Search Results (3,462)

Background/Objectives: Patient Support Programs (PSPs) are increasingly used to support treatment adherence and continuity of care in chronic, high-cost conditions. In hemophilia A, consistent prophylaxis is essential to prevent bleeding episodes and long-term joint damage. In Mexico, disparities in access to treatment have encouraged the development of public–industry collaborative models. The objective of this study was to describe the structure, implementation, and operational characteristics of a PSP delivering home-based prophylactic treatment for individuals with hemophilia A in Mexico, and to compare annual bleeding rates according to factor VIII dosing adequacy. Methods: A cross-sectional, retrospective analysis was conducted using fully anonymized operational data from the PSP registry between January 2023 and March 2024. Variables included infusion location and administrator, prescribed and used doses, weekly infusion frequency, program incorporation and discontinuation, geographic coverage, and bleeding events. Annual bleeding rates were compared across dosing categories using Poisson regression models with patient-years as an offset. Results: A total of 1173 patients contributed 16,331 infusion records. Participants were predominantly male (99.8%), with a median age of 26 years; 71.8% had severe hemophilia. Home infusion accounted for 92.0% of administrations, primarily self-administered or caregiver-delivered. The median prescribed and used monthly doses were 18,000 IU and 16,000 IU, respectively, with dose concordance observed in 66.8% of records. Only 40.7% of patients achieved the recommended prophylactic frequency of three infusions per week. Geographic coverage increased from 62.5% to 71.9% of states. The overall annualized bleeding rate was 2.24 bleeds per patient-year. When stratified by dosing adequacy, patients receiving doses consistent with clinical recommendations showed the lowest bleeding rate (0.18 bleeds per patient-year), compared with those with overdosing (3.84) and underdosing (6.68), with statistically significant differences between groups. Knees, elbows, and ankles were the most frequently affected sites. Conclusions: This PSP achieved broad national reach and high adoption of home-based infusion. The observed dose-dependent differences in bleeding rates underscore the clinical relevance of appropriate prophylactic dosing within structured support programs and support the value of PSPs in strengthening treatment continuity in middle-income settings. Full article

Background: Oral health is a key component of general health and quality of life in the elderly. Residents of long-term care facilities (LTCFs) are particularly vulnerable to poor oral health due to multimorbidity, polypharmacy, and dependence on caregivers. Despite increasing awareness of this issue, dental needs in institutionalized populations remain largely unmet. Objectives: The objective of this study was to evaluate the dental treatment needs of LTCF residents in Warsaw. The analysis focused on oral health status, oral hygiene practices, difficulties with food intake, and the need for assistance in daily oral and nutritional care. Material and methods: A cross-sectional study was conducted among 29 LTCF residents. Data collection included interviews on hygiene habits and dietary difficulties, followed by clinical examination assessing oral mucosa, dentition, prosthetic status, and plaque coverage (Plaque Index). Statistical analyses were performed using GraphPad Prism with Mann–Whitney U, Fisher’s exact, and Spearman’s rank correlation tests. Results: The median number of missing teeth ranged from 22 to 24. Active caries were found in 17 residents and periodontitis in 19. Oral hygiene was poor, with plaque covering up to 100.0% of tooth surfaces. Women had significantly more missing teeth than men (p = 0.0128). Difficulties with food intake were reported by 69.0% of residents. No significant associations were found between oral hygiene products use and dental or prosthetic status. Conclusions: This study revealed severely compromised oral health among LTCF residents. Extensive tooth loss, poor hygiene, and limited access to preventive dental care indicate the need for systematic, on-site oral health programs, caregiver training, and integration of dental services into standard geriatric care. Full article

