Search Results (771)

Context: Many patients at the end of life receive antibiotics to alleviate symptoms and improve quality of life; however, clear guidelines supporting decision making about the use of antibiotics are still lacking. Objectives: This study aimed to evaluate the benefits and harms of antibiotic use among patients under a palliative care community support team in Portugal. Methods: An observational, cross-sectional, retrospective study was conducted on 249 patients who died over a two-year period, having been followed for at least 30 days prior to their death. Data included patient demographics, clinical diagnoses, antibiotic prescriptions, and symptomatic outcomes. The effects of commonly prescribed antibiotics—amoxicillin + clavulanic acid, cefixime, ciprofloxacin, and levofloxacin—were compared using statistical analyses to assess survival, symptom intensity, and functional scales. Results: Adverse events, primarily infections and secretions, occurred in 57.8% of cases, with 33.7% receiving antibiotics. No significant difference in survival was observed across the antibiotic groups (p = 0.990). Symptom intensity significantly reduced after 72 h of treatment (p < 0.05), with ciprofloxacin demonstrating the greatest symptom control. The Palliative Outcome Scale decreased uniformly, with higher scores associated with amoxicillin + clavulanic acid (p = 0.004). The Palliative Performance Scale declined post-treatment, with significant changes noted for cefixime and ciprofloxacin (p < 0.05). Conclusions: Antibiotics may improve symptom control and quality of life in the end-of-life stage. While second-line antibiotics may offer additional benefits, the heterogeneity of the sample and limited adverse effect data underscore the need for further research to guide appropriate prescription practices in palliative care. Full article

Background/Objectives: Accurately assessing the independence level of older adults using useful assessment tools is an important step toward providing them with the necessary care while preserving their dignity. These tools allow older adults to receive effective, personalized home care, which improves their quality of life. This study aimed to clarify the current prevalence of severe and complete functional dependence and associated factors among Kazakhstan’s older adults aged >60 years. Methods: This cross-sectional study was conducted in several polyclinics and geriatric service care centers in two cities of Kazakhstan from March to May 2024. Functional status was assessed by the Barthel Index. We combined the selection into two categories: total dependency and severe dependency in the category “dependent”, and moderate dependency, slight dependency, and total independence in the category “active patients”. Results: Among the 642 older people in this study, 43.3% were dependent patients, and 56.7% were active patients. The odds of severe and total functional dependence are significantly higher for frail participants (adjusted odds ratio (AOR) = 2.96, 95% confidence interval (CI) [1.70, 5.16], p < 0.001) compared to those that are not frail; eleven times higher for those at home (AOR =11.90, 95% CI [5.77, 24.55], p < 0.001) than those in nursing homes; two times higher for participants with sarcopenia (AOR =2.61, 95% CI [1.49, 4.55], p < 0.001) compared to those with no sarcopenia; and three times higher for participants with high risk of fracture (AOR =3.30, 95% CI [1.94, 5.61], p < 0.001) compared to those with low risk. The odds of having severe and total functional dependence are significantly higher for participants with low dynamometry (AOR =1.05, 95% CI [1.03, 1.07], p < 0.001) compared to those with normal dynamometry. Conclusions: Old age, low dynamometry (for men ≤ 29 kg, for women ≤ 17 kg), frailty, being at home, high risk of fracture and osteoporosis, and sarcopenia were associated with increased risk of severe and total functional dependence. Full article

This paper presents a case study of the Local Care Ecosystems developed by the provincial government of Gipuzkoa (Basque Country, Spain) to strengthen coordination between social services, health services, and community-based initiatives at the municipal level. The initiative seeks to personalize care, enhance service integration, and support community-based care with the overarching goal of improving the quality of life for older adults living at home. These ecosystems incorporate social, institutional, and technological innovations aimed at supporting individuals who are frail or vulnerable throughout the care cycle. At present, 18 Local Care Ecosystems are active, providing services to 1202 people over the age of 65 and 167 families. The model addresses a growing global challenge linked to population aging, which has led to increasing demand for care and support services that are often fragmented, under-resourced, and constrained by outdated regulatory frameworks. These structural issues can compromise both the quality and efficiency of care for dependent individuals. Based on the findings, the paper offers policy recommendations to support the transfer and adaptation of this model, with the aim of improving the well-being of older adults who wish to remain in their own homes. Full article

