Search Results (690)

With rapid global aging, the community environment has become a critical factor influencing cognitive health in older adults. However, most existing studies focus on single environmental attributes and rely on linear analytical methods, which fail to capture the complex and synergistic effects of community features. Guided by an integrated theoretical perspective on environmental psychology, aging, and cognitive health, this study examines how multiple community environmental factors jointly affect cognitive function in elderly people. A case study was conducted among 215 older residents in Shanghai, China. An exploratory factor analysis (EFA) identified the following five key dimensions of community environment: pedestrian friendliness, blue–green spaces, infrastructure, space attractiveness, and safety. We then applied both Partial Least Squares Structural Equation Modeling (PLS-SEM) and Fuzzy Set Qualitative Comparative Analysis (fsQCA) to reveal linear and configurational relationships. The findings showed that pedestrian friendliness, blue–green spaces, and space attractiveness significantly enhance cognitive health, while fsQCA highlighted multiple pathways that underscore the non-linear and synergistic interactions among environmental features. These results provide theoretical insights into the mechanisms linking community environments and cognitive function and offer practical guidance for designing age-friendly communities. Full article

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: Pneumococcal disease is a significant health burden, particularly among older adults and individuals with chronic conditions. Sequential pneumococcal vaccination (PCV13 followed by PPSV23) has been recommended in Italy since 2017 for its demonstrated efficacy, safety, and cost-effectiveness in preventing invasive pneumococcal disease (IPD). Nevertheless, limited data are available on the sequential pneumococcal vaccination coverage in Italy. This study aimed to evaluate the coverage and trends of sequential pneumococcal vaccination among individuals who turned 65 years old within the Viterbo Local Health Authority between 2018 and 2023. Methods: A retrospective cohort study was conducted using data from the Regional Vaccination Registry (AVR), a comprehensive digital vaccination dataset. Vaccination coverage was calculated based on individuals completing the sequential pneumococcal vaccination within two years after turning 65 years old. Trends as well as subgroup variations based on sex, citizenship, district of residence, and municipality size were analyzed. Results: Among 27,657 individuals who turned 65 years of age during the study period, only 2.32% completed the sequential pneumococcal vaccination. Coverage increased steadily from 2018 (0.60%) to a peak in 2020 (3.27%), followed by a plateau and a decline in 2023 (2.53%). Coverage varied across demographic and geographic subgroups: females (2.58%) had higher coverage than males (2.04%), Italian citizens (2.45%) exceeded foreign residents (0.64%), and residents in District C (3.03%) led over District A (1.08%). Smaller municipalities (≤10,000 inhabitants) showed higher coverage (2.52%) than larger ones (1.98%). Conclusions: Adherence to sequential pneumococcal vaccination has been very low throughout the considered study period. This is highly relevant information to consider in the view of new available pneumococcal vaccines for immunization of the elderly. Furthermore, geographic and demographic differences highlight the need for targeted public health interventions. 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

(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/Objectives: Proper management of food services aimed at preventing malnutrition and weight loss among residents of long-term care facilities is a critical priority. Accordingly, accurate prediction of energy intake requirements is necessary. This study aimed to estimate the energy intake required to prevent weight loss in residents of Japanese long-term care facilities. Methods: Body weight and 12-day dietary intake were measured from residents aged ≥75 years with a body mass index (BMI) < 25.0 kg/m² who were consuming a regular or chopped diet. In the survey, individuals with oral intake were included, while those with swallowing problems, serious illnesses, dietary restrictions, or medications causing appetite loss were excluded. The rate of body-weight loss and the energy intake per kilogram of body weight (kcal/kg BW) during each 6-month period were calculated. The energy intake per kilogram of body weight corresponding to the rate of body-weight loss of 0% was estimated from the regression line between the rate of body-weight loss and energy intake per kilogram of body weight. Results: The data was analyzed for 99 residents (15 men and 84 women, age 89.3 ± 5.0 years, BMI 20.3 ± 2.6 kg/m²). From the regression results in all participants, the energy intake per kilogram of body weight corresponding to the rate of body-weight loss of 0% was 31.4 kcal/kg BW overall and 33.4 kcal/kg BW for those with a BMI < 18.5 kg/m². Conclusions: The calculation of energy intake using a regression line may be able to predict the energy intake required for weight maintenance without using instrumental measurements or estimation equations, especially in the case of underweight individuals. Full article

