Visits by older people to the Emergency Department (ED) have increased in recent decades with higher revisiting and admission rates after discharge, particularly for those with frailties. This study used a before–after design aimed at evaluating Comprehensive Geriatric Assessment (CGA) screening in older ED patients (aged ≥ 75 years) during the 12-month preintervention period. Additionally, a CGA-based structured follow-up program after ED discharge was executed during the next 12-month intervention period. Amongst the 358 participants (median age 82 years), involving 122 in the preintervention period and 236 in the intervention period, 77 participants (21.5%) were identified as pre-frailty, while 274 (76.5%) were identified as frail using the Fried frailty phenotype. One-hundred ten (110) (30.7%) patients revisited the ED with 73 (20.4%) being admitted and 20 (5.6%) dying within three months after ED discharge. Compared with preintervention and intervention period, it was shown that the rates of admission at the index ED visit (50.8% vs. 23.1%), and mortality (10.7% vs. 3.0%), were both were significantly reduced. Using multivariate regression analysis, it was shown frailty was significantly associated with three-month mortality after adjusting for potential confounders. On the contrary, the program significantly decreased admission and death rate. It is suggested that frailty was prevalent amongst the older ED patients, and should be screened for in order to decrease revisits/admissions after ED discharge.

We evaluated the predictability of self-reported Health-related quality of life (HRQoL) assessed by the 3-level 5-dimensional Euro-Quality of Life tool (EQ-5D-3L) and the EQ-Visual Analog Scale (EQ-VAS) on clinical outcomes of elderly patients who were admitted to an acute geriatric ward. A total of 102 participants (56.9% men) with a median age of 81.0 years (interquartile range or IQR: 76.0–85.3 years) were studied. The age-adjusted Charlson comorbidity index was 5.0 (IQR: 4.0–6.0) with a median length of stay (LOS) of 9.0 days (IQR: 7.0–15.0 days). No death occurred during hospitalization, and within 30 days after discharge, 15 patients were readmitted. During hospitalization, the EQ-5D-3L index was 0.440 at admission and that improved to 0.648 at discharge (p < 0.001). EQ-VAS scores also improved similarly from 60 to 70 (p < 0.001). Physical, cognitive function, frailty parameters (hand grip strength and walking speed), and nutritional status at admission all improved significantly during hospitalization and were related to EQ-5D-3L index or EQ-VAS scores at discharge. After controlling for relevant factors, EQ-5D-3L index at admission was found to be associated with LOS. In addition, EQ-VAS was marginally related to readmission. HRQoL assessment during hospitalization could be useful to guide clinical practice and to improve outcome.

Background: Spiritual care plays a significant role in holistic patient care, addressing not only physical ailments but also attending to patients’ emotional and spiritual well-being. While the importance of spiritual care in nursing is widely recognized, there is often a gap in understanding nurses’ willingness to provide such care. This cross-sectional study aimed to explore the association between self-efficacy, spiritual well-being, and willingness to provide spiritual care among nursing staff.Methods: The study conducted a cross-sectional survey of full-time registered nurses at a hospital in Taiwan from January 2019 to December 2019. A sample comprising 168 nurses was selected for participation in the study through a random sampling method. In addition to collecting demographic variables, the assessment tools used in the study include the General Self-Efficacy Scale (GSES) for measuring self-efficacy, the Spiritual Index of Well-Being Chinese Version (SIWB-C) for evaluating spiritual well-being, and the Spiritual Care Needs Inventory (SCNI) to gauge willingness to provide spiritual care.Results: Most participants in the study were female, accounting for 98.2% (n = 165). The mean age of all 168 nurses was 37.1 ± 9.3 years. Additionally, most participants held a Bachelor’s degree (79.2%,n = 133) and possessed clinical experience was 10.5 ± 9.3 years. Through logistic regression analysis, it was found that regardless of whether participants have received sufficient spiritual care training, both GSES and SIWB-C remain influential factors in determining the provision of spiritual care.Conclusions: Collaboration between healthcare management and nursing staff is essential for fostering a healthcare environment that not only appreciates the physical and spiritual dimensions of patient care but also prioritizes the enhancement of nurses ' self-efficacy and well-being.