Background: This study aims to compare the logistical challenges of Home Health Care (HHC) services in Portugal and Brazil, highlighting the structural and operational differences between both systems. Methods: Guided by an abductive research approach, data were collected using a semi-structured survey with open-ended questions, applied to 13 HHC teams in Portugal and 18 in Brazil, selected based on national coordination recommendations. The data collection process was conducted in person, and responses were analyzed using descriptive statistics and qualitative content analysis. Results: The results reveal that Portugal demonstrates higher productivity, stronger territorial coverage, and a more integrated inventory management system, while Brazil presents greater multidisciplinary team integration, more flexible fleet logistics, and more advanced digital health records. Despite these strengths, both countries continue to address key logistical aspects, such as scheduling, supply distribution, and data management, largely through empirical strategies. Conclusions: This research contributes to the theoretical understanding of international HHC logistics by emphasizing strategic and systemic aspects often overlooked in operational studies. In practical terms, it offers insights for public health managers to improve resource allocation, fleet coordination, and digital integration in aging societies. Full article

As global populations age, there is increasing demand for effective, person-centered healthcare solutions that support older adults to age in place. Home healthcare has emerged as a crucial strategy to address the complex health and social needs of older adults while reducing reliance on institutional care. This umbrella review aimed to synthesize evidence from existing systematic reviews and meta-analyses on home healthcare services and interventions targeting older adults. A comprehensive search was conducted across five databases and gray literature sources, including Google Scholar, for reviews published between 2000 and 2025. The review followed the Joanna Briggs Institute methodology and PRISMA statement. Twenty reviews met the inclusion criteria, encompassing a total of over 3.1 million participants. Interventions were grouped into four categories: integrated and multidisciplinary care, preventive and supportive home visits, technological and digital interventions, and physical, transitional, and environmental support. Results indicated that many interventions led to improved health outcomes, including enhanced functional ability, reduced hospital readmissions, and increased satisfaction. However, effectiveness varies depending on the intervention type, delivery model, and population. Challenges such as caregiver burden, digital exclusion, and implementation in diverse settings were noted. This review highlights the promise of home healthcare interventions and underscores the need for context-sensitive, equitable, and scalable models to support aging populations. Full article

Background/Objectives: The demand for accessible and reliable digital health services has increased significantly in recent years, particularly in regions facing physician shortages. HomeDOCtor, a conversational AI platform developed in Slovenia, addresses this need with a nationally adapted architecture that combines retrieval-augmented generation (RAG) and a Redis-based vector database of curated medical guidelines. The objective of this study was to assess the performance and impact of HomeDOCtor in providing AI-powered healthcare assistance. Methods: HomeDOCtor is designed for human-centered communication and clinical relevance, supporting multilingual and multimedia citizen inputs while being available 24/7. It was tested using a set of 100 international clinical vignettes and 150 internal medicine exam questions from the University of Ljubljana to validate its clinical performance. Results: During its six-month nationwide deployment, HomeDOCtor received overwhelmingly positive user feedback with minimal criticism, and exceeded initial expectations, especially in light of widespread media narratives warning about the risks of AI. HomeDOCtor autonomously delivered localized, evidence-based guidance, including self-care instructions and referral suggestions, with average response times under three seconds. On international benchmarks, the system achieved ≥95% Top-1 diagnostic accuracy, comparable to leading medical AI platforms, and significantly outperformed stand-alone ChatGPT-4o in the national context (90.7% vs. 80.7%, p = 0.0135). Conclusions: Practically, HomeDOCtor eases the burden on healthcare professionals by providing citizens with 24/7 autonomous, personalized triage and self-care guidance for less complex medical issues, ensuring that these cases are self-managed efficiently. The system also identifies more serious cases that might otherwise be neglected, directing them to professionals for appropriate care. Theoretically, HomeDOCtor demonstrates that domain-specific, nationally adapted large language models can outperform general-purpose models. Methodologically, it offers a framework for integrating GDPR-compliant AI solutions in healthcare. These findings emphasize the value of localization in conversational AI and telemedicine solutions across diverse national contexts. Full article

