Community-based mobile health (mHealth) services are increasingly used to support chronic disease management in underserved rural populations facing workforce shortages, geographic isolation, and rapid aging. South Korea entered a super-aged society in December 2024, intensifying pressures in rural regions where multiple mHealth programs are embedded within primary care and public health systems. However, evidence on sustained use in real-world settings remains limited. This study aimed to explore user experiences and acceptance of community-based mHealth services in an underserved rural area of South Korea and identify facilitators and barriers to sustained engagement, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). A convergent mixed methods design was used, with qualitative and quantitative data collected in parallel, analyzed separately, and integrated at the interpretation stage. Overall, 24 participants with ≥6 months of experience using 1 of 4 publicly funded mHealth services in Pyeongchang County, Gangwon State, were purposively recruited. Semistructured interviews guided by the UTAUT2 were analyzed using directed content analysis, combining deductive and inductive coding. Structured questionnaires assessing usability and behavioral intention were analyzed using descriptive statistics. Findings were integrated through joint interpretation. Participants had a mean age of 71.3 (SD 9.2) years, and 70.8% (17/24) were female; hypertension (18/24, 75%) and hyperlipidemia (15/24, 58.3%) were the most common. Perceived difficulty was low (mean 2.54, SD 2.06, on a 0-10 scale), intention for continued use was high (23/24, 95.8%), and recommendation intention was unanimous (24/24, 100%). Willingness to pay was reported by 79.2% (19/24), most commonly KRW 1000-5000 (US $1-3) per month. Qualitative findings identified performance expectancy, social influence, facilitating conditions, and habit as the most salient determinants of sustained use. Real-time monitoring enhanced health awareness, motivated dietary modification, and increased physical activity. Public health center nurses served as human-in-the-loop facilitators, providing continuous training, troubleshooting, and emotional support, while family and peers reinforced engagement. Habit formation emerged as a central mechanism, with 91.7% (22/24) integrating mHealth use into routines anchored to waking, exercise, and bedtime. Effort expectancy barriers among older participants were mitigated through nurse-led training, and hedonic motivation was driven by intrinsic satisfaction and peer interaction. Integrated analysis showed convergence for ease of use and behavioral intention, and partial divergence for willingness to pay. Community-based mHealth services were successfully integrated into daily life and supported chronic disease self-management among older adults in an underserved rural setting. Sustained engagement was driven by perceived health benefits, continuous human support, and habit formation rather than technology features alone, underscoring the importance of relationship-centered, human-in-the-loop implementation models. Strengthening intuitive design, hands-on onboarding, multidisciplinary primary care teams, and stable financing will be essential for equitable digital health adoption in rural and aging communities.
Population aging has become a critical global challenge, with South Korea entering a super-aged society and facing rapidly increasing health care demands. In response, digital health care devices have emerged as promising tools for supporting personalized health management and improving health care accessibility among older adults. However, despite their potential, adoption rates among older adults remain relatively low. Prior research based on the Technology Acceptance Model (TAM) has largely relied on variable-centered approaches, overlooking substantial heterogeneity in acceptance patterns among older adults. A person-centered segmentation approach is therefore needed to identify diverse acceptance profiles. Few studies have integrated the augmented TAM with K-means clustering to identify acceptance-based segments in this population. This study aims to segment older adults based on their acceptance patterns toward digital health care devices by integrating the TAM framework with data-driven clustering techniques. A cross-sectional survey was conducted with 349 adults aged 65 years and older who were recruited from older adult welfare centers and community facilities in the Seoul metropolitan area of South Korea. We measured 10 constructs within an augmented TAM framework: 2 core constructs (perceived usefulness, perceived ease of use), 6 extended constructs (compatibility, privacy, self-efficacy, price consciousness, health empowerment, attitude toward digital health care), 1 health-related construct (health threat susceptibility), and intention to use as the outcome. Principal component analysis (PCA) and K-means clustering were used to identify latent segments. The number of components was determined using parallel analysis and the Kaiser criterion, and the optimal number of clusters was validated using the silhouette coefficient. Robustness was further assessed through 100-seed stability analysis and PCA sensitivity tests. We identified 2 principal components, and a 4-cluster solution was selected (K=4, silhouette coeffficient=0.383). The analysis revealed 4 distinct segments: core adopters (57/349, 16.3%), who scored highest across all constructs; potential adopters (64/349, 18.3%), who recognized the value of digital health care devices but exhibited low self-efficacy and perceived ease of use; neutral majority (159/349, 45.6%), who showed near-average scores; and rejecters (69/349, 19.8%), who scored negatively across all dimensions. Robustness checks confirmed high clustering reliability (94%-99% agreement). Notably, potential adopters represented a critical target group, as their acceptance barriers stemmed from capability constraints rather than lack of motivation. This group combined high perceived usefulness (+0.50) with the lowest self-efficacy (-1.07) and perceived ease of use (-0.83). This study demonstrated that technology acceptance among older adults is heterogeneous rather than uniform and highlights the importance of segment-specific strategies. By integrating theory-driven acceptance constructs with unsupervised machine learning, the study provides a practical framework for identifying actionable user segments and designing tailored diffusion strategies. These findings offer important implications for policymakers, technology developers, and health care professionals seeking to facilitate inclusive adoption of digital health care technologies in aging societies.
