Lu Shao

Background: The fragmentation of the US healthcare system imposes a high cognitive burden on older adults. Coordinated Care (CC) is hypothesized to improve patient outcomes, but the relationship between multidimensional CC experiences and cognitive aging remains unclear. We investigated whether experiences across three domains of CC (perceived CC, tangible support, and technical support) are associated with cognitive trajectories and incident cognitive impairment. Methods: Data were drawn from the Health and Retirement Study (2016–2022), including the 2016 CC module ( N = 1321; aged ≥ 50). Baseline CC was assessed via three patient‐reported scales: perceived CC (provider communication consistency, 0–20 scale), tangible support (family/professional assistance with medical tasks, 0–11 scale), and technical support (patient portal offered and used, 0–4 scale). Cognitive function was measured biennially (2016–2022) using the 27‐point Telephone Interview for Cognitive Status ( TICS ). Incident cognitive impairment was defined as the first follow‐up score of ≤ 11 among those cognitively normal at baseline. Linear mixed‐effects models estimated 6‐year cognitive trajectories, and Cox proportional hazards models assessed risk of incident impairment. Results: In fully adjusted models, higher perceived CC ( β = 0.25, p < 0.05) and technical support ( β = 0.22, p < 0.05) were associated with higher baseline cognitive scores. Greater tangible support was associated with lower baseline cognition ( β = −0.48, p < 0.001) but also with slower cognitive decline over time (interaction β = 0.005, p < 0.05). Tangible support was associated with higher risk of impairment in unadjusted analyses ( HR = 1.26), but this association was not statistically significant after adjustment. Conclusions and Implications: Perceived CC and technology use characterized cognitively robust older adults, whereas tangible support identified vulnerable individuals yet was associated with slower cognitive decline. These findings underscore the need for nuanced CC strategies: digital tools engage those aging well, while intensive tangible support may be especially important for those with greater vulnerabilities. These associations are observational and do not establish causality.

Background: Sepsis is a critical global health issue, particularly affecting older adults. Despite advances in acute sepsis management, the long‐term outcomes for survivors, particularly those transitioning to skilled nursing facilities (SNFs), remain poorly characterized. Aim: To evaluate the prognostic value of the age‐adjusted Charlson Comorbidity Index (ACCI) in predicting 6‐month mortality among older adult sepsis survivors discharged to SNFs. Study Design: An observational cohort study of older adult sepsis patients in the intensive care unit (ICU) of a tertiary academic medical centre in Boston from 2008 to 2019 was performed. Patients were stratified into low (≤ 5), intermediate (6, 7) and high (≥ 8) ACCI score groups. Using the Cox proportional hazards model, we determined the association between ACCI scores and 6‐month mortality, calculating hazard ratios (HR) and 95% confidence intervals (CIs). The predictive performance was assessed using ROC curve analysis and compared with Sequential Organ Failure Assessment (SOFA) scores. Results: The study included 3713 sepsis survivors aged 65 and older discharged to SNFs. The median age was around 80 years, and 52.6% of the participants were female. The analysis revealed that each one‐point increase in the ACCI was associated with an 18% higher risk of mortality within 6 months (HR 1.18; 95% CI 1.14–1.22; p < 0.001). Furthermore, compared with individuals with low ACCI scores, those in the moderate ACCI score group had a HR of 1.55 (95% CI: 1.26–1.91, p < 0.001), and those in the high ACCI score group had a HR of 2.43 (95% CI: 1.96–3.03, p < 0.001). ACCI demonstrated superior predictive performance compared with SOFA scores (area under the curve [AUC] 0.65 vs. 0.53, p < 0.001). Conclusions: ACCI serves as an independent predictor of 6‐month mortality in older adult sepsis survivors discharged to SNFs. Relevance to Clinical Practice: Critical care nurses can use ACCI as a risk stratification tool to identify high‐risk older sepsis survivors, inform discharge planning and improve interprofessional communication for tailored post‐acute care interventions in SNFs.

Aim: The purpose of this study was to translate the Stoma‐quality of life into Chinese and evaluate its psychometric properties in Chinese patients.Background: Quality of life is an important issue for patients with colostomy, and its appropriate and precise measurement is beneficial to promoting better care. The Stoma‐quality of life questionnaire has been widely used; however, the validity and reliability of its Chinese version has not been determined.Design: A cross‐sectional validation study was conducted.Methods: We translated the Stoma‐quality of life into Chinese using standardized methods. Then it was psychometrically tested on a convenience sample of 513 patients with colostomy. Construct validity was evaluated via exploratory factor analysis and confirmatory factor analysis. Reliability was measured with Cronbach's alpha and the split‐half Spearman–Brown coefficient.Results: The content validity, the Cronbach's α coefficient and the Spearman–Brown split‐half reliability coefficient indicated adequate validity and reliability. The exploratory factor analysis yielded four common factors, and the cumulative variance contribution rate was 67.5%. Moreover, the confirmatory factor analysis showed a good model fit.Conclusion: This study confirmed that the Chinese version of Stoma‐quality of life is an effective and reliable measurement for evaluating the quality of life of patients with colostomy.

Purpose Resilience plays an important role in helping individuals to adapt to adversity and improve their psychosocial outcome. This study aims to examine the mediating role of coping in the relationship between family function and resilience in adolescents and young adults (AYAs) who have a parent with lung cancer. Method A total of 135 AYAs with a lung cancer parent were recruited from a tertiary grade A cancer center in southern China, and investigated using a self-designed general information questionnaire, the Resilience Scale for Chinese Adolescents, the Simplified Coping Style Questionnaire, and the Family Adaptation, Partnership, Growth, Affection, Resolve index. Results The mean score of AYAs’ resilience was (3.61 ± 0.49), and its influencing factors included AYAs’ years in work, family function and positive coping. The total effect of family function on resilience was significant (total effect = 0.38, 95% CI [0.048–0.115]), and a positive indirect effect was identified for family function on resilience via positive coping (indirect effect = 0.10, 95% CI [0.005–0.043]). Conclusion Family functioning can facilitate resilience either directly or by promoting positive coping. This study suggests that individualized interventions can be made to improve resilience by promoting family function, or by enhancing positive coping in AYAs with a lung cancer parent.