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To examine the prevalence of factors of cognitive frailty in patients undergoing maintenance haemodialysis (MHD).
A cross-sectional study.
From September 2023 to January 2024, 1023 patients undergoing MHD were recruited from 11 hospitals in Chengdu, China, using convenience sampling. The participants' sociodemographic and lifestyle factors, health information and laboratory indicators were assessed using a general information questionnaire. Cognitive frailty was assessed using the Fried Frailty Phenotype and Montreal Cognitive Assessment Scales. Multivariate logistic regression was used to examine the associations between cognitive frailty and sociodemographic and clinical characteristics. Independent variables for the multivariate logistic regression model encompassing age, sex, educational level, marital status, visual impairment, hearing impairment, falls within a year, depression, weight, height, Malnutrition-inflammation score and serum albumin, sodium, phosphorus, total cholesterol and creatinine levels.
Among 1023 participants with a mean age of 69.52 years, 300 (29.3%) had cognitive frailty, with a predominance of older patients. Regression analysis showed that advanced age, low literacy and low serum creatinine, sodium and total cholesterol levels were positively correlated with cognitive frailty. Furthermore, 17.1% of the participants experienced depression, a risk factor for cognitive frailty, and malnutrition was an independent risk factor for cognitive frailty.
Older adult patients undergoing (MHD) are at an increased risk of developing cognitive frailty. The aetiology of cognitive frailty in this cohort was multifactorial. Targeted interventions should be designed and implemented based on these factors, prioritising nutritional guidance and mood management to prevent or reverse cognitive frailty.
The study adhered to the STROBE checklist.
Older adult patients undergoing MHD are at increased risk of developing cognitive frailty. Cognitive frailty screening must be incorporated into the routine assessment of older patients undergoing MHD.
No patient or public contribution.
Intimate partner violence (IPV) is associated with multiple adverse health consequences. Nurses (including midwives) are well positioned to identify patients subjected to IPV, and provide care, support, and referrals. However, studies about nursing response to IPV are limited especially in low- and middle-income countries (LMICs). The study aimed to examine nurses' perceived preparedness and opinions toward IPV and to identify barriers and facilitators in responding to IPV.
An explanatory sequential mixed-methods study was conducted by collecting quantitative data first and explaining the quantitative findings with qualitative data.
The study was conducted in two tertiary general hospitals in northeastern (Shenyang city) and southwestern (Chengdu city) China with 1500 and 1800 beds, respectively. A total of 1071 survey respondents (1039 female [97.0%]) and 43 interview participants (34 female [79.1%]) were included in the study. An online survey was administered from September 3 to 23, 2020, using two validated scales from the Physician Readiness to Manage Intimate Partner Violence Survey. In-depth, semistructured interviews were conducted from September 15 to December 23, 2020, guided by the Consolidated Framework for Implementation Research.
The survey respondents largely agreed with feeling prepared to manage IPV, e.g., respond to discourses (544 [50.8%] of 1071) and report to police (704 [65.7%] of 1071). The findings of surveyed opinions (i.e., Response competencies; Routine practice; Actual activities; Professionals; Victims; Alcohol/drugs) were mixed and intertwined with social desirability bias. The quantitative and qualitative data were consistent, contradicted, and supplemented. Key qualitative findings were revealed that may explain the quantitative results, including lack of actual preparedness, absence of IPV-related education, training, or practice, and socially desirable responses (especially those pertaining to China's Anti-domestic Violence Law). Commonly reported barriers (e.g., patients' reluctance to disclose; time constraints) and facilitators (e.g., patients' strong need for help; female nurses' gender advantage), as well as previously unreported barriers (e.g., IPV may become a workplace taboo if there are healthcare professionals known as victims/perpetrators of IPV) and facilitators (e.g., nurses' responses can largely meet the first-line support requirements even without formal education or training on IPV) were identified.
Nurses may play a unique and important role in responding to IPV in LMICs where recognition is limited, education and training are absent, policies are lacking, and resources are scarce. Our findings support World Health Organization recommendations for selective screening.
The study highlights the great potential of nurses for IPV prevention and intervention especially in LMICs. The identified barriers and facilitators are important evidence for developing multifaceted interventions to address IPV in the health sector.
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