Functional recovery of older people with hip fracture: does malnutrition make a difference?

Aim To report a study of the effects of protein‐energy malnutrition on the functional recovery of older people with hip fracture who participated in an interdisciplinary intervention. Background It is not clear whether protein‐energy malnutrition is associated with worse functional outcomes or it affects the interdisciplinary intervention program on the functional recovery of older people with hip fracture. Design A randomized experimental design. Methods Data were collected between 2002–2006 from older people with hip fracture ( N  = 162) in Taiwan. The generalized estimating equations approach was used to evaluate the effect of malnutrition on the functional recovery of older people with hip fracture. Results The majority of older patients with hip fracture were malnourished (48/80, 60% in the experimental group vs. 55/82, 67% in the control group) prior to hospital discharge. The results of the generalized estimating equations analysis demonstrated that subjects suffering from protein‐energy malnutrition prior to hospital discharge appeared to have significantly worse performance trajectories for their activities of daily living, instrumental activities of daily living, and recovery of walking ability compared with those without protein‐energy malnutrition. In addition, it was found that the intervention is more effective on the performance of activities of daily living and recovery of walking ability in malnourished patients than in non‐malnourished patients. Conclusion Healthcare providers should develop a nutritional assessment/management system in their interdisciplinary intervention program to improve the functional recovery of older people with hip fracture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99041/1/jan12027.pd

Evaluation of Medical Outcomes Study Short Form-36 Taiwan version in assessing elderly patients with hip fracture

The Medical Outcomes Study Short Form-36 (SF-36) is a widely used measure of generic health related quality of life. The purpose of this study is to establish the validity and reliability of the SF-36, Taiwan Version, when applied to a sample of elderly patients with hip fracture in Taiwan. Data from two samples were used, the first sample ( n =87) from a prospective descriptive study for testing psychometric scaling assumptions, scale responsiveness and criterion validity, and the second sample ( n =69) from a clinical trial for examining the validity of the differences in the group. The SF-36 Taiwan version demonstrated good evidence of supporting the scaling assumption. Cronbach’s alpha coefficients above 0.70 for all scales support the internal consistency. The Physical Function (PF) scale had an effect size of 0.88 from months 1 to 3, and 0.59 from months 3 to 6 after discharge, which appears to have the best responsiveness to clinical changes. Notable floor and ceiling effects (>15%) for Role Emotion (RE), Role-Physical (RP) and PF scales were found. High correlation of 0.62 between the PF and measures of activities of daily living (ADLs), and between RP and instrumental activities of daily living (IADLs) (0.63) supports the construct validity. Significantly higher performance in most SF-36 scales in elders without risk for depression than those who were at risk supported the validity of the group differences. In its current form, the SF-36 Taiwan version demonstrated good reliability and validity as applied to patients with hip fracture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45910/1/198_2003_Article_1580.pd

Consistency in end-of-life care preferences between hospitalized elderly patients and their primary family caregivers

[[abstract]]Purpose: This study explored the consistency between preferences for end-of-life care for elderly hospitalized patients and their primary caregivers and predictors of consistency. Patients and methods: This cross-sectional correlational study recruited 100 dyads of elderly hospitalized patients and their primary caregivers from a medical center in Central Taiwan. A structural questionnaire about preferences for seven end-of-life medical treatment options involved cardiopulmonary resuscitation, intravenous therapy, nasogastric tube feeding, intensive care unit, blood transfusion, tracheotomy, and hemodialysis. Results: The consistency was 42.28% for preferences of end-of-life medical care between patients and caregivers. The Kappa values for seven life-sustaining medical treatments ranged from 0.001 to 0.155. Logistic regression showed that the predictors of consistency for preferences of treatment were: a patient with a signed living will (odds ratio [OR] = 6.20, p<0.01) and a male family caregiver (OR= 0.23, p<0.01) for cardiopulmonary resuscitation; a patient who visited relatives in the intensive care unit (OR= 2.94, p< 0.05) and a spouse caregiver (OR= 3.07, p< 0.05) for nasogastric tube feeding; a spouse caregiver (OR=3.12, p<0.05) and a caregiver who visited the intensive care unit (OR= 5.50, p<0.01) for tracheotomy; and a spouse caregiver (OR= 2.76, p<0.05) and a caregiver who visited the intensive care unit (OR= 4.42, p<0.05) for hemodialysis. Conclusion: End-of-life medical treatment preferences were inconsistent between patients and family caregivers, which might be influenced by Asian culture, the nature of the relationship and individual experiences. Implementation of advance care planning that respects the patient's autonomy and preferences about end-of-life care is recommended

Predictors of functional recovery for hip fractured elders during 12 months following hospital discharge: a prospective study on a Taiwanese sample

