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OBJECTIVE: Extending collaborative care, a model integrating mental health services into primary care, to include community-based organisations (CBOs) may improve older patient health outcomes by increasing access to care and addressing patients social needs; however, little is known about how CBOs contribute to such partnered depression care. We explored how six primary care clinic and CBO partnerships came together to provide late-life depression care through the Care Partners funded in 2014. DESIGN: 43 key informant interviews and 15 focus groups were conducted with care managers, administrators and primary care providers partnering to provide late-life depression care. Data were coded and analysed iteratively using qualitative thematic analysis. SETTING: Six primary care clinic-CBO sites across California. PARTICIPANTS: Care managers, administrators and primary care providers participated in this study. RESULTS: Three unique contributions of CBOs to depression care in these clinic-CBO partnerships were identified: (1) CBOs added new services that focus on social needs and enhanced depression care; (2) CBOs strengthened core aspects of collaborative care for depression; (3) CBOs provided new avenues for building connections and trust with underserved patients. CONCLUSIONS: CBOs, when partnered with clinics, enhanced both medical and social aspects of depression treatment for older adults. CBOs are well positioned to assist primary care clinics in treating the complex health needs of older adults by providing new and strengthening existing aspects of partnered depression care while building patient trust among culturally diverse populations.

Background: The health issues experienced by older people can often be severe and complex, and an increasing number are using residential aged care services to meet their care needs. High-quality nursing care is fundamental to the health and safety of aged care residents and is contingent on nurses' accurate assessment, informed decision-making, and delivery of timely interventions. However, the role of the aged care nurse is often challenging, impeded by factors such as understaffing, high workloads, and a lack of access to clinical infrastructure and resources. When these challenges mount, residents are put at greater risk of adverse outcomes, such as avoidable clinical deterioration and hospital transfers. This study describes the adaptation and implementation of the emergency nursing framework, HIRAID® (History including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment, communication and plan)—a tool to assist nurses' assessment, decision-making and care in residential aged care. Methods: The HIRAID® framework will be adapted for residential aged care using a real-time Delphi and panel of aged care and nursing experts. The co-designed HIRAID® Aged Care framework will be trialled in 23 residential aged care homes in Sydney, Australia, in a modified stepped-wedge cluster randomised controlled trial design. All homes will be randomised into one of four clusters. Outcomes of interest include the rate of clinical deterioration events resulting from nurses' actions, the rate of hospital transfers determined to be inappropriate, performance against the national mandatory aged care quality indicators, resident satisfaction with care, nurse and medical staff satisfaction with communication, and the quality of nursing documentation. These outcomes will be evaluated using a combination of qualitative and quantitative analysis of routinely collected resident data, expert assessments of facility documentation events against validated criteria, and pre- and post-intervention surveys of residents, family carers, nurses, and medical staff. Discussion: This protocol describes a pragmatic trial that aims to translate an evidence-based framework from the emergency care context into residential aged care. The adapted HIRAID® Aged Care framework will be the first of its kind to standardise and guide holistic nursing assessment, decision-making, and documentation in residential aged care in Australia. Ethics and dissemination: This research has been approved by the Western Sydney Local Health District Human Research Ethics Committee: 2023/ETH00523. A waiver of consent has been approved to access resident health data and nursing documentation at each participating site. Trial registration: Australian and New Zealand Clinical Trial Registry, ACTRN12623000481673. Registered 12 May 2023. Protocol version: Version 1.0 6 February 2024. [ABSTRACT FROM AUTHOR]

The article discusses the need for a philosophical shift in the Australian residential aged care sector to better cater to the physical, social, and psychological needs of older people. It proposes reframing aged care as communities within social and ecological communities to move away from consumerist approaches. By recognizing residents as part of interconnected communities, the sector can address critical challenges identified by the Royal Commission and promote social and environmental justice. The article emphasizes the importance of relationships in shaping personhood and advocates for a holistic approach to care that considers the broader community and ecological impact. [Extracted from the article]

Objectives: To determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator. Study design: Retrospective population‐based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data. Setting, participants: People aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 – 31 December 2018. Main outcome measures: Thirty‐day (primary outcome), 120‐day, and 365‐day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator. Results: Registry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015–2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre‐admission walking ability, and residential status, 30‐day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30–0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46–0.82) than for low indicator adherence hip fractures, as was 365‐day mortality (high adherence: aRR, 0.59 [95% CI, 0.51–0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63–0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61–0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67–0.83) were associated with lower mortality risk at each time point. Conclusions: Clinical care for two‐thirds of hip fractures attained a high level of adherence to the six quality care indicators, and short and longer term mortality was lower among people who received such care than among those who received low adherence care. [ABSTRACT FROM AUTHOR]

Background: In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those identified as 'at risk' may help reduce malnutrition risk and associated healthcare use, and improve quality of life. The aim of this study is to explore how primary care practitioners (PCPs) and older adults perceive, use and respond to an intervention to support those identified as 'at risk'. Methods: We developed and optimised an intervention (screen and treat protocol, online tools and printed materials) to support primary care practitioners to identify malnutrition risk among older adults, and intervene where necessary. We recruited older adults (described as 'patients' here) taking part in a feasibility study, and carried out semi-structured interviews to assess PCPs' and patients' engagement with the intervention, and identify any contextual issues that supported or undermined their engagement. Results: Four themes were developed, encompassing patients' and PCPs' perceptions of undernutrition, study measures and appointments, constraints on PCPs' enthusiasm to make a difference, and patients' expectations of nutritional appointments. Key findings included patients commonly not accepting advice for undernutrition/malnutrition but welcoming support for their nutritional needs; checklists potentially distracting patients from recalling discussions about their nutritional needs; a tension between PCPs' desire to recruit less-well patients and logistical difficulties in doing so; and patients compromising their nutritional needs to suit others. Conclusions: Diverse factors influence whether an intervention succeeds in primary care. PCPs learn about an intervention/study in different ways, vary in how they understand and accept its aims, and desire to make a difference to their patients. Patients bring perceptions and expectations about the study's aims, coloured by their habits and preferences, prior experience of research and healthcare, and pressure from social expectations. Each aspect must be considered when developing a successful primary care intervention that is viewed as relevant and meaningful, and presented using language that aligns with participants' values and goals. Our findings suggest that references to 'malnutrition risk' should be avoided in any patient-facing materials/interactions as participants do not accept or identify with this label. [ABSTRACT FROM AUTHOR]

