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Globally, the older population is increasing rapidly, becoming one of the most significant demographic trends of the 21st century. This growth poses important social, health, and technological challenges for societies that must adapt their environments and services to promote independent and healthy aging. In Spain, the population aged 65 years and older reached 18% of the total population in 2020, and projections indicate that this proportion will continue to rise in the coming decades. Within this context, smart homes have emerged as one of the most promising avenues to support aging in place and improve the quality of life. Smart homes encompass a wide variety of functions, including environmental control, safety monitoring, communication, and other assistive technologies, that may help older people stay healthy, safe, and independent in their own homes. However, older people are not a homogeneous group. Their lifestyles, health conditions, and technological experiences differ substantially, which means that, as with any assistive technology, smart home functions must match the real and perceived needs of the target users to ensure acceptance, adoption, and long-term use. In this study, as a step forward toward the adaptability of smart home technology, we present a method to analyze the practical needs of smart home functions for older people. Specifically, we aim to understand the Spanish older population's readiness and needs for smart homes and to provide insights that can guide the design of more adaptive and user-centered solutions. We conducted an online survey focusing on residentially based lifestyles, health conditions, and preferences for smart home functions, targeting older adults living in Spain. The survey collected information about participants' demographic profiles, daily activities, health self-assessment, and attitudes toward technology. A total of 102 valid responses were analyzed. We then classified the older adults according to their residentially based lifestyles using clustering techniques and analyzed the preferences and needs for smart home functions in each identified group. Four clusters emerged based on the information provided by the participants: (1) high quality of life and independent life, (2) poor quality of life, (3) social-centered life, and (4) creative and personal-centered hobbies at home. On the basis of this classification, we explored each group's specific needs for smart homes and estimated their readiness to embrace different aspects of technology. As a result, the top-priority smart home functions for each group were identified and compared. This research contributes to understanding the practical user needs of smart homes as assistive technologies for older people. It provides a methodological approach to anticipate and prioritize functions according to user characteristics, supporting the development of personalized, adaptive, and more acceptable smart home solutions for aging populations.
Unplanned hospital admissions are distressing for older persons and are associated with a high risk of adverse outcomes and a burden on health systems. Understanding the risk and protective factors for unplanned admissions can help to design new preventive interventions in primary care. To explore primary healthcare professionals' experiences on factors affecting unplanned hospital admissions in community-dwelling older adults and identify opportunities for preventive interventions. We performed a focus group study with a purposive sample of Dutch primary healthcare professionals. Four focus groups were conducted with a total of 22 primary healthcare professionals comprising 10 general practitioners (GPs) and 12 other primary healthcare professionals. All focus groups were recorded, transcribed, and thematically analysed. Factors affecting unplanned admissions were grouped into characteristics of the patient, the healthcare professional, and healthcare organisation. Patient-related risk factors included the presence of chronic conditions, health-seeking behaviour, the presence and capacity of an informal caregiver, and cultural expectations of healthcare. Continuity of care, advance care planning, and professional experience as a GP were identified as mitigating professional-related factors for unplanned admissions. Organisational factors that potentially contributed to unplanned admissions were poor informational continuity, suboptimal care coordination, and lack of alternatives to hospitalisation. Unplanned hospital admissions in older adults were perceived to be influenced by patient, healthcare professional, and healthcare organisation-related factors. Strategies such as ensuring broad access to patients' clinical information and treatment wishes, improving personal continuity of care, and structural provision of advance care may contribute to reduce unplanned admissions.
