Chenjuan Ma

Abstract

The effect of the COVID-19 related stressors on the mental health of both infected patients and the general public has been well established. However, knowledge is limited on how psychosocial support buffers the association. This study aimed to examine this buffering role in the context of China. We utilized cross-sectional data collected online in mid-March 2020, involving 585 respondents. Mental health status was determined through depression symptoms and loneliness. COVID-19 related stressors include three aspects: perceived severity, perceived threat to life and health, and perceived risk of COVID-19 infection. Psychosocial support included family and social supports. Analyses include ordinary linear regression. The finding showed that psychosocial support buffered the negative effect of loneliness in the context of perceived severity of COVID-19, but appeared to intensify the negative effect of depression symptoms in the context of perceived threat to life and health. However, there was no significant buffering effect on depression or loneliness in the context of the perceived risk of infection. The buffering effect of psychosocial support on COVID-19 related stressors is of mixed patterns. This study contributes to the emerging body of literature trying to understand how the COVID-19 impacts the mental health of individuals.

Abstract

BACKGROUND: New graduate nurses experience difficulty in adapting to a new environment, which affects intent to leave. However, data on the factors contributing to difficulty in adapting and intent to leave among new graduate nurses are insufficient.PURPOSE: The aim of the study was to explore and compare factors associated with difficulty in adapting and the intent to leave among new graduate nurses in South Korea.METHODOLOGY: This cross-sectional study used secondary data analysis. Primary data were obtained from the 2015-2016 Korean National Graduates Occupational Mobility Survey. Descriptive statistics, independent t tests, and chi-square statistics with weighted samples besides multivariate logistic regression analyses were conducted (N = 467).RESULTS: Roughly 46% of nurses reported difficulty adapting, and 16% expressed their intent to leave. The factors linked to difficulty in adapting were working at large hospitals with rotating shifts, low person-job fit, and low satisfaction with personal competency; intent to leave was associated with high monthly salary and low satisfaction with the workplace (all ps < .05). Difficulty in adapting did not equate to their intent to leave.CONCLUSIONS: There were high rates of difficulty in adapting and intent to leave among new graduate nurses. Although different factors were associated with difficulty adapting and intent to leave, workplace condition is a common factor.PRACTICE IMPLICATIONS: Different strategies are needed to improve adaptation and intention of leaving among new graduate nurses. For better adaptation, developing training programs enhancing professional competency with a sufficient training period is required. In addition, providing staff and resources to reduce the intent to leave is crucial.

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, home health aides (HHAs) provided daily medical and personal care to community-dwelling older adults and those with chronic conditions. Prior qualitative studies have found that providing care during COVID-19 left HHAs susceptible to physical, financial, and emotional risks. However, limited quantitative data exist The objective of this study was to assess the impact of COVID-19 on HHAs and to understand the challenges and opportunities for current and future pandemic planning. A cross-sectional survey of 256 HHAs in the downstate New York region was conducted by telephone in English, French Creole, Chine, Spanish, and Russian between August and November 2020. The survey found that HHAs experienced a variety of physical, financial, and emotional challenges during COVID-19. To better support this work force, action by public health officials and policymakers is warranted, particularly with respect to workplace protections and safety, mental health, compensation, and access to basic resources.

Abstract

Purpose: Home health care is one of the fastest growing health care sectors in the United States. However, little is known of differences in trends in quality performance between rural and urban home health agencies over time. This study aimed to examine disparities in quality performance between rural and urban home health agencies between 2014 and 2018. Methods: This is a cohort study using 2014-2018 national Home Health Compare data and Providers of Service Profile data, including 7,908 home health agencies, of which 1,537 were rural agencies. Quality performance measures included timely initiation of care, hospitalization, and emergency department (ED) visits. Two-level hierarchical regression models were used to identify rural-urban differences in these quality indicators over time when controlling organizational characteristics. Findings: Rural agencies were less likely to be for-profit and accredited, and more likely to be hospital-based, serve both Medicare and Medicaid beneficiaries, and have hospice programs. Rural agencies consistently outperformed on timely initiation of care over time, and urban agencies consistently outperformed on hospitalization and ED visits over time. These gaps between rural and urban agencies were steady over time except the gap in hospitalization, which slightly narrowed over time (Coef. = 0.11, P =.001 for urban and year interaction term). Conclusions: Significant differences exist in quality of care between rural and urban home health agencies and such differences have not been significantly narrowed over time. To reduce rural-urban disparities, policy makers should take into account unique challenges faced by urban and rural agencies when making policy decisions.