Assessments for frailty, comorbidity and disability should be conducted for elderly patients in the emergency department (ED) using suitable scales. We evaluated the predictive values derived from the Eastern Cooperative Oncology Group Performance Status Scale (ECOG), Charlson Comorbidity Index (CCI), and Clinical Frailty Scale (CFS) in an ED context. This prospective cohort study, conducted in the EDs of two Taoyuan City, Taiwan hospitals for 8 months. Patients aged 65 or older and their families participated in interviews and filled out questionnaires. The study then analyzed the scales' performance in predicting patient mortality and average hospital stay length. The study included 593 patients. Participants had a mean age of 75.8 years. The majority, 74.4%, were categorized as level III under the Taiwan Triage and Acuity Scale (TTAS). Meanwhile, 114 patients (19.2%) were deemed critical (TTAS levels II or I). Admission and mortality rate were significant associated with three scales above cut-off value after adjusted to age, gender and TTAs by logistic regression analysis, except for ECOG >3 group in predicting admission to hospital (p = 0.055). The CCI demonstrated significantly higher predictability for mortality compared to other scales, boasting an area under the curve (AUC) of 0.810 (95% confidence interval (CI): 0.730-0.891). This was followed by the CFS with an AUC of 0.706 (95% CI: 0.614-0.799) and the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) with an AUC of 0.660 (95% CI: 0.565-0.754). However, there was no significant difference among these scales in predicting hospital admission (CCI AUC: 0.600, 95% CI: 0.552-0.648; CFS AUC: 0.583, 95% CI: 0.535-0.632; ECOG-PS AUC: 0.580, 95% CI: 0.531-0.628). As conclusion, this study evaluated the performance of ECOG, CCI, and CFS in predicting outcomes during ED triage. Although CCI can predict in-hospital mortality, its application in ED needs more comprehensive research. [ABSTRACT FROM AUTHOR]

Objectives: Current policies for older patients do not adequately address the barriers to effective implementation of optimal care models in New Zealand, partly due to differences in patient definitions and the in-patient pathway they should follow through hospital. This research aims to: (a) synthesise a definition of a complex older patient; (b) identify and explore primary and secondary health measures; and (c) identify the primary components of a care model suitable for a tertiary hospital in the midland region of the North Island of New Zealand. Method: This mixed-methods study utilised a convergence model, in which qualitative and quantitative data were investigated separately and then combined for interpretation. Semi-structured interviews (n=11) were analysed using a general inductive method of enquiry to develop key codes, categories and themes. Univariate data analysis was employed using six years of routinely collected data of patients admitted to the emergency department and inpatient units (n=261,773) of the tertiary hospital. Results: A definition of a complex older patient was determined that incorporates chronic conditions, comorbidities and iatrogenic complications, functional decline, activities of daily living, case fatality, mortality, hospital length of stay, hospital costs, discharge destination, hospital readmission and emergency department revisit and age – not necessarily over 65 years old. Well-performing geriatric care models were found to include patient-centred care, frequent medical review, early rehabilitation, early discharge planning, a prepared environment and multidisciplinary teams. Conclusions: The findings of this New Zealand study increase understanding of acute geriatric care for complex older patients by filling a gap in policies and strategies, identifying potential components of an optimal care model and defining a complex geriatric patient. Implications for Public Health: The findings of this study present actionable opportunities for clinicians, managers, academics and policymakers to better understand a complex older patient in New Zealand, with significant relevance also for international geriatric care and to establish an effective acute geriatric care model that leads to beneficial health outcomes and provides safeguard mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: The oral health status of older adults in the United States is a public health crisis and a silent epidemic. Maine's Oral Team‐Based Initiative Vital Access to Education (MOTIVATE) Program is an innovative interprofessional oral health program aimed at enhancing oral health education and practice of interprofessional health care teams in nursing homes. Using a blended learning model, a combination of in‐person and online learning, this program provides a foundation from which to implement evidenced based oral care in nursing homes. Methods: Learning outcomes were assessed via a three‐part timed series survey. A set of self‐report assessment items measured skills implemented at baseline and post‐training. Results: Learning domain scores increased over time from baseline to post‐training. Confidence in providing oral healthcare and role clarity in providing oral health care improved over time. Staff identified using new skills in daily oral care and communication across the interprofessional team. Discussion: The MOTIVATE program is an effective collaborative‐based model for developing oral health competencies and promoting evidence‐based oral health care in nursing homes. [ABSTRACT FROM AUTHOR]

Objective: Given the diverse ethnic backgrounds of aged care clients, there is a critical requirement to translate psychosocial assessment tools into various languages to effectively evaluate social engagement and quality of life in older adults receiving aged care services. This study aimed to translate psychosocial tools into Turkish, Korean and Mandarin, the primary languages spoken by clients of an Australian community aged care provider. Methods: A co‐development approach encompassing forward and backward translations of the Australian Community Participation Questionnaire and ICEpop CAPability measure for Older people tools, along with focus group discussions involving bilingual staff (n = 7) and clients (n = 16), was employed to ensure precision and cultural relevance. Multiple iterations were undertaken until linguistic, conceptual and scaling equivalence was achieved, with recorded sessions transcribed and analysed thematically. Results: Cultural appropriateness significantly impacted the delivery of questions within the tools, emphasising translation challenges tied to specific queries. These difficulties included the lack of terms for unique places of worship, the use of outdated language (e.g., references to reading newspapers), and varying priorities in social and well‐being matters between Western and Eastern/Asian cultures. Staff feedback identified that formal translated tool versions eased administration for culturally and linguistically diverse (CALD) clients, enabling them to independently interpret questions, resulting in improved questionnaire completion rates. Conclusions: Insights indicate the need for continued efforts in tailoring assessment tools to diverse cultural contexts to ensure accurate and meaningful data collection. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Delirium is one of the most frequent syndromes among elderly patients admitted to emergency units and, despite presenting well-established symptoms and signs, there are still diagnostic failures. Thus, the aim of the study was to adapt the Abbreviated Mental Test (AMT) as a screening tool for delirium in elderly adults admitted to an emergency department. METHODS: This cross-sectional study was conducted at the emergency department of a university hospital in Brasília, Brazil between April and June, 2014. We evaluated 90 patients of both sexes, aged 60 years or older. The Confusion Assessment Method (CAM) Instrument was considered the gold standard for diagnosing delirium. The complete translated AMT, administered in four different culturally adapted models, as well as condensed models, were compared to the CAM receiver operating characteristics curve (significance < 0.05; H0: AUC = 0.5). Inter-rater agreement was evaluated with the kappa test, using SPSS version 22.0.0.0. RESULTS: The prevalence of delirium was 25.6%. The best of the four AMT models presented sensitivity and specificity of 78.3% and 85.1%, respectively, with good inter-rater reproducibility (Kappa = 0.793). The best condensed model included four questions, with sensitivity and specificity of 82.6% and 82.1%, respectively, and a kappa of 0.746. CONCLUSIONS: Compared to the gold standard, the adapted AMT (complete or condensed) was adequate as an alternative for quick delirium screening in elderly patients admitted to an emergency department, especially for unaccompanied patients with no prior cognitive deficit.

OBJECTIVES: To assess clinical and coronary angiographic characteristics, previous medical history, and clinical course, by age group, in older adults after myocardial infarction who underwent primary percutaneous coronary intervention (pPCI). METHODS: Single-center, cohort study that enrolled all patients with ST-segment elevation myocardial infarction who underwent pPCI at a specialized cardiology reference center in the South of Brazil. Older adults were defined as age ≥ 60 years, as set out in Brazilian legislation. Patients in the following age groups were compared: 60 to 64 years, 65 to 69 years, 70 to 74 years, 75 to 79 years, and ≥ 80 years. Patients' clinical course was assessed at initial hospital admissions and after 2 years of clinical follow-up. Data were analyzed using SPSS 19, and significance was established at p < 0.05. RESULTS: From December 2015 to December 2018, a total of 636 patients were enrolled consecutively. Angiographic success rates were around 90% in all age groups. There were no differences in medications used, except for glycoprotein IIb/IIIa inhibitors, which were more frequently used in patients of lower age groups. Older patients had more in-hospital acute renal failure and higher in-hospital mortality. Predictors of mortality were age over 75, chronic renal failure, need for ventilatory support, severe arrhythmia, and sepsis. CONCLUSIONS: pPCI in older adult patients is a saf e procedure with a high success rate.