Healthy aging and community well-being are the priorities of Egypt Vision 2030; hence, the need to promote non-pharmacological approaches to mental health among the older adults. This paper examines how physical activity can be used as a form of therapy in improving the mental health and quality of life of older adults who attend sports clubs in EL Minya, Arab Republic of Egypt, using the notion of movement as therapy. A cross-sectional, quantitative research design was used, and a sample of 422 older adults (aged ≥60 years) was used. The participants took a questionnaire in a structured form (Arabic version of DASS-21 to evaluate depression, anxiety, and stress) and the Rapid Assessment of Physical Activity (RAPA). The data were reviewed on descriptive statistics, chi-square tests, and multiple linear regression to determine the relation between the level of physical activity and mental health outcomes, and the results were adjusted by age. It was found that almost one-third (31) of the respondents did not have any physical activity, and the remaining 69.2% participated in different levels of physical activity weekly. The most common was walking (92.4%). The level of mental health symptoms was also much lower in the highly active group; that is, individuals who exercised 10 h/week or more had a mean DASS-21 of 12.3 (normal) versus 34.2 among inactive ones (clinically significant distress). The relationship between dose and response was evident (all p < 0.001). The level of exercise was the strongest negative predictor of psychological distress (β = 0.41, p < 0.001) and could predict 23 percent of the variance of the DASS-21 scores (F = 31.28, p < 0.001). The results justify the inclusion of customized and socially entrenched movement initiatives, especially walking and light aerobic activities, in national aging and mental health policies. This initiative can make physical activity not a personal habit but a civic intervention, both dignified, resilient, and mentally healthy aging, in accordance with Egypt Vision 2030.
Globally, the older population is rapidly increasing and might be a challenge for healthcare providers in the future. Therefore, new methods of providing home-based care are urgently needed. Telemonitoring (TM) has been proposed to optimize patient care and enhance remote monitoring and management by clinicians. This feasibility study aimed to describe the experiences and perceptions of home-based TM among older adults with chronic conditions and healthcare professionals (HCPs). A feasibility study including interviews with older adults and diaries written by HCPs during the intervention. Participants were recruited from two municipalities in central Sweden. The intervention involved home-based TM for 4 months. TM systems, equipped with sensors for monitoring blood pressure, body weight, physical activity, and oxygen saturation, were tailored to individual needs and installed in participants' homes by an IT company. Data were collected between 2023 and 2024 and analysed using deductive content analysis regarding demand, acceptability, implementation and practicality, to examine whether TM is feasible in real-life settings. The data collection included 12 older adults and 21 healthcare professionals. From interviews with older adults (n=4), and diaries (n=9) from HCPs. Older adults measured their blood pressure every morning and entered the data on a tablet. They reported becoming more aware of changes in their health, particularly with body weight and blood pressure. For sustained engagement and motivation, a comprehensive education plan for TM involving patients, relatives, and HCP is essential. This study indicates that raising health awareness among older adults is positive and underscores the importance of person-centered care. However, some aspects were not fully realized in our study, highlighting the need for further research and refinement in TM implementation to better meet the needs of older adults and healthcare professionals. ClinicalTrials.gov Identifier: NCT04955600 registration date 2021-03-01.
Child maltreatment is a significant risk factor for mental and metabolic health, with negative effects that can persist into adulthood. Using data from a U.S.-nationwide study, the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examined the associations between child maltreatment, specifically childhood threat (i.e., harm or threat of harm) and deprivation (i.e., absence of expected environmental inputs), and young adult mental (i.e., depressive symptoms) and metabolic health (i.e., metabolic risk). The moderating effect of social support was also examined, focusing on both quality of different types of support (i.e., from teachers, friends, and other adults) and variety of support sources. Results showed that young adults who experienced more threat during childhood exhibited higher levels of depressive symptoms in young adulthood, and those exposed to more deprivation reported elevated levels of metabolic risk. This study also highlighted the protective-stabilizing role of quality of teacher support in buffering the impact of deprivation on depressive symptoms, and the protective-stabilizing role of high-quality other adult support in the link between childhood deprivation and metabolic risk, such that the benefits of social support remained stable across increasing levels of deprivation. Additionally, the variety of social support showed a protective-reactive pattern in moderating the link between deprivation and metabolic risk, wherein the benefits of variety of social support were released under low deprivation but not high deprivation conditions for metabolic risk. These findings underscore the importance of eliminating child maltreatment experiences and highlight potential interventions, such as enhancing teacher-student relationships and broadening adolescents' access to diverse support networks, to buffer the long-term mental and metabolic health consequences associated with early experiences of threat and deprivation.
