Search Results (1,065)

Background/Objectives: Toileting-related falls may arise from interacting urinary symptoms, impaired mobility and balance, cognitive or psychological factors, environmental hazards, and caregiver limitations that are often managed separately. This study aims to evaluate the implementation, safety, and 6-month clinical outcomes of an integrated multidisciplinary prevention, treatment, and rehabilitation pathway for older adults and people with disabilities at risk of toileting-related falls. Methods: This multicenter, prospective, single-arm implementation study will enroll 300 adults aged ≥18 years across 15 centers. Participants will undergo standardized assessment of urinary function, gait and balance, physical function, psychological/cognitive factors, activities of daily living, fall history, and toileting-related environmental risks. Prespecified risk domain criteria will guide individualized urinary, rehabilitation, psychological/cognitive, caregiver, and environmental interventions, with reassessment and adjustment during follow-up. The primary outcome will be the 6-month cumulative incidence of at least one toileting-related fall. The secondary outcomes will include nighttime and total falls, urinary symptoms, nocturia, mobility, and functional independence. The implementation will be evaluated using RE-AIM and intervention fidelity measures. Expected Results: The study will characterize pathway reach, adoption, delivery, fidelity, safety, follow-up performance, data completeness, clinical event rates, and within-participant change. Conclusions: The findings may support a reproducible multidisciplinary care pathway and inform subsequent comparative evaluations of effectiveness, sustainability, component contributions, and resource use. Full article

Background: Malnutrition causes complications and adverse effects in older people and is a burden on healthcare systems. Older people with, or at risk of malnutrition who receive nutrition care in hospitals do not appear to be adequately engaged with post-discharge nutrition care processes. Food-based approaches (exclusive of oral nutritional supplements) are commonly considered the ‘first’ or frontline approach by dietetic professionals in the community setting. The aim of this scoping review is therefore to identify and synthesise the literature on food-based nutrition care provided to older community-dwelling adults who have been identified as malnourished or at risk of malnutrition during a recent hospital admission. Methods: This scoping review follows the methodological framework by Arskey and O’Malley, revised by the Joanna Briggs Institute. Results are reported according to the PRISMA-ScR guideline. Studies evaluating food-based nutrition care interventions provided to patients post-discharge from a hospital admission returning to a community setting were included in this review. Results: A total of 4086 records were screened, and eleven articles from seven independent studies were included. Highly heterogeneous findings may suggest improvements in weight, dietary intake, quality of life, physical function, anxiety and/or depressive symptoms, and reduction in readmissions associated with interventions including food-based nutrition care. However, sample sizes were generally small and evaluated as part of multicomponent care. Conclusions: Additional research is required to support frontline, food-based approaches for older community-dwelling adults, with or at risk of malnutrition, who are recently discharged from hospital. In the interim, multi-component nutrition interventions may be considered to improve nutritional intake. Full article

Sarcopenia is increasingly recognized as a systemic complication of inflammatory bowel disease (IBD)—more accurately described as an IBD-associated muscle disorder than as a classical extraintestinal manifestation—but it remains inconsistently defined and rarely integrated into routine care. Consensus frameworks require low muscle strength confirmed by low muscle quantity or quality, so studies reporting only computed tomography (CT)-derived muscle area describe low muscle mass rather than consensus-defined sarcopenia; myosteatosis, the fat infiltration of muscle, is a further and partly independent dimension of muscle quality. This narrative review, supported by a structured literature search that was re-run and extended during peer review, synthesized peer-reviewed human evidence published from 1 January 2010 to 5 July 2026 in adult patients. Overall, 152 records were identified through PubMed/MEDLINE and citation tracking; after 19 duplicate or overlapping records were removed, 133 records were screened, 66 full-text reports were assessed, and 54 sources were included: 39 empirical IBD studies, 5 IBD-specific systematic reviews or meta-analyses, 6 consensus or standardization documents and 4 mechanistic or narrative reviews. Sarcopenia in IBD is driven by chronic inflammation, malnutrition, dysbiosis, corticosteroid exposure, inactivity and impaired anabolic signaling. Prevalence is definition- and setting-dependent, from approximately 10% in stable outpatients assessed with functional criteria to more than 40–50% in CT-based or active-disease cohorts. Sarcopenia is consistently associated with—rather than proven to cause—hospitalization, abscess formation, postoperative complications, treatment escalation or failure and impaired function. Muscle ultrasound and automated, artificial intelligence-assisted analysis of opportunistic CT and magnetic resonance imaging (MRI) are emerging as practical routes to routine assessment. We propose a drivers–detection–prognosis–intervention framework, aligned with the sequential European Working Group on Sarcopenia in Older People 2 (EWGSOP2) and Asian Working Group for Sarcopenia (AWGS) 2019 algorithms, to support opportunistic imaging review, strength testing and integrated nutrition–exercise care; this framework is an expert proposal that requires prospective, multicenter validation. Full article