INTRODUCTION: Self-efficacy is defined as the strength of a person's convictions in being able to perform a given activity and obtain the expected result. It may act as a potent mediator between chronic musculoskeletal pain and how older adults cope with their disabilities. OBJECTIVE: To evaluate the determinants of self-efficacy beliefs and fear of physical exercise in community-dwelling older adults with chronic musculoskeletal pain. METHODS: This cross-sectional study recruited older adults with chronic musculoskeletal pain. Only individuals living in an urban area in southern Brazil and who reported pain for more than 3 months were included. A convenience sample was selected in a nonprobabilistic fashion. The study variables consisted of sociodemographic data; pain based on the Brief Pain Inventory and the Leeds Assessment of Neuropathic Symptoms and Signs for Patients with Chronic Pain; and self-efficacy based on the Chronic Pain Self-Efficacy Scale. Also, simple questions were created for physical exercise beliefs. For statistical analysis, absolute and relative frequency, χ2 test, and Mann-Whitney U test were used as appropriate. RESULTS: The sample consisted of 193 older adults, mostly women with low level of education. Self-efficacy was best rated by older adults living alone and by those who were classified as exclusively nociceptive pain. CONCLUSION: Despite having chronic pain, older adults with higher self-efficacy feel confident in performing their tasks and have greater ability to cope with changes related to aging and to engage in self-care.

At present, the aging situation in China is becoming increasingly severe. The elderly are facing difficulties in acquiring elderly service and medical care in the process, in which the elderly need digital service of the combination between medical and nursing care urgently. However, there still exist some problems of the combination of medical and nursing care in the present stage, such as imperfect models, low level of intelligence, inefficient integration mechanism of resources related to "medical care" and "nursing care", and the inadequate phenomenon in which the service of combination of medical and nursing care leads to "the castle in the air". In view of the current difficulties and blocking points in the combination of medical and nursing care, the research team of this paper use digital and intelligent methods to construct 5 types of smart medical and nursing service models, including "full chain" "multi-subject integration" "active health" of traditional Chinese medicine, "return to the community" and "return to the home". Furthermore, the research team issused 6 group standards, seted up 2 landmark projects, and established more than 20 demonstration application bases across the country in the meantime as well as incorporate 500 community/township promotion plans of Henan Provincial government, which achieve good demonstration effects. This paper briefly introduces five types of model specifications from four aspects of model conception, model composition, model operation mechanism and model function, so as to facilitate the further study and popularization of the five models.

Background With the acceleration of the aging process in society, the demand for hospice services is increasing. The development of hospice care in China started relatively late, and relevant institutional construction standards and management norms are still in the trial stage. As one of the important integrated medical and nursing service institutions, elderly care institutions currently lack an effective and homogeneous model and service system for hospice services. Objective To establish a scientific, standardized and feasible hospice service model for elderly care institutions. Methods From April to May in 2020, Chinese/English databases were systematically searched to obtain the literature related to hospice services. Five experts in the field of hospice care were invited to carry out semi-structured interviews, and the initial index system was constructed based on the results of literature retrieval and semi-structured interviews. In May 2020, a purposive sampling method was used to select fifteen experts in the field of hospice care to conduct two rounds of correspondence, and the indicator system was determined based on the analysis of the research group and expert suggestions. After two rounds of correspondence, an expert group interview was conducted to further optimize and adjust the formed indicator system. Results In both rounds of correspondence, the questionnaire response rate was 100.0%, with expert authority coefficients of 0.89 and 0.94, respectively. The Kendall's W coefficients for the first level indicator were 0.54 and 0.59, respectively, and the Kendall's W coefficients for the second level indicator were 0.18 and 0.10, respectively. The final constructed indicator system for the hospice service model of elderly care institutions included three primary indicators of necessary resources and conditions, content and processes, assessment indicators, and 36 secondary indicators. In the second round of inquiry, the average importance score of the indicator was 3.87 to 5.00 points, the coefficient of variation was 0 to 0.25, and the full score rate was 63.0% to 100.0%. Conclusion The scientificity and reliability of the model hospice service model for elderly care institutions constructed in this study are good, which can provide reference for elderly care institutions to provide high-quality medical services for elderly patients at the end of their lives.

Falls are the important causes of morbidity and mortality in older adults. Although clinical staff have paid attention to the management of falls, adherence to fall interventions is not satisfactory, resulting in the high incidence of fall. Understanding the older adults' own perception of fall risk from their perspective may be the key to fall prevention, especially active fall prevention. In this paper, we reviewed the concept of fall risk perception, behavioral consequences and influencing factors of fall risk perception in older adults from the perspective of "the first person responsible for health", and found that there are fewer studies on fall risk perception in older adults at home and abroad, the conceptual connotation still needs to be further explored. Subjective perceptions of fall risk in older adults can lead to different patterns of fall risk coping behaviors that influence fall risk. The influencing factors of fall risk perception mainly focus on the emotional psychology, physiological conditions, social culture, and physical environment, with the influencing process through subjective cognition. Empirical studies can be used to further validate the psychological cognitive mechanisms of fall risk perception in conjunction with the risk perception formation process in the future, in order to provide empirical evidence for proactive fall prevention.

The purpose of the pilot survey was to understand current practice patterns and responses to the Patient-Driven Groupings Model and the coronavirus disease 2019 (COVID-19) pandemic in home health occupational therapy care. Fifty home health occupational therapy practitioners from 27 states in the United States completed the survey. Descriptive analysis was used to organize and summarize survey responses. The survey items on practice patterns included assessment tools, treatment approaches, and care coordination with physical therapy colleagues. The most reported assessment of occupational performance was the Barthel Index. The common treatment approaches included activities of daily living retraining, energy conservation, and functional mobility and transfer. The majority of respondents (n = 44) communicated with their physical therapy colleagues at least once a week. The communications were often related to scheduling and changes in a patient's condition. Seventy percent of practitioners experienced a reduction in home visits during the recent Medicare payment reform and the pandemic. These practitioners perceived that some patients might have been discharged from home health care prematurely. Additional studies to investigate the impact of policy changes and the pandemic on therapy intensity and patients' functional outcomes are warranted. [ABSTRACT FROM AUTHOR]

Objective: To characterise the socio‐demographic characteristics, aged and health care needs, and aged care services used by older Aboriginal and Torres Strait Islander people assessed for aged care service eligibility. Study design: Population‐based retrospective cohort study; analysis of Registry of Senior Australians (ROSA) National Historical Cohort data. Setting, participants: Aboriginal and Torres Strait Islander people aged 50 years or older who were first assessed for aged care service eligibility (permanent residential aged care, home care package, respite care, or transition care) during 1 January 2017 – 31 December 2019. Major outcome measures: Socio‐demographic and aged care assessment characteristics; health conditions and functional limitations recorded at the time of the assessment; subsequent aged care service use. Results: The median age of the 6209 people assessed for aged care service eligibility was 67 years (interquartile range [IQR], 60–75 years), 3626 were women (58.4%), and 4043 lived in regional to very remote areas of Australia (65.1%). Aboriginal health workers were involved in 655 eligibility assessments (10.5%). The median number of health conditions was six (IQR, 4–8); 6013 (96.9%) had two or more health conditions, and 2592 (41.8%) had seven or more. Comorbidity was most frequent among people with mental health conditions: 597 of 1136 people with anxiety (52.5%) and 1170 of 2416 people with depression (48.5%) had seven or more other medical conditions. Geriatric syndromes were recorded for 2265 people (36.5%); assistance with at least one functional activity was required by 6190 people (99.7%). A total of 6114 people (98.5%) were approved for at least one aged care service, 3218 of whom (52.6%) subsequently used these services; the first services used were most frequently home care packages (1660 people, 51.6%). Conclusion: Despite the high care needs of older Aboriginal and Torres Strait Islander people, only 52% used aged care services for which they were eligible. It is likely that the health and aged care needs of older Aboriginal and Torres Strait Islander people are not being adequately met. [ABSTRACT FROM AUTHOR]