Background and Objectives: Population ageing is a major challenge of the 21st century and is associated with declining physical and mental abilities, increased disease burden, and higher mortality. Latvia has the lowest healthy life expectancy in the European Union. Social well-being is an important component of healthy and active ageing and may be associated with older adults' quality of life (QoL). This study aimed to assess the relationship between social well-being, as a component of health, and QoL, including its components (control, autonomy, self-realisation and pleasure), among adults aged 50 and older in Latvia. Materials and Methods: Data from 1643 Latvian participants in wave 9 of the Survey of Health, Ageing, and Retirement in Europe (2022) were analysed using linear regression. QoL was measured using the 12-item Control, Autonomy, Self-Realisation, and Pleasure (CASP-12) scale. Social well-being factors included household composition, education, employment status, financial capacity, living area, social network (SN) characteristics, and received help, based on self-reported questionnaires. Results were considered statistically significant if the p-value was less than 0.05. Results: The factors positively associated with overall QoL were being employed, better financial capacity, greater satisfaction with SN, larger SN, participation in social activities, and higher educational attainment. Being employed and the ability to make ends meet easily were positively associated with all QoL components. Higher satisfaction with the SN and participation in social activities were positively related to the control, autonomy, pleasure, and self-realisation components. Conclusions: These findings underscore the importance of social and economic resources for QoL in later adulthood, suggesting that both the quality of social relationships and material security play a central role in shaping overall QoL and its components among older adults.
Cancer in women represents a significant disease burden, posing challenges for prevention, treatment, and caregiving. This study aimed to analyze the epidemiological trends of the women's cancer burden and the main influencing factors in the group of twenty (G20) from 1990 to 2023. Incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for breast, cervical, uterine, and ovarian cancers, as well as fertility rates for G20 and its 98 locations, were sourced from the Global Burden of Disease Study 2023. Age-standardized rates (ASRs), quality of care index (QCI), and 5-year relative survival of integrated women's cancers were calculated. Average annual percent changes (AAPCs) were used to determine the temporal trends by age and region. Decomposition analysis identified drivers of changes in case numbers, linear regression assessed the associations with DALY rate changes, and dominance analysis identified dominant predictors. In 2023, the incidence, prevalence, mortality, and DALYs from women's cancers in G20 were 3.29 [95% uncertainty interval (UI) 2.60-4.14], 26.71 (95% UI 21.99-32.40), 1.16 (95% UI 0.91-1.45), and 36.58 million (95% UI 28.40-46.32), respectively, with ASRs of 87.63/100,000 (95% UI 65.12-115.85), 706.16/100,000 (95% UI 555.75-890.02), 30.03/100,000 (95% UI 22.10-39.58), and 994.79/100,000 (95% UI 728.43-1328.81). The QCI was 75.13 [95% confidence interval (CI) 73.67-76.59], and the 5-year relative survival was 65.74% (95% CI 65.53-65.95). From 1990 to 2023, there was a significant increase in incidence, prevalence, mortality, and DALYs in G20, primarily driven by population growth. Age-standardized incidence rate, QCI, and 5-year relative survival increased, while age-standardized mortality and DALY rates decreased. Changes in prevalence rates of breast cancer and cervical cancer for women aged 15-49 years were positively associated with changes in DALY rates of women's cancers, whereas changes in the total fertility rate were negatively associated. Dominance analysis confirmed these three factors consistently as dominant predictors between 1990 and 2023. Reducing the prevalence of breast and cervical cancers and increasing fertility among women aged 15-49 years could lower the overall DALY burden attributable to women's cancer. The incidence, prevalence, mortality, and DALYs of women's cancers in G20 have increased substantially from 1990 to 2023. Tailored prevention strategies should consider age and cancer type, emphasizing reproductive health for women of reproductive age.
