Search Results (340)

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: 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

The quality of living environments for older adults represents a critical component of social sustainability in an ageing society. Among various housing options, nursing homes are the most institutionalised form of elderly care and demand special attention regarding architectural design. This paper explores the impact of architectural and open space features on social sustainability in living environments for older adults. A comparative analysis of three Slovenian nursing homes is presented. The first two, built in the post-war period, were based on elevated architectural criteria inspired by Swedish human-centred housing design. The third was completed in 2021 in the post-COVID-19 era, which revealed the vulnerability of such housing typologies. An integrated methodological framework was developed by applying two complementary assessment tools: the Safe and Connected, developed by the authors to evaluate the spatial, health, and social resilience of nursing home environments, and the Well-being and Integration, addressing the role of open space with a particular emphasis on the identification of older adults with their environment and the facilitation of social resilience. Both tools evaluate indicators linked to the social dimension of quality of life for older adults. The results show a gradual improvement in architectural quality from the 1960s to the 1980s, followed by a partial decline in the contemporary case. The Swedish example scored highest across both tools. In contrast, the newest Slovenian facility scored surprisingly low in social integration, highlighting critical gaps in current nursing home design. This study demonstrates the value of applying interdisciplinary, tool-based evaluations in identifying design strategies that foster resilient and inclusive LTC environments, and the proposed framework may serve as a decision-making aid for architects, planners, and policymakers. This research highlights the importance of reintroducing human-oriented design principles to support socially sustainable nursing home environments. Full article

(1) Background: The provision of monofunctional or inadequately distributed services in urban park green spaces often constrains residents’ opportunities and diversity for outdoor activities, particularly limiting access and participation for specific age groups or activity preferences. However, functional nodes with temporal and spatial flexibility demonstrate high-quality characteristics of resilient and shared services through integrated development. Accurately identifying user demand provides a solid basis for optimizing the functional configuration of urban parks. (2) Methods: This study took the old city area of Zhengzhou, Henan Province, China, as a case study. By collecting and integrating various types of data, such as geographic spatial data, field investigation data, and behavioral observations, we developed a population demand quantification method and a modular analysis approach for park service functions. This framework enabled correlation analysis between diverse user needs and park services. The study further classified and combined park functions into modular units, quantifying their elastic and shared service capabilities—namely, the adaptive flexibility and shared utilization capacity of park services. Additionally, we established a demand-responsive evaluation system for identifying and diagnosing problem areas in park services based on multi-source data. (3) Results: The demand response index and diagnostic results indicate that the supply of fitness facilities—particularly equipment-based installations—is insufficient within the old urban district of Zhengzhou. Among the three user groups—children, young and middle-aged adults, and the elderly—the elderly population exhibited the lowest demand response index, revealing a significant gap in meeting their specific needs. (4) Conclusions: Based on the research findings, a three-tier optimization strategy is proposed: A. improve green space connectivity to expand the service coverage of parks; B. implement multifunctional overlay and coordinated integration in spatial design based on site characteristics and demand diagnostics; and C. increase the total supply of facilities to enhance spatial efficiency in parks. By integrating the demand assessment data and diagnostic results, this approach enabled a data-driven reorganization of service types and targeted allocation of resources within existing park infrastructure, offering a practical tool and reference for the planning of urban outdoor activity spaces. Full article

Background: After an older person moves into a nursing home, the next of kin often continues to participate in the care provided there. This participation in care may contribute valuable knowledge of the preferences and wishes of the older person, thereby helping nursing staff deliver personalised care. Objectives: The aim of this study was to explore how next of kin experience their participation in the care of older persons residing in nursing homes after educating nursing staff about participation in palliative care. Methods: This follow-up study used a qualitative design based on semi-structured interviews with 37 next of kin. A thematic analysis was applied. Results: Participation of the next of kin involved active communication and collaboration with nursing staff, expressed in three themes: striving to achieve co-created care, navigating involvement through presence, and building commitment through communication and information. The dual role of being an emotionally close next of kin and a participant in the relative’s care was challenging and became increasingly burdensome and often overwhelming when the older person’s health deteriorated. Conclusions: This study reveals the need to develop and implement a policy for the participation of next of kin in the care of older people living in nursing homes. In addition, support groups can increase well-being through dialogue with other next of kin, thereby alleviating emotional strain. Increased implementation of life stories and the use of digital communication would keep the next of kin informed about the older person’s condition, especially when they cannot be present in person. Life story is a valuable tool for person-centred care and strengthens the relationships between the next of kin, the older person, and the nursing staff. Full article

