considering both living situations and digital literacy. Enhancing digital access, especially for those in inter-generational households, could help address unmet healthcare needs and improve overall care satisfaction.
This study using the STROBE CHECKLIST for reporting guideline.
No patient or public contribution.
By comparing data from both the United States and China, it highlights the importance of considering family structure and digital inclusion when addressing healthcare needs globally. The findings suggest that older adults in inter-generational living arrangements without digital access face higher clinical care demands but still struggle with unmet healthcare needs. This underscores the need for healthcare systems worldwide to address digital exclusion and adapt care strategies to individual living circumstances to enhance healthcare outcomes for the elderly population.
To investigate the correlation between intensive care unit (ICU) nurses' demographic characteristics, teamwork, moral sensitivity and missed nursing care.
Teamwork, moral sensitivity and missed nursing care are important health challenges among ICU nurses. Clarifying the relationship between variables is benefit to improve the quality of patients care. Nevertheless, a comprehensive conceptualisation of the relationship between teamwork, moral sensitivity and missed nursing care remains lacking.
A cross-sectional design.
This study follows the STROBE checklist. ICU nurses were recruited by two hospitals between November 2023 and January 2024, in Shandong Province, China. The demographic characteristic questionnaire, teamwork perceptions questionnaire, moral sensitivity questionnaire–revised version into Chinese and the Chinese version of the missed nursing care questionnaire were used for investigation. Multiple linear regression was used to clarify the factors affecting missed nursing care. Pearson correlation was used to test the correlation between teamwork, moral sensitivity and missed nursing care.
The level of missed nursing care for ICU nurses was low, with overall mean score of 37.49. Missed nursing care for ICU nurses in the labour dispatch were much higher than nurses with the contract system and personnel agency (p < 0.05). The 12-h shifts of ICU nurses also influenced missed nursing care. Furthermore, teamwork has a positive relationship with moral sensitivity (r = 0.653, p < 0.001).
Hospital and nursing managers should pay attention to the clinical sense of belonging of ICU nurses, reasonably set the working shifts, which will help to reduce the occurrence of missed nursing care.
It is recommended that nursing managers should invest in strategies to enhance nurse teamwork and implement a 12-h shift pattern, which can alleviate moral distress and improve quality of care.
No patient or public contribution. (The data of this were collected from nurses and not related to patients. They were informed of the research process and precautions, signed informed consent.)
To evaluate the prevalence of frailty and its impact on quality of life (QoL) in older Chinese breast cancer (BC) patients, which have not been thoroughly reported in this population.
A prospective multi-centre cross-sectional registry study.
Data were collected from Cancer Hospital of the Chinese Academy of Medical Sciences, Peking University Third Hospital and Beijing Chaoyang District San Huan Cancer Hospital between October 2021 and July 2023.
BC patients aged over 65 years were enrolled in this study. They completed three assessment scales including the FRAIL scale, Hospital Anxiety and Depression Scale (HADS) and European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ-C30), to screen for frailty, related factors and QoL. Clinical and pathological data were also collected. Analysis of frailty and prefrailty risk factors was performed via logistic regression. A multivariable linear regression model was used to evaluate the mean differences in scores for each QoL domain between patients with different frailty statuses.
A total of 946 patients were enrolled from three hospitals in Beijing between October 2021 and July 2023. Their median age was 69 years and 73.6% of them had early-stage breast cancer. Further, 37.2% of these patients had ≥ 1 comorbidity. The prevalence of frailty was 8.8% and frailty was more common in those with aged ≥ 75 years (22.3%), those with advanced tumours (15.6%), those with anxiety (31.3%) and those with depression (29.3%). More than half (57.2%) of the patients were prefrail. Regression analysis revealed that older age (odds ratio [OR] 1.12 [95% CI 1.07–1.17], p < 0.001), an advanced tumour (OR 2.27 [1.33–3.89], p = 0.003), anxiety (OR 2.74 [1.37–5.48], p = 0.004) and depression (OR 3.84 [1.97–7.49], p < 0.001) were significantly associated with frailty. After adjusting for other factors, different frailty states were shown to be independent influencing factors for QoL in both the functional and the symptom domains (all p < 0.05).
Our study provides data on the prevalence of frailty and prefrailty in older Chinese patients with BC. Both conditions are closely related to poor QoL. It is helpful for oncologist and clinical care to making intervention and better treatment decisions.
The study adhered to the STROBE checklist.
This study provides detailed data on the prevalence of frailty in older Chinese patients with BC and correlative factors. It suggests that clinical care should fully assess patients' frailty before making treatment decisions and provide early intervention for related factors.
Patients participated in the implementation of the project (including the informed consent and questionnaire process). No other public contribution to this research.
This study provides data on the prevalence of frailty in Chinese older BC patients and correlative factors. It indicates that clinicians should fully assess patients' frailty before making treatment decisions and provide early intervention for related factors.
ChiCTR2200056070
The objective of this study was to construct and validate a structural equation model (SEM) to identify factors associated with sleep quality in awake patients in the intensive care unit (ICU) and to assist in the development of clinical intervention strategies.
In this cross-sectional study, 200 awake patients who were cared for in the ICU of a tertiary hospital in China were surveyed via several self-report questionnaires and wearable actigraphy sleep monitoring devices. Based on the collected data, structural equation modelling analysis was performed using SPSS and AMOS statistical analysis software. The study is reported using the STROBE checklist.
The fit indices of the SEM were acceptable: χ2/df = 1.676 (p < .001) and RMSEA = .058 (p < 0.080). Anxiety/depression had a direct negative effect on the sleep quality of awake patients cared for in the ICU (β = −.440, p < .001). In addition, disease-freeness progress had an indirect negative effect on the sleep quality of awake patients cared for in the ICU (β = −.142, p < .001). Analgesics had an indirect negative effect on the sleep quality of awake patients cared for in the ICU through pain and sedatives (β = −.082, p < .001). Sedation had a direct positive effect on the sleep quality of conscious patients cared for in the ICU (β = .493; p < .001).
The results of the SEM showed that the sleep quality of awake patients cared for in the ICU is mainly affected by psychological and disease-related factors, especially anxiety, depression and pain, so we can improve the sleep quality of patients through psychological intervention and drug intervention.
FreshRSS 