Oral health of the older population has long been overlooked in global healthcare agenda. Limited access to oral healthcare for dependent older adults results in poor oral health, negatively impacting their quality of life, nutrition and overall well‐being. Especially for nations experiencing rapid ageing population, efforts must be urgently made to integrate oral healthcare services into the current healthcare system and policy. Singapore stands out as one of the most rapidly ageing nations in Southeast Asia, achieving remarkable progress in the healthcare field, as well as advancements in social modernization and economic growth. It now faces the growing burden of the dependent older population and is required to respond to the complex challenges associated with providing holistic eldercare services and ensuring the well‐being of its ageing population. This narrative review offers an overview of Singapore's current healthcare policy and system development for the older population, with a specific focus on oral healthcare. The goal is to shed light on this underexplored area, highlighting the challenges that need to be tackled to improve the accessibility of oral health services for dependent older adults. [ABSTRACT FROM AUTHOR]

Traditional emergency departments (EDs) are overcrowded and sometimes not suitable for older adults with complex needs. Specialised geriatric urgent care pathways for selected patients can alleviate ED demand and improve patient experience. To address urgent care needs for older adults in Southern Adelaide, the Complex And RestorativE (CARE) service was established. CARE offers alternative, geriatrician‐led treatment pathways consisting of a ward‐based treatment centre and an in‐home visiting team called Eyes on Scene (EoS). Both pathways offer medical, nursing and allied health treatment. Routinely collected clinical data were analysed to explore the reach of the service and the incidence and nature of adverse events. Between September 2021 and March 2023, the CARE service attended to 5324 older adults requiring urgent care. A significant proportion of patients were discharged to or remained in their regular place of residence, with few requiring inpatient admissions or referrals to other facilities. A total of 7% of patients required transfer to ED and adverse events were rare. The CARE service demonstrates a feasible and safe alternative model of urgent care for older Australians. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe the characteristics of clients receiving home‐based dietetic intervention and to evaluate the effectiveness of these interventions in improving nutritional status, functional status, and quality of life in a culturally and socioeconomically diverse client group. Methods: Participants referred to a home‐based dietetic service were recruited to this prospective cohort study. Dietetic interventions were recommended at baseline and reviewed at 3‐month follow‐up. Assessment of nutritional, functional and quality of life markers was measured using the Mini Nutritional Assessment (MNA), Timed Up and Go (TUG) and EQ‐5D‐5L, respectively, at baseline and after home‐based dietetic intervention. Results: Participants (n = 99) were recruited from consecutive referrals. Participant's weight, body mass index (BMI), total daily energy and protein intake, MNA total score, and TUG significantly improved after a 3‐month nutrition intervention (effect sizes 0.257, 0.257, 0.580, 0.533, 0.577 and 0.281, respectively). The most common interventions dietitians utilised were nutrition education, use of oral nutritional supplements (ONS) and meal fortification. In total, 339 dietetic interventions were recommended to participants at baseline with 197 (58.11%) implemented at 3 months, with meal planning and referral to other relevant allied health or Commonwealth Home Support Program (CHSP) services the most implemented interventions. Conclusions: Home‐based dietetic intervention improves nutritional status, functional status and quality of life in community‐dwelling older adults referred for dietetic input. Improvements observed in nutritional and functional status were consistent with benchmarks of change from published literature. [ABSTRACT FROM AUTHOR]

It is well known that over the last few decades, there has been significant growth of the aging population worldwide and especially in Europe, with an increase of more than two years per decade since the 1960’s. Currently, in Europe, people aged over 65 years old represent 20% of the population, creating many new and complex challenges for national healthcare systems. In many countries, geriatric medicine is an established medical specialty, integrated into the primary and secondary care of the older population. In some countries, such as Portugal, specialist training in geriatric medicine is not available, even though the life-expectancy in Portugal is currently 81 years due to a decrease in fertility and mortality, and people aged over 60 currently represent nearly a third of the population. There is strong evidence in the medical literature that a fracture following a fall, and especially a neck of femur fracture, is one of the most serious events that can happen in an older person’s lifetime. These fractures have been associated with increased morbidity, loss of independence, a high rate of institutionalization, and mortality. Rates of mortality after a year from femoral fractures have been proven to be three to four times higher than the expected in the general population, ranging between 15% to 36%. This emphasizes the importance of developing well-organized care pathways for these patients, which combine specialized geriatric care (also known as orthogeriatric care). This narrative review will focus on the core principles of orthogeriatric care and how medical professionals, including those who are not specialized in geriatric care, can effectively use them.

Abstract Background To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients. Methods We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention. Results We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37–4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41–8.97, p

Abstract Background Person-centred medicine is recommended in the care of older patients. Yet, involvement of care home residents and relatives in medication processes remains limited in routine care. Therefore, we aimed to develop a complex intervention focusing on resident and relative involvement and interprofessional communication to support person-centred medicine in the care home setting. Methods The development took place from October 2021 to March 2022 in the Municipality of Aarhus, Denmark. The study followed the Medical Research Council guidance on complex intervention development using a combination of theoretical, evidence-based, and partnership approaches. The patient involvement tool, the PREparation of Patients for Active Involvement in medication Review (PREPAIR), was included in a preliminary intervention model. Study activities included developing programme theory, engaging stakeholders, and exploring key uncertainties through interviews, co-producing workshops, and testing with end-users to develop the intervention and an implementation strategy. The Consolidated Framework for Implementation Research and the Interprofessional Shared Decision Making Model were used. Data were analysed using a rapid analysis approach. Results Before the workshops, six residents and four relatives were interviewed. Based on their feedback, PREPAIR was modified to the PREPAIR care home to fit the care home population. In total, ten persons participated in the co-producing workshops, including health care professionals and municipal managerial and quality improvement staff. The developed intervention prototype was tested for three residents and subsequently refined to the final intervention, including two fixed components (PREPAIR care home and an interprofessional medication communication template) delivered in a flexible three-stage workflow. Additionally, a multi-component implementation strategy was formed. In line with the developed programme theory, the intervention supported health care professionals´ awareness about resident and relative involvement. It provided a structure for involvement, empowered the residents to speak, and brought new insights through dialogue, thereby supporting involvement in medication-related decisions. The final intervention was perceived to be relevant, acceptable, and feasible in the care home setting. Conclusion Our results indicate that the final intervention may be a viable approach to facilitate person-centred medicine through resident and relative involvement. This will be further explored in a planned feasibility study.