Mental health issues such as depression, loneliness, and cognitive decline are prevalent among older adults. They are particularly pronounced in rural areas due to socioeconomic disadvantages, limited health literacy, and social isolation. These challenges have been exacerbated by the COVID-19 pandemic, highlighting the urgent need for accessible, community-based mental health strategies. Social prescribing-linking individuals to nonmedical community resources-offers a promising model, especially when coupled with culturally relevant and digitally facilitated interventions. This study aimed to evaluate the effectiveness of a pilot social prescribing project for individuals aged 65 years and older residing in rural South Korea. Specifically, it examined the changes in social support, loneliness, depression, cognitive function, and life satisfaction among the older adults before and after the intervention and the relationships among these factors. A quasi-experimental, nonequivalent control group pretest-posttest design was conducted with 294 participants from Wonju City, Gangwon-do (n=148 in the experimental group, n=146 in the control group). The 8-week intervention featured a community-based music storytelling program incorporating local cultural elements and digital education. Statistical analyses, including t tests, difference-in-differences analysis, and structural equation modeling, were conducted to evaluate changes in scores and the effectiveness of the program intervention. The study confirmed that the social prescribing pilot project effectively reduced depression and increased social support and life satisfaction compared with the control group (P<.05, 95% CI). While cognitive function showed slight improvement, the change was not statistically significant. Social support emerged as a key mediating factor, positively influencing cognitive function and life satisfaction, and was negatively associated with depression. There was no statistically significant direct effect found between loneliness and cognitive function or social support. This pilot study supports the feasibility and mental health benefits of integrating community and digital support through culturally embedded social prescribing for rural older adults. The findings highlight the importance of leveraging local resources and social networks to address mental health disparities in underserved aging populations, offering valuable insights for policymakers and practitioners developing inclusive aging and health promotion strategies.
Background and Objectives: represents a major public health challenge in rapidly aging societies. While lifestyle behaviors are established modifiable risk factors for frailty, the longitudinal impact of composite lifestyle trajectories-particularly by sex-remains poorly understood. This study examined sex-stratified associations between Healthy Lifestyle Score Trajectories (HLSTs) and frailty among community-dwelling middle-aged and older adults in South Korea. Using 19 years of nationally representative panel data from the Korean Longitudinal Study of Aging (2006-2024), we analyzed 6603 participants (2684 males; 3919 females). Materials and Methods: Group-Based Trajectory Modeling was applied to Waves 1-6 to derive sex-specific HLSTs based on smoking, alcohol consumption, physical activity, and body mass index. Generalized Estimating Equations were used to assess longitudinal associations between HLSTs and Frailty Index (FI) scores across Waves 6-10, adjusting for sociodemographic covariates. Results: Five distinct HLSTs were identified in both sexes. In both males and females, persistently poor or deteriorating trajectories were independently associated with higher FI scores relative to the Favorable HLST reference group. The effect size for Poor HLST was more than twice as large in females (B = 0.039) than in males (B = 0.018), consistent with the sex-frailty paradox. Among females, the Improving HLST group did not demonstrate a statistically significant frailty benefit (B = 0.014, p = 0.091). Stratified analyses revealed that the lifestyle-frailty association among males was significant only in rural-dwelling participants, whereas in females the association was consistent across both urban and rural settings. Conclusions: Persistently unfavorable composite lifestyle trajectories were independently associated with higher frailty burden, with disproportionately greater impact in women. Late-life lifestyle improvement was not significantly associated with reduced frailty in women, reinforcing the importance of early and sustained behavioral maintenance. The rural-specific association in men highlights the role of structural disadvantage in amplifying lifestyle-related frailty risk. However, given the observational design of this study, the possibility of reverse causality cannot be excluded, and these findings should be interpreted as associative rather than causal. These findings support sex-sensitive, trajectory-based, and geographically tailored frailty prevention strategies.
Early detection of cognitive decline may be effective in reducing the adverse impacts of Alzheimer's disease and related dementias (ADRD). Given that functional declines precede ADRD evaluation and diagnosis, regular assessments of everyday function are an avenue for detecting cognitive performance changes. While app-based measures of everyday function and cognition are promising tools for early detection, perceptions of these tools' value remain unexamined. This study explored perceptions of an app-based measure of everyday function (i.e., comfort with sharing performance data and perceived utility in healthcare) with community-dwelling midlife and older adults in South Carolina, United States (N = 131, Mage = 67.08 years). Participants completed daily tasks through a mobile app objectively measuring everyday function then shared their feedback through a semi-structured interview. Our thematic analysis found that interest and confidence in utilizing this technology was connected to beliefs around the value of having real-time information about one's cognitive performance, experiences with healthcare providers, and trust in technology security and accuracy. Additionally, some adults have not thought critically about the role of these technologies in their healthcare. As health-tracking technology expands in cognitive healthcare, researchers and practitioners must be aware of midlife and older adults' perceptions and educate users on its potential function.