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder marked by both motor and non-motor symptoms. The home-based wearable sensor monitoring Parkinson’s KinetiGraph (PKG) evaluates clinical efficacy, caregiver satisfaction, and cost-effectiveness in the clinical management of Parkinson’s disease (PD) compared to prior usual standard care. Methods: We analyzed 50 patients with Parkinson’s disease, comparing baseline clinical outcomes, healthcare utilization, and caregiver burden without PKG to follow-up data after 12 months with PKG. We used IBM SPSS Statistics for the analysis. Statistical significance was set at p < 0.05 for hypothesis testing. We employed the Wilcoxon signed-rank test to evaluate differences between the two time points, while exploratory bivariate associations between caregiver burden (Zarit score) and various outcomes were examined using Spearman’s rank correlation. Results: Over a 12-month period following the implementation of PKG-guided care, significant improvements were observed in various clinical, functional, and economic areas for the patients. Key findings include the following: motor function improved, with UPDRS Part III scores showing a 20% median reduction (from 25 to 20); medication adjustments decreased by 40% (from 5 to 3); outpatient visits were reduced by 60% (from 5 to 2); hospital admissions decreased by 100% (from 1 to 0); caregiver burden, as measured using the Zarit caregiver burden score, declined by 37.5% (from 48 to 30); and total direct medical costs decreased by 17.9% (from AED 261,800 to AED 215,000). Conclusions: These findings indicate substantial reductions in healthcare utilization, costs, and caregiver burden following the integration of PKG monitoring into clinical practice. Full article

Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and long-term adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centre-based model and to support more flexible, patient-centred care. Methods: This narrative “review on a systematic backbone” synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and tele-rehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multi-component digital CR solutions. Only original studies with clinical, functional, or patient-reported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealth-enabled home-based or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centre-based CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved risk-factor profiles and quality of life to a degree comparable with face-to-face CR. Conclusions: Digital technologies can credibly support core objectives of CR in high-risk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patient-centred rehabilitation. Full article

Vascular access remains the cornerstone of effective hemodialysis but also constitutes a major source of burden, including dysfunctions, infections, patient discomfort, and other access-related morbidities. As dialysis care evolves, there is a pressing need to move beyond conventional approaches, marked by repeated needle punctures and open connection systems, toward safer, more comfortable, and technologically advanced solutions. This narrative article presents a forward-looking vision of vascular access connectivity supported in current clinical and technological knowledge. It explores how emerging connectivity, particularly needle-free port systems, could reshape the future of dialysis care. We briefly review existing vascular access modalities, including central venous catheters (CVCs) and arteriovenous (AV) accesses, along with their associated limitations. Special focus is given to the burden of infection, patient-reported discomfort, and workflow inefficiencies. We then examine emerging closed-system technologies designed to reduce contamination risk, improve patient experience, and potentially support long-term clinical outcomes. Drawing on advances in material science, biomedical engineering, and infection prevention, we outline a forward-looking vision for vascular access that aligns with patient-centered care, facilitates home-based treatment and remote connectivity, and anticipates future developments, such as wearable artificial kidneys within a value-based healthcare framework. However, the clinical adoption of these new technologies will require careful evaluation of long-term safety, durability, cost-effectiveness, training requirements, and real-world performance, underscoring the need to balance innovation-driven benefits against practical, regulatory, and organizational challenges. Full article

As artificial intelligence (AI) continues to expand across clinical environments, healthcare is transitioning from static decision-support tools to dynamic, autonomous agents capable of reasoning, coordination, and continuous interaction. In the context of geriatric medicine, a field characterized by multimorbidity, cognitive decline, and the need for long-term personalized care, this evolution opens new frontiers for delivering adaptive, assistive, and trustworthy digital support. However, the autonomy and interconnectivity of these systems introduce heightened cybersecurity and ethical challenges. This paper presents a Secure Agentic AI Architecture (SAAA) tailored to the unique demands of geriatric healthcare. The architecture is designed around seven layers, grouped into five functional domains (cognitive, coordination, security, oversight, governance) to ensure modularity, interoperability, explainability, and robust protection of sensitive health data. A review of current AI agent implementations highlights limitations in security, transparency, and regulatory alignment, especially in multi-agent clinical settings. The proposed framework is illustrated through a practical use case involving home-based care for elderly patients with chronic conditions, where AI agents manage medication adherence, monitor vital signs, and support clinician communication. The architecture’s flexibility is further demonstrated through its application in perioperative care coordination, underscoring its potential across diverse clinical domains. By embedding trust, accountability, and security into the design of agentic systems, this approach aims to advance the safe and ethical integration of AI into aging-focused healthcare environments. Full article