Health care service providers face increasing challenges in delivering high-quality care due to an aging population, workforce shortages, and limited financial budgets. Mobile Integrated Healthcare (MIH) offers an alternative value-based solution for elderly patients with manageable acute conditions at home. Finland is piloting this model, but its value, task redesign, and cost-efficiency require thorough evaluation before formal integration. This study explores the value of MIH for patients and the health care system through the lens of value creation, delivery, and capture. Qualitative data were collected via semistructured interviews with 21 frontline health care professionals (HCPs) involved in Finland's MIH service. MIH provides human-centered acute care for the elderly, enabling convenient access to emergency services at home and reducing unnecessary hospital visits. Value is cocreated through integrated networks of emergency and social services, leveraging paramedics' and geriatric nurses' expertise while standardizing care pathways. Effective implementation requires coordination and task-shifting across emergency departments, MIH teams, and social care providers. MIH enhances care quality, supports elderly independence, and contributes to the sustainability of the health care system by reducing emergency interventions and hospitalizations. Health managers should prioritize skill development for health care professionals (HCPs), integration across governance, service, HCPs, and patient levels, and the establishment of coordinated information systems. This study offers policymakers a valuable example of how MIH can be organized within a collective, publicly funded health care system to promote equity, accessibility, and sustainability for value-based health care.
The trend of demographic change is irreversible, and the aging of the rural population has become a significant factor undermining the foundations of food security. The relationship between this phenomenon and land ecosystems has not yet been thoroughly explored. To address this research gap, this study constructs an analytical framework of 'aging-factor allocation-ecological security' to empirically examine the impact of rural population aging on land ecological security and its underlying mechanisms. The results indicate that aging exerts a significant negative impact on land ecological security; however, within the pathway through which aging influence land ecological security, aging promotes land ecological security by facilitating the adoption of agricultural production services, increasing land transfers, expanding large-scale farming operations, and adjusting crop patterns. The results of the heterogeneity analysis indicate that the impact of rural population aging on land ecological security varies. The negative impact of aging on land ecological security is more pronounced in western regions, areas with rugged terrain, among those with a medium level of education, and in sample groups not experiencing a low birth rate. This finding provides a rationale for policy interventions, suggesting that increasing inputs into productive agricultural services, promoting land transfer and large-scale operations, and increasing subsidies for planting food may be important pathways to improving land ecology and increasing food security.
Effective health-promoting interventions can support older adults in maintaining and regaining good health and can foster healthy aging. The Reflective STRENGTH-Giving Dialogues (STRENGTH) intervention was created to optimise a holistic healthcare delivery that supports older adults in learning to live with long-term musculoskeletal pain. Findings from previous studies indicate that the dialogues contributed to an increased sense of well-being and had an immediate pain-alleviating effect. The aim of this extended study was to explore the health effects of the STRENGTH intervention among older community-dwelling adults living with long-term health problems. Older adults (n = 47) in Sweden completed questionnaires inquiring about levels of well-being, impact of health problems on daily life, depression symptom occurrences, health-related quality of life, physical performance, and consumption of care using a quasi-experimental design. Descriptive statistics were used to explain and compare results within groups. Data were collected before, during, and after the STRENGTH intervention in autumn 2017 and spring 2018. It consisted of health-care professionals engaging in recurrent dialogues to guide and support older adults in ways that increase sense of well-being, joy, strength, and meaning in life through carrying out small and large life projects. According to self-reports, the STRENGTH intervention had immediate positive effects on perceived well-being and health problems. From a longitudinal perspective, although no significant differences in health outcomes were found based on comparisons of baseline and follow-up data within groups, positive effects were shown. To contribute to healthy aging, HCPs need favourable conditions for conversations in care encounters, extensive knowledge about the importance and potential of dialogues, and an understanding of how to integrate dialogues into health and social care.