What is known? Hip fractures are debilitating osteoporotic fractures that are increasingly pervasive in our aging population. SES has an overarching influence on health outcomes and well-being, having already been proven in other morbid diseases. What is new? Overall, this study demonstrates that hip fracture patients experience poorer perioperative quality of life at different time points based on SES, though both groups recuperate to attain comparable outcomes by 1 year. What is the impact? Our findings suggest that hip fracture prevention should be emphasised across all socioeconomic strata. Health policies and coverage should be re-examined in the aging population, especially the need for mental health support during immediate recovery. Hip fractures are increasingly prevalent in our fast-aging population, but effects of socioeconomic status (SES) on these patients' perioperative wellbeing are not well understood. This study aims to investigate the effect of SES, represented by hospital ward class, on perioperative function and health-related quality of life (HRQoL) in hip fracture patients. Four hundred forty-five hip fracture patients were prospectively followed up and categorised into private (PTE) and government-subsidised (SUB) ward classes as a surrogate for SES. Patients were evaluated using Parker Mobility Score (PMS), EuroQol-5 Dimensions (EQ-5D) and Short Form-36 (SF-36; including Physical Function [PF] and Mental Health [MH]) scores premorbidly, and postoperatively at 3 months, 6 months and 1 year. Group PTE scored significantly higher in PMS across all time points and in PF at 6 months (42.5 ± 27.3 vs 35.0 ± 29.1, p = 0.033) postoperatively. Group PTE also had superior EQ-5D scores at 3 (0.620 ± 0.282 vs 0.497 ± 0.325, p = 0.002) and 6 months (0.715 ± 0.268 vs 0.576 ± 0.334, p = 0.001) postoperatively. Group PTE had higher MH scores at 3 months (85.9 ± 15.0 vs 80.9 ± 18.1, p = 0.014) postoperatively, though its scores continued to decline by 6 months. Changes over time in EQ-5D scores favoured Group PTE (p = 0.016). Both groups had an overall decline at 3 months before gradually returning towards baseline at 1 year. This study highlights SES-based disparities in hip fracture patients perioperatively, though both groups converge to comparable outcomes by 1 year. Health policies should consider MH support during recovery for all, regardless of SES.
IntroductionSmart devices hold significant value for enhancing the health of older adults by promoting healthcare utilization and supporting chronic disease prevention.MethodsThis study investigates the relationship between smart device usage and health status among older adults, along with the underlying mechanisms, using panel data from the 2018 and 2020 waves of the China Longitudinal Aging Social Survey (CLASS). The baseline analysis employs a Two-Way Fixed Effects model to estimate the relationship between smart device usage and multiple health indicators. To ensure robustness, we further conduct instrumental variable estimation and exclude specific interfering samples. Additionally, heterogeneity across demographic subgroups is examined using interaction-term-based split-sample regression.ResultsUse of smart wristbands is associated with better self-rated health (SRH), lower depression scores, and higher social adaptation. Smart assistants and audiobooks are also associated with better social adaptation. Overall, smart devices enhance health by increasing healthcare utilization, encouraging social participation, strengthening social support, and facilitating early diagnosis of chronic diseases. These effects vary notably across gender, marital status, residence, age, and education level. Moreover, smart device use is linked to a pronounced reduction in medical expenditures.ConclusionThe findings reveal a positive association between smart device use and health outcomes among older adults, indicating the important role of smart devices in supporting health management and alleviating medical burdens among older adults. This study provides empirical evidence for promoting digital health interventions and suggests that policy efforts should consider demographic differences to enhance the equitable adoption of smart technologies.
To our knowledge, previously there have been no reviews about the impact of social isolation on physical and mental health among people aged over 60, who are empty-nest older adults. To conduct an integrative review of empirical studies to provide a comprehensive understanding of social isolation and its influence among empty-nest older adults' health. An integrative literature review. PubMed, Web of Science, Scopus, Embase, EBSCOhost, CNKI, Wanfang data, VIP were searched for studies from the database inception to October 2025. Of 2,833 scrutinized articles, 14 were eligible for inclusion and subjected to independent quality appraisal. One mixed-method study, two qualitative research studies, and 11 quantitative research studies were selected. Social isolation among empty-nest older adults is linked to elevated physical health risks, including higher mortality, as well as mental health issues such as depression, self-neglect, loneliness, reduced life satisfaction, and cognitive decline. It also impacts comprehensive health indicators like intrinsic capacity and quality of life. Mediating factors, including aging attitudes, loneliness, perceived stress, and health-promoting behaviors, exacerbate these effects. Social isolation adversely affects both physical and mental health in empty-nest older adults, underscoring the need for developing interventions to promote social support networks and expand social connections.
