Adults In Community Settings Research Articles

Age Friendly Care: What do Community Aging Services Professionals Need to Know?

ABSTRACT There is an increasing need for community-based health education to help older adults understand and manage their complex medical needs. Community Aging Services Professionals (CASPs) are non-medical service providers who facilitate aging in place by providing health education, socialization, and care coordination for older adults in community settings. Through in-depth interviews with 13 CASPs, this study assessed CASPs’ knowledge of older adults’ medical issues and health education needs. Our goal was to assess CASPs’ knowledge of older adults’ medical issues and health education needs and determine overlap with the Age Friendly Health System 4 Ms framework. CASPs described promoting older adults’ health by providing medical referrals, education, and advice. The interviews revealed that CASPs feel underprepared to provide requested medical support for older adults, and that both CASPs and older adults desire more clinical education to help identify and manage older adults’ medical conditions. This study established CASPs as ideal providers to receive and disseminate clinical health education for older adults aging in the community. The results also showed the 4 Ms model of age friendly care is well-received as a framework for health education in community settings.

Association between COVID-19 stress, coping mechanisms and stress-related oral conditions among Egyptian adults: a cross-sectional study

The present study investigated the association between COVID-19 stresses and oral conditions including gingivitis, oral hygiene, oral ulcers, and dry mouth. This was a cross-sectional study that collected data from adults in community settings in Alexandria, Egypt, between October 2021, and February 2022. Gingival condition and oral hygiene were assessed using the gingival and plaque indices. Participants were asked if they experienced oral ulcers during the past week and dry mouth during the past year. COVID-19 fears and coping were assessed using the COVID Stress Scale (CSS), and the Brief Resilience Coping Scale (BRCS), respectively. Oral health behaviors were assessed using the World Health Organization questionnaire. Regression analyses were used to assess the association between the dependent variables (clinically assessed gingival and plaque indices, reported presence of oral ulcers, and dry mouth) and explanatory variables (CSS and BRCS) after adjusting for confounders (COVID-19 status, oral health behaviors, smoking, age in years, sex, and highest educational level). The response rate was 88.8% (373/420). The mean (SD) age = 39.26 (11.45) with 74.3% females and 49.3% reporting completing high school or higher education. The mean (SD) plaque and gingival indices were 1.59 (0.66) and 1.39 (0.59), respectively. Only 20.1% reported the presence of oral ulcers and 41.6% reported xerostomia. Lower plaque score was associated with higher COVID-19 contamination fears (B = − 0.03, 95% CI − 0.05, − 0.02) and higher compulsive checking and reassurance-seeking (B = − 0.02, 95% CI − 0.03, − 0.009). Lower gingival score was associated with higher COVID-19 contamination fears (B = − 0.02, 95% CI − 0.03, − 0.002). Higher odds of reporting dry mouth were associated with greater fear of COVID-19 socioeconomic consequences (AOR = 1.05, 95% CI 1.001, 1.09), and lower coping scores (AOR = 0.93, 95% CI 0.88, 0.99). The findings suggest an association between COVID-19 specific stresses and stress-related oral conditions and shed light on the possible link between mental and oral health, emphasizing the importance of integrated planning of care services.

Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review

ObjectivesTo establish the evidence base for the effects on health outcomes and costs of social prescribing link workers (non-health or social care professionals who connect people to community resources) for...

Validation of the Circular Tandem Walk Test and Optimal Cutoff Score to Determine the Risk of Falls in Active Community-Dwelling Older Adults.

This study was to develop and validate the circular tandem walk test (CTWT) by deriving an optimal cutoff score to indicate the fall risk in 89 active community-dwelling older individuals. The participants aged 65years and older were assessed for their demographic data, fear of fall variables, and history of falls in the past 6months. Subsequently, participants were randomized for the sequence of tests between the tandem walk test and the CTWT. The outcomes of CTWT showed the highest significant correlation with all the fall variables (ranging from .631 to .827, p < .001). Moreover, the time to perform the CTWT ≥ 14.6s and ≥ two error scores had excellent and acceptable diagnostic accuracy to determine the risk of falls in the older individuals, respectively. The CTWT can be used as alternative screening tests for assessing the fall risk in active older adults in community settings.

