Search Results (230)

Introduction: Falls are the leading cause of Emergency Department (ED) presentations among residents from residential aged care facilities (RACFs). While most current studies focus on post-fall evaluations and fall prevention, limited research has been conducted on decision-making in post-fall management. Objective: To develop and internally validate a model that can predict the likelihood of RACF residents being discharged from the ED after being presented for a fall. Methods: The study sample was obtained from a previous study conducted in Shepparton, Victoria, Australia. Consecutive samples were selected from January 2023 to November 2023. Participants aged 65 and over were included in this study. Results: A total of 261 fall presentations were initially identified. One patient with Australasian Triage Scale category 1 was excluded to avoid overfitting, leaving 260 presentations for analysis. Two logistic regression models were developed using prehospital and ED variables. The ED predictor model variables included duration of ED stay, injury severity, and the presence of an advance care directive (ACD). It demonstrated excellent discrimination (AUROC = 0.83; 95% CI: 0.79–0.89) compared to the prehospital model (AUROC = 0.77, 95% CI: 0.72–0.83). A simplified four-variable Discharge Eligibility after Fall in Elderly Residents (DEFER) score was derived from the prehospital model. The score achieved an AUROC of 0.76 (95% CI: 0.71–0.82). At a cut-off score of ≥5, the DEFER score exhibited a sensitivity of 79.7%, a specificity of 60.3%, a diagnostic odds ratio of 5.96, and a positive predictive value of 85.0%. Conclusions: The DEFER score is the first validated discharge prediction model for residents of RACFs who present to the ED after a fall. Importantly, the DEFER score advances personalised medicine in emergency care by integrating patient-specific factors, such as ACDs, to guide individualised discharge decisions for post-fall residents from RACFs. Full article

Background/Objectives: Violence is a significant occupational health issue for paramedics, yet underreporting limits efforts to identify and mitigate risk. Leveraging a novel, point-of-event violence reporting system, we aimed to identify characteristics of 9-1-1 calls associated with an increased risk of violence in a single paramedic service in Ontario, Canada. Methods: We retrospectively analyzed all electronic violence and patient care reports filed by paramedics in Peel Region and used logistic regression to identify call-level predictors of any violence and, more specifically, physical or sexual assault. Results: In total, 374 paramedics filed 974 violence reports, 40% of which documented an assault, corresponding to a rate of 4.18 violent encounters per 1000 9-1-1 calls. In adjusted models, the risk of violence was elevated for calls originating from non-residential locations (e.g., streets, hotels, bars), occurring during afternoon or overnight shifts, and involving young or working-age males. Presenting problems related to intoxication, mental health, or altered mental status were strongly associated with increased risk, with particularly high adjusted odds ratios for assault. Conclusions: These findings support the utility of near-miss and violence surveillance systems and highlight the need for multidisciplinary crisis response to high-risk calls, especially those involving mental health or substance use. Full article

Background: Falls in residential aged care facilities (RACFs) have a significant impact, often leading to costly and unnecessary emergency department (ED) transfers. This scoping review examined the ED discharge proportions and patient characteristics of RACF residents presenting to the ED following a fall, to identify factors that could reduce unnecessary ED transfers. Methods: The databases MEDLINE, CINAHL, Scopus, and Web of Science were searched, resulting in an initial 1385 articles. Nine of these articles met the inclusion criteria and were included in this review. Results: The median age of patients reported in the nine papers ranged from 80.8 to 88 years. Discharge proportions from ED back to RACF ranged from 36% to 91%, with an average of 63%. The studies that reported on computed tomography of the brain (CTB) showed that CTB findings did not significantly influence discharge decisions. Conclusions: Many RACF residents transferred to EDs following falls are discharged without hospital admission. The heterogeneity of study methods makes it challenging to draw definitive conclusions about factors that may help identify patient groups that do not require transfer to the ED following a fall. However, this scoping review highlights potential opportunities to reduce ED transfers from RCAFs. These findings highlight a need for geriatric-specific, person-centred protocols that reduce unnecessary ED transfers while safeguarding quality of care and respecting residents’ advance care preferences. Full article

