Želimir Bertić

Background: Population aging represents a major public health challenge, accompanied by an increasing prevalence of chronic diseases and age-related functional decline. Declines in lower-extremity physical function are particularly important, as they are strongly associated with mobility limitations, loss of independence, increased risk of falls, hospitalization, and mortality in older adults. Reliable and valid tools to assess physical performance are therefore essential in both clinical and research settings. The Short Physical Performance Battery (SPPB) is a widely used instrument for assessing lower-extremity physical performance in older adults and is recommended within the diagnostic algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP2) for evaluating physical performance severity. However, the SPPB has not yet been psychometrically validated in the Croatian older population. This study aimed to evaluate the reliability and validity of the SPPB in Croatian older adults. Methods: This study examined the metric properties of the SPPB in a sample of 153 older adults recruited from nursing homes and community settings. Results: The SPPB demonstrated acceptable internal consistency (Cronbach’s alpha = 0.74) and good test–retest reliability (ICC = 0.893) for the total score. Convergent and construct validity were supported by significant associations with established measures of functional mobility and muscle strength. Conclusions: The Croatian version of the SPPB is a reliable and valid instrument for assessing lower-extremity physical performance in older adults. Its use is supported in clinical practice and research settings in Croatia. Further studies should examine responsiveness and predictive validity in nationally representative samples.

Background/Objectives: Sarcopenia is a growing public health challenge in older adults, being associated with functional decline, frailty, and increased mortality. The SARC-F questionnaire is a widely recommended screening tool for sarcopenia; however, no validated Croatian version has been available so far. This study aimed to translate, culturally adapt, and validate the Croatian version of the SARC-F questionnaire for older adults. Methods: In a cross-sectional design, 153 participants aged ≥ 65 years from Zagreb and Bjelovar were enrolled between March and September 2025. Psychometric evaluation included internal consistency (Cronbach’s α), test–retest reliability (intraclass correlation coefficient, ICC), item–total correlations, and split-half reliability. Convergent validity was assessed via correlations with handgrip strength (HGS), Short Physical Performance Battery (SPPB), and timed up-and-go (TUG) tests. Known groups and construct validity were also examined. Results: The Croatian SARC-F showed good internal consistency (Cronbach’s α = 0.76; 95% CI: 0.70–0.82), with item–total correlations ranging from 0.34 (falls) to 0.80 (stairs) and excellent test–retest reliability (ICC = 0.86). Strong correlations were found with SPPB (ρ = −0.50; p < 0.001), TUG (ρ = 0.50; p < 0.001), and handgrip strength (ρ = −0.42; p < 0.001), supporting convergent validity. An exploratory factor analysis indicated a unidimensional structure explaining 43% of the variance. Conclusions: The Croatian version of SARC-F is a reliable, valid, and clinically feasible tool for identifying older adults who are at risk of sarcopenia. The results support its use in national screening and cross-cultural research across Europe.

Background/Objectives: Formal and lifelong education on pressure injuries enables the acquisition and maintenance of relevant knowledge and represents a key link in ensuring quality and safe care. Critical planning and continuous implementation of education programs directly contributes to better management of these injuries and ensures consistent application of best practices in everyday nursing care. Methods: This study is based on a cross-sectional, quantitative methodology conducted in a state hospital in Croatia, on a sample of 268 participants. Results: Work experience did not show a significant correlation with test scores while the level of education, a master’s degree in nursing, had the highest mean percentages in prevention and overall score. Differences in test performance across department type showed a significant difference for the prevention subscale for neurological department staff. Activities such as reading the professional literature and attending lectures showed a positive correlation with higher scores in different areas of prevention, staging and the overall test. Internet use was positively associated with all subscales and the overall score. Conclusions: Despite the unsatisfactory level of knowledge of the respondents, the positive impact of formal and lifelong education on the existing level of information about pressure ulcers is evident. These findings highlight the need for improvement and better organization of educational programs, with an emphasis on their accessibility, continuity and focus on clearly defined learning outcomes.