The progressive increase in HIV infection among older adults requires constant research and monitoring, given that geriatric syndromes associated with HIV comorbidities have become an important public health problem. We reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and it has a central question: Is the incidence of cognitive impairment higher in older patients living with HIV than in their seronegative peers? The following databases were searched for this review: MEDLINE/PubMed, EMBASE, LILACS, Web of Science, and Scopus. The inclusion criteria were studies whose samples were ≥ 50% patients aged ≥ 50 years, with and without HIV, and a main outcome related to the incidence of cognitive impairment. Only cohort studies with follow-up lasting ≥ 24 months were considered. Three reviewers independently screened the documents for eligibility criteria, extracted the data, assessed the risk of bias (Newcastle-Ottawa Scale), and evaluated the quality of evidence. A narrative synthesis was prepared. In total, 10 798 trials were screened, 8884 were excluded, 14 were analyzed, and 5 were included in this review. Only 1 applied cognitive assessment tests; the rest used secondary data from the medical records. Most found that the incidence of cognitive disorders was higher among older people living with HIV, which highlights the need for public policies aimed at primary and secondary prevention strategies. Further research from other countries is still required. PROSPERO register (CRD42022321914).

Background In the context of population aging, the care needs of the disabled elderly cannot be ignored. A comprehensive understanding of the care and support needs of the elderly with disabilities can provide basis for government policymakers in the development of rational care strategies. Objective To systematically review qualitative studies on the care and support needs of the disabled elderly. Methods In this study, a systematic search of Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, and CBM for relevant qualitative studies was conducted from inception to February 26, 2023. The Joanna Briggs Institute's Critical Appraisal Tool for qualitative studies was performed to evaluate the quality of included qualitative studies. The results of the original qualitative studies were synthesized through a pooled integration approach. Results A total of 33 qualitative studies were finally included, and 7 themes with 18 categories were distilled, including daily activities-related needs (basic activities of daily living, household activities, and caregiving characteristics) , functional independence-related needs (independence in physical functioning, independence in autonomous decision-making) , health care-related needs (content of health care services, health care service experience, expression of needs for health care services) , contextual support-related needs (objective environmental support, policy support) , positive emotional support-related needs (psychological comfort, spiritual care) , social support-related needs (community support services, social engagement, relationship connection, information linkage) , health technology-related needs (care auxiliary equipment, technical services) . Conclusion The care and support needs of the disabled elderly are both complex and diverse. To meet the physical, psychological, social, healthy and environmental needs of the disabled elderly, it is essential for the government to integrate resources from family, community and institutions. Furthermore, attention should be given to the equitable of care resources from a group perspective, and additional social welfare should be provided to support the disabled elderly.

Objective: To investigate the factors associated with urinary incontinence in older adults living in nursing homes. Methods: This exploratory, cross-sectional, observational, and quantitative study used exploratory and path analysis (PA). Eighty-six older adults living in nursing homes in the city of Salvador, Brazil, and the city of Brasília, Brazil, were included. Data were collected from January to March 2020, before the Covid-19 pandemic. The following variables were evaluated: sex, age group, functional performance, global cognitive function, comorbidities, and health conditions. We considered urinary incontinence for older adults who answered affirmatively to the "In the last 12 months, have you had an involuntary loss of urine?". Data were initially analyzed by descriptive analysis and nonparametric statistical tests. A PA was performed using generalized structural equation modeling toinvestigate the relationship between the variables of interest and the direct and indirect effects of the independent variables and UI according to the theoretical model. Subsequently, the statistical distributions of the variables and the connections were defined for the regression estimation. After the analysis, the model was respecified, excluding the variables and paths that were not statistically significant to determine the best model. The final model was designed after statistical adjustments, corroborating or not with the theoreticalmodel. Results: Urinary incontinence was associated with educational level, marital status, hypertension,one or more difficulties in basic activities of daily living, mood, insomnia, lossof appetite,fecal incontinence, and difficulty swallowing. In the PA, depression and difficulty swallowing were directly associated with urinary incontinence, and urinary incontinence wasdirectly and significantly associated with insomnia and fecal incontinence. Conclusion: Given the variety of social and health components associated with urinary incontinence, it is necessary to assess, prevent, treat, and rehabilitate this condition in Brazilian nursing homes. Interventions in urinary incontinence demand integrated actions in functional, clinical, and mental healthaspects to promote the well-being of older adults living in nursing homes.

Background: Person-centred medicine is recommended in the care of older patients. Yet, involvement of care home residents and relatives in medication processes remains limited in routine care. Therefore, we aimed to develop a complex intervention focusing on resident and relative involvement and interprofessional communication to support person-centred medicine in the care home setting. Methods: The development took place from October 2021 to March 2022 in the Municipality of Aarhus, Denmark. The study followed the Medical Research Council guidance on complex intervention development using a combination of theoretical, evidence-based, and partnership approaches. The patient involvement tool, the PREparation of Patients for Active Involvement in medication Review (PREPAIR), was included in a preliminary intervention model. Study activities included developing programme theory, engaging stakeholders, and exploring key uncertainties through interviews, co-producing workshops, and testing with end-users to develop the intervention and an implementation strategy. The Consolidated Framework for Implementation Research and the Interprofessional Shared Decision Making Model were used. Data were analysed using a rapid analysis approach. Results: Before the workshops, six residents and four relatives were interviewed. Based on their feedback, PREPAIR was modified to the PREPAIR care home to fit the care home population. In total, ten persons participated in the co-producing workshops, including health care professionals and municipal managerial and quality improvement staff. The developed intervention prototype was tested for three residents and subsequently refined to the final intervention, including two fixed components (PREPAIR care home and an interprofessional medication communication template) delivered in a flexible three-stage workflow. Additionally, a multi-component implementation strategy was formed. In line with the developed programme theory, the intervention supported health care professionals´ awareness about resident and relative involvement. It provided a structure for involvement, empowered the residents to speak, and brought new insights through dialogue, thereby supporting involvement in medication-related decisions. The final intervention was perceived to be relevant, acceptable, and feasible in the care home setting. Conclusion: Our results indicate that the final intervention may be a viable approach to facilitate person-centred medicine through resident and relative involvement. This will be further explored in a planned feasibility study. [ABSTRACT FROM AUTHOR]

Background: To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients. Methods: We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention. Results: We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37–4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41–8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24–3.16, p = 0.0042), and number of PIMs use (ꞵ = − 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20–1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75–2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups. Conclusions: The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization. Trial registration: Clinical Research Information Service, KCT0004360. Registered on 21 October 2019. [ABSTRACT FROM AUTHOR]

Background: Transfers to the emergency department can be burdensome for the residents of long‐term residential care facilities (LTRCFs) and often lead to adverse effects. Since March 2019, a nurse‐led acute outreach service unit "Mobile hospital" (in Finnish, Liikkuva sairaala, LiiSa) has been providing on‐site care to LTRCF residents to reduce transfers to the emergency department. Methods: This study compares the numbers and acuities of emergency medical service (EMS) missions carried out in the LTRCFs of Espoo and Kauniainen during two six‐month periods: before the implementation of LiiSa and with LiiSa in use. In Finland, EMS missions are divided into four categories (A–D), with category A missions being the most urgent. These categories were used to investigate the impact on mission acuities. Results: Due to the implementation of LiiSa, the number of EMS missions decreased by 16.8% (95% confidence interval 10.6%–22.6%, p < 0.001), the number of category D missions by 19.8% (7.1%–30.8%, p = 0.003) and the number of category C missions by 30.3% (17.3%–41.3%, p < 0.001). Changes in the numbers of category A and B missions were not statistically significant. Conclusions: LiiSa helped to avoid many transfers of frail LTRCF patients to the emergency department, and it did not hinder the care of patients with true emergencies by EMSs. [ABSTRACT FROM AUTHOR]