Background: Older adults living in aged care are at risk of poor health outcomes due to influenza, pneumococcal disease, and herpes zoster infections. Despite these conditions being vaccine-preventable, little is known about vaccine uptake rates in the residential elderly care setting in Australia. Methods: This was a retrospective cohort study examining the medical records of residents of 31 aged care homes in Australia (n = 1108). Data were extracted from medical records for the period March 2023 to September 2023. The proportion of residents vaccinated against influenza, pneumococcal disease, and herpes zoster was calculated. Univariate and multivariate logistic regressions were used to identify possible demographic and other characteristics associated with the vaccination uptake. Results: This study included 1108 residents. Two-thirds (68%) were female, and the median age was 87 years. All residents had one or more comorbidities. Most (92.6%) had received an influenza vaccine within the prior two years, but only 38.3% had received a pneumococcal vaccine, and 16.8% had received herpes zoster vaccination. In all models, receipt of the other vaccines was a significant predictor for vaccine administration. The other factor associated with influenza vaccination was non-consumption of alcohol and younger age for herpes zoster vaccination. Conclusions: While there is a high uptake of influenza vaccines, there is a low uptake of both pneumococcal and herpes zoster vaccines in residents of aged care facilities. Further research into the barriers and enablers of vaccine uptake should be undertaken, with the goal of increasing the vaccination uptake in this vulnerable population. Full article

Background/Objectives: The role of environmental modifications and design in mitigating behavioural symptoms is increasingly being recognised as a way to address the psychosocial needs of individuals with dementia. This study aims to investigate various nature-based interventions for reducing agitation in people with dementia in long-term residential care environments. Methods: Database searches were conducted on MEDLINE, PsycINFO, Scopus, and Web of Science. A literature search was conducted with the following inclusion criteria: (i) peer-reviewed journal publication written in English; (ii) random controlled trials (RCTs) and quasi-experimental design with results for pre- and post-testing reported; (iii) interventions using natural elements, where the effectiveness of the reduction in agitation was measured using a validated instrument; and (iv) participants aged 65 and older with dementia residing in long-term care facilities. Results: This meta-analysis included 29 studies with 733 participants. The results showed that such interventions had a significant negative mean effect on lowering agitation in this population. Additionally, intervention settings (indoor vs. outdoor) and the presence of social interaction were significant predictors of the effect size for agitation reduction. At the same time, no significant differences in effect size were observed between the types of experiences with nature (indirect vs. direct) or the duration of the interventions. Conclusions: This study demonstrates that, when thoughtfully applied, nature-based interventions can significantly alleviate agitation in patients with dementia residing in long-term residential care facilities. This review lays the groundwork for future research aimed at developing design guidelines and planning strategies to integrate natural elements into dementia-friendly environments effectively. Full article

Background and Objectives: Orthodontic treatment, whether fixed or removable, offers several benefits, including improved aesthetics, enhanced oral function, and increased self-confidence. However, it may also cause discomfort and pain, particularly following adjustment visits. This study aimed to assess pain characteristics (latency and continuity), food impairment, weight loss, and analgesic use in relation to treatment duration and appliance type. Methods: This observational study included 160 orthodontic patients who completed a structured questionnaire comprising 13 single-choice items. The questionnaire assessed age, gender, residential environment, educational status, type and duration of orthodontic treatment, pain characteristics (duration, latency, continuity), food impairment, and analgesic use. Inclusion criteria specified patients with moderate anterior crowding undergoing fixed orthodontic treatment or treatment with clear aligners on both arches, for at least one month. All fixed appliance cases involved 0.022-inch-slot Roth prescription brackets. Results: Patients undergoing fixed orthodontic treatment reported a higher frequency of pain (91.4%), greater need for analgesics (95.2%), and more food impairment compared to those with clear aligners. Patients treated for less than 6 months more frequently reported pain lasting 1 week (57.1%), while those treated for 1–2 years more commonly reported pain lasting several days (43.8%). Conclusions: Fixed orthodontic appliances are associated with greater discomfort, longer pain latency, more frequent analgesic use, and higher dietary impact compared to clear aligners. These findings emphasize the importance of personalized patient counseling and proactive pain management to improve compliance, enhance quality of life, and support informed decision-making in orthodontic care. Full article