Background/Objectives: Pressure injuries (PIs) are an increasing public health concern, particularly affecting hospitalised patients with limited mobility and chronic illnesses, such as those undergoing cardiac surgery. The EuroSCORE II index, a validated model for predicting operative risk in cardiac surgery, can serve as an accurate PI risk assessment tool for cardiac surgery patients. Methods: A cross-sectional study was conducted on patients undergoing cardiac surgery over a six-month period. The sample consisted of patients selected according to the calculated EuroSCORE II index and admitted for elective surgical procedures. The Braden Scale was used for the standard preoperative and postoperative PI risk assessment. Categorical variables are shown as frequencies with corresponding percentages. Continuous variables are presented as median and interquartile range. Group differences in continuous variables according to EuroSCORE II were analysed using the Mann–Whitney U test, with the Hodges–Lehmann estimator of the median difference and the corresponding 95% confidence interval. Results: The assessment showed that patients with a medium and high EuroSCORE II index (>4.0) were significantly older (M = 73; IQR: 68–77), with a higher preoperative Braden score (M = 20; IQR: 17–21), longer intraoperative total time (M = 6; IQR: 5–7) and overall longer duration of hospitalisation (M = 14; IQR: 10–21). A statistically significant difference (p = 0.043) was observed in the occurrence of PI after the procedure. Within the group of patients with a medium/high EuroSCORE II index, the recorded frequency of PI after the procedure was 30.8%, compared to the group of patients with a low EuroSCORE II index, among whom the observed frequency was 17.6%. Conclusions: The findings of this study show that a higher EuroSCORE II index is significantly associated with an increased risk and incidence of PI in patients undergoing cardiac surgery, highlighting its potential use as a predictive tool for postoperative PI risk stratification.

Introduction: Chronic musculoskeletal pain is common among older adults (OAs). This study aimed to identify and describe the characteristics of chronic musculoskeletal pain, pain management, and coping strategies among OAs from Turkey, Croatia, and Romania. The study also aimed to explore cultural differences in pain experience and management. Methods: A total of 337 OAs with chronic pain participated: 100 from Turkey, 131 from Croatia and 106 from Romania. The mean age was 76.3 years in Croatia, 73.1 years in Romania, and 74.0 years in Turkey. The majority of participants in Croatia and Romania were female, while the majority of participants in Turkey were male. A structured questionnaire was used to explore four main topics, including factors influencing pain, coping strategies, management strategies, and health-related quality of life. Results: Significant differences in pain-related factors, pain management, and coping strategies were found between the three countries (p≤ 0.05). Physical activity, relaxation exercises, and warm showers/hot packs were associated with pain reduction. Climbing stairs was a significant pain increasing factor in both Romania and Turkey, with participants in these countries more than 2.5 times more likely to report it as a pain increasing factor compared to Croatia. Sitting had the opposite effect in Romania and Turkey. Significant predictors included higher visual analog scale-VAS scores, which were associated with worse self-rated health. Country of origin also influenced health perceptions, with Romanians less likely to report better health than Croatians. Discussion: The findings highlight the cultural implications of pain perception and management. They reveal that older adults’ coping strategies and health-related quality of life are shaped not only by physical factors but also by beliefs and health perceptions unique to each country and influenced by culture. Education, including physical activity, medication use, and non-pharmacological methods like physiotherapy and interventions that consider cultural context can enhance pain control and health among older adults.

Background: Understanding and preventing pressure ulcers is a key aspect of healthcare, with nurses playing a crucial role in their management and prevention through education and clinical practice to improve patient outcomes. Objectives: This quantitative, psychometric, cross-sectional study aimed to translate and culturally adapt the Pieper–Zulkowski Pressure Ulcer Knowledge Test and to evaluate the psychometric properties of the Croatian version of this measurement instrument. Methods: A study was conducted in a state hospital in Šibenik, Croatia, on a sample of 268 participants. Results: The content validity of the instrument, with an S-CVI of 0.981, indicates excellent validity, while its internal consistency is acceptable, as reflected in an overall KR-20 of 0.79. The maximum split-half reliability is 0.87 and Guttman Lambda 6 reaches 0.89, indicating excellent internal consistency. The overall test–retest reliability is excellent (ICC = 0.91), with the Prevention subscale showing the highest reliability (ICC = 0.88), followed by Staging (ICC = 0.86) and Wound Description (ICC = 0.84). Item-level difficulty and discrimination index were also calculated. Conclusions: The adapted, translated, and validated questionnaire represents a valuable tool for measuring knowledge about pressure ulcers among healthcare professionals, suitable for use in Croatian society. This instrument can be used to assess knowledge in clinical settings and evaluate the effectiveness of educational programs, providing valuable insights into the education and professional competence development of healthcare professionals.

