Objective To evaluate the impact of immersive virtual reality（IVR）-based cognitive training on the cognitive function,activity of daily living（ADL） and negative emotion for people with subjective cognitive decline （SCD）,mild cognitive impairment（MCI） or Alzheimer’s disease（AD）. Methods 11 electronic databases,such as PubMed,Embase,CINAHL etc.,and clinical trials registry platforms were searched for related articles published in English and Chinese from inception until April 27th,2021. We retrieved randomized controlled trials or quasi-experience studies focused on IVR-based cognitive training in adults with SCD,MCI or AD. Literature search,study selection,data extraction and methodological quality evaluation were conducted by 2 researchers independently. Meta-analysis was performed by RevMan 5.4. Results 8 studies involving 406 patients were included. Meta-analysis indicated that IVR-based cognitive training significantly enhanced the overall cognition[SMD=0.37,95%CI（0.15,0.60）,P=0.001],short-term memory[SMD=0.62,95%CI（0.19,1.04）,P=0.005] and ADL [SMD=0.84,95%CI（0.57,1.11）,P<0.001] in people with MCI or AD. However,after IVR-based cognitive training,effects on executive function[SMD=-0.24,95%CI（-0.56,0.08）,P=0.140] and long-term memory[SMD=0.00,95%CI（-0.42,0.41）,P=0.990] were not statistically significant in people with MCI or AD,and effects on negative emotion was unclear. Moreover,there was a paucity of intervention studies on IVR-based cognitive training for SCD. Conclusion This meta-analysis suggests that IVR-based cognitive training can provide positive influences on cognitive function and ADL in people with MCI or AD. Due to limited quantity and different interventions of the included studies,more studies with larger sample sizes are required to verify the above conclusions. Moreover,more studies are needed to explore the effects of IVR-based cognitive training for people with SCD.

Objective To explore the perceptions and suggestions of nurses in long-term care of older patients with mild cognitive impairment（MCI） on the participation of these patients in shared decision making,and to provide references for promoting the implementation of shared decision making. Methods Using the descriptive phenomenological research method,semi-structured interviews were conducted from November 2020 to February 2021 with nurses from 3 tertiary hospitals in Beijing who had the experience of providing health-care services to older patients with MCI,and Colaizzi 7-step analysis method was used to analyze the data. Results Perception of nurses on elderly MCI patients’ participating in shared decision making can be summarized into 5 themes：①respect for patients’ preferences,②guarantee of comprehensive improvement of nursing quality,③limitations by patients’ decision-making ability,④negative emotional coping affected patients’ participation,⑤clinical implementation was restricted. Suggestions from nurses were as follows：①further inspire patients’ decision-making awareness,②call for family support,③expect to improve the implementation conditions. Conclusion Shared decision making has important practical significance,but there were some obstacles in its clinical implementation. In the future,it is necessary to strengthen the decision-making consciousness of patients,cultivate the decision-making ability of nurses,improve the implementation conditions of shared decision making,so as to give full play to the guiding role of nurses.

Objective To evaluate the evidence-based guidelines for the management of frail elderly at home and abroad,and analyze the characteristics of each guideline,so as to provide references for the management of frail elderly in China. Methods We conducted a systematic retrieval of the relevant guidelines on frailty management of the elderly published or updated since the database was established until October 2018（the deadline for retrieval）,in authoritative domestic and foreign guide websites,Chinese and English databases and the website of the professional society of gerontology and medicine. The 2017 updated version of the clinical research and evaluation tool for quality evaluation of guidelines meeting inclusion and exclusion criteria was used to analyze the characteristics of the guidelines. Results A total of 3 relevant evidence-based guidelines at home and abroad were retrieved. The average standardized scores of quality evaluation for the 6 areas were 97.5% for scope and purpose,68.5% for participants,65.3% for rigor,95.7% for clarity,68.7% for application,and 61.1% for independence. For overall quality,1 was Grade A and 2 were Grade B. Conclusion There is still a lack of evidence-based guidelines for the management of frail elderly at home and abroad,and the quality of developed guidelines needs to be improved,and contents need to be refined. Local evidence-based guidelines in China should be developed to guide the implementation of management of frail elderly.