Urban mobility resilience plays a central role in sustainable urban planning discussions, especially considering the challenges of extreme events, climate change, and the increasing scarcity of fossil fuels. This study evaluates urban mobility resilience in Petrópolis (RJ), incorporating socio-spatial heterogeneity and energy vulnerability. This research fills methodological gaps in the literature by proposing a composite resilience index that integrates technical, socioeconomic, and fossil fuel dependency variables within a robust multicriteria framework. We selected eleven variables relevant to urban mobility and organized them into inference blocks. We normalized the variables using Gaussian functions, respecting their maximization or minimization characteristics. We applied the Analytic Hierarchy Process (AHP) to assign weights to the criteria and then aggregated and ranked the results using multicriteria analysis. The final index represents the adaptive capacity of urban territories facing the energy crisis, and we applied it spatially to the neighborhoods of Petrópolis. The analysis identified a significant concentration of neighborhoods with low resilience, particularly in quadrants, combining deficiencies in public transportation, high dependence on fossil fuels, and socioeconomic constraints. Factors such as limited pedestrian access, insufficient motorized public transport coverage, and a high proportion of elderly residents emerged as significant constraints on urban resilience. Intervention strategies that promote active mobility, improve accessibility, and diversify transportation modes proved essential for strengthening local resilience. The results emphasize the urgent need for public policies to reduce energy vulnerability, foster active mobility, and promote equity in access to transportation infrastructure. Full article

Background/Objectives: Healthy diets and proper nutrition are fundamental for human survival. With economic development and rising incomes, the food consumption structure of rural residents in China has noticeably changed. However, substantial disparities still exist in the quality of food consumption between urban and rural areas, and the dietary structure of rural populations remains imbalanced. Methods: This study uses 2020 China Rural Revitalization Survey (CRRS) samples of rural residents for analysis since it asked residents questions about their digital literacy and food consumption. A total of 2827 valid rural resident samples were finally obtained, and the participants had a mean age of 54.844 years. This study employs the ordinary least squares (OLS) model and the two-stage least squares (2SLS) method to examine the impact of digital literacy on the food consumption structure of rural households and its underlying mechanisms. Results: Based on the regression analyses, digital literacy significantly improves the food consumption structure of rural residents (p < 0.05). Heterogeneity analysis shows that at the regional level, digital literacy has a stronger impact on the food consumption structure of rural residents in southern China (β = −153.255, p < 0.05); at the individual level, its impact is more pronounced among rural residents with lower educational attainment (β = −427.506, p < 0.01) and among middle-aged and elderly populations (β = −212.705, p < 0.05). The mechanism analysis reveals that digital literacy can enhance the food consumption structure of rural residents by increasing their awareness of dietary health and food safety. Conclusions: These findings highlight the necessity of integrating the optimization of food consumption structures with enhancements in digital literacy into policy-making and provides valuable insights for developing policies aimed at improving the nutritional health of rural residents. Full article

The current research examines the issue of social inclusivity in the context of digitalization of smart city governance and explores ways to overcome the digital divide, which impedes equal access to online services for vulnerable population groups (elderly people, people with disabilities, low-income individuals, and residents of remote areas). Based on a literature review, the study outlines three generations of the digital divide: access, digital skills, and the ability to derive socio-economic benefits. A methodology is proposed that combines cluster analysis of 27 European cities using 11 integrated indicators, aimed at identifying typical development profiles while accounting for infrastructure, air quality, and levels of digital literacy. The results revealed four clusters: “Digital Leaders with Environmental Awareness”, “Mid-Level Cities with Development Potential”, “Opportunities with Environmental Challenges”, and “Advanced Digital Hubs with High Quality of Life”. The study confirms the hypothesis regarding the effectiveness of a comprehensive approach that integrates infrastructure investment, educational programs, and inclusive planning. The article’s conclusions emphasize the need to apply universal design principles, subsidize internet access, and regularly monitor digital inclusion indices to achieve SDGs 11 and 16. Full article

Background/Objectives: In the Republic of Serbia, measles vaccination was first introduced in 1971, while combined vaccination (measles, mumps, rubella) was made mandatory in 1996 as part of the national vaccination program. Reported prevalence values for 2023 were <0.75 cases per 100K population for measles, 0.09 cases per 100K for mumps, and no cases of rubella. Methods: This cross-sectional study was performed in May, 2024 as part of the project “Herd Immunity to Vaccine-Preventable and Other Relevant Infections in the Belgradian Population.” It focused on assessing herd immunity to measles, mumps and rubella (MMR) among residents insofar as these remain a public concern despite the availability of vaccines. A total of 2533 subjects were distributed across nine age groups, covering those aged 1–70⁺ years and various professional groups residing in Belgrade. Participants were stratified by age and activity. Upon obtaining individual information by online questionnaire and receiving a signed statement of informed consent, blood samples were obtained for IgG antibody testing (ELISA) to determine MMR serological status. The results were compared to national and international immunization standards to evaluate herd immunity levels. Results: Our results indicate varying levels of immunity for each virus, with specific demographic groups showing different immunity levels. Total measles seroprevalence during this study was 74.7%, with significant variation across all age groups. While high seropositivity was observed in both children (90.7%) and elder age groups (98.4%), middle-aged individuals in the age group 30–49 years showed significantly lower IgG levels. Between 2021 and 2023, there were no registered cases of rubella detected in Serbia, which indicates a high level of immunity. This was confirmed here with consistently high IgG levels across all age groups, with an average seropositivity of 94.8%. Average mumps seropositivity across all age groups was 85.1%. The lowest value was in the young child (1–5 years) age group (76.1%); the highest was in the elderly group (92.6%). Conclusions: The current findings suggest that the Belgradian population has strong overall immunity to MMR, yet with some concerns regarding measles immunity in middle-aged adults, suggesting a potential need for catch-up vaccinations. While rubella status indicates strong herd immunity and minimal risk of outbreaks, mumps immunity in some groups (children, middle-aged adults) is below the protective threshold. While it is still sufficient to prevent widespread transmission, it should be closely observed. To our knowledge, this study is the first of its kind to provide data about MMR seroprevalence in Belgrade. Findings indicate the need for constant surveillance and revaccination of vulnerable/seronegative groups. Full article