Abstract

Emerging studies have suggested an association between grip strength and health-related quality of life (QOL). However, evidence for which specific domains of QOL are associated with grip strength remains limited and inconsistent. Particularly, such evidence is scarce in the oldest old, who constitute one of the most vulnerable populations. This cross-sectional study aimed to examine the association between grip strength and overall QOL as well as specific domains in the oldest old. It included 400 community-dwelling older adults aged 80 years or older from Shanghai, China. QOL was assessed using the WHO Quality of Life of Older Adults instrument, and grip strength was measured using a digital spring-type dynamometer. On average, the overall QOL score was 54.68 (SD = 12.05). Estimates of risk-adjusted linear regressions indicated that higher grip strength was associated with better overall QOL (β = 4.40, p < 0.001) as well as the domains of autonomy (β = 6.74, p <0.001); fulfillment with past, present, and future activities and achievements (β = 3.52, p = 0.004); and satisfaction with social participation (β = 6.72, p < 0.001). Our findings highlight the importance of maintaining or improving grip strength in delaying or reducing the decline in QOL among the community-dwelling oldest old. Also noteworthy is that the associations between grip strength and specific domains of QOL in the oldest old vary.

Abstract

Background: Home health care (HHC) is a leading form of home and community-based services for persons with dementia (PWD). Nurses are the primary providers of HHC; however, little is known of nursing care delivery and quality. Objective: The objective of this study was to examine the association between continuity of nursing care in HHC and rehospitalization among PWD. Research Design: This is a retrospective cohort study using multiple years (2010-2015) of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency. Subjects: This study included 23,886 PWD receiving HHC following a hospitalization. Measures: Continuity of nursing care was calculated using the Bice and Boxerman method, which considered the number of total visits, nurses, and visits from each nurse during an HHC episode. The outcome was all-cause rehospitalization during HHC. Risk-Adjusted logistic regression was used for analysis. Results: Approximately 24% of PWD were rehospitalized. The mean continuity of nursing care score was 0.56 (SD=0.33). Eight percent of PWD received each nursing visit from a different nurse (no continuity), and 26% received all visits from one nurse during an HHC episode (full continuity). Compared with those receiving high continuity of nursing care (third tertile), PWD receiving low (first tertile) or moderate (second tertile) continuity of nursing care had an adjusted odds ratio of 1.33 (95% confidence interval: 1.25-1.46) and 1.30 (95% confidence interval: 1.22-1.43), respectively, for being rehospitalized. Conclusions: Wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.

Abstract

Background: Little is known about the longitudinal association between social participation and incident frailty in community-dwelling older adults in general and particularly in China. This study examined the impact of type, frequency and diversity of social participation on incident physical frailty at two-year follow-up. Method: Longitudinal data from three waves of the China Health and Retirement Longitudinal Study were used. Older adults who were non-frail and aged 60 years or more at baseline and had information on physical frailty at follow-up were included. Frailty was measured using the modified frailty phenotype criteria. Social participation was measured as the type, frequency and diversity of engagement in social activities, including interacting with friends, playing group games, participating in sports clubs, community-related organizations, and voluntary activities. Results: A total of 6959 eligible respondents were included. Playing group games (OR=0.73, 95%CI=0.55–0.96) or participating in the activities of sports clubs (OR=0.54, 95%CI=0.34–0.85) once or more times per week led to a decreased risk of developing frailty in two years whereas participating in voluntary activities occasionally (OR=0.50, 95%CI=0.30–0.84) had a protective effect on the development of frailty. More diverse social participation was significantly associated with lower risk of incident frailty at two-year follow-up. Conclusions: The association between social participation and onset of physical frailty differed by the specific type and frequency of the activities that older adults engaged in. Promoting social participation of various types and at an appropriate frequency may be a promising way to mitigate the burden associated with physical frailty among older adults.

Abstract

Introduction: This study aimed to evaluate the quality of home care in China using the Home Care Quality Assessment Tool (HCQuAT). Method: We recruited 38 home health agencies in Shanghai, China, which included 18 in urban areas, 11 in suburban areas, and nine in rural areas. Data on quality of home care from each agency were collected by trained staff using the HCQuAT. Results: On average, these home health agencies scored 74.28/100.00 (SD = 6.80) on the HCQuAT, with an excellence rate of 39.5% and a failing rate of 23.7%. The mean scores on the structure quality module, process quality module, and outcome quality module were 71.2 ± 21.8, 86.6 ± 9.2, and 44.1 ± 37.5, respectively. Significant differences existed across geographic locations (p =.018). Discussion: Significant variations were identified in the quality of home care across quality modules and geographic locations. Outcome quality and quality in rural areas were lower than those for their counterparts.