Validation of the Somatic Symptom Disorder-B Criteria Scale for Adults in South Korea.

The Somatic Symptom Disorder-B Criteria Scale measures the cognitive, affective, and behavioral features of the Diagnostic and Statistical Manual of Mental Disorders-5 somatic symptom disorder. This study examined the psychometric properties of the Korean version of the Somatic Symptom Disorder-B Criteria Scale in a community sample of Korean adults. The sample included 349 Korean adults (71.6% female (n = 250); mean age, 22.6 SD = 4.8). Exploratory and confirmatory factor analysis was performed for construct validity, Pearson r correlations were used to assess convergent validity, and internal consistency was calculated by Cronbach's alpha coefficients and item-total correlation. Findings of exploratory and confirmatory factor analysis demonstrated that the Korean version of the Somatic Symptom Disorder-B Criteria Scale had a modified unifactorial structure. Indices of convergent validity, test-retest reliability, and internal consistency reliability of the Korean version of the Somatic Symptom Disorder-B Criteria Scale were acceptable. These results suggest that the Korean version of the Somatic Symptom Disorder-B Criteria Scale is suitable for assessing the cognitive, affective, and behavioral features of the Diagnostic and Statistical Manual of Mental Disorders-5 somatic symptom disorder in Korean adults in community settings.

Development of a risk prediction model and a sample risk chart for long-term care certification based on the functional health of older adults

Objectives The first aim of this study was to develop risk prediction models based on age, sex, and functional health to estimate the absolute risk of the 3-year incidence of long-term care certification and to evaluate its performance. The second aim was to produce risk charts showing the probability of the incident long-term care certification as a tool for prompting older adults to engage in healthy behaviors.Methods This study's data was obtained from older adults, aged ≥65 years, without any disability (i.e., they did not certify≥care level 1) and residing in Yabu, Hyogo Prefecture, Japan (n=5,964). A risk prediction model was developed using a logistic regression model that incorporated age and the Kihon Checklist (KCL) score or the Kaigo-Yobo Checklist (KYCL) score for each sex. The 3-year absolute risk of incidence of the long-term care certification (here defined as≥care level 1) was then calculated. We evaluated the model's discrimination and calibration abilities using the area under the receiver operating characteristic curves (AUC) and the Hosmer-Lemeshow goodness-of-fit test, respectively. For internal validity, the mean AUC was calculated using a 5-fold cross-validation method.Results After excluding participants with missing KCL (n=4) or KYCL (n=1,516) data, we included 5,960 for the KCL analysis and 4,448 for the KYCL analysis. We identified incident long-term care certification for men and women during the follow-up period: 207 (8.2%) and 390 (11.3%) for KCL analysis and 128 (6.6%) and 256 (10.2%) for KYCL analysis, respectively. For calibration, the χ2 statistic for the risk prediction model using KCL and KYCL was: P=0.26 and P=0.44 in men and P=0.75 and P=0.20 in women, respectively. The AUC (mean AUC) in the KCL model was 0.86 (0.86) in men and 0.83 (0.83) in women. In the KYCL model, the AUC was 0.86 (0.85) in men and 0.85 (0.85) in women. The risk charts had six different colors, suggesting the predicted probability of incident long-term care certification.Conclusions The risk prediction model demonstrated good discrimination, calibration, and internal validity. The risk charts proposed in our study are easy to use and may help older adults in recognizing their disability risk. These charts may also support health promotion activities by facilitating the assessment and modification of the daily behaviors of older adults in community settings. Further studies with larger sample size and external validity verification are needed to promote the widespread use of risk charts.

Qualitative Perceptions of an Anticipated Fresh Food Prescription Program.