Background: In this work, we examine determinants of staff departure rates in the NHS, a critical issue for workforce stability and continuity of care. High turnover, particularly among clinical staff, undermines service delivery and incurs substantial replacement costs. Methods: Here, we analyse a unique dataset derived from Electronic Staff Records at Ashford and St. Peter’s NHS Foundation Trust, using a machine learning approach to move beyond traditional survey-based methods, to assess propensity to leave. Results: In addition to established predictors such as salary and length of service, we identify drivers of increased risks of staff exits, including the distance between home and workplace and, especially for medical staff, cost centre vacancy rates. Conclusions: These findings highlight the multifactorial nature of staff retention and suggest the potential of local administrative data to improve workforce planning, for example, through hyperlocal recruitment strategies. Whilst further work will be required to assess the generalisability of our findings beyond a single Trust, our analysis offers insights for NHS managers seeking to stabilise staffing levels and reduce attrition through targeted interventions beyond pay and tenure. Full article

Background: Mobility limitation is a pivotal but under-documented dimension of disability in Saudi Arabia. Leveraging the 2017 National Disability Survey, this cross-sectional study provides a population-wide profile of mobility-related physical difficulty. Objectives: Five research aims were pursued: (1) estimate national prevalence and severity by sex; (2) map regional differentials; (3) examine educational and marital correlates; (4) characterize cause, duration, and familial context among those with multiple limitations; and (5) describe patterns of assistive-aid and social-service use. Methods: Publicly available aggregate data covering 20,408,362 Saudi citizens were cleaned and analyzed across 14 mobility indicators and three baseline files. Prevalence ratios and χ² tests assessed associations. Results: Overall, 1,445,723 Saudis (7.1%) reported at least one functional difficulty; 833,136 (4.1%) had mobility difficulty, of whom 305,867 (36.7%) had mobility-only impairment. Severity was chiefly mild (35% of cases), with moderate (16%) and severe (7%) forms forming a descending pyramid. Prevalence varied more than threefold across the thirteen regions, peaking in Aseer (9.4%) and bottoming in Najran (2.9%). Mobility difficulty clustered among adults with no schooling (36.1%) and widowed status (18.5%), with sharper female disadvantage in both domains (p < 0.001). Among those with additional limitations, chronic disease dominated etiology (56.3%), and 90.1% had lived with disability for ≥25 years; women were overrepresented in the longest-duration band. Aid utilization was led by crutches (47.7%), personal assistance (25.3%), and wheelchairs (22.6%), while 83.8% accessed Ministry rehabilitation services, yet fewer than 4% used home or daycare support. Conclusions: These findings highlight sizeable, regionally concentrated, and gender-patterned mobility burdens, underscoring the need for education-sensitive prevention, chronic-care management, investment in advanced assistive technology, and distributed community services to achieve Vision 2030 inclusion goals. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with rural populations experiencing higher prevalence and worse outcomes. This paper explores the transformative potential of nurse-led palliative care models in addressing the unique challenges faced by rural patients with COPD and their informal caregivers and synthesizes current evidence on nurse-led palliative care interventions, highlighting their impact on symptom management, advance care planning, and psychosocial support. Methods: This is a comprehensive synthesis of nurse-led palliative care programs, focusing on home-based care, telehealth, community outreach, and primary care integration. Results: Nurse-led interventions significantly improve patient satisfaction, reduce symptom burden, and enhance the likelihood of advance care planning discussions. Home-based care models and telehealth are particularly effective in rural settings, offering accessible and continuous support. Conclusions: Nurses have a critical role in bridging the palliative care gap for rural patients with COPD and their informal caregivers. Expanding nurse-led palliative care services can improve quality of life, reduce healthcare utilization, and promote health equity. Future research should focus on long-term outcomes, cost-effectiveness, and strategies for scaling nurse-led palliative care programs in rural contexts. Full article