Quantifying geographic variation is crucial for policy evaluation, yet researchers often rely on complex national surveys not designed for sub-national inference. This design-analysis mismatch creates two challenges when decomposing variance across domains like states: informative sampling confounds substantive heterogeneity with design artifacts, and finite-sample variance inflation conflates sampling noise with signal. We introduce the Bayesian Hybrid Framework that reconciles design-based and model-based inference through Bayesian Pseudo-Likelihood for design consistency and a hybrid generalized linear mixed model that simultaneously estimates substantive domain effects and nuisance design effects (strata, PSUs). We propose a Dual Estimand Framework distinguishing between Descriptive (total observed variance) and Policy (substantive variance net of design) estimands, with explicit de-attenuation to correct finite-sample inflation. Simulations based on the 2019 National Survey of Early Care and Education demonstrate negligible bias and superior efficiency compared to standard alternatives. Applied to subsidy receipt among home-based child care providers, we find the observed between-state variation (16.7%) reduces to only 5.4% after accounting for design artifacts and sampling noise. This three-fold reduction reveals that local factors, not state policies, drive most heterogeneity, highlighting the necessity of our framework for rigorous geographic variance decomposition in complex surveys. An accompanying R package (version 0.3.0), bhfvar, implements the complete framework. Full article

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is highly prevalent among individuals residing in care homes, where effective disease management can enhance quality of life by slowing disease progression. Care home staff are central to COPD management in these settings, and their capacity to deliver optimal care may be strengthened through targeted education and training interventions. This scoping review aimed to synthesise existing evidence on education and training intended to enhance COPD care delivery by care home staff. Methods: A scoping review was conducted in accordance with Joanna Briggs Institute (JBI) guidelines and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. Four electronic databases (CINAHL, EMBASE, MEDLINE, and PsycINFO) were systematically searched for studies evaluating educational or training interventions regarding COPD for care home staff. Results: Only one study met the eligibility criteria for inclusion. This mixed methods study encompassed both a randomised control trial and semi-structured interviews, evaluating the effects of a COPD education programme for healthcare professionals working in a care home setting. This education intervention led to increased COPD-related knowledge and improved support for staff managing residents with COPD. Conclusions: Evidence for educational interventions for care home staff caring for individuals with COPD is extremely limited. While the included study shows potential for educational programmes, substantial gaps persist. Further research is needed to develop, implement, and rigorously assess education and training interventions to support high-quality COPD care in care homes. Full article

Background: Digital transformation in healthcare has advanced rapidly in hospitals and primary care, while long-term care facilities have often lagged behind. In nursing homes, nurses play a central role in coordinating care and accessing medical expertise, yet digital tools to support these tasks remain inconsistently implemented. The CareConnect study, funded under the German Model Program for Telecare (§ 125a SGB XI), aimed to develop and implement a multiprofessional telecare system tailored to nursing home care. Objective: This implementation study examined the feasibility, acceptability, and early adoption of a multiprofessional telecare system in nursing homes, focusing on implementation processes, contextual influences, and facilitators and barriers to integration into routine nursing workflows. Methods: A participatory implementation design was employed over 15 months (June 2024–August 2025), involving a university hospital, two nursing homes (NHs), and four medical practices in an urban region in Germany. The telecare intervention consisted of scheduled video-based teleconsultations and interdisciplinary case discussions supported by diagnostic devices (e.g., otoscopes, dermatoscopes, ECGs). The implementation strategy followed the Standards for Reporting Implementation Studies (StaRI) and was informed by the Consolidated Framework for Implementation Research (CFIR). Data sources included telecare documentation, nurse surveys, researcher observations, and structured feedback discussions. Quantitative and qualitative data were analyzed descriptively and triangulated to assess implementation outcomes and mechanisms. Results: A total of 152 documented telecare contacts were conducted with 69 participating residents. Most interactions occurred with general practitioners (48.7%) and dermatologists (23%). Across all contacts, in 79% of cases, there was no need for an in-person visit or transportation. Physicians rated most cases as suitable for digital management, as indicated by a mean of 4.09 (SD = 1.00) on a 5-point Likert scale. Nurses reported improved communication, time savings, and enhanced technical and diagnostic skills. Key challenges included delayed technical integration, interoperability issues, and varying interpretations of data protection requirements across facilities. Conclusions: This pilot study suggests that telecare can be feasibly introduced and accepted in nursing home settings when implemented through context-sensitive, participatory strategies. Implementation science approaches are essential for understanding how telecare can be sustainably embedded into routine nursing home practice. Full article