Background/Objectives: Coercive measures remain a common practice in mental health, despite ethical concerns, potential risks, and uncertain efficacy. Mental healthcare workers’ (MHCWs) attitudes toward coercion can influence their use. However, research in Italy is limited. This study aimed to investigate Italian MHCWs’ attitudes toward coercion and their associations with sociodemographic and professional characteristics. Methods: A cross-sectional study was conducted on 356 MHCWs from a mental health department in Southern Italy. Participants completed the Staff Attitude to Coercion Scale (SACS), which assesses negative, pragmatic, and positive attitudes toward coercion. Descriptive statistics (i.e., frequencies, percentages, means) and bivariate analyses (i.e., one-way ANOVA) were used to explore the associations between variables. Results: The majority of participants were male (56.7%), nurses (50.3%), and worked in acute psychiatric settings (52%), with a mean age of 51.08 years (±10.59) and 13.74 years (±12.14) of experience in mental health. Attitudes differed significantly according to age, sex, professional role, and work setting. More negative attitudes were found among staff in residential settings and non-caring roles (p < 0.001). Pragmatic attitudes were lower among older staff (p = 0.012) and among those in residential settings and non-caring roles (p < 0.001). Positive attitudes were higher among males (p = 0.001), nursing staff (p < 0.001), and staff in acute settings (p = 0.049). Conclusions: Italian MHCWs reported different attitudes toward coercion, which was influenced by personal and professional factors. These findings highlight the need for targeted interventions and policy strategies to promote attitudinal change, particularly in settings where positive attitudes are prevalent. Full article

This article aims to evaluate the seasonal efficiency of natural gas boilers used in European households, highlighting the cost effectiveness, environmental benefits, and user comfort associated with higher-efficiency models, particularly those based on condensing technology. The study applies a standardized algorithm used in European energy labeling schemes to calculate the seasonal efficiency of household gas boilers. It further includes a comparative analysis of selected boiler models available on the Serbian market and outlines a step-by-step method for estimating gas savings when replacing older, less efficient boilers with modern units. Condensing boilers demonstrate significantly higher seasonal efficiency than standard models by recovering additional heat from exhaust gases. These improved boilers produce lower greenhouse gas emissions and offer annual fuel savings of approximately 10% to 30%, depending on the boiler’s age, system design, and usage patterns. The results also confirm the direct correlation between seasonal efficiency and annual fuel consumption, validating the use of efficiency-based cost comparisons. The analysis focuses on residential gas boilers available in the Serbian market, although the models examined are commonly distributed across Europe. The findings highlight the important role of energy efficiency labels—based on a standardized algorithm—in guiding boiler selection, helping consumers and policymakers make informed decisions that promote energy savings and reduce environmental impact. This article contributes to the theoretical and practical understanding of gas boiler efficiency by integrating algorithm-based evaluation with market data and user-centered considerations. It offers actionable insights for consumers, energy advisors, and policymakers in the context of Europe’s energy transition. Verifying the efficiency calculations of gas boilers requires a careful combination of theoretical methods, measured data, and adherence to standards. Full article

A growing number of research studies show that children spend less time in natural environments, which may have detrimental effects on children’s mental and physical health. This study explores changes in children’s (6–12 years) use of nearby nature and constraints on playing in nature between 2013 and 2023. We apply an ecological approach, including individual, social, and structural constraints on outdoor play. The study is based on national surveys of parents reporting child play behavior for eight activity categories and nineteen categories of constraints/motivation. Findings reveal a decreasing tendency for time spent on all activity categories and increasing constraints for 17 of 19 categories during the study period. Our ecological approach reveals that there is less time for children’s nature use in contemporary society, and activities are more common in built areas than in nature. The survey identifies some important socio-cultural differences regarding gender, age, and residential setting. In future research, the focus should be on how reduced connection to nature affects children’s mental and physical health, and beyond this, how it affects the understanding of and care for nature among future generations. Full article