Canada’s national surveillance shows an 11% year-over-year decline in deaths from opioid and other unregulated drug poisonings, and a 10% drop in related hospitalisations in 2024. In stark contrast, Québec, home to more than nine million residents, and Montréal, the country’s second-largest city, experienced a continued rise in suspected drug-poisoning mortality through 2024, with fentanyl or analogues detected in almost two-thirds of opioid deaths. We conducted a narrative synthesis of provincial coroner and public-health surveillance tables, Health Canada dashboards, and the 2022–2025 Québec Strategy on Psychoactive-Substance Overdose Prevention. Results indicate a 40% increase in opioid-related mortality since 2018, a parallel uptick in stimulant toxicity, and a five-fold rise in overdose reversals at Montréal supervised-consumption services during the COVID-19 pandemic recovery. We aim to summarise the key problems underlying this epidemic and offer province-specific public-health strategies while also sending a call to action for first-line clinicians and psychiatrists to integrate overdose-risk screening, take-home naloxone, and stimulant-use-disorder treatments into routine care. We further urge Québec healthcare professionals to deepen their knowledge of provincial services such as supervised-injection sites and stay up to date with the rapidly evolving substance-use-prevention literature. Québec’s divergent trajectory underscores the need for region-tailored harm-reduction investments and stronger policy-to-clinic feedback loops to reduce preventable deaths. Full article

This study presents the findings of an academic extension project focused on promoting oral health and diagnosing oral lesions in institutionalized elderly individuals. The project involved visits by students and faculty to two nursing homes in southern Brazil. Data collection included extraoral and intraoral clinical examinations and educational activities such as lectures and the distribution of printed materials on oral and denture hygiene. According to caregiving staff, oral hygiene, including denture cleaning, was generally performed once daily during morning showers. A total of 118 older adults (68 males and 50 females; mean age 76.1 ± 8.6 years) were examined. Forty-nine used dentures, of whom only 24 (49%) reported satisfaction with their prostheses. In total, 42 oral lesions were identified, mainly angular cheilitis (8), inflammatory fibrous hyperplasia (7), irritation fibroma (7), frictional hyperkeratosis (7), prosthetic stomatitis (5), actinic cheilitis (3), traumatic ulcers (3), and leukoplakia (2). Educational sessions also targeted caregivers, offering practical guidance for improving hygiene practices. The results underscore the need for better oral care and improved access to dental services for institutionalized elderly populations. Academic extension activities play a valuable role in health promotion and in training future professionals in elderly care. Full article

Maternal mortality and morbidity are critical health challenges in the U.S., and building the perinatal workforce is a key to providing high-quality maternal medical care and services. Texas Southern University (TSU), home to a Doctor of Pharmacy program, launched the first Maternal Health Education and Research Training (MHERT) program to educate a cohort of high school, pharmacy, and health sciences students. Aiming to raise awareness of maternal health issues, build research skills, and promote action-based solutions. MHERT integrated online self-paced interactive lessons with hands-on research or community projects. Topics included maternal health epidemiology, causes of morbidity and mortality, research methods, literature reviews, and the development of action plans addressing maternal health challenges. Assessment tools included quizzes, open-ended reflection responses, training surveys, and course evaluations. Running from 3 June to 26 July 2024, the program enrolled 22 students. All participants completed both course components. Course evaluations showed strong and consistent satisfaction with the program, with teaching effectiveness rated at 95% and 96% for mid-program and final evaluations, respectively. MHERT enhanced participants’ understanding of maternal health, improved research skills, and encouraged community engagement and interdisciplinary collaboration. It offers a scalable model to strengthen public health education among high school, pharmacy, and health sciences students. Full article

Background: China’s rapidly aging population has increased the need for effective community-based eldercare services. However, the lack of standardized, culturally relevant evaluation frameworks hinders consistent service quality assessment and improvement. Objective: This systematic review aims to identify, synthesize, and critically evaluate the existing quality indicators (QIs) currently utilized for home-based community elderly care HCEC in China. It also aims to highlight gaps to inform the development of a more comprehensive and context-appropriate quality framework. Methods: Following PRISMA guidelines, systematic searches were conducted across Web of Science, PubMed, Wiley, and CNKI databases for studies published in English and Chinese from 2008 onward. Extracted QIs from eligible studies were categorized using Donabedian’s structure–process–outcome (SPO) model. Results: Fifteen studies met the inclusion criteria, with QI sets ranging from 5 to 64 indicators. Most studies emphasized structural and procedural aspects, while outcome measures were limited. Key gaps include inconsistent terminology, insufficient medical care integration, narrow stakeholder engagement, and limited cultural adaptation of Western theoretical frameworks. Furthermore, subjective weighting methods predominated, impacting indicator reliability. Conclusions: Currently, there is no formal quality framework to guide service providers in HCEC, and therefore, quality indicators can be described as fragmented and lack cultural specificity, medical integration, and methodological robustness. Future research should prioritize developing culturally anchored and medically comprehensive QI frameworks, standardize indicator terminology, actively involve diverse stakeholders through participatory methods, and adopt hybrid methodological approaches combining subjective expert insights and objective, data-driven techniques. Alignment with established international standards, such as the OECD long-term care quality indicators, is essential to enhance eldercare quality and support evidence-based policymaking. Full article

