Robustness in Older Adults: A Concept Analysis Using Rodgers' Evolutionary Approach.

This study examined the underlying types of intergenerational relationship and social support network among impaired older adults in China and explained how they may influence the home- and community-based service (HCBS) purchase intentions of these individuals. Based on the 2018 and 2020 waves of the Chinese Longitudinal Aging and Social Survey, a total of 3,397 older adults (aged ≥ 60 years, with at least one child) were selected. First, we used K-means cluster analysis to identify five types of intergenerational relationship among Chinese families: ‘tight-knit and proximal’, ‘parent-oriented and intimate’, ‘distant but intimate’, ‘independent-intimate’ and ‘child-oriented but emotionally detached’. Second, we examined the sizes of three distinct types of social support network among older Chinese adults: contact, instrumental and emotional. Subsequently, binary logistic regression was conducted to examine the relative impact of intergenerational relationships and social support networks on impaired older adults’ HCBS purchase intentions. Our findings revealed that under the moderation of social support networks, reciprocal intergenerational relationships exhibited fewer HCBS purchase intentions, while imbalanced intergenerational relationships exhibited diverse HCBS purchase intentions. The findings also underscore the ‘bridge’ function of older adults’ social support networks and the importance of community participation in promoting older adults’ utilization of support services.

To conduct a concept analysis of evidence-based leadership in a nursing context. Rodgers' evolutionary method was employed to identify attributes, antecedents, consequences, definitions and surrogate and related terms. We systematically searched three databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Scopus) for relevant publications. The databases were searched from their inception to 4 February 2024. We included 12 papers published between 2005 and 2022. The attributes include leadership attributes (personality, developing common goals and visions and influencing others) and evidence-based attributes (valuing evidence-based practice, integrating evidence and adapting evidence). The antecedents include individual internal factors (commitment to growth and proficiency in implementation science) and individual external factors (growing need for evidence-based practice, training support and available resources), while the consequences are personal growth, organisational benefit and disciplinary development. Based on the concept analysis, evidence-based leadership can be defined as a process whereby individuals, based on their personality and values towards evidence-based practices, integrate the best evidence into practice, adapt the evidence integration process based on evaluations and influence others towards achieving a common goal and vision. This concept analysis enhances our understanding of evidence-based leadership, guiding nurses to integrate evidence into their leadership practices to achieve specific goals and visions within the healthcare context. Future studies could consider developing instruments to evaluate evidence-based leadership based on this refined concept, ultimately promoting nurses' leadership competencies in real-world settings. This concept analysis not only raises awareness of the responsibilities of nurses as healthcare professionals, including the provision of evidence-based practice, but also facilitates their effective execution of these responsibilities. Empowering nurses to actively incorporate evidence into their leadership practices can further enhance the quality of healthcare delivery. Not applicable. Not applicable.

Background:Despite the importance and prominent role as a clinical, theoretical, and research approach in nursing practice, humanistic care nature and boundaries are not explicit and challenging for nurses to understand. This study was conducted to clarify the concept of humanistic care in nursing.Materials and Methods:Based on Rogers's evolutionary concept analysis, keywords such as “humanistic car *,” “caring behave *,” “humanistic nurs *,” “humanistic model of care,” were searched in PubMed, SCOPUS, Science Direct, Web of Science, WILEY, Springer, SAGE, ProQuest, SID, Iranmedex without time limit until November 2018. Sixty-five documents in nursing and ten documents in the medical discipline were finalized for thematic analysis.Results:Nine attributes of the humanistic care, including “excellence in clinical literacy,” “creating a healing environment,” “a comprehensive and unique viewpoint,” “contribution to clients' adaptation and flourishing of their talents,” “unrequited love and affection,” “preservation of human dignity,” “real presence,” “constructive dynamic interaction,” and “nurse's self-care,” were recognized. Assessing the historical and evolutionary course of the concept's semantic tendency revealed three periods: The focus in first, second, and third was on the nurse-patient relationship, quantitative tendency/measurement, and metaphysics/spiritual humanism, respectively. The comparison of interdisciplinary differences indicated greater semantic comprehensiveness and depth in the nursing discipline.Conclusions:Clear and practical definition and identification of humanistic care in nursing can be helpful in the further development of existing knowledge, instrumentation, designing guidelines, clinical interventions, knowledge translation, and correction of concept misuse. The identified antecedents and consequences can be in various aspects of clinical management.