Maintaining balance is essential for older adults to preserve independence and reduce fall risk. However, empirical evidence linking trunk stability with balance and gait is scarce, partly due to the lack of accessible field tests. Smartphone-based accelerometry field tests offer a promising approach to assess trunk stability outside the laboratory. The study aimed to determine (1) the association between trunk stability and whole-body balance and gait and (2) the extent to which trunk stability and whole-body balance field tests align with laboratory-based assessments in older adults. A total of 53 physically active older adults performed 2 trunk stability tests (ie, the lumbopelvic stability [field] and the unstable sitting posturographic [laboratory] tests), 2 whole-body balance tests (ie, the tandem stance posturographic [laboratory] and the whole-body static balance [field] tests), and 2 gait-related tests (ie, the straight-line gait and the modified Timed Up and Go [field] tests) 2 times. A Spearman correlation analysis was performed after assessing the reliability of the variables. Significant positive low-to-high correlations were found between the lumbopelvic stability and the whole-body static balance tests (0.380≤r≤0.700; P<.01). A low positive correlation (r=0.436; P<.01) was also observed between the unstable sitting posturographic test and the tandem stance posturographic test. No correlations were found between trunk stability and any gait-related test. No moderate-to-high relationships (0.289≤r≤0.487; P<.05) were found between laboratory and field tests (both for trunk stability and whole-body balance). Better static lumbopelvic control during exercises like the back bridge and the bird-dog is linked to improved whole-body balance in active older adults, suggesting that these positions be included in future interventions to enhance trunk stability. Accessible smartphone-based field tests for lumbopelvic stability offer a promising approach for the standardized assessment of trunk stability. However, direct extrapolation from field tools to laboratory findings is unfeasible due to a lack of correlation. These findings highlight the potential of smartphone-based field tests to complement clinical and research assessments of balance in older adults.
This study examined hip fracture trends in older Chinese adults from 1990 to 2023, finding a sharp rise in cases, especially from falls, but less disability over time. It highlights the need for better prevention, particularly for women, to ease the growing health burden as China's population ages. With China's rapidly aging population, hip fractures have become a leading cause of disability and healthcare burden among older adults. This study examined the incidence and disability burden of hip fractures among adults aged 60 years and above from 1990 to 2023 in mainland China and described sex-specific patterns and changes over time. Data were obtained from the Global Burden of Disease (GBD) 2023 study. We extracted the number of hip fractures, crude incidence rate, and years lived with disability (YLDs) rate for adults aged 60 years and older in mainland China. Age standardization followed the 2020 China census population. Temporal changes were assessed by comparing percent differences between the 1990 and 2023 estimates, with all results reported together with their 95% uncertainty intervals. In 2023, mainland China had an estimated 3.23 million hip fractures among adults aged 60 years and above (2.28 to 4.43 million), including 1.16 million cases among males (0.83 to 1.59 million) and 2.07 million among females (1.45 to 2.85 million). The age-standardized incidence rate reached 1065.47 per 100,000 population (685.35 to 1597.70) in 2023, increasing by 58.3% compared with 1990. The age-standardized rate was higher in females at 1312.98 per 100,000 (833.36 to 1976.11) than in males at 799.29 per 100,000 (517.93 to 1202.45). In contrast, the age-standardized YLD rate showed a modest decline from 1990 to 2023, decreasing from 222.51 (151.48 to 304.89) to 197.35 (135.20 to 277.92). Across causes, falls remained the leading contributor to hip fractures throughout the study period. Hip fractures among older adults in mainland China continued to rise in both number and incidence rate from 1990 to 2023, with women experiencing a consistently higher burden than men. The decrease in age-standardized YLDs suggests some improvement in post-fracture management, although the growing incidence highlights the need for strengthened prevention strategies, particularly fall prevention and osteoporosis management in older adults.