Background: Understanding and preventing pressure ulcers are key aspects of healthcare, with nurses playing a crucial role in their management and prevention through education and clinical practice to improve patient outcomes. Objectives: This quantitative, psychometric, cross-sectional study aims to translate and culturally adapt the Pieper-Zulkowski Pressure Ulcer Knowledge Test and to evaluate the psy-chometric properties of the Croatian version of this measurement instrument. Meth-ods: A study was conducted in a state hospital in Šibenik, Croatia on a sample of 268 participants. Results: The content validity of the instrument, with an S-CVI of 0.981, indicates excellent validity, while its internal consistency is acceptable, as reflected in an overall KR-20 of 0.79. The maximum split-half reliability is 0.87, and Guttman Lambda 6 reaches 0.89, indicating excellent internal consistency. The overall test-retest reliability is excellent (ICC = 0.91), with the Prevention subscale showing the highest reliability (ICC = 0.88), followed by Staging (ICC = 0.86) and Wound Description (ICC = 0.84). Item-level difficulty and discrimination index were calculated. Conclusions: The adapted, translated, and validated questionnaire represents a valuable tool for measuring knowledge about pressure ulcers, suitable for use in Croatian society. The instrument can be used to assess knowledge in clinical settings and evaluate the effec-tiveness of educational programs, providing valuable insights into the education and professional competence development of healthcare professionals.

Zbog sve većeg broja starijeg stanovništva povećava se i broj osoba koje žive u statusu umirovljenika. Kako bi osobe postigle što bolju kvalitetu života i očuvale svoj potencijal te i u starijoj dobi nastavile davati doprinos društvu, potrebno je kontinuirano provoditi istraživanja o prilagodbi na umirovljenje. Fokus ovoga istraživanja usmjeren je na dobivanje jasnijeg uvida u prilagodbu starijih osoba na umirovljenje s obzirom na samoprocjenu zdravlja i percepciju socijalne podrške te na mogućnost prepoznavanja faktora kojima bi se moglo djelovati u poboljšanju loše prilagodbe na umirovljenje. Istraživanje je provedeno u jesen 2019. godine, a uključivalo je 208 osoba oba spola starijih od 65 godina, bez tjelesne invalidnosti ili teških tjelesnih, kognitivnih ili mentalnih bolesti, koje žive u Domu umirovljenika u Bjelovaru i koji su korisnici gerontoloških centara u Zagrebu. Razlike u prilagodbi na umirovljenje s obzirom na samoprocjenu vlastitog zdravlja i percepciju socijalne podrške razmatrane su prema Atchleyevom (2000) modelu prilagodbe na umirovljenje. Dobiveni rezultati potvrđuju konceptualne pretpostavke ranijih istraživanja te ukazuju na pozitivniju orijentiranost prema životu u mirovini ispitanika s boljim rezultatima u samoprocjeni vlastitog zdravlja i percepciji socijalne podrške. Razlozi tomu mogli bi biti bolje zdravlje koje pojedincu pruža mogućnost da ostane više društveno aktivan i bude usmjeren na svoju ulogu umirovljenika, a stalna socijalna podrška pomaže u postizanju pozitivnih iskustava tijekom prilagodbe na umirovljenje. Rezultate predstavljene u ovom radu treba promotriti i u kontekstu otvaranja prostora za daljnja istraživanja, ali i za nove rasprave u području zdravstvenih i socijalnih pitanja budućih i trenutnih umirovljenika.

Due to the spread of coronavirus people throughout the world, many countries, Croatia included, have been forced to impose social distancing resulting in an increased number of people at risk of another public health problem – loneliness. Loneliness can be defined as the presence of negative emotions associated with the perceived social exclusion and is identified as one of the major issues of the aging population. There is a relatively small number of studies either dealing with the use of various communication methods, particularly information and communication technologies, by the elderly during the COVID-19 pandemic or determining potential benefits of such activities. The aim of this research was to determine the difference in self-assessment of social and family loneliness according to the means of communication used by the elderly during the COVID-19 pandemic. The research was conducted in March and April 2020 covering the period from the introduction of the epidemiological measures of social distancing and self-isolation until the relaxation of virus-related restrictions in Croatia. The research included 107 subjects over the age of 65 living in their own homes in the Croatian city of Bjelovar. A Frequency of the Used Communication Methods Questionnaire was constructed for the purpose of this research. The Social and Emotional Loneliness Scale for Adults was used to determine the level of loneliness. The obtained results indicate that lower levels of social and family loneliness were shown by subjects who stated in their self-assessment a higher intensity level of communication during the COVID-19 pandemic, such as making telephone/mobile phone calls, using information technology (computers for video calls, social networks, etc.) and mobile chat applications (Viber, Skype, WhatsApp, etc.), as well as having face-to-face communication. Subjects who rarely or never communicated by using any means of the abovementioned communication showed higher levels of social and family loneliness. Results of this research suggest that using various communication methods, particularly modern communication technologies, have a positive effect on reducing the level of loneliness in the elderly. Teamwork of gerontologists, communication technologists and other experts who work with older population could introduce them to communication technology thus making them more satisfied and improving their quality of life.