BackgroundInternet technologies have become important for older adults to not only seek, understand, and evaluate information on health management but also apply and share acquired knowledge. Despite the disparity in e-health literacy among older adults, which affects health outcomes, its conceptual definition has not been distinctly clarified in previous studies. This study aimed to analyse the concept of e-health literacy among older adults and to identify its contexts in the nursing field.MethodsWe identified concepts, attributes, antecedents, and consequences of e-health literacy in older adults using Rodgers’ evolutionary approach to various fields of study, time, and cultural differences. A literature search was conducted using the National Assembly Library, Research Information Sharing Service, National Digital Science Library, DataBase Periodical Information Academic, PubMed, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, and Cochrane.ResultsA total of 28 studies were included, and we categorised the following three attributes: active information seeking, two-way interactive communication, and information utilization/sharing. The antecedents included personal factors, health status, socioeconomic factors, cultural factors, and attitudes toward the Internet while the consequences included increased health interest, health behaviour promotion, and active decision-making.ConclusionsAs e-health literacy in older adults affects their health and quality of life, this study clarifies the concept and provides a conceptual framework for nursing practice and research. Further studies are needed to identify and expand the constantly evolving concept of e-health literacy in older adults.

Background: Falls are a major cause of disability in India’s ageing population. The World Health Organization emphasizes maintaining intrinsic capacity (IC) and preventing frailty in older adults. However, urban–rural differences in these associations remain underexplored. This study examined the relationships among IC, frailty, and fall risk in older Indian adults, including urban–rural differences. Methods: We performed a cross-sectional analysis using Wave 1 (2017–2018) data from the Longitudinal Ageing Study in India (LASI), including 31,902 individuals aged ≥60 years. IC was measured using a composite score (0–10) across five WHO-ICOPE domains, and frailty was assessed using the Fried phenotype. Multivariable logistic regression accounts for complex survey design and covariates, estimated adjusted odds ratios (aORs) for falls, high IC, and frailty. Results: Fall prevalence was higher in rural areas (12.5%) than in urban areas (9.5%; p<0.001). Urban residence was associated with lower odds of falling (aOR 0.73; 95% CI 0.67–0.80) and higher odds of high IC (aOR 1.91; 95% CI 1.78–2.05). High IC was associated with lower odds of falling (aOR 0.80; 95% CI 0.67–0.96), while frailty increased fall risk (aOR 1.24; 95% CI 1.10–1.40). Depression and multimorbidity, which refers to the presence of multiple chronic health conditions, were associated with lower independence in daily activities (IC) and higher frailty. Conclusions: IC and frailty contribute to fall risk among older adults in India, with urban–rural differences suggesting an important role for environmental context.

De-escalation of aggressive behaviour in healthcare settings: Concept analysis

The aim of this concept analysiswas to develop a contemporary operational definition of Clinical Judgement in nursing. Concept analysis. Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist. This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion. The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.

To explore the meaning of healthcare self-management support for post-discharged stroke patients. Rodgers' evolutionary approach was used to identify antecedents, attributes, related terms, surrogate terms and consequences. Literature from 2012 to 2022 was searched from MEDLINE, CINAHL, PsycINFO and Google Scholar. Three antecedents preceded healthcare self-management support for post-discharged stroke patients: loss of inpatient support, preparedness for self-management and presence of self-management support. Healthcare self-management support for post-discharged stroke patients was defined by eight attributes: pre-discharge assessment and planning; provision of continuous education and training; collaborative goal-setting; reinforcement and documentation of vital information; coordination of post-discharge care; provision of rehabilitation support and promoting community reintegration; provision of counselling support; and using clear communication, patient empowerment and promoting self-efficacy. The identified consequences of the concept were as follows: improved patient outcomes; improved life quality; decreased healthcare cost; decreased re-admission rate and inpatient care burden; and decreased complication rate. Healthcare self-management support for post-discharged stroke patients is an emerging concept that can help to significantly improve stroke patients' health outcomes and life quality. However, its applicability is uncertain considering the workload, time and resources available to healthcare professionals. There is a need for future studies to focus on the feasibility and applicability of this concept in clinical practice and to identify any challenges healthcare providers may have in supporting stroke patients after discharge. This concept analysis brings clarity to the concept of healthcare self-management support of post-discharged stroke patients and distinguishes it from other self-management supports. It provides an opportunity for further studies and a pathway for generalized healthcare self-management support for stroke patients after discharge to improve health outcomes and quality of life. No patients, service users, caregivers or members of the public were involved in conducting this concept analysis.