With the rapid advancement of urbanization in China, the demand for community-based elderly care facilities (CECFs) has been increasing. One pressing challenge is the question of how to provide CECFs that not only meet the health needs of the elderly but also make efficient use of limited urban land resources. This study addresses this issue by adopting an integrated multi-method research framework that combines multi-objective optimization (MOO) algorithms, Spearman rank correlation analysis, ensemble learning methods (Random Forest combined with SHapley Additive exPlanations (SHAP), where SHAP enhances the interpretability of ensemble models), and Self-Organizing Map (SOM) neural networks. This framework is employed to identify optimal building configurations and to examine how different architectural parameters influence key daylight performance indicators—Useful Daylight Illuminance (UDI) and Daylight Factor (DF). Results indicate that when UDI and DF meet the comfort thresholds for elderly users, the minimum building area can be controlled to as little as 351 m² and can achieve a balance between natural lighting and spatial efficiency. This ensures sufficient indoor daylight while mitigating excessive glare that could impair elderly vision. Significant correlations are observed between spatial form and daylight performance, with factors such as window-to-wall ratio (WWR) and wall thickness (WT) playing crucial roles. Specifically, wall thickness affects indoor daylight distribution by altering window depth and shading. Moreover, the ensemble learning models combined with SHAP analysis uncover nonlinear relationships between various architectural parameters and daylight performance. In addition, a decision support method based on SOM is proposed to replace the subjective decision-making process commonly found in traditional optimization frameworks. This method enables the visualization of a large Pareto solution set in a two-dimensional space, facilitating more informed and rational design decisions. Finally, the findings are translated into a set of practical design strategies for application in real-world projects. Full article

Evaluating the walkability of embedded community service facilities is crucial for fostering age-friendly neighborhoods. Existing studies predominantly focus on qualitative analyses of single age groups, lacking a quantitative framework that integrates multigenerational demands and dynamically combines accessibility with facility usability. This study proposes a novel age-differentiated walkability evaluation framework through a case study of the Maple Community in Chengdu, China. The framework innovatively integrates facility classification weighting systems, population-specific distance decay functions, and multisource spatial data analysis to reveal intergenerational disparities in facility demand and spatial suitability. Key contributions include the following: (1) developing mobility-attenuated accessibility models tailored to distinct age groups, overcoming the limitations of traditional single-function approaches; (2) establishing a multidimensional evaluation system that bridges accessibility theory and usability metrics; (3) empirically demonstrating the spatial equity improvements through embedded facility optimization. The results highlight that elderly residents prioritize healthcare facilities (weight = 0.22), while adolescents rely heavily on cultural–recreational amenities (weight = 0.32). Post-renewal walkability scores in core areas increased by 52.3%, yet persistent peripheral disparities underscore intergenerational accessibility gaps. The framework provides theoretical and methodological advancements for age-friendly community planning, offering actionable insights for data-driven urban renewal policies. Full article

The introduction of COVID-19 vaccinations has significantly altered the course of the pandemic by markedly reducing the number of severe infection cases, hospitalizations, and deaths due to COVID-19. Elderly individuals constitute a particularly vulnerable group at risk of severe disease progression, which is often related to decreased immune system effectiveness and comorbidities. Severe infection outcomes in vaccinated individuals, though substantially rarer than in the unimmunized population, can still lead to death due to underlying health conditions. This analysis aims to describe the population of elderly individuals who, despite being vaccinated, died from interstitial pneumonia complicating SARS-CoV-2 infection. Data on the infection course and co-existing diseases were obtained from the database of the Józef Struś Multispecialty City Hospital in Poznań, which was converted into a dedicated facility during the pandemic. The inclusion criteria for the analysis were being over 60 years of age on the day of hospital admission, confirmed pneumonia in radiological examination, COVID-19 infection confirmed by PCR test, and an adverse disease course resulting in death. Patients admitted to the hospital from 1 June 2021 to 31 December 2021 were analyzed. Out of all hospitalizations, only 18 individuals met the inclusion criteria. Given the small number of patients, the authors employed descriptive methods to illustrate the clinical states of the individual patients, presenting SARS-CoV-2 infection in the context of co-existing diseases that significantly affect prognosis. The qualitative analysis employed highlights the complex and multidimensional courses of severely ill COVID-19 patients more emphatically. Full article