Maternal sleep deprivation (MSD) is a common but usually unnoticed issue during pregnancy, and in recent years, it has been increasingly recognised as an important prenatal stressor that may adversely influence maternal physiology, placental function, and fetal neurodevelopment. Sleep disturbances during pregnancy, including reduced sleep duration, fragmented sleep, poor sleep quality, circadian disruption, and rapid eye movement sleep restriction, have been associated with altered hypothalamic-pituitary-adrenal axis activity, systemic inflammation, oxidative stress, and impaired circadian regulation. Emerging evidence from clinical and preclinical studies suggests that these alterations may affect fetal neurogenesis, synaptic development, neuroimmune signaling, and maturation of brain circuits involved in cognition and emotional regulations. Within the framework of the Developmental Origins of Health and Disease, maternal sleep disturbances may contribute to epigenetic modifications, mitochondrial dysfunction, microglial activation, and altered neuroplasticity-related pathways, which are increasingly implicated in long-term neurological vulnerability. Experimental findings further indicate that prenatal sleep disruption may impair offspring cognitive performance, emotional behavior, and stress responsiveness, while potentially influencing biological pathways associated with brain aging-related processes. However, the extent to which MSD directly contributes to pathological brain aging in humans remains incompletely understood. Factors such as timing and duration of exposure, sex-specific responses, and postnatal environmental conditions may further influence offspring outcomes. Therefore, this narrative review critically summarizes current evidence regarding MSD and examines the molecular, cellular, and neurodevelopmental mechanisms through which prenatal sleep disturbances may influence long-term neurological health and vulnerability to brain aging-associated alterations in offspring.This graphical abstract illustrates the mechanistic framework connecting maternal sleep deprivation to the developmental programming of brain aging in offspring. [ MSD: maternal sleep deprivation; DOHaD: Developmental Origins of Health and Disease; 11β HSD2: 11β hydroxysteroid dehydrogenase type 2; ROS: reactive oxygen species; REM: rapid eye movement; HPA axis: hypothalamic pituitary adrenal axis; BDNF: brain derived neurotrophic factor].
For people in old age, the risk of limitations in activities of daily living (ADL), low physical performance, and chronic diseases increases. Home rehabilitation targeting physical performance is a common intervention for older people with multimorbidity. Still research on home rehabilitation is mainly diagnosis specific. The objectives of this study were to summarize intervention components and evaluate the effects of home rehabilitation on ADL and physical performance in community-dwelling older people (65 years or older) with low physical performance and/or ADL difficulties. The databases MEDLINE, Web of Science, and CINAHL (January 2006-September 2025), plus references were screened, using keywords related to aging, home rehabilitation, ADL, and physical performance in randomized controlled trials (RCTs). RCTs of supervised home rehabilitation, targeting physical performance and/or basic and/or instrumental ADL (BADL/IADL) in community-dwelling people 65 years of age or older with low physical performance and/or ADL difficulties. scope of specific diagnoses, assisted living settings, centre-based, interventions areas outside the occupational therapy or physiotherapy disciplines, mainly delivered by home help service staff, exclusively outcomes outside the scope of ADL and physical performance conducted at home or non-English publications. 3,360 records were screened independently by two reviewers. Data extraction followed the PROSPERO protocol. Methodological quality was assessed using the Joanna Briggs Institute RCT checklist (2020) (JBI), and certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Random effects models generated pooled effects. The review included 27 RCTs (n = 4,948), which were grouped into three intervention approaches. Twenty-three studies were graded as having low risk of bias, three as moderate risk of bias, and one of high risk of bias, using the JBI tool. The age of the participants ranged from 74 to 87 years of age. Activity-based interventions improved BADL (n = 1,048, SMD 0.29, 95% CI 0.17 to 0.41, P<.001; moderate evidence) but not IADL (n = 603, SMD - 0.15, 95% CI - 0.31 to 0.01) or selected ADL tasks (n = 158, non-significant). Exercise-based interventions improved BADL and physical performance (n = 310, SMD 0.43, 95% CI 0.21 to 0.66, P<.001; n = 1,472, SMD 0.20, 95% CI 0.10 to 0.30, P<.001), with low evidence due to imprecision and risk of bias according to GRADE. Reablement-based interventions showed no significant effects on selected ADL tasks measured with Canadian Occupational Performance Measure (COPM) (n = 291, COPM performance MD 0.30, 95% CI - 0.25 to 0.86; COPM satisfaction MD 0.19, 95% CI - 0.04 to 0.42) or physical performance (n = 555, SMD 0.12, 95% CI - 0.05 to 0.28), with low to very low evidence according to GRADE. Home rehabilitation comprises three main intervention approaches. The Activity-based and Exercise-based yield small improvements in BADL and physical performance. Evidence for other ADL outcomes and the Reablement-based remains limited. PROSPERO (CRD42023488726).