Intrinsic capacity-the composite of all the physical and mental capacities of an individual-has been proposed by WHO as a marker of healthy ageing. However, the association of movement behaviours (physical activity and sedentary behaviour) with intrinsic capacity remains largely unexplored. We aimed to prospectively analyse the association of movement behaviours with intrinsic capacity in older adults. The Seniors-ENRICA-2 prospective, population-based study included a cohort of male and female community-dwelling older adults aged 65-94 years living in Spain. Accelerometer-based levels of sedentary, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were assessed at baseline. An intrinsic capacity composite score (with higher scores indicating higher intrinsic capacity) was calculated at baseline and at two follow-up assessments across six domains: vitality (handgrip strength, appetite, and weight loss), cognition (Mini-Mental State Examination), psychological (Geriatric Depression Scale), locomotion (Short Physical Performance Battery), vision, and hearing. Between Dec 2, 2015, and Nov 23, 2017, 3273 participants were recruited to the Seniors-ENRICA-2 study. 2477 (75·7%) of 3273 participants had complete data for movement behaviours and intrinsic capacity at baseline and were therefore included in the analyses. 1314 (53·0%) of 2477 participants were female and 1163 (47·0%) were male. 1463 (59·1%) of 2477 participants provided follow-up data over a median of 2·3 years (IQR 2·1 to 2·5) and 940 over 5·5 years (5·2 to 5·8). When analysed as a continuous variable, higher levels of MVPA (mean percentage change [MPC] per 15 min 0·63%, 95% CI 0·06 to 1·21), but not LPA (-0·39%,-0·85 to 0·07), were associated with improvements in intrinsic capacity during follow-up, whereas higher levels of sedentary behaviour were associated with declines in intrinsic capacity (-0·29%, -0·57 to -0·01). Analyses by tertiles of physical activity confirmed that the highest (MPC 4·83%, 95% CI 1·98 to 7·75) and intermediate (5·44%, 2·52 to 8·45) tertiles of MVPA were associated with improvements in intrinsic capacity compared with the lowest tertile. By contrast, compared with the highest tertile, the lowest (MPC 5·48%, 95% CI 2·88 to 8·02) and intermediate (5·73%, 3·16 to 8·22) tertiles of sedentary behaviour were associated with improvements in intrinsic capacity. Sedentary behaviour was associated with a reduction of intrinsic capacity, and MVPA (but not LPA) was associated with an improvement in intrinsic capacity in older adults. Our findings support the importance of promoting physical activity and reducing sedentary behaviour for healthy ageing. Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, French Agence Nationale de la Recherche, European Regional Development Fund/European Social Fund, Fondo de Investigaciones Sanitarias, the EU NextGenerationEU/Plan de Recuperación, and Transformación y Resiliencia.

Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced?

Ageing in place has been promoted in the Netherlands to encourage optimal functional ability (FA) and independent living among older adults. FA is likely dependent on intrinsic capacity (IC), a composite measure of an individual's mental and physical capacities-and its interaction with the physical environment in which people live. This study aimed to examine the association between IC and FA, as well as to explore how the physical environment may modify this relationship in older adults. Data of older adults of the Longitudinal Aging Study Amsterdam were used (n=1,637). FA was assessed as six-year functional decline (yes/no). IC scores (0-100) and characteristics of the physical environment, i.e., urbanisation, air pollution (particulate matter (PM10) and nitrogen dioxide (NO2)), area-level socio-economic status, and neighbourhood walkability, were assessed at baseline. Multiple logistic regression analyses were conducted to investigate the association between IC and functional decline, and the modifying effect of each environmental variable. The mean age at baseline was 69.39 years (SD=7.51) and 54.7% were women. Higher IC was associated with lower odds of functional decline (OR: 0.90, 95% CI: 0.88-0.93). Stratified analyses showed a stronger inverse association between IC and functional decline in lower PM10 (OR: 0.84, 95% CI: 0.76-0.92), compared to higher PM10 environments (OR: 0.92, 95% CI: 0.89-0.95) in fully adjusted models. Higher IC was related to less functional decline. Exposure to higher levels of PM10 appears to mitigate the protective association between IC and FA in older adults.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

BackgroundLife-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity.MethodsOur dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization’s Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities.ResultsWe discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory.ConclusionsThese findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years.

Social support for nursing students: A concept analysis study

BackgroundThe World Health Organization (WHO) has proposed healthy aging framework, supposing that intrinsic capacity (IC), environment and their interaction may have influence on functional ability (FA). It was still unclear how the IC level and age-friendly living environment impact on FA. This study aims to confirm the relationship between the IC level and age-friendly living environment with FA, especially in older adults with low IC.MethodsFour hundred eighty-five community-dwelling residents aged ≥ 60 years were enrolled. IC constructed by locomotion, cognition, psychological, vitality, and sensory domains was assessed using full assessment tools recommended by WHO. Age-friendly living environment was measured with 12 questions adapted from the spatial indicators framework of age-friendly cities. FA was assessed using activities of daily living (ADL) and one question about mobile payment ability. Multivariate logistic regression was used to explore the association between IC, environment and FA. The influence of the environment on electronic payment and ADL under the IC layer was assessed.ResultsOf 485 respondents, 89 (18.4%) had ADL impairment, and 166 (34.2%) had mobile payment function impairment. Limited IC (odds ratio [OR] = 0.783, 95% confidence interval [CI] = 0.621–0.988) and poor environment (OR = 0.839, 95% CI = 0.733–0.960) were associated with mobile payment ability impairment. Our results suggested that a supportive age-friendly living environment influenced FA was more prominent in older adults with poor IC (OR = 0.650, 95% CI = 0.491–0.861).ConclusionsOur results confirmed IC and the environment had an impact on mobile payment ability. The relationship between environment and FA showed differences according to IC level. These findings suggest that an age-friendly living environment is important to maintain and enhance elders’ FA, especially in those with poor IC.