Background: The aging of the population has increased the number of frail people living in long-term care facilities, underscoring the need for continuous updates in infectious diseases prevention strategies. The aim of this study was to analyze two pneumococcal disease outbreaks in elderly residences in Gipuzkoa, northern Spain, their impact on residents, and the containment measures implemented. Material and methods: The outbreaks took place in 2023 and in 2024 in two residences of 111 and of 155 residents, respectively. Diagnosis was based on clinical criteria, radiological findings, and microbiological techniques. Pneumococcal isolates were characterized by whole-genome sequencing. Results: The outbreaks involved five and six residents, respectively. Most residents in both facilities had been vaccinated with the pneumococcal polysaccharide 23-valent vaccine (PPV23) more than five years prior. The median attack rates were 4.5% and 3.9%, lower than those reported in similar outbreaks. The adopted infection transmission prevention measures successfully limited the spread of the outbreaks. Conclusions: PPV23 vaccination did not prevent invasive pneumococcal infection in the affected residents. The vaccination of elderly people living in long-term care facilities with 20-valent and 21-valent pneumococcal conjugated vaccines should be evaluated as a new preventive measure. Full article

Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key dimensions—availability, accessibility, accommodation, and acceptance—affect patients’ experiences and the utilisation of diabetes-related healthcare services. This study also seeks to identify gaps and challenges within the current healthcare delivery system, particularly for low-income populations, to inform strategies for improving equitable and sustainable access to care. Methods: This study was conducted in a public health clinic in Melaka, Malaysia. Purposive sampling was used among T2DM patients under the “Health Care Scheme for Group B40” programme in a public health clinic in Melaka, Malaysia. The study included participants with at least a 6-month history of T2DM to ensure substantial experience in accessing healthcare services. Results: Fifteen patients participated in this study. Elderly individuals, retirees, and those with average incomes demonstrated higher healthcare service utilisation. Ethnic diversity was crucial, revealing its impact on health behaviours and healthcare-seeking patterns. Primary or secondary education levels among participants highlighted the necessity for targeted health literacy efforts. Conclusions: This study highlighted notable awareness and satisfaction among patients concerning the availability, accessibility, and accommodation of services, particularly emphasising the importance of geographical proximity in healthcare services. However, challenges faced by elderly individuals in accessing social support are also highlighted. The potential of enhancing the amenities of healthcare facilities to improve patient experiences is also reflected in our results. These insights provide evidence for the effectiveness of the Malaysian healthcare system in catering to a diverse demographic and can also be helpful in refining healthcare strategies and further optimising patient-centred care in Malaysia. Full article

As individuals grow older, they experience notable shifts in their health conditions, social positions, and personal identity. Studies show that finding meaning in life correlates with healthier lifestyle choices and enhanced overall well-being. This sense of meaning functions as a protective factor against life’s challenges, strengthening resilience during later years. The research utilized thematic analysis within a qualitative methodology to investigate the subjective sources of meaning among elderly people living in Romanian institutional settings. The analysis revealed several interconnected themes. Religiosity and spirituality emerged as a fundamental anchor, with participants often mentioning God, Divinity, and Higher Power in their narratives. They typically conceptualized life as a sacred gift and emphasized the importance of religious practices such as prayer and church attendance as essential to their sense of purpose. The intergenerational transmission of values also proved significant, with elderly individuals finding meaning in passing down moral and spiritual principles to younger family members, viewing this as their enduring legacy. Interpersonal connections played a crucial role as well, with quality relationships with family and friends fostering a sense of belonging, while broken relationships or isolation negatively impacted well-being. Daily life objectives, including short-term goals like maintaining routines or anticipating family visits, along with preserving functional independence, provided structure and immediate purpose for many participants. The research distinguished between religiosity and spirituality as related but separate concepts: while formal religious rituals offered community-based meaning, those less engaged with organized religion discovered transcendence through personal spiritual experiences such as connecting with nature. This study highlights cultural specificities, particularly how Orthodox Christian traditions shape existential narratives among Romanian elderly, and proposes practical interventions for retirement facilities to incorporate activities focused on spiritual engagement, relationship building, and opportunities for elders to share their wisdom with younger generations. Full article