We studied the nutritional status of older adult adults receiving home nursing care using demographic data, household category, polypharmacy, and potentially inappropriate medications (PIMs). Cross-sectional study. Two Norwegian municipalities during 2017-2019; home nursing service clients aged ≥70 years. Inclusion of patients and data collection were done by nurses working in the home services. Recorded data were participants' age, sex, living alone or with others, nutritional status (Mini Nutritional Assessment–Short Form and body mass index), regular prescription drugs, and potentially inappropriate medications (PIMs) according to the Norwegian General Practice Nursing home (NORGEP-NH) criteria. Descriptive statistics and logistic regression were used. Of the 270 patients (mean age 84.2 years; 64.8% females; 188 living alone), 25 (9.3%) were malnourished and 154 (57%) at risk of malnutrition; in addition, 14.8% had a BMI <21 and 27.8% had lost weight in the previous 3 months. The odds for being at malnutrition risk was higher if living with others vs living alone: adjusted odds ratio (OR) 2.23 (1.20-4.13). Female sex, older age, and better mobility was associated with living alone. The mean number of regular drugs was 7.3. Overall, 43.3% of the participants used at least 1 PIM. Using 0 to 5 drugs vs ≥6 drugs (polypharmacy) was associated with higher odds for malnutrition risk: adjusted OR 1.97 (1.04-3.75). Compared with well-nourished patients, those at risk for or who were malnourished used fewer cardiovascular and musculoskeletal drugs. Exposure to PIMs was not associated with nutritional status. Two-thirds of home nurse clients were either malnourished or at risk for malnutrition. Living with others or using fewer daily drugs implied increased risk for malnourishment, probably reflecting differences in morbidity and possible inappropriateness of medication use. Future research on nutritional status and medication use should aim for including more clinical data than simple drug counts. [ABSTRACT FROM AUTHOR]

Objective: Hospitalisations are an important indicator of safety and quality of care in residential aged care facilities (RACFs). This study aimed to investigate changes in hospital use 12 months before and 12 months after RACF entry using routinely collected data from 25 Australian RACFs. Methods: This was a retrospective longitudinal cohort study using linked aged care provider and hospital record data. The sample comprised 1029 residents living in an aged care facility between July 2014 and December 2019 who had stayed a minimum of 12 months in an RACF. The outcome measures were all‐cause hospitalisations and fall‐related hospitalisations. We applied an interrupted time series analysis using segmented regression to examine changes in both outcome measures over time. Stratified analyses were conducted by gender and dementia status. Results: The rate of all‐cause hospitalisations increased dramatically over the 12 months before RACF entry, from 97 per 1000 residents per month 12 months prior to RACF admission to 303 per 1000 residents at the second month prior to RACF entry. All‐cause hospitalisations then decreased considerably to 55 per 1000 residents upon RACF admission and stabilised across the next 12 months. Such trajectories were also observed in fall‐related hospitalisations and were consistent for gender and dementia status. Conclusions: In this study, hospitalisation rates decreased significantly after RACF entry, and such reductions were maintained for residents who stayed for 12 months in RACFs. Multiple hospital admissions are likely to precipitate entry into RACF. Additional investigation of how community‐based services can be successful in reducing the escalating hospitalisations is needed. [ABSTRACT FROM AUTHOR]

Abstract Background Primary mental healthcare (PMHC) allows for complex mental health issues in old age to be addressed. India has sought to improve PMHC through legislation, strategies and programmes. This study analyses the challenges and opportunities involved in strengthening PMHC for older persons in India from the perspectives of key stakeholders. Methods Semistructured interviews were conducted with 14 stakeholders selected from the PMHC system in India and analysed using thematic analysis. First, the analysis was organizationally structured in accordance with the six WHO mental health system domains: (1) policy and legislative framework, (2) mental health services, (3) mental health in primary care, (4) human resources, (5) public information and links to other sectors, and (6) monitoring and research. Second, for each building block, challenges and opportunities were derived using inductive coding. Results This study highlights the numerous challenges that may be encountered when attempting to strengthen age-inclusive PMHC. Among these challenges are poor public governance, a lack of awareness and knowledge among policy-makers and other stakeholders, and existing policies that make unrealistic promises to weak primary healthcare (PHC) structures with an excessive focus on medicalizing mental health problems. Thus, the mental health system often fails to reach vulnerable older people through PHC. Established approaches to comprehensive, family- and community-oriented PHC support attempts to strengthen intersectoral approaches to PMHC that emphasize mental health promotion in old age. Targeting the PHC workforce through age-inclusive mental health education is considered particularly necessary. Experts further argue that adequate monitoring structures and public spending for mental health must be improved. Conclusions In this study, we aim to elaborate on the mental healthcare developments that may serve to achieve equity in access to mental healthcare in India. Coordinated and collaborative efforts by public and private stakeholders involved in the care of older persons, both with and without lived mental health experiences, as well as their families and communities, are necessary to bring the vision of those policies for PMHC to fruition. The findings presented in this study can also inform future research, policies and practice in other low- and middle-income countries.

This article explores the crucial and frequently disregarded domain of men’s health as they age, specifically focusing on the consistently increased rates of mortality among males worldwide. Although men display increased cardiovascular risk factors and higher rates of injury, there persists an inequity in the focus given to men’s health in comparison to women’s health. Given the projected increase in the global population of individuals aged 60 and beyond, it is essential to emphasize healthcare for elderly males. Initially grounded in andrology and urology, the World Health Organization has broadened the definition of men’s health to include overall well-being, encompassing physical, mental, and social aspects. Given the increasing life expectancy and the corresponding increase in age-related conditions, adopting a multidisciplinary approach involving a range of healthcare providers is crucial. The review examines critical elements of health in aging men, including genitourinary infections, cardiovascular diseases, malignancies, stress-coping strategies, and the distinct challenges associated with urological issues and sexual health in elderly males.

Background: Due to the lack of studies, the long-term prognoses of unfit patients with gastric cancer (GC) who did not receive any aggressive cancer treatment (best supportive care [BSC] cases) remain unclear, especially for those with potentially curable GC. We conducted this observational study to capture the real-world data of characteristics and outcomes for BSC cases. Method: Consecutive clinical records of patients with GC diagnosed at Steel Memorial Muroran Hospital from January 2017 to December 2021 were analyzed. Result: Of 481 patients diagnosed with GC, 91 (18.9%) were BSC cases. The median overall survival (OS) was 12.4, 8.3, and 2.5 months for clinical stage (cStage) I, II?III, and IV, respectively. Patients with potentially curable GC (cStage I?III) had significantly longer OS than those with incurable disease (cStage IV), with a hazard ratio for death of 0.29 (95% confidence interval: 0.18?0.47). Conclusion: Our report provides useful information for decision-making for unfit patients with GC in daily clinical practice.