Urban green spaces (UGSs), including parks, forests, and community gardens, play a critical role in enhancing public health and well-being by providing essential ecosystem services such as improving air quality, reducing surface temperatures, and mitigating harmful substances. As urbanization accelerates, especially in rapidly growing cities like Jinan, China, the demand for UGSs is intensifying, necessitating careful urban planning to balance development and environmental protection. While previous studies have often focused on city-level green coverage, this study shifts the analytical focus from UGS as a whole to urban functional units (UFUs), allowing for a more detailed examination of how green space is distributed across different land use types. We investigate UGS changes in Jinan over the past two decades and assess the influence of socio-economic factors—such as housing prices, land use types, and building age—on UGS distribution within UFUs. Remote sensing technology was employed to analyze the spatiotemporal dynamics of UGS and its correlation with these variables. Our findings reveal a significant shift in UGS distribution, with parks and leisure areas becoming primary drivers of UGS expansion. This study also highlights the growing influence of economic factors, particularly housing prices, on UGS distribution in more affluent UFUs. Additionally, while UGS in Jinan has generally expanded, challenges remain in balancing green space with urban expansion, especially in commercial and residential UFUs. This paper contributes to a more nuanced understanding of UGS distribution by integrating the UFU framework and identifying socio-economic drivers—including housing prices, construction age, and land use type—that shape green space patterns in Jinan. Our findings demonstrate that the spatial pattern of UGS in Jinan mirrors socio-economic and land use disparities observed in other global cities, highlighting both the universality of these patterns and the need for targeted planning in rapidly urbanizing contexts. Full article

Approximately 72% of older adults in residential care have dementia and present with different levels of functioning. People living with dementia (PLwD) may not always be facilitated to independently carry out activities of daily living (ADLs) in care, increasing the likelihood of excess disability. This study incorporated Behavioural Skills Training (BST) to train healthcare staff how to increase opportunities for independence for PLwD by using task analyses and least-to-most (L-M) prompting procedures during ADLs. Three healthcare staff, two female and one male (mean age = 42.67, SD = 16.82), participated in the intervention. The What Works Clearinghouse (WWC) Single-Case Design Technical Documentation guided the study’s design. A randomised single-case experimental (N-of-1) design was employed, using a multiple-baseline design (MBD) across participants (n = 3) for three separate ADLs. The dependent variable (DV) was the percentage of correct staff responses when implementing the L-M prompting procedure for each step during ADLs. Visual and statistical analyses demonstrated an increase in the correct use of a task analysis and L-M prompting for all three participants during the intervention compared to the baseline: for ADL1 (assistance to stand), effect sizes were d = 5.39, d = 9.38, and d = 6.79 for the three participants, respectively; for ADL2 (assistance with drinking), effect sizes were d = 3.27, d = 8.55, and d = 3.67; and for ADL3 (assistance to brush teeth), effect sizes were d = 5.99, d = 12.93, and d = 9.39. Maintenance data ranged from 70% to 100% correct responses at follow-up (mean = 93.11% SD = 7.85). Participants successfully generalised skills learned to two new ADLs (PLwD eating a meal and putting on a jumper). BST was demonstrated to be an effective training strategy to increase opportunities for independent responding for PLwD in care environments. The contingencies influencing staff behaviour require attention within the healthcare environment. Full article

Cognitive–motor integration is the coordination of cognitive and motor processes; it is commonly impaired among people living with dementia (PWD) and may be improved through exercise. This pilot randomized controlled trial (1:1) aimed to determine the effect of 6 months of exercise on cognitive–motor integration compared to usual care in n = 42 PWD at two residential care facilities. Participants completed single- and dual-task standing (30 s of standing while counting backward by 1 s), walking (4 m walk while naming words), and timed-up-and-go (TUG) tests (TUG with a category task), measured using APDM inertial sensors at baseline and 6 months (age = 82 years, 35% female, Montreal Cognitive Assessment = 10.2 ± 5.9, NCT05488951). The adapted Otago Exercise Program involved 60 min of lower-body strength and balance exercises and walking 3x/week for 6 months. Usual care involved regular social activities and healthcare appointments. Exercise provoked increased single-task stride length and increased dual-task TUG turn velocity compared to usual care (p < 0.05). Usual care may reduce the ability to appropriately select cautious gait, as the usual care group exhibited faster dual-task gait speed at 6 months compared to the OEP plus usual care (p < 0.05), which was faster than their single-task gait speed. Our results support implementing the OEP to improve cognitive–motor integration in PWD. Full article