Food insecurity (FI) is a growing public health problem. Produce prescriptions are known to improve healthy eating and decrease FI; however, few studies have incorporated community voice prior to its implementation. In this study, we aimed to elicit perspectives of individuals at risk for FI and the potential impact of a fresh food prescription (FFRx) program. We conducted this qualitative descriptive study through an academic medical center in collaboration with community partners. We conducted focus groups involving Latinx (N = 16) and African-American (N = 8) adults in community settings. Data were interpreted using an inductive thematic analysis. Three overarching themes emerged: (1) fresh food accessibility was limited by cost, household size, and transportation but enhanced by food pantries, budgeting, and education; (2) cooking behaviors were curbed by time constraints and unfamiliarity but propagated by passion, traditions, and communal practices; and (3) health and wellness deterrents included unhealthy diets driven by cultural and familial norms; however, weight loss and awareness of comorbidities were positive motivators. Participants shared their preference for local produce and cooking classes as components of a FFRx program while raising concerns about low participation due to the stigma of receiving aid. Our findings illuminated interest in engaging in a FFRx program and learning ways to prepare healthy foods. A program distributing fresh produce and healthy lifestyle education could close gaps identified in African-American and Latinx communities at risk for FI.

Advances in knowledge of screening practices and their use in clinical practice to prevent malnutrition

Malnutrition is common among older adults and is associated with a progressive decline in overall health and increased mortality. With a rapidly ageing population, the detection, prevention and management of malnutrition require urgent attention within health service planning and delivery. Routine screening for malnutrition among older adults in community settings, which addresses aetiological as well as phenotypic factors, is considered an important step for prevention and early intervention. The aim of this review is to summarise current malnutrition screening literature and highlight research that seeks to understand and address community-based approaches to malnutrition screening and management. Key healthcare professionals (HCPs) that encounter community-dwelling older adults include general practitioners (GPs), community-based nurses, community pharmacists and a range of other health and social care professionals including dietitians, physiotherapists, speech and language therapists, and occupational therapists. The key barriers to implementing screening in primary care include lack of knowledge about malnutrition among non-dietetic HCPs, lack of resources allocated to managing malnutrition, lack of access to dietetic services, and poor GP knowledge about oral nutritional supplement prescribing. In addition, older adults have poor insight into the clinical condition and the associated negative health implications. Investment in education among HCPs and public awareness is required, as well as accompanying resources to successfully implement malnutrition screening programmes for community-dwelling older adults.

Effects of StrongPeople Strong Bodies on Functional Fitness: A Community-Based Randomized Trial

ABSTRACT Purpose Despite the established benefits of strength training among older adults, access to strength training facilities in rural communities is limited. Local community educator–led classes using affordable equipment that can be easily stored and moved (e.g., handheld weights) offer a feasible approach for improving strength training access among older rural adults; however, very few studies have examined the effects of these types of community-based classes led by nonexercise specialists. The objective of this study was to evaluate the effects of a community-based progressive strength training program led by Cooperative Extension county educators on functional fitness and physical activity among older rural adults. Methods Adults 50 yr and older recruited from rural Montana counties were randomized to a 12-wk, 1-h, twice-weekly, progressive strength training program, or a delayed intervention control group. Data were collected at baseline and postintervention via accelerometry, functional fitness tests, and questionnaires about physical activity, social support, and exercise attitudes. Linear mixed models and general additive models, adjusted for sex and age, were used to assess pre–post changes in outcomes between groups. Results Intervention participants (n = 83) experienced significantly greater improvements in aerobic endurance, upper body strength, lower body strength, exercise-related social support from friends, and attitudes toward exercise (all P &lt; 0.01) compared with control participants (n = 84); improvements were both statistically significant and functionally meaningful. Conclusions The present study provides strong evidence in support of strength training for older adults in community settings, led by nonexercise professionals, to improve cardiorespiratory fitness, strength, social support for physical activity, and attitudes toward exercise. Trial Registration The study was registered at ClinicalTrials.gov (Identifier: [NCT04203563]).