To explore what is known about the attitudes, beliefs and perceptions of appropriate prescribing from the view of older First Nations Peoples (aged 45 years or older, residing in the community or residential care), substitute decision-makers and health-care professionals working with First Nations Peoples. The scoping review was conducted in accordance with the JBI methodology for scoping reviews and PRISMA-ScR. Databases and grey literature sources were searched with no limitations from inception until 12 May 2025. Titles and abstracts were screened by two independent reviewers, with full-text assessment for inclusion and data extraction undertaken by two independent reviewers. Study characteristics were described descriptively. Five articles were included for analysis. First Nations Peoples represented included Māori, American Indians and Australian Aboriginal and/or Torres Strait Islander Peoples. Health-care workers represented included Aboriginal Health Workers, general practitioners and nurses. From the older First Nations People's perspective, themes regarding traditional medicine use, lack of medication information provision and concerns about adverse effects were identified. Dominant themes from health-care workers included medication information, compliance to medications and continuity of care. Older First Nations Peoples expressed a desire for more medication information and culturally appropriate care. Included studies indicated most health-care workers supported interventions to increase knowledge and understanding of medications for First Nations Peoples. Unfortunately, paternalistic attitudes remain, which limit the provision of information and prevent a trusted partnership from forming.
This study aims to identify and map innovative care models for LGBTQ+ older adults and characterise the supporting evidence base. Older LGBTQ+ adults face persistent inequalities in health and social care, including discrimination, invisibility and barriers to appropriate support. As the population of openly LGBTQ+ older people grows, ensuring equitable and affirming provision has become increasingly urgent in the UK and beyond. In response, care models that may be considered innovative (whether newly developed, adapted for LGBTQ+ communities or applied in novel ways) have begun to emerge. However, no review has yet systematically mapped what is currently known about innovations in LGBTQ+ care and the evidence supporting them. This scoping review therefore aims to identify and map innovative care models for LGBTQ+ older adults and to characterise the supporting evidence base. This scoping review will be conducted in accordance with Arksey and O'Malley's framework and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Evidence will be included where a care model or initiative is described or evaluated along with its implications for LGBTQ+ older people. For this review, care models are defined as organised approaches to care-that is, services, policies, practices (including training), initiatives or interventions-implemented in formal or informal care settings-such as residential care homes, housing with care schemes (eg, supported accommodation, retirement communities), domiciliary care, communities or informal long-term care arrangements. Use of the term 'innovation' will not be required for inclusion and will instead be coded by reviewers during charting. English-language sources of any design published between 2015 and 2025 will be included; sources without LGBTQ+ relevance, purely theoretical pieces, protocol papers and conference abstracts without full reports will be excluded. Searches will be conducted in Scopus, Social Science Premium Collection, CINAHL and PsycINFO, with grey literature identified through Overton. Additional searching of SCIE, Google Scholar, relevant third-sector resources and reference lists will be undertaken following source selection. After de-duplication, two reviewers will independently screen titles/abstracts and full texts, with disagreements resolved through discussion or consultation with a third reviewer. Data will be charted on author and year, country, source type, participants or source focus, intended beneficiary population, intervention/model/practice described, study design or document design, context/setting, methods, type of evidence, innovation basis, innovation level/domain, reviewer rationale for innovation coding, outcome or implementation indicators reported, main findings relevant to the review question and limitations of the study or evidence. Findings will be presented in tables and through narrative synthesis to map the models of care, their innovative features and the nature of the evidence base, and to identify implications for UK policy, practice and research. As this review will use data from publicly available sources, ethical approval is not required. Findings will be disseminated through peer-reviewed publication, presentations and accessible outputs for relevant stakeholders, including community-facing materials where appropriate.