Since 2019, China has been promoting the renovation of old urban residential areas built in 2000 or earlier. However, older communities surrounding large urban hospitals face unique challenges, including deteriorating infrastructure, complex social dynamics, and conflicts between tenants and residents. This study focuses on old communities near Xiangya Hospital in Changsha, Hunan Province, employing questionnaire surveys to analyze residential satisfaction and demands across three dimensions: housing spaces, community public spaces, and social relations. Using multilevel linear regression, structural equation modeling, and moderation effect analysis, this research systematically investigates influencing factors and group heterogeneity. The findings reveal that community greening, recreational facilities, and property management are core drivers of residential satisfaction, while social relationships and public spaces play critical mediating roles. Distinct group-specific needs emerged: elderly residents prioritized greening, security, and property management responsiveness; medical students emphasized sound insulation and tenant management; and patients and their families heavily emphasized ventilation and lighting, hygienic conditions, and infrastructure. To address these issues, the study proposes an integrated renewal strategy emphasizing the integration of physical upgrades and soft governance. The findings provide theoretical and practical insights for the systematic renewal of similar older hospital-adjacent communities. Full article

With the growing trend of population mobility and the aging process in China, a significant number of accompanying elderly migrants have moved to major cities. However, in community public spaces, the behavioral differences between caregiver-oriented elderly migrants (CO-AEMs), family reunion-motivated elderly migrants (FR-AEMs), and local elderly residents hinder social interactions between these groups. This study aims to explore opportunities for cross-group social interaction within the community environment. By utilizing GPS data collection and activity log analysis, along with spatiotemporal behavioral research methods, this study reconstructs the spatiotemporal trajectories of three groups of elderly individuals. The study proposes a social interaction potential (SIP) model based on the “support-constraint” framework. Through qualitative analysis of spatiotemporal behavioral characteristics and quantitative measurement of the degree of spatiotemporal behavioral co-occurrence across four modes, this study reveals the differentiated impact mechanisms of spatial and behavioral factors on social interactions, ultimately assessing SIP in differentiated community spaces and activities. This research highlights differences across spatial, behavioral, and temporal dimensions that hinder social interactions between the groups. Spatial and behavioral differences are primarily attributable to the lifestyle habits and activity preferences of the elderly, while temporal discrepancies reflect varying degrees of family-related constraints across the different groups. Furthermore, informal community public spaces show higher SIP than formal facilities. Additionally, the similarity in behaviors across groups facilitates social interactions. FR-AEMs and local elderly residents show higher SIP in self-care behaviors, while CO-AEMs and local elderly residents demonstrate stronger SIP in behaviors related to their family and grandchildren. Based on the segmented assimilation theory, this study proposes hierarchical community governance and spatial optimization strategies for activities and spaces with different SIP. The aim is to cultivate opportunities for interaction while respecting the characteristics of accompanying elderly migrants and to foster the construction of an inclusive community environment. The findings provide theoretical support and practical pathways for community space planning and social governance in the context of an aging society. Full article

Rapid population aging worldwide has created pressing demands for transformative changes in tourism management and service provision, necessitating urgent age-friendly modifications to destination infrastructure and facilities. However, the existing research on age-friendly facility assessments has often relied on methods such as surveys and field observations, which are inefficient and highly subjective, significantly limiting their applicability. This paper proposes a novel age-friendly assessment method that integrates multiple computer-vision-based object detection and recognition models. By calculating the spatiotemporal occupancy rates of resting facilities and the proportion of elderly usage, this method enables an efficient quantification of the age-friendly adequacy of rest areas. Using field data collected from the Xuanwu Lake Scenic Area, we designed accuracy analysis and validation experiments, demonstrating that this method surpasses traditional approaches in both evaluation efficiency and accuracy. The results indicate that the service facility adequacy in the FangQiao and LingQiao rest areas is insufficient, with resting facility density below four per 100 m, making it difficult to meet the resting needs of elderly visitors. This method can effectively supplement current age-friendly facility assessment practices in tourist destinations, offering a scientific and efficient basis for infrastructure upgrades tailored to elderly needs. Full article

With global aging accelerating, improving the efficiency and quality of elderly care is increasingly critical. This study proposes smart nursing home design guidelines to enhance care through smart device integration. The guidelines include two parts: smart device selection criteria, based on next-generation elderly needs identified via Japanese public surveys, and smart nursing home model templates, built upon existing Japanese housing standards. These guidelines provide practical recommendations on device usage, placement, and spatial optimization to improve accessibility and nursing efficiency. The study concludes by validating the effectiveness of the guidelines in addressing the requirements of the next generation of elderly people through a case study, which shows that although construction costs have increased by an average of 18.35%, the guidelines have ensured a safer, more comfortable, and technologically advanced nursing home environment. Full article