Hip Protectors for Community-Dwelling Older Adults

&#x0D; In community-dwelling older adults who wore hip protectors there was no difference in the risk of hip fractures or pelvic fractures, compared to those who did not wear hip protectors.&#x0D; Three guidelines were identified that include recommendations around the use of hip protectors in older adults. One guideline suggests that hip protectors should be considered in adults at risk for falls and hip fracture. One guideline conditionally recommends hip protectors for frail older adults in the appropriate environment. One guideline suggests that hip protectors should not be considered in older adults in community settings.&#x0D;

Fall prevention education to reduce fall risk among community-dwelling older persons: A systematic review.

ObjectivesThis review aims to identify types of the existing fall prevention education (FPE) and their effectiveness in promoting fall risk awareness, knowledge and preventive fall behaviour change among community‐dwelling older people.BackgroundFPE is a cost‐effective and helpful tool for reducing fall occurrences.EvaluationThis is a systematic review study using electronic searches via EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar in March 2021. The review protocol was registered with PROSPERO (CRD42021232102). The Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) statement flow chart guided the search strategy. Articles published from January 2010 to March 2021 were included for quality appraisal using the ‘Transparent Reporting of Evaluations with Non‐randomised Designs’ (TREND) and the ‘Consolidated Standards of Reporting Trials’ (CONSORT) statement for randomised controlled trial studies.Key issuesSix FPE studies selected emphasised on personal health status, exercise and environmental risk factors. These studies reported an increase in fall risk awareness or knowledge and a positive change in fall preventive behaviours. Two studies included nurses as educators in FPE.ConclusionFPE evidently improved awareness or knowledge and preventive fall behaviour change among older adults. Nurses are in great potential in planning and providing FPE for older adults in community settings.Implications for Nursing ManagementExpand nurses' roles in fall prevention programmes in community settings by using high‐quality and evidence‐based educational tools. Highlight the nurse's role and collaborative management in FPE.

Oro-mucosal midazolam maleate: Use and effectiveness in adults with epilepsy in the UK

BackgroundOro-mucosal midazolam maleate (OMM) with suitable training to family and carers is being increasingly recognized as the treatment of choice to mitigate the development of status epilepticus in non-hospital community settings. There are no studies to describe the use, effectiveness, and suitable dosing of OMM in adults with epilepsy in community settings. PurposeTo describe the use, effectiveness, and dosing of OMM in the emergency treatment of epileptic seizures in community settings. MethodsA retrospective observational study (2016–17) design was used with participant recruitment from four UK NHS secondary care outpatient clinics providing epilepsy management. Study sample was of adult people with epilepsy (PWE) having had a recent seizure requiring OMM. Data on patient demographics, patient care plans, details of a recent seizure requiring emergency medication, and dose of OMM were collected from medical records. ResultsStudy data from 146 PWE were included. The mean age of PWE was 41.0 years (SD 15.2) and mean weight was 64.8Kg (SD 18.2). Fifty-three percent of PWE were recorded as having intellectual disability. The most frequently used concomitant medications were lamotrigine (43%). The majority of seizures occurred at people’s homes (n = 92, 63%). OMM was most often administered by family/professional care-givers (n = 75, 48.4%). Generalized (tonic/clonic) seizures were recorded in most people (n = 106, 72.6%). The most common initial dose of OMM was 10 mg (n = 124, 84.9%). The mean time to seizure cessation after administration of this initial dose was 5.5 minutes (SD = 4.5, Median 5.0, IQR 2.1–5.0). Only a minority of seizures led to ambulance callouts (n = 18, 12.3%) or hospital admissions (n = 13, 9%). ConclusionThis is the first observational study describing the use and effectiveness of OMM in adults in community settings. Minimal hospital admissions were reported in this cohort and the treatment was effective in ending seizures in adults in community settings.

Facilitators and barriers to stakeholder engagement in advance care planning for older adults in community settings: a hybrid systematic review protocol.