Background: Hypertension commonly complicates Type 2 diabetes mellitus (T2DM), contributing significantly to increased morbidity and mortality. This study determined the prevalence and factors associated with hypertension among people with T2DM at a tertiary health facility in Northern Uganda. Methods: A hospital-based cross-sectional study was conducted from 18 July to 24 October 2024. Participants with confirmed T2DM were selected through systematic random sampling at Lira Regional Referral Hospital (LRRH) in Lira City, Uganda. Data were collected using a structured questionnaire adapted from the WHO STEPS (2022) tool. Patient charts and registers were used to verify information. Data were analyzed using STATA version 16. Multivariable logistic regression was performed, and p-values < 0.05 were considered statistically significant. Results: A total of 340 participants were enrolled in the study; the median age was 55 years; 244 (71.8%) were female; and nearly half of the participants (163, 47.9%) had attained primary education. Overall, 67.1% (228/340) of the participants with T2DM had hypertension. Factors independently associated with higher odds of hypertension were as follows: age 61+ years (aOR = 5.55, 95% CI: 1.34–23.1, p = 0.018), being overweight (aOR = 3.77, 95%CI: 1.05–13.57, p = 0.042), T2DM duration of more than five years (aOR = 2.51, 95% CI: 1.41–4.67, p = 0.002), and being widowed (aOR = 8.04, 95% CI: 1.87–34.61, p = 0.005). Earning UGX 50,001–100,000 per month (aOR = 0.35, 95% CI: 0.13–0.93, p = 0.037) was associated with 65% lower odds of having hypertension. Conclusions: Two-thirds of patients with T2DM had hypertension, and factors such as older age, being overweight, a longer T2DM duration, and marital status significantly increased hypertension risk; meanwhile, moderate-income status offered a protective effect. The high burden of hypertension among patients with T2DM demonstrates the necessity for targeted public health interventions such as comprehensive lifestyle modification programs, routine screening for hypertension, early detection, and its management among patients with T2DM through enhanced healthcare access. These interventions should focus on integrated care approaches that monitor and manage T2DM alongside hypertension. Full article

Digital technologies seem to contribute to health promotion and disease prevention, allowing older people to benefit from targeted health interventions supported by digital resources. The current study aimed to develop a substantive theory focusing on the experiences of older people who use smartphone technology daily and its repercussions on healthy aging. This qualitative study employed Charmaz’s constructivist grounded theory approach. Purposeful and theoretical sampling was used to recruit 37 older Brazilian people from a community extension project that integrates nurses who offer personalized guidance and support using smartphone devices. Individual phone-call interviews and reflective journals were conducted between August 2022 and March 2023. Four interrelated theoretical categories emerged: (1) technological progress during the aging process; (2) technological learning using smartphones and participation in virtual groups; (3) expanding social and personal development through smartphone communication; and (4) virtual groups for older people on healthy aging. The core category “Experiencing guided smartphone use as a resource for healthy aging” portrays the individual, social and cultural aspects involved in the habits and attitudes that older people develop to promote independence and quality of life. This study offers valuable insights into the daily use of smartphones by older people, and its repercussions on individual and social issues that bring people and places closer together, expand the social network, and modify communication patterns. The findings indicate that older adults undergo changes and adaptations in their daily lives and in the dynamics of interpersonal relationships, and that using digital applications such as smartphones contradicts the stereotype of fragility or limited understanding associated with aging. The findings can also help with the implementation of policies and practices aligned with a more person-centred care approach. Full article

Multiple chemical sensitivity (MCS) is a chronic condition characterized by adverse reactions to low-level environmental chemicals, often resulting in multisystem symptoms triggered by volatile organic compounds (VOCs) emitted from fragranced personal care and household products. The condition raises public health and accessibility concerns, as people with MCS may face barriers to accessing workplaces, healthcare settings, educational institutions, and other public environments. This descriptive cross-sectional study aimed to characterize the chemical exposures participants attributed to the onset of MCS and to subsequent symptom provocation, and to describe the associated symptom patterns. A cross-sectional survey was administered to Canadian residents aged 18 years or older, living with MCS for at least 1 year, with 18 questions assessing exposure history and onset of MCS and symptom provocation. A total of 119 participants completed the survey. Participants most frequently attributed the onset of MCS to the workplace (55%) or home (35%), with (61%) reporting ongoing exposures over time as the most frequently reported circumstance associated with onset. Fragranced products, including perfumes, air fresheners, cleaning products, disinfectants, construction materials, and laundry products, were the exposures most frequently reported in relation to both onset and subsequent symptom triggering. Symptoms involved multiple organ systems, with nearly one-third of participants reporting 11 or more symptoms; cognitive and respiratory symptoms were most prevalent. Nearly three-quarters of participants (74%) reported symptoms associated with third-hand exposure, and 51% reported discarding contaminated items, suggesting that third-hand exposure may represent an underrecognized pathway for symptom provocation. Full article