Background: Primary mental healthcare (PMHC) allows for complex mental health issues in old age to be addressed. India has sought to improve PMHC through legislation, strategies and programmes. This study analyses the challenges and opportunities involved in strengthening PMHC for older persons in India from the perspectives of key stakeholders. Methods: Semistructured interviews were conducted with 14 stakeholders selected from the PMHC system in India and analysed using thematic analysis. First, the analysis was organizationally structured in accordance with the six WHO mental health system domains: (1) policy and legislative framework, (2) mental health services, (3) mental health in primary care, (4) human resources, (5) public information and links to other sectors, and (6) monitoring and research. Second, for each building block, challenges and opportunities were derived using inductive coding. Results: This study highlights the numerous challenges that may be encountered when attempting to strengthen age-inclusive PMHC. Among these challenges are poor public governance, a lack of awareness and knowledge among policy-makers and other stakeholders, and existing policies that make unrealistic promises to weak primary healthcare (PHC) structures with an excessive focus on medicalizing mental health problems. Thus, the mental health system often fails to reach vulnerable older people through PHC. Established approaches to comprehensive, family- and community-oriented PHC support attempts to strengthen intersectoral approaches to PMHC that emphasize mental health promotion in old age. Targeting the PHC workforce through age-inclusive mental health education is considered particularly necessary. Experts further argue that adequate monitoring structures and public spending for mental health must be improved. Conclusions: In this study, we aim to elaborate on the mental healthcare developments that may serve to achieve equity in access to mental healthcare in India. Coordinated and collaborative efforts by public and private stakeholders involved in the care of older persons, both with and without lived mental health experiences, as well as their families and communities, are necessary to bring the vision of those policies for PMHC to fruition. The findings presented in this study can also inform future research, policies and practice in other low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the value of the neutrophil-to-lymphocyte ratio (NLR), B-type natriuretic peptide (BNP), and D-dimer (D-D) in predicting pneumonia severity in older adults with community-acquired pneumonia (CAP). Methods: The retrospective study included older adults with CAP at the General Hospital of Northern Theater Command from January 2017 to December 2019. Patient demographic information and clinical characteristics were collected. Logistic multivariable analysis was used to analyze the factors associated with CAP severity. Receiver operating curve (ROC) analysis was used to evaluate the value of each biomarker in severity prediction. Results: A total of 158 patients were included: 85 with mild-moderate CAP and 73 with severe CAP. The multivariable logistic analysis showed that CRP (OR = 1.011; 95% CI: 1.011 - 1.022; p = 0.039), BNP (OR = 1.003; 95% CI: 1.001 - 1.004; p = 0.001), D-D (OR = 1.289; 95% CI: 1.031 - 1.611; p = 0.026), and NLR (OR = 1.111; 95% CI: 1.011 - 1.222; p = 0.030) were independent factors associated with pneumonia severity. ROC analysis demonstrated the value of each biomarker in pneumonia severity prediction: CRP (AUC = 0.791, 95% CI: 0.720 - 0.861), BNP (AUC = 0.803, 95% CI: 0.649 - 0.806), D-D (AUC = 0.727, 95% CI: 0.734 - 0.872), and NLR (AUC = 0.817, 95% CI: 0.751 - 0.883). The positive and negative predictive values were 0.68 and 0.81 for CRP, 0.79 and 0.75 for BNP, 0.62 and 0.80 for D-D, and 0.80 and 0.76 for NLR. Conclusions: CRP, BNP, D-D, and NLR might be helpful independent factors in predicting pneumonia severity in older adults with CAP. [ABSTRACT FROM AUTHOR]

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Abstract Background Socially assistive devices (care robots, companions, smart screen assistants) have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. One of the most prevalent arguments in the debate is the double-benefit argument claiming that socially assistive devices may not only provide benefits for autonomy and well-being of their users but might also be more efficient than other caring practices and might help to mitigate scarce resources in healthcare. Against this background, we used a subset of comparative empirical studies from a comprehensive systematic review on effects and perceptions of human-machine interaction with socially assistive devices to gather and appraise all available evidence supporting this argument from the empirical side. Methods Electronic databases and additional sources were queried using a comprehensive search strategy which generated 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 39 reports using a comparative study design, a narrative synthesis was performed. Results The data shows positive evidential support to claim that some socially assistive devices (Paro) might be able to contribute to the well-being and autonomy of their users. However, results also indicate that these positive findings may be heavily dependent on the context of use and the population. In addition, we found evidence that socially assistive devices can have negative effects on certain populations. Evidence regarding the claim of efficiency is scarce. Existing results indicate that socially assistive devices can be more effective than standard of care but are far less effective than plush toys or placebo devices. Discussion We suggest using the double-benefit argument with great caution as it is not supported by the currently available evidence. The occurrence of potentially negative effects of socially assistive devices requires more research and indicates a more complex ethical calculus than suggested by the double-benefit argument.

The Integrated Home Assistance Service (IHAS) was created to provide integral home care for elderly people who are unable to go to the health care units of the Brazilian Navy. A cross-sectional, quantitative, and descriptive study was carried out to evaluate the general health and dental hygiene profile of these patients. The study included elderly people aged 60 years or older who were assisted between February 2017 and December 2022. Most of them were long-lived, with a mean age of 82.52 (±8.66) years, women (63.52%) and totally dependent on performing basic activities of daily living (88.9%). The most common diagnosis among them was dementia syndrome, accounting for 44.3% of cases. Additionally, a large portion of the elderly had associated comorbidities (71.9%), with Systemic Arterial Hypertension (59.2%) and Diabetes Mellitus (28.9%) as the most recurrent conditions. The study found a high prevalence of elderly with unsatisfactory (34.7%) or irregular (57.2%) oral hygiene. Nevertheless, there was no significant association between dental hygiene and comorbidities or the degree of dependence. Therefore, it is imperative that elderly people living at home receive guidance and undergo meticulous and ongoing monitoring, in conjunction with their caregivers to promote improvements in the oral hygiene of these patients.

Abstract Background Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question “What matters to you?”. However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home. Methods Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis. Results Overall, there was considerable correspondence between the four stakeholder groups’ perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) “self-reliance – living independently at home as long as possible”; (2) “remaining active and social within the community”; (3) “support for living at home as long as possible”; (4) “accessible information and services”; (5) “continuity of services”; and (6) “compassionate and competent healthcare professionals”. Conclusions In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens’ autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens’ needs.