Assessing mortality levels, causes of death and associated risk factors is critical for strengthening health systems and guiding targeted health interventions. We examined overall and cause-specific mortality and their associated risk factors among middle-aged and older adults in a rural, rapidly transitioning South African setting. Data were drawn from the Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community (HAALSI) cohort. Risk factors for mortality from 2014/2015 to 2021 were analysed using Cox-Proportional Hazards and Fine and Gray competing-risk models. The 5059 adults aged 40 years and older at enrolment in the HAALSI cohort in 2014/2015 experienced 1116 (22.1%) deaths over 28 955 person-years of follow-up by 2021. Overall, mortality was higher in men (48.3 deaths per 1000 person-years) than women (30.7 deaths per 1000 person-years). Risk of death increased with age and was significantly associated with male sex, lower education, history of smoking or alcohol use, poor self-rated health, underweight, limitations in activities of daily living, slower walk speed, lower grip strength and histories of hypertension, diabetes, stroke, tuberculosis and unsuppressed Human Immunodeficiency Virus (HIV) infection. Cardiovascular diseases were the leading causes of death (30.3%) in both men (25.9%) and women (35.8%), followed by other infectious diseases (23.8%), neoplasms (14.4%), HIV/AIDS and tuberculosis (10.1%). These findings highlight the dual mortality burden from non-communicable and infectious diseases among older adults in rural South Africa. Integrated interventions targeting non-communicable diseases, infectious diseases and physical function are urgently needed to reduce premature mortality and improve health outcomes.
The Health Assessment Tool (HAT) is a validated instrument designed to comprehensively assess the health of older adults. This study examinedthe feasibility and acceptability of implementing the HAT in Swedish primary care, while exploring older patients' needs and professional perspectives, drawing on experiences from a multicenter prospective validation study. A qualitative design was employed using reflexive thematic analysis. Data were collected through semi-structured interviews with patients and healthcare managers, and a focus group discussion with healthcare staff familiarized with the HAT in six Swedish primary care centers. Analysis followed Braun and Clarke's six-phase thematic approach, integrating inductive and deductive reasoning. The analysis constructed one overarching theme: 'For the needs left waiting, the HAT is a feasible bridge to holistic care of older adults', supported by two main themes: 'Voices of aging, unmet needs unveiled' and 'The HAT: a dependable compass for decision making in the care of older people'. Findings revealed challenges for older adults, including rapid health decline, loss of independence, loneliness, and gaps in primary care. The HAT was positively received for its comprehensive, person-centered approach, despite some concerns regarding time required for its assessment. The HAT was perceived as feasible and acceptable by older patients and healthcare providers, with the potential to transform care of older adults through proactive, holistic assessments. Its use may foster collaboration between health and social care professionals, a key prerequisite for meeting the complex needs of older people. Future research should evaluate a HAT-based model to support its integration into routine primary care.
ObjectivesSocial security benefits are associated with better psychological health among older adults in resource-limited settings, yet the mechanisms underlying this association remain underexplored. We examined the role of healthcare accessibility in the relation between social security benefits and psychological health among older adults in Tanzania.MethodsWe analyzed cross-sectional data from a 2024 survey of Tanzanian adults aged 60 and above (n = 2,012) in four geographic zones. We examined associations using structural equation modeling (SEM) with bias-corrected bootstrapping (5,000 replications). Social security benefits (combining pension and health insurance receipt), self-reported healthcare accessibility, and psychological health (a composite of anxiety and depression symptoms) were included as primary variables.ResultsSocial security benefit receipt was significantly associated with better psychological health (β = -0.106, BCCI: -0.152, -0.060, p < 0.001). Healthcare accessibility was positively associated with psychological health and showed a significant association with the relationship between social security benefits and psychological health (β = -0.057, BCCI: -0.092, -0.022, p < 0.01), consistent with an indirect association in this cross-sectional analysis.ConclusionsHealthcare accessibility plays a significant role in the relation between social security benefits and psychological health, suggesting a pathway through which social security benefits may influence psychological health beyond direct financial mechanisms. These findings point to potential policy considerations, including administrative coordination between pension and health insurance schemes and interventions to improve healthcare accessibility for older adults. For low- and middle-income countries facing rapid population aging, integrated approaches to social security benefits and health systems may help maximize the health returns of social investments.