To examine the longitudinal changes in overall and individual physical activities of daily living (PADLs) and instrumental activities of daily living (IADLs), at 1, 3, 6, and 12 months after hospital discharge in elderly subjects, 110 hip fractured elders (mean±SD age, 79.4±7.5; 60.9% females) were enrolled in a prospective study. At 12 months following hospital discharge, 56.1% subjects had recovered their overall PADLs, 37.9% had recovered their overall IADLs, and 74.2% could walk independently or with the aide of a cane. When analyzed by generalized estimating equations (GEE), for individual PADL, bathing and climbing stairs had consistently improved at every time point throughout the 1-year follow-up period, while transferring, toileting, and walking ability only improved significantly in the first 3 months after discharge. For individual IADL, the proportion of recovery for mobility appeared to increase significantly during the first 6 months post-discharge, and the remaining IADLs appeared to be stable. These results indicated that the recovery rate is varied for performance of different activities according to the complexity and the involvement of the lower extremities. We also found that less concomitant diseases, and a shorter hospital stay could predict a better recovery trend of overall and of most individual PADLs. These findings may be applicable to other countries with Chinese populations, and could provide a reference for health care providers to develop specific interventions for Chinese hip fractured elders.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45908/1/198_2003_Article_1557.pd

Changes in quality of life among elderly patients with hip fracture in Taiwan

To examine the longitudinal change in health related quality of life (HRQoL) during 1 year following hospital discharge in elderly subjects, 110 hip fractured subjects (age, mean±SD: 79.3±7.4 years) were enrolled in a prospective study. Face-to-face interviews with the patients were conducted, using Short Form 36 (SF-36) at 1, 3, 6, and 12 months after they were discharged from the hospital. The GEE approach was employed to evaluate changes in the variables of interest among different time points. Subjects in this study appeared to have lower scores in most dimensions of SF-36, with physical function and role limitation being the lowest due to physical problems (mean±SD=10.97±16.19; 6.32±20.60) during the 1st month after hospital discharge, compared to community dwelling subjects (mean±SD=77.5±20.5; 63.8±45.30). Most of the dimensions of SF-36, except general health (6th month versus 3rd month=57.56±21.90 versus 61.75±23.46, P >0.05) improved significantly from the 1st month to the 3rd month (range of means of improved scores from 12.81 to 30.76, P <0.01). After the 3rd month after discharge, physical functions kept improving significantly until 6 months after hospital discharge (3rd month versus 6th month=25.18±23.66 versus 40.30±25.94, P <0.05). Role limitation due to physical problems reached a plateau between the 3rd and 6th month, and then again improved significantly during the 6th month and the 1st year after hospital discharge (6th month versus 1st year=17.69±31.78 versus 32.22±44.47, P <0.05). The rest of the dimensions of SF-36 remained stable from the 3rd month to 1 year after discharge. These results indicated that different aspects of SF-36 recovered differently for the hip fractured patients in Taiwan. Similar studies may be helpful for health-care providers in other countries with Chinese populations to develop specific intervention programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45907/1/198_2003_Article_1533.pd

A Pilot Investigation of the Short-Term Effects of an Interdisciplinary Intervention Program on Elderly Patients with Hip Fracture in Taiwan

To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan. Design : Randomized experimental design. Setting : A 3,800-bed medical center in northern Taiwan. Participants : Elderly patients with hip fracture (N=137) were randomly assigned to an experimental (n=68) or control (n=69) group. Intervention : An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning. Measurements : Demographic and outcome variables were measured. Outcome variables included service utilization, clinical outcomes, self-care abilities, health-related quality-of-life (HRQOL) outcomes, and depressive symptoms. Results : Subjects in the experimental group improved significantly more than those in the control group in the following outcomes: ratio of hip flexion 1 month after discharge ( P= .02), recovery of previous walking ability at 1 month ( P= .04) and 3 months ( P= .001) after discharge, and activities of daily living at 1 month ( P= .01) and 2 months ( P= .001) after discharge. Three months after discharge, the experimental group showed significant improvement in peak force of the fractured limb's quadriceps ( P= .04) and the following health outcomes: bodily pain ( P= .03), vitality ( P <.001), mental health ( P= .02), physical function ( P < .001), and role physical ( P= .006). They also had fewer depressive symptoms ( P= .008) 3 months after discharge. Conclusion : This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes, self-care abilities, and HRQOL and by decreasing depressive symptoms within 3 months after discharge.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65320/1/j.1532-5415.2005.53253.x.pd

Enhancing Nurse–Robot Engagement: Two-Wave Survey Study

BackgroundRobots are introduced into health care contexts to assist health care professionals. However, we do not know how the benefits and maintenance of robots influence nurse–robot engagement. ObjectiveThis study aimed to examine how the benefits and maintenance of robots and nurses’ personal innovativeness impact nurses’ attitudes to robots and nurse–robot engagement. MethodsOur study adopted a 2-wave follow-up design. We surveyed 358 registered nurses in operating rooms in a large-scale medical center in Taiwan. The first-wave data were collected from October to November 2019. The second-wave data were collected from December 2019 to February 2020. In total, 344 nurses participated in the first wave. We used telephone to follow up with them and successfully followed-up with 331 nurses in the second wave. ResultsRobot benefits are positively related to nurse–robot engagement (β=.13, P<.05), while robot maintenance requirements are negatively related to nurse–robot engagement (β=–.15, P<.05). Our structural model fit the data acceptably (comparative fit index=0.96, incremental fit index=0.96, nonnormed fit index=0.95, root mean square error of approximation=0.075). ConclusionsOur study is the first to examine how the benefits and maintenance requirements of assistive robots influence nurses’ engagement with them. We found that the impact of robot benefits on nurse–robot engagement outweighs that of robot maintenance requirements. Hence, robot makers should consider emphasizing design and communication of robot benefits in the health care context