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To summarize the current evidence on reducing loneliness among informal caregivers of people with dementia, such as family members or friends.
A systematic review.
The methodological quality was evaluated using the revised Cochrane risk-of-bias tool for randomized controlled trials and the revised JBI critical appraisal checklist for quasi-experimental studies. Data were extracted as predefined and synthesized narratively. The Template for Intervention Description and Replication checklist was used to report the intervention characteristics.
Six electronic databases (MEDLINE via PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science Core Collection) were searched for studies published in peer-reviewed English journals from the inception of each database until 28 January 2024.
Eight studies were included in this review, published between 2002 and 2023, with three being randomized controlled trials. All included interventions were psychosocial. Only one study reported significant improvements in loneliness. Five studies utilized remote and online interventions, such as social networking, psychotherapy, and online social support. Interventions varied in their impact on secondary outcomes, including stress, depressive symptoms, anxiety, and caregiver burden. Four studies demonstrated a positive effect on caregiver stress levels. One pilot trial reported a positive impact on depressive symptoms, and another study noted potential improvements in anxiety. One pilot study reported an average improvement in caregiver burden.
While the evidence is insufficient for conclusive statements, this systematic review suggests potential benefits of interventions to reduce loneliness and improve mental health among these caregivers. It highlights the promise of remote interventions in addressing loneliness among dementia caregivers.
The findings suggest that tailored interventions, especially those delivered remotely, can enhance the support provided to caregivers, potentially improving their mental health and overall well-being.
This systematic review adhered to the PRISMA statement.
No patient or public contribution.
Patients undergoing orotracheal intubation (OTI) are prone to oral mucosal pressure injuries (OMPI), yet clinical recognition and prevention remain insufficient. The knowledge, attitudes and practices (KAP) of ICU nurses regarding OMPI prevention are unclear, particularly in multicentre settings.
To assess ICU nurses' KAP on OMPI prevention in Western China, identify gaps, and inform targeted training and practices.
Cross-sectional survey.
A multicentre cross-sectional survey used convenience sampling. ICU nurses completed a 36-item KAP-OMPI questionnaire online. Data were analysed using R 4.3.3 and Zstats 1.0. Cronbach's α assessed internal consistency. Group comparisons used chi-square, Mann–Whitney U or Kruskal–Wallis tests (α = 0.05). Multivariate linear regression and mediation analysis (1000 bootstraps) tested the KAP pathway.
A total of 667 questionnaires were returned from ICU nurses in 48 hospitals. Median total KAP-OMPI score was 136. Knowledge scored 30, attitude 40 and practice 64. Univariate analysis showed that education, professional title, age, years of experience, prior OMPI care, training and active literature learning were significantly associated with all scores (all p < 0.05). Multivariate regression identified lack of training, no prior OMPI care and no active literature learning as independent predictors of lower total, knowledge and practice scores (all p < 0.05). Mediation analysis showed attitude partially mediated the knowledge–practice relationship (indirect effect 0.294), accounting for 31.35% of the total effect.
ICU nurses showed positive attitudes and moderate-to-high practices, but knowledge, assessment and evidence-based learning gaps persist. We recommend targeted training on staging and standardized protocols to improve OMPI prevention and reduce OTI-related complications.
Leveraging these findings, OMPI staging training and standardized protocols should be implemented to bridge the KAP gap and reduce intubation-related OMPI.
No patient or public involvement; data from anonymous nurse surveys only.
Chinese Clinical Trial Registry: ChiCTR2500112798 (Date: November 19, 2025)
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