This study examines how the sense of home for people with dementia is shaped not only by physical settings but by dynamic atmospheric compositions emerging through memory, sensation, and everyday practices. Building on a preliminary literature mapping that identified three dimensions of home in later-life care environments—safe space, small world, and connection—we developed a multisensory co-design toolkit combining key-element cards and curated olfactory prompts. The study was conducted in a dementia-friendly residential care facility in Italy. Nine residents with mild–moderate dementia (aged 75–84) participated in two group sessions and six individual sessions, facilitated by two design researchers with care staff present. Data consist of audio-recorded and transcribed interviews, guided olfactory sessions, and researcher fieldnotes. Across sessions, participants articulated “small worlds” as micro-environments composed of meaningful objects, bodily comfort, routines, and sensory cues that supported emotional regulation and identity continuity. Olfactory prompts, administered through a low-intensity and participant-controlled protocol, supported scene-based autobiographical recall for some participants, often eliciting memories of domestic rituals, places, and relationships. Rather than treating home-like design as a fixed architectural style, we interpret home as continuously re-made through situated sensory–temporal patterns and relational practices. We translate these findings into atmospheric design directions for dementia care: designing places of self and refuge, staging accessible material memory devices, embedding gentle olfactory micro-worlds within daily routines, and approaching atmosphere as an ongoing process of co-attunement among residents, staff, and environmental conditions. The study contributes a methodological and conceptual framework for multisensory, narrative-driven approaches to designing home-like environments in long-term care. Full article

Background: Therapeutic drug monitoring (TDM) is a promising strategy to personalize chemotherapy dosing, especially for agents with narrow therapeutic indices such as epirubicin. However, widespread adoption is hindered by logistical challenges associated with venous blood sampling and centralized laboratory workflows. Objective: This study aimed to perform a method-comparison validation of the True Dose^® TD-EPI microsampling kit by verifying analytical agreement between capillary and venous epirubicin measurements in real patient samples. The study focuses on analytical performance and does not constitute validation of the whole decentralized workflow, including unsupervised patient self-sampling. Methods: 13 patients with early-stage breast cancer receiving the first cycle of neoadjuvant or adjuvant epirubicin were enrolled. Capillary samples were collected using the finalized TD-EPI kit (Cap-TD) at 2.5 h (n = 13) and/or 48 h (n = 10) post-infusion and stored at room temperature for 72 h before analysis. Matched venous samples were analyzed using both conventional protein precipitation (“Traditional”) and a modified lab-based True Dose workflow (Lab-TD). Epirubicin concentrations were quantified via validated liquid chromatography–tandem mass spectrometry (LC–MS/MS). Results: Cap-TD concentrations showed strong agreement with Traditional venous values (r = 0.953), with minimal bias (mean difference = 0.013 μM) in Bland–Altman analysis. Passing–Bablok regression confirmed analytical equivalence. Intra-assay variability remained within ICH M10 guidelines (CV ≤ 15%), and recovery was unaffected by 72 h ambient storage. Lab-TD results closely matched Traditional workflows, supporting reproducibility. Conclusions: The TD-EPI kit enables accurate decentralized monitoring of epirubicin, eliminating the need for venous access, cold-chain logistics, or in-clinic sampling. These findings support its integration into personalized oncology care and future applications in home-based TDM. Trial Registration: This study is part of an approved protocol registered in the EU Clinical Trials Register (EUCT Number 2024-514818-12-00; EudraCT Number 2017-000641-44; registration date: 15 June 2017). Full article

Diabetes prevalence in older people residing in care homes is rising. This cohort of patients is characterised by multiple morbidities, polypharmacy, and frailty. As a result, they are exposed to an increasing burden of hypoglycaemia, which leads to unnecessary hospital visits and negative consequences. In addition, due to their high baseline morbidities, the risk of cardiovascular events increases. The newly introduced therapy of SGLT-2 inhibitors and GLP-1RA has a very low risk of hypoglycaemia and a significant cardiovascular protective effect. This makes it an appealing choice to be used in older people with complex morbidities, such as care home residents. So far, the current use of these agents is suboptimal in these settings because clinicians are cautious of side effects and tolerability, and also, clinical studies have not included this population. Furthermore, the guidelines in this area lack a personalised approach and are too general, with no clear specific description of which patients are suitable for such therapy. The currently available little evidence is indirect, which confirms the superior benefits of such therapy in frail compared with robust subjects, especially in those who are overweight or obese. The demographic mix of care homes is largely heterogeneous in terms of variations in body composition. In addition to malnourished, frail phenotype subjects, the prevalence of individuals with obesity living in these settings is increasing. Therefore, there is scope for increased use of these new agents in residents who have at least a normal or higher body weight. Because of the high baseline cardiovascular risk, these patients will benefit most from such therapy. Otherwise, these agents are better when less used for frail patients who are anorexic and malnourished because of the risk of inducing further weight loss, volume loss, low blood pressure, falls, and fractures. Full article