Background and Objectives: Chronic kidney disease (CKD) is an increasingly important global health challenge and is frequently accompanied by psychiatric symptoms, including anxiety. A multidimensional assessment of anxiety in hemodialysis (HD) using the Endler Multidimensional Anxiety Scales (EMAS) has not, to our knowledge, been previously reported. We aim to evaluate the reliability, convergent validity, and exploratory domain-level structure of EMAS in HD patients treated at a dialysis center in Craiova, Romania. Materials and Methods: A total of 103 HD patients underwent clinical and sociodemographic/socioeconomic profiling, cognitive screening using the Mini-Mental State Examination (MMSE), and EMAS administration at two time points (4-week interval) for test-retest evaluation. The anxiety subscale of the Depression, Anxiety, and Stress Scale-21R (DASS-21R) was administered to assess convergent validity. Internal consistency (Cronbach's α), temporal stability (test-retest correlations and intraclass correlation coefficients), and convergent validity (Pearson correlations) were computed. Exploratory factor analyses were conducted on EMAS domain scores (state, trait, and perceived anxiety domains) as an exploratory structural check. Results: EMAS state and trait anxiety scores were higher in women than in men, while perceived anxiety showed a more heterogeneous pattern across dimensions. Total state anxiety increased with age, particularly after 50 years. Domain-level internal consistency was good for state and acceptable for trait components (standardized α ≈ 0.84 and 0.78 across administrations), whereas perceived anxiety domains showed low cross-domain coherence, consistent with context-specific appraisal. The DASS-21R anxiety subscale showed good internal consistency (α = 0.863). Convergent validity analyses indicated small, domain-specific associations between EMAS scores and DASS-21R anxiety. Domain-level EFA supported a theoretically coherent pattern in which state and trait domains clustered distinctly, while perceived anxiety domains formed a partially separable factor; this pattern was broadly consistent across both administrations. Conclusions: In this HD cohort, EMAS demonstrated good reliability and limited but domain-specific evidence of convergent validity, and exploratory domain-level analyses supported its multidimensional organization. Further studies with larger samples are warranted for item-level structural testing and to inform feasibility-oriented shortening for potential clinical use.
Escalating healthcare expenditure and population aging have intensified interest in value-based care (VBC), particularly within publicly funded health systems. To date, most value-based initiatives and published implementation experiences have focused on inpatient or procedural care. In contrast, outpatient and longitudinal conditions pose distinct challenges for outcome definition, data availability, and care coordination, and remain relatively under-documented, especially in Asian healthcare contexts. This paper describes and operationalizes a locally developed implementation framework designed to support condition-based, value-driven outcomes monitoring for outpatient care. The framework was developed and applied in a large tertiary public hospital in Singapore that has expanded its value-based initiatives beyond nationally mandated programmes. We outline a four-stage implementation framework comprising scoping, exploration and analysis, baseline assessment, and improvement planning. The application of this framework is illustrated through two outpatient case studies: radioiodine therapy for hyperthyroidism and chronic pain management. Across both case studies, the framework facilitated systematic outcome selection, structured engagement between clinicians and administrators, and identification of actionable opportunities for care improvement, despite data and measurement constraints inherent to outpatient settings. This community case study provides practical insights into operationalizing value-based care for outpatient and chronic disease pathways and offers transferable lessons for health systems seeking to extend value-based care beyond inpatient and procedural contexts.
Aortic aneurysm (AA) is a life-threatening vascular disease that primarily affects older adults and represents a major global health challenge. However, the global burden of AA among the older adult population and the contribution of environmental lead exposure remain insufficiently characterized. Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed the burden of AA among individuals aged ≥60 years. Secondary analyses were conducted for deaths, disability-adjusted life years (DALYs), the age-standardized death rate (ASDR), and the age-standardized DALYs rate at the global level, across five Socio-demographic Index (SDI) groups, 21 GBD regions, and 204 countries. The contribution of lead exposure to AA burden was assessed, and future trends in ASDR and age-standardized DALYs rate were projected for the next 15 years based on trends from 1990 to 2021. Between 1990 and 2021, the global burden of AA among adults aged ≥60 years decreased modestly, although substantial regional heterogeneity persisted, particularly in less-developed regions. Lead exposure contributed disproportionately to the AA burden among older men. Projections based on historical trends indicate that both ASDR and the age-standardized DALYs rate will continue to decline steadily over the next 15 years, with a more pronounced decrease in males than in females. Despite overall improvements, the burden of AA among older adults remains unevenly distributed worldwide. Given the notable contribution of lead exposure-especially among older men-region-specific strategies that integrate vascular risk management with environmental lead control are needed to mitigate the impact of population aging and address geographic and sex-related disparities in AA burden.