Background: The number of vaccines recommended for adults and older people has increased in recent years, and same-visit coadministration represents a potential strategy to improve vaccination coverage and timeliness. However, its implementation in primary care may depend on general practitioners’ (GPs) attitudes, vaccination experience, and organisational factors. This study investigated knowledge, attitudes, and practices (KAP) regarding vaccine coadministration among GPs in Apulia, Southern Italy. Methods: We conducted an anonymous cross-sectional online survey between January and June 2026 among practicing GPs and general practice trainees working in outpatient primary care settings in Apulia. The questionnaire assessed vaccination activity, intended coadministration practices, perceived effects on vaccine effectiveness and coverage, safety in very old adults or patients with multimorbidity, and perceived barriers to vaccination. Descriptive and bivariate analyses were performed, followed by multivariable logistic regression to identify factors independently associated with a positive perception of coadministration safety in very old or multimorbid patients. An additional sensitivity analysis excluded respondents reporting insufficient information to assess safety. Results: A total of 256 physicians completed the survey; 71.1% were aged ≥50 years. Most respondents had administered adult vaccines during the previous year, and 68.0% were classified as high vaccinators, having administered three or more different vaccine types. Although 68.0% believed that coadministration could increase vaccination coverage, only 13.3% reported willingness to administer three or more vaccines during a single visit. Overall, 50.0% considered coadministration very or fairly safe in very old or multimorbid patients, 24.2% considered it slightly or not at all safe, and 25.8% reported insufficient information to assess its safety. In the fully adjusted model, high vaccination activity was associated with higher odds of a positive safety perception (adjusted odds ratio [aOR] 1.93, 95% confidence interval [CI] 1.01–3.70), whereas difficulties using vaccination IT platforms were associated with lower odds (aOR 0.48, 95% CI 0.26–0.86). Age ≥ 50 years was not independently associated with the outcome after adjustment (aOR 0.66, 95% CI 0.35–1.26). Conclusions: GPs in Apulia showed generally favorable attitudes toward vaccine coadministration, although substantial uncertainty remained regarding its use in very old and multimorbid patients. Confidence in coadministration was primarily associated with greater vaccination activity and fewer difficulties with vaccination IT platforms, whereas age-related differences observed in bivariate analyses were attenuated after multivariable adjustment. Educational, organisational, and digital-support interventions may facilitate broader implementation of same-visit adult vaccination in primary care. Full article

Background/Objectives: The aim of the study is to determine factors that affect informal caregivers’ ability to care for older migrants with dementia, with a broad aim of providing a framework for improving regional formal support. We used patient journey mapping as a method to identify experiences of informal caregivers. Methods: The study took place in three phases. In the first phase, the content of the patient journey was outlined, and semi-structured interviews were conducted with 14 informal caregivers of people with dementia and a migrant background. In the second phase, results of the interviews were discussed in workshops with professionals. In the third phase, professionals worked together on a plan for improving care and support. Results: Besides positive experiences with care and support, informal caregivers expressed the need for knowledge and training, timely information as well as practical culturally sensitive care and support. Professionals expressed a need for more knowledge of culturally sensitive issues and conversation techniques. They also indicated the need for more integrated care and the ability to offer practical solutions for informal caregivers. As a final result, a multidisciplinary programme on improving knowledge, information for clients, informal caregivers and professionals, use of key figures, culturally sensitive support, a multidisciplinary care path and education for future professionals was launched for the region. Conclusions: A patient journey is a valuable method to pinpoint problems and needs of informal caregivers as well as professionals. It provides a foundation for multidisciplinary communication and collaboration to improve care and support. Full article