Urban parks deliver vital ecosystem services and enhance residents’ well-being globally, yet equitable access remains challenging in high-density cities. The prevailing planning paradigms predominantly rely on proximity-based metrics, overlooking critical interactions between demographic diversity, differentiated social demands, and park typology distinctions. Moreover, the existing studies frequently examine aggregate green space distributions without categorically analyzing justice implications. This study develops a geospatial–quantitative framework integrating spatial equality and social justice metrics, applied in Xuhui District, Shanghai. Key findings reveal the following: (1) spatial inequality characterized by large parks clustered in low-density peripheries, while high-density central zones lack adequate park coverage; (2) significant social justice deficits for priority groups (elderly, youth, low-income), exacerbated by insufficient consideration of socioeconomic needs; (3) pronounced disparities in justice across park types, with pocket parks exhibiting the most severe inequities. Consequently, we recommend prioritizing the social demand in park allocation and implementing community-centered pocket park development. This study not only diagnoses spatial–environmental injustices in high-density urban cores but also provides a transferable framework for equitable park planning. Full article

Background: Post-traumatic sequelae have many negative impacts on the health and quality of life of patients, especially for those groups at a high risk of exposure to injuries. Therefore, this study was conducted to identify some factors related to post-traumatic sequelae in people in a mountainous province in Northern Vietnam. Materials and Methods: A cross-sectional study was conducted with 228 residents from two communes (Pom Lot and Thanh Minh) in Dien Bien province. The participants had all experienced an injury from any cause within the year preceding the study. The post-traumatic sequelae and potential associated factors were assessed. Result: The rate of post-traumatic sequelae among the study participants was 62.3%. An older age (>40), belonging to an ethnic minority group, a short treatment duration, and a lack of family and social support were factors associated with an increased risk of post-traumatic sequelae. Conclusions: Post-traumatic stress disorder is a significant health burden for people in the mountainous regions of Northern Vietnam. This study identified vulnerable groups, particularly the elderly, ethnic minorities, and those with inadequate treatment or social support. The results highlight the urgent need for targeted interventions and focused support policies to reduce the consequences of post-traumatic stress disorder for this high-risk group. Full article

Facing severe depopulation and aging, rural Japanese communities—particularly marginal settlements (genkai shūraku)—increasingly require revitalization strategies that integrate local culture and elder well-being. This study examines the Ōsawa Engawa Café, a community-led initiative in a mountainous tea-growing village, as a site of ikigai-zukuri—the active creation of life purpose among elderly residents. With the use of a mixed-methods approach, including spatial analysis, household surveys, and interviews, Chi-square Automatic Interaction Detection (CHAID) decision tree analysis was applied to identify factors shaping distinct household café operational states: Operating, Discontinued, and Never Operated. Qualitative findings reveal that support from local leaders, experts, and the government enabled the Ōsawa Engawa café’s launch. Broad household participation, often guided by elderly women, sustained the initiative by sharing local culture—such as engawa (verandas), Zairai tea (native variety), and omotenashi (hospitality)—thereby nurturing residents’ ikigai through daily engagement. Complementing these insights, the CHAID analysis revealed a hierarchy of influential factors: high-frequency support from out-migrated family members was the strongest predictor of continued operation; in the absence of such support, co-resident family cooperation proved essential; where both were lacking, agricultural engagement distinguished households that discontinued from those that never operated. Practically, the Ōsawa model offers a replicable, bottom-up strategy that activates the Rural Cultural Landscape (landscapes shaped by traditional rural life and culture, RCL) through community engagement grounded in cultural practices and elderly ikigai-zukuri, contributing to sustainable rural livelihoods. Theoretically, this study reframes ikigai-zukuri as a key socio-cultural pillar of community resilience in aging rural areas. Fostering such culturally embedded, purpose-driven initiatives is essential for building vibrant, adaptive rural communities in the face of demographic decline. However, the study acknowledges that the Ōsawa model’s success is rooted in its specific socio-cultural context, and its replication in other cultural settings may be limited without contextual adaptation. 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

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