Background/Objectives: Oral frailty and hypofunction in older adults are strongly associated with declines in nutritional status, physical function, swallowing ability, and overall health. Isolated interventions usually fail to achieve sufficient improvement since these conditions result from interrelated biological, psychological, and social factors. Multidisciplinary approaches combining oral management, nutritional support, and physical rehabilitation have shown promise. This narrative review synthesized evidence from 15 studies examining multifaceted interprofessional interventions across hospitals, communities, long-term care facilities, and home-care settings. Methods: A structured search of PubMed and Web of Science (2000–2025) identified original studies assessing oral, nutritional, or physical outcomes in older adults post-interprofessional interventions. Fifteen eligible studies were extracted; the findings were integrated using narrative synthesis owing to design and outcome heterogeneity. Results: Educational multidisciplinary interventions improved oral hygiene, caregiver awareness, and oral motor function. Multidisciplinary rehabilitation and multidomain programs consistently improved tongue pressure, swallowing function, mastication ability, appetite, body composition, activities of daily living, and oral intake resumption. Nutrition support team-delivered interventions reduced aspiration risks and improved oral environment and swallowing function. Community-based programs using munchy meals and combined exercises enhanced oral and physical functions. Social participation provided psychological benefits. Home-care dysphagia rehabilitation enabled 69% of tube-fed patients to resume oral intake. Conclusions: This narrative review supports a triadic, interprofessional approach in geriatric care, highlighting consistent improvements in oral function through integrated oral, nutritional, and rehabilitative interventions. Full article

Background and Objectives: Immunosenescence is a complex biological process associated with aging, characterized by a progressive decline in immune function and increased chronic inflammation (“inflammaging”), with clinical implications such as frailty, functional decline, multimorbidity, and a higher risk of adverse events in older adults. Nurses in community and primary care settings play a central role in preventive and health promotion interventions that may indirectly influence these processes. However, the available literature remains fragmented. Therefore, this scoping review aims to map and synthesise nursing interventions targeting older adults (≥60 years) that may indirectly influence immunosenescence by acting on its clinical correlates and modifiable determinants, organising the evidence within a four-pillar conceptual framework. Materials and Methods: A scoping review was conducted following JBI methodology and the PRISMA-ScR checklist. We included primary studies on nurse-led interventions in community, home care, primary care, territorial, or long-term care settings. PubMed, Scopus, and Web of Science were searched (English; last 10 years). Interventions were classified into four pillars: nursing nutrition and immunonutrition support, physical activity and exercise support, nursing vaccination coaching, and frailty monitoring and prevention of functional decline. Results: Twenty-five primary studies were included, mostly randomised or cluster-randomised trials in community, primary care, home care, and transitional care settings. Interventions mapped mainly to Pillar 4 and Pillar 2, while Pillar 1 was less frequent and usually part of multicomponent programmes; no primary studies targeted Pillar 3. Overall, effectiveness appeared driven more by intervention intensity and integration than by frailty identification alone: structured, multicomponent nurse-led programmes combining exercise with nutritional and psychosocial components showed the most consistent benefits on frailty, functional outcomes, and well-being, whereas low-intensity preventive consultations and Comprehensive Geriatric Assessment (CGA)-based models often showed limited improvements over usual care. Conclusions: This scoping review highlights the key role of community and primary care nurses in preventive interventions targeting clinical correlates of immunosenescence. Multicomponent nurse-led programmes integrating physical activity, nutrition, and psychosocial support appear most promising for frailty and functional outcomes, while low-intensity interventions show limited effectiveness. No primary studies addressed nurse-led vaccination coaching, representing an evidence gap. Future research should include biological/immunological markers alongside clinical outcomes. Full article

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards. Full article