Japan has the world’s fastest-aging population. The number of older adults living alone has increased rapidly; however, the number of people waiting for nursing care facilities is high, especially in urban areas, and home care is unavoidable. Few studies have focused on older adults living alone who require nursing care, and almost no reports have examined the factors influencing the continuation or discontinuation of living alone. Furthermore, no reports were found that classified nursing care levels for the survey. This study’s purpose was to clarify what kind of long-term care for older adults living alone in urban areas is most effective in enabling them to continue living at home. A total of 122 older adults in need of long-term care in Osaka City were divided into two groups; one group was those who continued to live alone in December 2022, the other was those who had to discontinue doing so after January 2020. A questionnaire was distributed to the care managers responsible for older adults living alone who required nursing care. The participants’ basic attributes, long-term care services usage, and the characteristics of instrumental activities of daily living (IADL) support were compared according to care level using Fisher’s exact test. The relevant effective factors for continuing to live alone were extracted using a multivariate logistic regression analysis. The results showed differences in the characteristics of both groups at both care level categories used in the study, Support Care Level 1–Nursing Care Level 2 and Nursing Care Level 3–5. Among the support items, indoor temperature control was suggested as a factor that influences continued living alone. Full article

Background/Objectives: Using healthcare vouchers mitigates the financial burdens of low-income individuals, therefore enhancing mothers’ satisfaction and encouraging service utilization. In Yemen, reducing financial barriers results in marked improvement in reproductive health services utilization for mothers and their newborns. Such financial strain can be addressed through reproductive health vouchers, which reduce out-of-pocket expenses of family planning, pregnancy, birth, postnatal care and neonatal care. This study compares the Safe Motherhood and Family Planning Voucher Program in the Lahj governorate to the non-voucher program in the Abyan governorate in terms of enhancement of reproductive healthcare accessibility and use. Methods: This facility-based, quantitative, comparative, cross-sectional study was conducted in the Lahj governorate, which supports the Safe Motherhood and Family Planning Voucher Program, and the Abyan governorate, which does not. Results: The voucher-supported program has greatly improved mothers’ satisfaction, access, and use of all reproductive health services by covering transportation, covering lodging during hospitalization, and providing free reproductive treatments. Compared to Abyan mothers, Lahj governorate mothers more frequently used rental vehicles (paid for by the voucher program) and free reproductive health services (p-value < 0.001). Lahj governorate mothers (who used the vouchers) used family planning, prenatal care, facility-based delivery, home delivery by competent birth staff, cesarean section, postnatal care, and neonatal care more frequently than Abyan governorate mothers. A health institution which supported the Safe Motherhood and Family Planning Voucher Program (SMHFPVP) provided prenatal care (98.5%), competent birth services (99.0%), and modern contraceptive use (92.3%)—oral contraceptive pills, implants, injectables, contraceptive patches, vaginal rings, and intrauterine devices—for mothers who were interviewed and attended the targeted HFs in the Lahj governorate, compared with (77.6%), (80.3%), and (67.8%), respectively, for mothers in Abyan governorate who were not supported by the SMHFPVP. This study demonstrates substantially higher satisfaction levels among voucher-using mothers in the Lahj governorate compared to those in the Abyan governorate, across all satisfaction domains and overall satisfaction scores. Conclusions: This study found that women without access to maternal health vouchers experienced worse prenatal, natal, and postnatal care and were less satisfied with healthcare services compared with women who used vouchers. Full article