To the best of our knowledge, this is the first study that centres Indigenous queer (henceforth, Indigiqueer) and Indigenous older people and Elders’ voices to explore the everyday tensions between protecting Indigenous cultural protocols against colonial incursions and the challenges presented by shifts in essentialist understandings of gender in the country now called Australia. There is to date very little written that address this topic, although there are two seminal works that investigate the matters more broadly, one by leading Aboriginal scholar Professor Bronwyn Carlson, and another by Noongar Wardandi scholar Professor Braden Hil. Our study uses a set of vignettes based on two interviews with Indigiqueer people and a yarning circle with Indigenous older people and Elders. The interviews and yarning circle are structured as a discussion between community members to provide some preliminary analysis about contemporary dynamic intergenerational debates within Indigenous communities in which competing understandings of culture, gender, safety, and responsibility coexist. For participants, intergenerationality is seen as central to both harm and healing, feelings of belonging and ostracism and ultimately to current and future Indigenous and Indigiqueer survivance and thrivance. Indigenous older people and Elders demonstrate an openness to different sexualities and an acceptance of sexuality-diverse people but are hesitant to allow gender-diverse people to participate in gendered community activities such as playing the didgeridoo (yidaki). To the contrary, Indigenous queer (henceforth Indigiqueer) participants articulate their fears regarding safety, exclusion, care and social isolation emerging from exclusionist gendered binary protocols. Younger generations are seen by all participants as sites of potentiality, that in combination with the power of shared storytelling and mutually constructed understandings, enable a shift towards greater acceptance, openness, and visibility. The paper also reveals the ways in which Indigiqueer people navigate spatial, cultural and social differences between regional and urban spaces, that are seen as differentially accepting of either their Indigeneity or their gender and sexuality diversity. The study’s findings also demonstrate the importance of Indigiqueer-controlled spaces and culturally safe organisations, that are grounded in community-led practices of care, belonging, and self-determination. Full article

The aim of the study was to analyse the epidemiological characteristics of confirmed COVID-19 cases in the Tumbes region between March 2020 and December 2022. Method: An ecological design with a descriptive approach was used for the study population, which consisted of 51,421 confirmed cases of COVID-19 residing in the provinces of Contralmirante Villar, Tumbes, and Zarumilla in the department of Tumbes. Confirmed cases of COVID-19 reported in SISOVID by the Ministry of Health and the registry of confirmed cases of COVID-19 in all age groups were recorded. The sociodemographic data collected was supplemented with information available on the web platform of the National Institute of Statistics and Informatics (INEI). The data were organized into databases and analyzed using software such RStudio (versión 2024.12.1), applying epidemiological indicators (incidence, prevalence, mortality, and lethality). The epidemiological data were organized and analyzed in a database prepared in Microsoft Excel to consolidate the information through data filtering and organization. Results: Among the main findings, a decrease in incidence was observed between 2021 (7840/100,000 inhabitants) and 2022 (5721/100,000 inhabitants), although the cumulative case rate increased from 15% to 20%. The mortality rate fell significantly from 2.57 per 1000 inhabitants in 2021 to 0.33 in 2022. The highest fatality rates were concentrated among people over 60 years of age with comorbidities, especially men. Conclusion: The pandemic was unevenly distributed, affecting adults between 30 and 59 years of age, populations with pre- existing conditions, and densely populated urban areas the most. The geographic distribution of cases helped identify areas warranting priority for improving the health response. It is recommended to strengthen epidemiological surveillance, improve access to health services in densely populated areas, and prioritise care for vulnerable groups such as older adults and indigenous peoples. Full article

Background: With a rapidly ageing prison population in the United Kingdom (UK), an increasing number of people in prison are dying from chronic and life-limiting illnesses. Methods: A sample of 487 independent investigation reports into deaths from natural causes in UK prisons (2017–2020) was examined to explore palliative care referrals, appropriateness of restraints, applications for early release on compassionate grounds (ERCG), and equitable access to healthcare. Results: Most of the reports were based on male prisoners aged 60+, and the leading cause of death was cancer. While care was regarded as ‘equivalent’ in 83.7% of cases, several reports indicated delayed diagnosis, poor care coordination, and limited access to palliative care, particularly for people with non-malignant diseases. Restraints were regularly criticised as inappropriate or inhumane, and early release was not considered in 42% of cases, often due to delays or procedural issues. When viewed through Nussbaum’s Capability Approach, being unable to access healthcare ‘when needed’ represents a failure to secure the basic capability of bodily health, and reflects a profound restriction on practical agency. Conclusions: Delays in diagnosis, treatment, and referral are not merely inefficiencies but constitute structural barriers that constrain individuals’ real opportunities to achieve health and well-being. It is anticipated that older people in prison will experience layered capability inequalities, arising from age, health status, and custodial context. These findings suggest that prisons function as sites of punishment and environments in which capability deprivation is intensified towards the end-of-life. Full article