Background: Poor stakeholder engagement in advance care planning (ACP) poses national and international challenges, preventing maximisation of its potential benefits. Conceptualisation of advance care planning as a health behaviour highlights the need to design innovative, evidence-based strategies that will facilitate meaningful end-of-life care decision-making. Aim: To review systematically and synthesise quantitative and qualitative evidence on barriers and facilitators to stakeholders` engagement in ACP for older adults (≥ 50 years old) in a community setting. Methods: A hybrid systematic review will be conducted, identifying studies for consideration in two phases. First, databases will be searched from inception to identify relevant prior systematic reviews, and assess all studies included in those reviews against eligibility criteria (Phase 1). Second, databases will be searched systematically for individual studies falling outside the timeframe of those reviews (Phase 2). A modified SPIDER framework informed eligibility criteria. A study will be considered if it (a) included relevant adult stakeholders; (b) explored engagement in ACP among older adults (≥50 years old); (c) employed any type of design; (d) identified enablers and/or barriers to events specified in the Organising Framework of ACP Outcomes; (e) used either quantitative, qualitative, or mixed methods methodology; and (f) evaluated phenomena of interest in a community setting (e.g., primary care or community healthcare centres). Screening, selection, bias assessment, and data extraction will be completed independently by two reviewers. Integrated methodologies will be employed and quantitative and qualitative data will be combined into a single mixed method synthesis. The Behaviour Change Wheel will be used as an overarching analytical framework and to facilitate interpretation of findings. The Joanna Briggs Institute (JBI) Reviewers` Manual and PRISMA-P guidelines have been used to inform this protocol development. Registration: This protocol has been submitted for registration on PROSPERO, registration number CRD42020189568 and is awaiting review.

Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada

ObjectiveThis study tested the efficacy of AFFIRM, a brief affirmative cognitive-behavioural group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY).MethodSGMY (n = 138; M age = 22.44) were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organisations or an 8-week waitlisted control. At baseline, post-intervention or post-waitlist, participants completed self-reported assessments of depression, hope, coping, and stress appraisal. Implementation outcomes of feasibility and acceptability were also assessed.ResultsCompared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms (b = − 5.79, p = .001) as well as increased reports of hope (agency: b = 0.84, p = .001; pathway: b = 0.79, p = .001), and coping by emotional support (b = 0.59, p < .001), instrumental support (b = 0.67, p < .001), positive framing (b = 0.59, p < .001), humour (b = 0.36, p = .014), planning (b = 0.49, p < .001) as well as reflective coping (b = 0.27, p = .009). Intervention participants were also less likely to perceive stress as a threat (b = − 0.43, p = .001), and more likely to perceive stress as challenge (b = 0.67, p < .001) and have the resources to deal with that stress (b = 0.38, p = .016) in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition (8.5%) and high levels of engagement and acceptability (e.g. 99% agreed intervention was relevant to their lives). Over 63% of the community organizations that participated in the training hosted AFFIRM at least once during the study.ConclusionsResults demonstrate efficacy for the community-based implementation of an affirmative clinical intervention designed for SGMY to address depression and foster coping with universal and minority stressors.

Facilitators and barriers to stakeholder engagement in advance care planning for older adults in community settings: a hybrid systematic review protocol