Background: Previous research has confirmed that dietary diversity is positively linked to mental health outcomes in older populations. Nevertheless, relevant evidence focusing specifically on Chinese older adults remains limited, and the internal mechanisms underlying this association I confirm. are not fully understood. Against this background, this study intended to investigate the association between dietary diversity and mental health among Chinese older individuals, explore the chain mediating roles of sleep quality and self-perceived quality of life, and further test whether gender moderates the above direct and mediating pathways. Methods: Using 2018 CLHLS data, 10,089 older adults aged 60 and above were selected as valid samples. Pearson correlation analysis was employed to determine the relationships between key variables. Hayes' PROCESS macro Model 6 was used for baseline serial mediation analysis, and Model 85 was used for moderated serial mediation with gender as the moderator, adopting 5000 bootstrap samples. Results: The results revealed significant positive correlations (p < 0.01) between key variables, including dietary diversity, sleep quality, self-rated quality of life, and mental health. Model 6 showed that dietary diversity serves as a positive and significant predictor of mental health (B = 0.130, p < 0.001). Three significant mediating pathways were identified through which dietary diversity affects mental health: (1) sleep quality (B = 0.076, 95% CI: 0.062, 0.092), (2) self-rated quality of life (B = 0.100, 95% CI: 0.083, 0.118), and (3) sleep quality and self-rated quality of life (B = 0.020, 95% CI: 0.016, 0.025). The total mediating effect of the three pathways reached 59.94%. Model 85 found that the interaction term of dietary diversity x gender was non-significant (p > 0.05), demonstrating no statistically significant gender moderation of any pathway. Gender-stratified conditional effects revealed numerical differences across subgroups. Conclusions: Higher dietary diversity is significantly correlated with better mental health among Chinese older adults. Sleep quality and self-rated quality of life play significant roles as serial mediators in this association. Although gender does not statistically moderate the whole association mechanism, subtle gender heterogeneity exists in the pathway effect magnitude. The above findings offer novel insights into the underlying mechanisms. Strategies aimed at improving dietary diversity, combined with targeted interventions to enhance sleep quality and self-rated quality of life, with slight gender-differentiated auxiliary suggestions, may effectively promote mental health and contribute to active aging in later life.
The global aging population is rapidly increasing, prompting the United Nations to declare the "Decade of Healthy Aging" (2021-2030) to improve the quality of life for older adults. Health-related quality of life (HRQoL) is crucial in this context, and the International Classification of Functioning, Disability and Health (ICF) provides a standardized framework for its evaluation. This study aimed to apply a previously proposed method for converting SF-36 domain scores into ICF qualifiers in community-dwelling older adults attending primary care services in a middle-income country, describing the resulting classification of functioning domains using standardized ICF qualifiers. A cross-sectional study was conducted with older adults aged 60 and above who accessed primary healthcare services and had no cognitive impairment. Participants underwent HRQoL assessment using the SF-36, and ICF codes previously linked to SF-36 domains were classified using ICF qualifiers. A simple calculation method was developed to convert SF-36 scores into ICF qualifiers. The study included 52 participants, with a mean age of 71.6 ± 7.0 years, 92.3% of whom were women. The ICF framework qualified 27 codes from SF-36 domains. Moderate impairments were observed in "Bodily Pain," "General Health," and "Vitality" domains, while "Physical Functioning," "Social Functioning," and "Mental Health" domains showed mild impairments. No impairments were noted in the "Role Physical" and "Role Emotional" domains. The application of ICF qualifiers to SF-36 domain scores yielded standardized classifications of HRQoL domains across the ICF framework, allowing HRQoL outcomes to be described according to the severity levels defined by the ICF qualifier scale.