Background: Falls are the leading cause of emergency department (ED) presentations among residential aged care facility (RACF) residents. This study identified the factors influencing the decision to discharge RACF residents from the ED following fall-related presentations. Methods: A single-centred, cross-sectional observational study was conducted in rural Shepparton, Victoria, Australia. The study included residents aged ≥65 in RACFs with fall-related ED presentations between 1 January and 19 November 2024. The main outcome was to determine factors that may prevent unwarranted ED transfers among RACF residents following falls. Statistical methods, including multivariate logistic regression, were used to examine factors associated with ED dispositions. Results: A total of 181 presentations (69.4%) were discharged, and 80 (30.6%) were admitted. The presence of an Advance Care Directive (ACD) (adjusted odds ratio [aOR] = 2.89; 95% confidence interval [CI]: 1.37–6.05) and lower triage levels (aOR = 2.69; 95% CI: 1.06–6.80) increased the odds of discharge. Major injuries (aOR = 0.20; 95% CI: 0.09–0.42) and obvious injuries (aOR = 0.24; 95% CI: 0.10–0.56) reduce discharge chances. Whether computed tomography brain scans were performed or anticoagulation therapy was used did not significantly influence ED discharge chances. Conclusion: In addition to traditional factors associated with ED discharge in post-fall patients from RACFs, an ACD was associated with increased discharge from the ED. Strengthening fall-specific advance care planning, improving ACD accessibility, and enhancing the clinical capacity of RACFs may reduce unnecessary ED transfers and better align care with residents’ goals, particularly in rural settings. Full article

Current research on aged housing prioritizes community planning and environmental enhancement over older adults’ needs, creating a retrofit mismatch amid population aging. To investigate the relationship between indoor environmental quality and residential satisfaction among elderly occupants, this study examines 72 households in aged residential buildings, analyzing four environmental indicators (thermal, lighting, acoustic environments, and air quality). The environmental measurements reveal that 81.9% of thermal environment parameters fall below the ASHRAE-55 comfort range, with winter average temperatures reaching only 13.94 °C. Insufficient illumination exists in kitchen and bedroom areas. Lifestyle patterns including infrequent air conditioning use (87%) and window ventilation substituting range hoods (32%) may deteriorate thermal comfort and air quality. An ordered logistic regression analysis demonstrates significant correlations between all four environmental indicators and elderly satisfaction levels. Thermal comfort emerges as the priority focus for aging-adapted retrofitting. Air quality improvement shows particularly significant potential for enhancing residential satisfaction. Although prolonged window opening (73%) exacerbates low-temperature/high-humidity conditions and noise exposure, it still contributes positively to overall satisfaction. This research provides crucial insights for aligning aged residential retrofitting with home-based elderly care requirements, promoting housing development that better accommodates the lifestyle patterns of older populations, thereby improving quality of life for aging-in-place residents. Full article

The aging population has posed significant challenges to the built environment (BE) in urban residential areas, particularly in addressing older adults’ activity and health needs. Understanding how the BE influences older adults’ activity and health is crucial for promoting active and healthy aging. This study explored the interactions among the BE, self-efficacy (SE), activity engagement (AE), and self-rated health (SH) for older adults in urban residential areas. A random sampling technique selected 372 older adults residing in urban residential areas to participate in the questionnaire survey. Spearman correlation and hierarchical regression analysis were used to develop the BE-SE-AE-SH model for older people based on social cognitive theory. Accessibility, land use mix, and street connectivity affect activity engagement by influencing older persons’ walking and self-care abilities. Land use mix discourages walking ability and activity engagement, while esthetics encourages activity engagement. Land use mix, street connectivity, transportation, walking ability, self-care ability, and activity engagement enhance older adults’ self-rated health. Practical recommendations for age-friendly urban residential areas include the following: (1) optimize elevators and footpaths; (2) decentralize small businesses and create multi-use parking; (3) shorten crossings and enhance pavements; (4) add natural and humanistic elements; (5) limit car speed and install traffic signals. Full article