BackgroundEvidence-based interventions addressing loneliness and social isolation are needed, including among low-income, community-dwelling older adults of diverse racial and ethnic backgrounds. Our objective was to assess the effect of a peer intervention in addressing loneliness, isolation, and behavioral health needs in this population.MethodsWe conducted a mixed-method, two-year longitudinal study of a peer-outreach intervention in 74 low-income older adults recruited via an urban senior center in San Francisco. Structured participant surveys were conducted at baseline and every 6 months for up to 2 years. Outcomes included loneliness (3-item UCLA loneliness scale), social interaction (10-item Duke index), self-perceived socializing barriers (range: 0-10), and depression (PHQ-2 screen). Data were analyzed using mixed-effects linear and logistic regression adjusted for age and gender. Qualitative, semi-structured interviews with participants (N = 15) and peers (N = 6) were conducted in English and Spanish and analyzed thematically.ResultsParticipants were on average 71 years old (range: 59-96 years), with 58% male, 15% LGBT, 18% African American, 19% Latinx, 8% Asian, 86% living alone, and 36% with an ADL impairment. On average, 43 contact visits (IQR: 31-97 visits) between participants and peers occurred over the first year. Loneliness scores decreased by, on average, 0.8 points over 24 months (p = 0.015). Participants reported reduced depression (38%-16%, p

Background/objectivesElectronic Health (eHealth) tools offer opportunities for people to access health information online; yet, most tools are not designed to meet the unique needs of diverse older adults, leading to health disparities. Our goal was to provide guidance for the development of eHealth tools for diverse older populations for use in geriatric care models.DesignGuidance for eHealth tools was compiled from user design resources and eHealth design literature. Pragmatic examples were provided from an evidenced-based eHealth tool called PREPAREforYourCare.org (PREPARE). We used quantitative feasibility data from PREPARE research studies and qualitative analysis of PREPARE focus groups, cognitive interviews, and feedback from randomized trials to further inform our recommendations.ResultsGuidance and lessons learned include: (1) define clear objectives and a conceptual framework; (2) co-create with the target population; (3) optimize the design and layout for accessibility and ease of use, such as text at the 5th grade reading level, closed captioning, etc.; (4) use simple, standardized navigation design; (5) use actionable information to enhance behavior change, such as modeling of behaviors; (6) align accompanying written materials with the eHealth tool; and (7) create tracking mechanisms for ongoing user feedback. PREPARE is used as a case example to provide pragmatic illustrations for how the guidance may be operationalized.ConclusioneHealth tools can be tailored to the unique characteristics, preferences, and needs of diverse older populations. Following the "lessons learned" may help decrease health disparities among diverse older adults and ensure eHealth tools are readily accessible and culturally appropriate.

Background The recurrence rate of late-life depression is high, however, there is a lack of research on intervention protocol to prevent recurrence of late-life depression at home and abroad.In the early stage, the research group explored the risk factors for recurrence of late-life depression, and the controllable risk factors were poor medication compliance, less physical activity, and less eating. Objective To search, evaluate and summarize the evidence related to the prevention of recurrence of late-life depression based on the above three risk factors. Methods In October 2022, the evidences related to the prevention of recurrence of late-life depression were searched in Web of Science, PubMed, Cochrane Library, American Guide Network, British Guidebook, Website of Registered Nurses Association of Ontario (RNAO), Evidence-based Nursing Center of Fudan University, CNKI and other databases from inception to October 2022, which include guidelines, systematic reviews, expert consensuses, evidence summaries, etc. The quality of the included guidelines, systematic reviews, expert consensuses and original researches were evaluated by investigators trained in systematic evidence-based medicine using the Appraisal of Guidelines for Research & EvaluationⅡ (AGREEⅡ) Instrument, AMSTAR, and the Australian Joanna Briggs Institute (JBI) evidence-based center evaluation standards (2016 version), respectively. Finally, the 2014 Australian JBI evidence-based health care center evidence grading and recommendation level system was used to summary, evaluate and grade the evidence. Results A total of 15 articles were included, including 3 guidelines, 11 systematic reviews and 1 RCT. The qualities of the 3 guidelines were graded as B or above, the qualities of 11 systematic reviews were graded as medium or above, and the quality of 1 RCT was graded as B. A total of 24 best evidence items were summarized from 6 aspects of intervention evaluation, diets and nutrition, exercise and rehabilitation training, psychosocial interventions, medication compliance, and effect evaluation. Conclusion The study summarizes the best evidence for prevention of late-life depression, suggesting that clinical staff should comprehensively evaluate the patients, and develop individualized intervention program focus on evaluation, diets and nutrition, exercise and rehabilitation training, medication compliance guidance, and psychosocial interventions, combining with the characteristics of patients and diseases.

Abstract Background Questions of equitable access to primary mental healthcare (PMHC) for older persons in India have been examined mostly in terms of the coverage of services, although perceptions of mental health and old age and social norms at the community level should be considered in the shaping of PMHC approaches. The present qualitative study, therefore, examined how social perceptions and norms of mental health in old age are and should be considered in the design and implementation of primary healthcare approaches in India. Methods A secondary thematic analysis of semi-structured interviews with key stakeholders (n = 14) of PMHC in India was conducted. Results Four key themes emerged from the analysis, in which social perceptions and norms were discussed: (1) family participation and low threshold access to mental healthcare, (2) the position of community health workers as an important pillar of old age and mental health-sensitive community-based care, (3) the role of social cohesion and traditional values in fostering a positive and supportive community environment for old age mental health, and (4) the empowerment of communities, families and older persons through mental health education. Conclusions PMHC, with its focus on mental health promotion, could be an important anchor for combatting negative attitudes about mental health and old age. The findings presented in this study can inform age-sensitive policies and programmes for mental health in India and could inform future research on the subject.

Background: Socially assistive devices (care robots, companions, smart screen assistants) have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. One of the most prevalent arguments in the debate is the double-benefit argument claiming that socially assistive devices may not only provide benefits for autonomy and well-being of their users but might also be more efficient than other caring practices and might help to mitigate scarce resources in healthcare. Against this background, we used a subset of comparative empirical studies from a comprehensive systematic review on effects and perceptions of human-machine interaction with socially assistive devices to gather and appraise all available evidence supporting this argument from the empirical side. Methods: Electronic databases and additional sources were queried using a comprehensive search strategy which generated 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 39 reports using a comparative study design, a narrative synthesis was performed. Results: The data shows positive evidential support to claim that some socially assistive devices (Paro) might be able to contribute to the well-being and autonomy of their users. However, results also indicate that these positive findings may be heavily dependent on the context of use and the population. In addition, we found evidence that socially assistive devices can have negative effects on certain populations. Evidence regarding the claim of efficiency is scarce. Existing results indicate that socially assistive devices can be more effective than standard of care but are far less effective than plush toys or placebo devices. Discussion: We suggest using the double-benefit argument with great caution as it is not supported by the currently available evidence. The occurrence of potentially negative effects of socially assistive devices requires more research and indicates a more complex ethical calculus than suggested by the double-benefit argument. [ABSTRACT FROM AUTHOR]

Enhancing access to care using telehealth is a priority for improving outcomes among older adults with heart failure, increasing quality of care, and decreasing costs. Telehealth has the potential to increase access to care for patients who live in underresourced geographic regions, have physical disabilities or poor access to transportation, and may not otherwise have access to cardiologists with expertise in heart failure. During the COVID-19 pandemic, access to telehealth expanded, and yet barriers to access, including broadband inequality, low digital literacy, and structural barriers, prevented many of the disadvantaged patients from getting equitable access. Using a health equity lens, this scientific statement reviews the literature on telehealth for older adults with heart failure; provides an overview of structural, organizational, and personal barriers to telehealth; and presents novel interventions that pair telemedicine with in-person services to mitigate existing barriers and structural inequities. [ABSTRACT FROM AUTHOR]

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Background: Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question "What matters to you?". However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home. Methods: Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis. Results: Overall, there was considerable correspondence between the four stakeholder groups' perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) "self-reliance – living independently at home as long as possible"; (2) "remaining active and social within the community"; (3) "support for living at home as long as possible"; (4) "accessible information and services"; (5) "continuity of services"; and (6) "compassionate and competent healthcare professionals". Conclusions: In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens' autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens' needs. [ABSTRACT FROM AUTHOR]