With the ever-increasing globalizing of aging, chronic comorbidity has become both common among the old population. The senile comorbidities pose as notable challenges of escalation of medication and medical expenditures, and loss in the quality of life of the mature patients. The increase in medication literacy would help reduce the land of unsafe drug administration, unfavorable feelings, and also improve the treatment rates among persons. But there is variation in the rate of medication literacy among the older adults living with varying comorbidities of chronic diseases. Thus, this paper utilizes latent profile analysis to segment medication literacy in this population group in an attempt to clarify the features that accompany medication Literacy among the older adults who with the presence of chronic comorbidities. Additionally, it discusses factors that contribute to medication literacy when using different types of chronic conditions, hence developing theoretical underpinnings to the upcoming individualized medication literacy interventions programs as per older adults patients with chronic comorbidities. The study is a cross-sectional study of 611 hospitalized patients over the age of 60 years with chronic comorbidities through Grade III hospitals in Shizuishan City in the period between January, 2024 and March, 2024 using the convenience sampling method. The General Data Scale, the Medication Literacy Scale among the Elderly Patients with Chronic Diseases, the Self-perceived Burden Scale and the Technophobia Scale were used to collect information. Latent profile analysis (LPA) disclosed that medication literacy of the older adults patients with chronic diseases could be classified into four different groups namely; high medication literacy (17.02%), medication Literacy-low critical type (38.13%), medication Literacy-high critical type (31.26%), and low medication Literacy (13.58%). Influential factor analysis showed that drinking history, educational level, marital status, occupational status, personal monthly income, family location, caregiver involvement, living style, type of medical insurance, daily exercise time, time duration of disease, number of hospitalizations in the past year, personal view of sleep status, age, and self-perceived burden, technophobia, had significant impact among the varied category of chronic disease patients in terms of medication literacy (p < 0.05). Medication literacy among chronic comorbidity patients is largely heterogeneous. It is advised that clinicians should do more specific interventional programs based on the nature of different levels of medication literacy to achieve better medication literacy rates within this category of population to improve treatment effects.
The burden of early-onset cancers is increasing, attracting scientific and media attention. There is, however, a need to disentangle the contribution of changes in risk, that is, age-standardized rate, due to changes in carcinogenic exposure or detection practices, from the contribution of population growth and aging, and to determine how these contributions differ for later-onset cancers. Using cancer registry data, we estimated these contributions in Switzerland between 1982 and 2021. Early-onset cancers include any cancer diagnosed in adults between 20 and 49 years, whereas later-onset cancers are those diagnosed at 50 years or older. To estimate the contribution of changes in risk, we computed the expected number of cases by applying the 1982 to 1986 (baseline) age-standardized rates to subsequent populations and calculated the difference between observed and expected cases. To estimate the contribution of population growth and aging, we subtracted the risk contribution from the total change in observed cases relative to 1982 to 1986. Between 1982 to 1986 and 2017 to 2021, the burden of early-onset cancers increased by 1,534 cases/year and that of later-onset cancers increased by 19,832. For early-onset cancers, population growth and aging explained 71% of the increase (men: 102%; women: 58%) and changes in risk explained the remaining 29% (men: -2%; women: 42%). These proportions differ by cancer site, with risk contributing to a higher proportion for prostate cancer, colorectal cancer, and melanoma. For later-onset cancers, population growth and aging explained 92% of the increase (men: 116%; women: 81%) and changes in risk explained the remaining 8% (men: -16%; women: 19%). Further research is needed to clarify whether risk changes are due to changes in carcinogenic exposure or in detection practices. Although population growth and aging are known to contribute to increasing cancer burden, their relative contribution compared with risk changes has not been quantified for early-onset cancers. Using four decades of Swiss cancer registry data, we show that demographics explain about three quarters of the increase in early-onset cases, whereas risk changes account for the remaining quarter. Contributions vary by cancer site and sex, with implications for prevention and healthcare planning.