Background: Poor stakeholder engagement in advance care planning (ACP) poses national and international challenges, preventing maximisation of its potential benefits. Conceptualisation of advance care planning as a health behaviour highlights the need to design innovative, evidence-based strategies that will facilitate meaningful end-of-life care decision-making. Aim: To review systematically and synthesise quantitative and qualitative evidence on barriers and facilitators to stakeholders` engagement in ACP for older adults (≥ 50 years old) in a community setting. Methods: A hybrid systematic review will be conducted, identifying studies for consideration in two phases. First, databases will be searched from inception to identify relevant prior systematic reviews, and assess all studies included in those reviews against eligibility criteria (Phase 1). Second, databases will be searched systematically for individual studies falling outside the timeframe of those reviews (Phase 2). A modified SPIDER framework informed eligibility criteria. A study will be considered if it (a) included relevant adult stakeholders; (b) explored engagement in ACP among older adults (≥50 years old); (c) employed any type of design; (d) identified enablers and/or barriers to events specified in the Organising Framework of ACP Outcomes; (e) used either quantitative, qualitative, or mixed methods methodology; and (f) evaluated phenomena of interest in a community setting (e.g., primary care or community healthcare centres). Screening, selection, bias assessment, and data extraction will be completed independently by two reviewers. Integrated methodologies will be employed and quantitative and qualitative data will be combined into a single mixed method synthesis. The Behaviour Change Wheel will be used as an overarching analytical framework and to facilitate interpretation of findings. The Joanna Briggs Institute (JBI) Reviewers` Manual and PRISMA-P guidelines have been used to inform this protocol development. Registration: This protocol has been submitted for registration on PROSPERO, registration number CRD42020189568 and is awaiting review.

A Statewide Approach to Falls Prevention: Widespread Implementation of A Matter of Balance in North Carolina, 2014-2019.

This study showcases the statewide strategies used to implement and sustain an evidence-based fall prevention program, A Matter of Balance (MOB) in North Carolina between 2014 and 2019. Statewide program implementation and data collection support strategies are detailed. The mostly White (not Hispanic/Latino), female participants were 75 years old on average. Pre- and post-self-reported assessments included demographic, health status, quality of life, and falls-related metrics. Survey responses were scaled and analyzed. Statistically significant improvements (p < .05) across health status measurements, times fallen, and falls resulting in injury were observed. These results offer a model for effective statewide implementation of the MOB program to reduce falls among older adults in community settings with support from a statewide resource center.

A Simulation-Based Empathy Enhancement Program for Non-Medical Care Providers of Older Adults: A Mixed-Methods Study.

ObjectiveStudies using simulation-based programs for empathy enhancement have been conducted mostly for health profession students and medical care providers in Western countries. No empirical research has been conducted for non-medical care providers of older adults in community settings in Asian countries. The purposes of this mixed-methods study were: to explore experiences and perceived usability of non-medical care providers of older adults in a simulation-based empathy enhancement program; and to examine if the program is effective in improving empathy and relevant outcomes. Methods104 non-medical care providers of older adults in South Korea participated in a simulation-based empathy enhancement program in 2018. Data were collected using self-reported questionnaires for effectiveness testing, a program evaluation questionnaire, and individual interviews and analyzed using statistical tests and thematic analysis. ResultsCare providers showed higher levels of empathy and lower levels of stress and burnout after the program participation (p<0.05). Qualitative findings supported the improved attitude and care strategies, increased empathy towards older adults, preparing for their own aging, and restoration of emotional stability through the participation in the program. ConclusionThis study suggests that the simulation-based program is useful in promoting empathic responses of non-medical care providers working with older adults.

ESPO/ Academy for Gerontology in Higher Education Section Symposium: Bridging the Gap: Shifting Population Dynamics and Opportunities to Inform and Educate Communities

This symposium is intended to highlight population-shifts and their impact on the individual, family, institution, and community levels. Currently, increases in diversity among individuals under age 18 continue to outpace those of individuals age 65-and-older, creating a substantial racial/ethnic diversity gap between generations. As it relates to education-level, individuals age 65-and-older who have earned at least a bachelor’s degree has increased from 5 percent in 1965 to 29 percent in 2018 (Population Reference Bureau, 2020). Population-shifts could be mitigated or better supported through enhancements to gerontology/geriatric education and training. This symposium will highlight the biopsychosocial aspects of these shifts and will link each aspect to the development of gerontology and geriatric curriculum. To start, presenter one will describe projects focused on community-based intergenerational programs to reduce social isolation and loneliness among rural older adults (Jill). Next, presenter two will describe findings from a university-based study, using surveys of aging and ageist attitudes to foster intergenerational connections between undergraduate students and older adult community members (Giselle). Presenter three will discuss a program to support the development of aging ministries to educate and support both caregivers and older adults in community settings (Lauren). Finally, presenter four will discuss findings from one-on-one interviews conducted with Chinese caregivers and Chinese geriatric social workers in efforts to develop and evaluate an end-of-life manual designed for Chinese immigrant caregivers (Mandong). The discussant will link the presenters’ findings to implications for future gerontology and geriatric education and training while identifying key topics to inform and engage communities.