Nickel is a heavy metal used in many industries. Nickel exposure can induce respiratory diseases and allergic reactions, and increase cancer risk. This study evaluated the introduction of a grinding and polishing system to prevent injuries from nickel toxicity in workers. We performed a controlled, interventional, before-and-after study from January 2018 to December 2019 at a faucet component industrial manufacturing site. Results from workplace environmental monitoring, questionnaire responses, and biomonitoring were collected before and after the intervention. Thirty-seven workers (100% men) aged 25.0 (interquartile range (IQR): 22.0–33.5) years were categorized into two groups, those with and without nickel exposure. In the exposed group, the median exposure time was 18.0 months (IQR 14.0–20.0 months). Urinary nickel concentration was lower in the exposed group than in the non-exposed group (13.8 (IQR 1.7–20.7); 23.1 (IQR 11.3–32.8) μg/g creatinine, respectively; p = 0.047). The median urinary nickel concentration was lower in the second year than in the first year (17.4 (IQR 2.2–27.4), 7.7 (IQR 4.3–18.5) μg/g creatinine, respectively; p = 0.022). Significant reductions in urinary nickel concentration were observed following the intervention and educational program. Thus, biomonitoring of urinary nickel concentration can successfully reflect the effectiveness of interventions and their relationship to nickel exposure.

To evaluate the relationship between oral health and geriatric disorders, as well as its role in clinical outcomes among acutely admitted older patients. A retrospective observational study was conducted. The study was conducted at a medical center in central Taiwan. A total of 1,141 patients (651 males and 490 females), aged 65 years or older, were admitted due to acute illness with geriatric syndromes from October 1, 2018, to March 31, 2023. A comprehensive geriatric assessment (CGA) was conducted, covering the comorbidity index, cognitive status, mood, physical function, nutritional status, mobility, health-related quality of life, frailty, and oral health condition. Oral health was evaluated using a bedside oral examination with scores ranging from 8 to 24, where scores of 8-10 indicated normal oral health, 11-14 indicated moderate impairment, and 15-24 indicated severe impairment. The primary outcome observed was in-hospital mortality. Among the participants, 40.5% experienced cognitive impairment, 24.8% exhibited depressive symptoms, 69.4% had low hand grip strength, 36.5% demonstrated low performance in mobility, and 78.9% were at risk of malnutrition. Severe impairment of oral health was found in 18.8% of the participants, while frailty was observed in 85.1%. Stratification of oral health severity revealed differences in various CGA parameters, including comorbidity, polypharmacy, cognitive impairment, depressive mood, physical activity, mobility, nutritional status, and quality of life, as well as clinical outcomes such as length of stay and in-hospital mortality between the groups. In univariable analysis, age, gender, frailty, oral health impairment, comorbidity index, nutritional status, and cognitive and physical functions were all significantly associated with in-hospital mortality. After adjusting for significant factors, severe oral health impairment remained significantly associated with mortality. In acutely admitted older patients, oral health was associated with geriatric disorders and was linked to in-hospital mortality. Early intervention in oral health may be necessary to improve outcomes.

This study evaluated changes of cognitive, physical, and nutritional status before and after the interruption and resumption of daycare services during the COVID-19 pandemic in older dementia people in a daycare center. Comprehensive geriatric assessment data were analyzed before and after the lockdown of daycare center services, including mini-mental state examination, activities of daily living (ADL) scores, mini-nutritional assessment-short forms (MNA-SF), and timed up-and-go (TUG) tests. Among 19 dementia people participating in daycare services, 17 participants were enrolled in the study with, finally, two excluded because of incomplete follow-ups. They had a median age of 81 years; their MNA-SF scores and TUG values deteriorated significantly after a 3-month closure of daycare services (p < 0.05), and after resumption of daycare services the MNA-SF scores and TUG values recovered to near the pre-lockdown levels (p < 0.05). Besides, baseline ADL scores predicted a decline and recovery of TUG and MNA-SF values. Our findings suggest that planning continuous support for older dementia adults is important for daycare facilities during COVID-19 pandemic confinement.