Population aging in rural China has increased caregiving demands for older adults living with disabilities, while formal long-term care resources remain limited. Evidence remains insufficient regarding how multidimensional caregiving burden is associated with depressive symptoms and whether formal and informal support buffer these associations. To examine the associations between multidimensional caregiving burden and depressive symptoms among rural caregivers and to investigate the buffering roles of formal and informal support, including heterogeneity by gender and educational attainment. Cross-sectional data from 781 rural caregivers in China were analyzed using multivariable linear regression models. Caregiving burden included overall burden and five dimensions: physical burden, psychological burden, financial burden, time-dependence burden, and social isolation. Formal support was measured by the availability of community care services, and informal support by caregivers' social networks. Stratified analyses were conducted by gender and educational attainment. All dimensions of caregiving burden were significantly associated with higher depressive symptoms. Financial burden and social isolation showed the strongest associations. Informal social support buffered the adverse effects of all burden dimensions, whereas formal community services mainly buffered physical and financial burden. Male caregivers benefited from both forms of support, while female caregivers relied primarily on informal support. Buffering effects were stronger among caregivers with lower educational attainment. Depressive symptoms among rural caregivers are closely associated with multidimensional caregiving burden. Policies should prioritize reducing financial strain and social isolation while strengthening both formal and informal support systems, particularly for women and less educated caregivers. Main findings: Financial burden and social isolation showed the strongest associations with depressive symptoms among rural caregivers of older adults living with disabilities, while informal social support consistently buffered caregiving stress.Added knowledge: This study demonstrates that formal and informal support systems differ in their buffering effects across caregiving burden dimensions and caregiver subgroups in rural China.Global health impact for policy and action: Strengthening community-based long-term care services and caregiver support systems may help reduce psychological distress among caregivers in rapidly aging rural populations in low- and middle-income countries.
Smart home technologies are increasingly being developed to support ageing in place, yet evidence of their impact remains unclear. This review aimed to synthesise the existing evidence on the role of smart home technologies in enabling older adults aged 65 years and above to live safely at home. A systematic review was conducted in accordance with PRISMA guidelines and retrospectively registered with the Open Science Framework (OSF; Registration DOI: 10.17605/OSF.IO/4ZJNC). Six databases were searched for studies published between 2020 and 2025. Quantitative, qualitative and mixed-methods studies evaluating smart home technologies were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist and the Mixed Methods Appraisal Tool. Data were synthesised thematically. Thirty studies from 10 countries were included. Smart home technologies supported physiological monitoring, safety, functional and emergency detection, social interaction and cognitive support. Reported benefits in some studies included reduced healthcare utilisation, improved quality of life and independence, enhanced chronic disease management, and positive experiences for users and carers. However, findings were heterogeneous across technologies, populations and outcome measures. Key barriers included privacy, cost, technical reliability and digital literacy. Smart home technologies show potential to support ageing in place by enhancing safety, independence and chronic disease management, while possibly reducing healthcare utilisation and improving quality of life. However, the evidence base remains heterogeneous, with a variety of technologies evaluated, study designs used and outcomes reported. Robust longitudinal studies, standardised outcome measures and comprehensive cost-effectiveness evaluations are needed to inform implementation, equity and policy development.
Continuous advancements in voice artificial intelligence technologies aim to assist older adults and caregivers, potentially improving quality of life and reducing caregiving burdens. Although research has explored the potential of voice-enabled artificial intelligence (VAI) assistants, such as Alexa (Amazon.com, Inc) and Google Home, to support older adults' health in informal care settings, there remains a significant gap in understanding the ethical dimensions and values that may influence their future adoption by caregivers and care recipients. This research aims to explore older adult and informal family caregivers' perspectives of VAI assistants for supporting informal care, including the ethical dimensions and values that influence their decisions about future adoption for these purposes. This research uses participatory speculative design to explore older adults' and informal family caregivers' perspectives of how VAI might support informal care in the future, and the ethical concerns they have about adopting VAI technologies. We conducted 8 workshop sessions with older adults and caregivers (n=9) over four months. Each phase focused on one of three goals: (1) to understand existing experiences, (2) to envision future VAI technologies, and (3) to reflect on ethical values that shape acceptance. In workshops, we aimed to gain insights into their experiences and challenges in managing informal care tasks and how future implementation of VAI might support the caregiving process to address their needs and concerns while emphasizing the ethical dimensions they value. The findings suggest older adults and informal family caregivers see potential opportunities for VAIs to support informal aging care by automating daily health tasks to improve efficiency, enhancing mental health and well-being, and offering companionship. However, participants felt that VAI alone might not be sufficient to address the complex needs of informal care. Additionally, they raised several ethical concerns related to transparency, privacy, inclusiveness, trust, affordability, and autonomy, which they felt needed to be addressed to encourage adoption of VAI technologies for informal care in the future. Based on the findings, we offer insights and design implications for VAI systems that balance efficiency with ethical values to support diverse caregiving needs and potentially encourage future adoption in the informal care space.