Evaluation of a nutrition-risk screening tool in Lao PDR: Identifying malnutrition in a low-resource clinical setting.

Malnutrition is a top priority in Lao PDR. In 2017, 33% of children under five years of age were stunted, 21.1% were underweight, 9% were wasted while 16.6% of adults in community settings were malnourished. Rates of malnutrition are presumed to be higher among hospitalized patients however, malnutrition risk screening in inpatient settings does not occur in Lao PDR. To address this gap, this study aimed to determine the prevalence of malnutrition among hospitalized patients and investigated the inter-user reliability and validity of a nutrition-risk screening tool (NRST). A cross-sectional study of pediatric (n=69) and adult (n=125) patients was conducted at two hospitals in Vientiane, Lao PDR. Inter-observer reliability of the NRST was determined by comparing final scores of two independent observers. Validity of the NRST was determined using sensitivity, specificity, and area-under-the-receiver-operating-characteristics (ROC) curve analyses. Among participants 0-4 years of age, 51% were diagnosed with malnutrition, while 58% of participants aged 5-17 years were malnourished. Among participants 18 years of age or older, 47% were diagnosed with moderate to severe malnutrition. The NRST showed 'fair' agreement between Observer 1 and Observer 2 NRST final scores (0.2737, p-value <0.001). Observer 1 and Observer 2 had a 64% and 70% probability of correctly distinguishing a malnourished from a not malnourished participant. The Lao NRST had a sensitivity of 85% and a specificity 35%. There is a high prevalence of malnutrition among hospitalized patients in Lao PDR. This study provides proof of concept that a nutrition-risk screening tool can be successfully administered in a low-resource setting. Timely identification of malnutrition among newly admitted hospitalized patients will help minimize adverse patient health outcomes and reduce the economic burden of healthcare in Lao PDR.

Facilitators and barriers to stakeholder engagement in advance care planning for older adults in community settings: a hybrid systematic review protocol

Background:Poor stakeholder engagement in advance care planning (ACP) poses national and international challenges, preventing maximisation of its potential benefits. Conceptualisation of advance care planning as a health behaviour highlights the need to design innovative, evidence-based strategies that will facilitate meaningful end-of-life care decision-making.Aim:To review systematically and synthesise quantitative and qualitative evidence on barriers and facilitators to stakeholders` engagement in ACP for older adults (≥ 50 years old) in a community setting.Methods:A hybrid systematic review will be conducted, identifying studies for consideration in two phases. First, databases will be searched from inception to identify relevant prior systematic reviews, and assess all studies included in those reviews against eligibility criteria (Phase 1). Second, databases will be searched systematically for individual studies falling outside the timeframe of those reviews (Phase 2). A modified SPIDER framework informed eligibility criteria. A study will be considered if it (a) included relevant adult stakeholders; (b) explored engagement in ACP among older adults (≥50 years old); (c) employed any type of design; (d) identified enablers and/or barriers to events specified in the Organising Framework of ACP Outcomes; (e) used either quantitative, qualitative, or mixed methods methodology; and (f) evaluated phenomena of interest in a community setting (e.g., primary care or community healthcare centres). Screening, selection, bias assessment, and data extraction will be completed independently by two reviewers. Integrated methodologies will be employed and quantitative and qualitative data will be combined into a single mixed method synthesis. The Behaviour Change Wheel will be used as an overarching analytical framework and to facilitate interpretation of findings. The Joanna Briggs Institute (JBI) Reviewers` Manual and PRISMA-P guidelines have been used to inform this protocol development.Registration:This protocol has been submitted for registration on PROSPERO and is awaiting review.