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After that, we approved the final SC version of KCL (KCL-SC; Table 1). The researchers recommend further validation of the KCL-SC and application among Chinese-speaking populations. We hope this instrument will provide useful references for the assessment of frailty for insurance applications for long-term care in the Chinese. The KCL-SC will add knowledge about crosscultural application of this instrument. AcknowledgementsWe thank Ling Siqi for the back-translation, He

IntroductionWith rapid population aging in China, geriatric depression has imposed a heavy burden on public health and society. This study aimed to investigate the prevalence and influencing factors of depressive symptoms among community-dwelling older adults in China. The findings of this study will contribute to the early detection and effective interventions for older adults with depressive symptoms.MethodsA cross-sectional study was conducted among people aged ≥65 years old in urban communities in Shenzhen, China, in 2021. This study assessed depressive symptoms (Geriatric Depression Scale-5, GDS-5), physical frailty (FRAIL Scale, FS), and physical function (Katz index of independence in the Activities of Daily Living, ADL). Multiple linear regression was used to examine potential predictors of depressive symptoms.ResultsA total of 576 participants aged 71.73 ± 6.41 years were included in the analysis. More than half of them were females (53.0%). The average score of GDS-5 was 0.57 ± 1.11, with 78 (13.61%) participants with depressive symptoms (≥2). The mean scores of FS and ADL were 0.80 ± 1.08 and 9.49 ± 1.67, respectively. The final regression model indicated that those who were living alone, less satisfied with their personal life, frailer, and with worse abilities in ADL had a higher level of depression symptoms (R2 = 0.406, p < 0.001).ConclusionThe prevalence of depressive symptoms is high in this urban community-dwelling older adults in China. Given the critical role of frailty and ADL on depressive symptoms, specific attention to psychological support should be paid to older adults who are living alone and with poor physical conditions.

BackgroundPatients with frailty are at a high risk of poor health outcomes, and frailty has been explored as a predictor of adverse events, such as perioperative complications, readmissions, falls, disability, and mortality in the neurosurgical literature. However, the precise relationship between frailty and neurosurgical outcomes in patients with brain tumor has not been established, and thus evidence-based advancements in neurosurgical management. The objectives of this study are to describe existing evidence and conduct the first systematic review and meta-analysis of the relationship between frailty and neurosurgical outcomes among brain tumor patients.MethodsSeven English databases and four Chinese databases were searched to identify neurosurgical outcomes and the prevalence of frailty among patients with a brain tumor, with no restrictions on the publication period. According to the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, two independent reviewers employed the Newcastle–Ottawa scale in cohort studies and JBI Critical Appraisal Checklist for Cross-sectional Studies to evaluate the methodological quality of each study. Then random-effects or fixed-effects meta-analysis was used in combining odds ratio (OR) or hazard ratio (RR) for the categorical data and continuous data of neurosurgical outcomes. The primary outcomes are mortality and postoperative complications, and secondary outcomes include readmission, discharge disposition, length of stay (LOS), and hospitalization costs.ResultsA total of 13 papers were included in the systematic review, and the prevalence of frailty ranged from 1.48 to 57%. Frailty was significantly associated with increased risk of mortality (OR = 1.63; CI = 1.33–1.98; p < 0.001), postoperative complications (OR = 1.48; CI = 1.40–1.55; p < 0.001; I2 = 33%), nonroutine discharge disposition to a facility other than home (OR = 1.72; CI = 1.41–2.11; p < 0.001), prolonged LOS (OR = 1.25; CI = 1.09–1.43; p = 0.001), and high hospitalization costs among brain tumor patients. However, frailty was not independently associated with readmission (OR = 0.99; CI = 0.96–1.03; p = 0.74).ConclusionFrailty is an independent predictor of mortality, postoperative complications, nonroutine discharge disposition, LOS, and hospitalization costs among brain tumor patients. In addition, frailty plays a significant potential role in risk stratification, preoperative shared decision making, and perioperative management.Systematic review registrationPROSPERO CRD42021248424

IntroductionLifestyle modifications are the first-line interventions for metabolic syndrome (MetS) management. The effectiveness of lifestyle interventions depends mostly on participants' adherence to the interventions. The current study was to explore the experiences of MetS patients in attending lifestyle intervention program (LIP) and the factors that influenced their adherence to the interventions.MethodsA descriptive qualitative study was designed following the COREQ guideline. Face-to-face semi-structured individual interviews were conducted with a purposive sample from the participants who attended the LIP using the data saturation principle. Content analysis of transcripts was conducted following the methods proposed by Graneheim and Lundman.ResultsThe study recruited 27 participants, including 13 males and 14 females. Four themes were identified: (i) the positive and beneficial experiences of attending the LIP, including incorporating lifestyle modifications into daily life, improved physical and psychological health, and empowerment; (ii) facilitators of adherence, including individualized lifestyle education, regular follow-ups, and adequate interpersonal support; (iii) barriers to adherence, including personal resistance, competing demands, and contextual factors; (iv) suggestions for future interventions: with multidisciplinary team, longer term intervention, and more efficient approaches. The findings also indicated that young-to-middle aged patients faced more conflicts with role-related commitments, and were open for e-approaches in lifestyle interventions.ConclusionThe LIP provided positive and beneficial experiences for the participants. Actively incorporating lifestyle modifications into daily life is the key to maintain participants' adherence to the LIP. Culturally appropriate and psycho-behavioral strategies should be adopted to overcome personal and contextual barriers. Special attentions should be paid for the young-to-middle aged population in MetS management.