Global aging is a vital issue of public health from the medical, social and economic points of view. Together with the aging of the population, there is also a higher risk of low mineral density (BMD) especially among people over the age of sixty which indirectly leads to significantly more fractures. The aim of the study is to evaluate the connection between selected factors connected to health, and predict the risk of fractures, obtained by means of an FRAX calculator. The study was conducted on a group of 540 people aged between 60 - 74 (early old age), 75 - 89, and 75 - 89 (late old age) living at home. The Timed Up and Go (TUG) test was used to evaluate functional fitness and the risk of falls. A scale of complex everyday activities as per Lawton (IADL). Moreover, to assess the risk of fracture, a Fracture Risk Assessment Tool (FRAX) was used. Ten-year-long absolute risk of fractures as per the FRAX calculator was: on a low level - 41.85%, medium level - 36.11% and on a high level - 22.04% of the study participants. A correlation was observed between the FRAX and the number of medications taken only once (p=0.000), fear of falling (p<0.001), body mass indicator (BMI) (p<0.001), ability to perform complex everyday activities (p<0.001), falling (p<0.001) and hospitalization during the last 12 months, 6 medicines taken together, fear of falling, experienced in the last year.
Morocco is experiencing rapid demographic aging alongside a rising cancer burden, creating structural challenges for the care of older adults with cancer. This review synthesizes current evidence on geriatric oncology in Morocco and proposes a conceptual framework to guide system-level adaptation. We conducted a structured narrative review of peer-reviewed publications, population-based registry data, national demographic reports, and policy documents published between 2000 and 2025 (last search: January 2026). Evidence was synthesized qualitatively and organized into six predefined analytical domains: (1) demographic transition, (2) cancer epidemiology, (3) health system organization, (4) access to care, (5) workforce capacity, and (6) geriatric assessment and clinical practice. These domains are applied consistently as the organizing framework across the Results sections and are explicitly mapped onto the WHO Health System Building Blocks and the Four-Phase Oncogeriatric Transition framework in the Discussion. In 2024, adults aged ≥60 years accounted for 13.8% of Morocco's population, while individuals aged ≥65 years represented approximately 8%, with projections indicating a marked increase by 2050. Population-based registries report age-standardized cancer incidence rates around 120-137 per 100,000. Available cohorts indicate high vulnerability prevalence (e.g., >80% abnormal G8 in some series), substantial metastatic presentation at diagnosis, limited geriatric workforce capacity, and a strong urban concentration of oncology services. Structured geriatric assessment is not yet consistently implemented in routine oncology care. These findings suggest that Morocco is entering an oncogeriatric transition characterized by a growing mismatch between demographic acceleration and geriatric-integrated oncology capacity. We propose a Four-Phase Oncogeriatric Transition framework to conceptualize this evolution and inform policy, workforce planning, and phased implementation strategies. Early integration of geriatric assessment, registry adaptation, and multidisciplinary coordination will be essential to ensure equitable, age-adapted cancer care in an aging society.
The aim of the study was to determine the prevalence of insomnia and identify associated sociodemographic and clinical factors among individuals aged 80 years and older. This descriptive cross-sectional study was conducted between October and November 2025 in the Advanced Age Unit of Elazığ City Hospital, Turkey. A total of 419 participants aged ≥80 years were enrolled. Sociodemographic and clinical data were collected using a structured questionnaire. The presence and severity of insomnia were assessed using the Insomnia Severity Index. An Insomnia Severity Index score ≥8 was accepted as indicative of insomnia. The prevalence of insomnia was 38.2%. Insomnia was significantly more frequent among women compared with men (p=0.010). Low economic status was associated with a higher rate of insomnia (p=0.033). A history of falls, hypertension, diabetes, and polypharmacy showed significant associations with insomnia (all p<0.05). Insomnia Severity Index score demonstrated a positive correlation with the number of chronic diseases (r=0.487; p<0.001) and the number of medications used (r=0.455; p<0.001). Insomnia is common among individuals aged 80 years and older and is associated with female gender, low economic status, polypharmacy, multiple chronic diseases, and a history of falls. Insomnia in older adults should not be considered a normal part of aging, but a manageable condition that affects overall well-being. Routine sleep assessment and management of underlying risk factors should be integral components of geriatric care.