Older people are at increased risk of medication-related problems, which may be identified by clinical pharmacists during hospital medication reviews. Some problems are better managed in primary care, where follow-up is possible. Medication-related communication by pharmacists may improve information transfer in care transitions, but this practice remains uncommon in Sweden. This qualitative study explored clinical pharmacists’ experiences and perceptions of writing referrals to primary care. Data were collected through four focus groups and three supplementary interviews with 19 clinical pharmacists from hospitals and primary care, and analysed using qualitative content analysis. Eleven participants had experience writing referrals, although none did so regularly. Four categories emerged: role of the pharmacist, current work procedures, pharmacist–physician relationship and facilitating factors. Pharmacists believe they can contribute to patient safety through involvement in transitions of care. An overall concept of an underused competence permeated the categories. Referrals identifying medication-related problems are hindered by limited pharmacist integration into the healthcare team and limited continuity. Writing referrals was considered a new procedure requiring collaboration with unfamiliar partners. Organisational changes, including increased pharmacist continuity and clearer pharmacist roles, are needed to implement referral practices. Further research is needed to evaluate effects on medication treatment and patient outcomes. Full article

Objective: Medication accessibility and adherence are essential factors in healthcare as they ensure patients can follow their doctor’s guidance, enhance treatment success, and lower healthcare costs. Yet, immigrants—a population facing structural disadvantages—remain underrepresented in adherence research. Drawing upon the assimilation theory, this study aims to identify independent and combined effects of cost-related medication nonadherence among immigrants. Study design: This is a secondary data analysis using the 2019–2022 National Health Interview Survey. The data included individuals who self-reported that they were born outside of the U.S. and were aged 18 years and older. Methods: Over four years, the total weighted sample is 53,739,380, and 52.7% had taken any medication within 12 months before the survey. Chi-squared tests were conducted to examine the differences in characteristics between people currently with and without medications and whether insurance, citizenship, and time in the U.S. affected their medication accessibility and adherence. Any p-value less than 0.05 is considered statistically significant. Results: Compared to immigrants without medications, immigrants with medications were more likely to have U.S. citizenship (53.4% > 36.8%, p < 0.001). Those who entered the U.S. less than five years ago are more likely to delay getting medical care due to cost (15.1% > 8.5%, p = 0.0022). Conclusions: Certain aspects of healthcare become more accessible for those living in the U.S. for more than five years. There are various possible explanations for these findings, including the 5-year policy required for permanent residents to access Medicaid. Insurance alone does not eliminate cost-related barriers. Targeted policy interventions for recently arrived and uninsured immigrants are needed to close these structural gaps. Full article

Introduction: Multimorbidity, defined as the coexistence of two or more chronic conditions, is a major global public health challenge. It exists on a continuum from non-complex to highly complex forms, with increasing complexity associated with greater instrumental activities of daily living (IADL) disability, frailty, and mortality. Objectives: This study aims (1) to assess chronic condition complexity (CCC) by distinguishing multiple chronic conditions (MCCs) from multimorbidity (MM); (2) evaluate their distribution and impact on care needs, medication adherence, and quality of life; and (3) examine associations between MM and sociodemographic factors among older adults in Albania. Methods: A descriptive, cross-sectional, multicenter observational study was conducted among older adults aged 65 years and older with ≥2 chronic conditions. Data were collected from participants attending six primary health care centers in southern Albania between March and December 2024. Medication adherence and quality of life were assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and the Older People’s Quality of Life Questionnaire (OPQOL-35), both validated for the Albanian population. Results: In a sample of 727 older adults with ≥2 chronic conditions, MM was significantly associated with advanced age, polypharmacy, medication non-adherence, and lower educational level (p < 0.05). Additional factors, such as reliance on family care and reduced quality of life, were also linked to higher odds of MM, while gender and secondary education showed non-significant associations. Conclusions: Although multimorbidity represents a smaller subgroup within MCCs, it is associated with greater clinical and functional complexity, particularly among older adults of advanced age and lower educational level, indicating that disease burden alone does not fully capture clinical complexity. Full article

Background: Environmental degradation and climate-related territorial transformation are increasingly recognized as social determinants of adolescent mental health. However, empirical evidence on solastalgia among young people in the Global South remains limited. This study aimed to examine psychosocial, health-related, school-related, family, and territorial factors associated with solastalgia among school-attending adolescents in Colombia. Methods: A quantitative, cross-sectional analytical study was conducted between August 2025 and February 2026 with 1005 adolescents from three Colombian territories undergoing different forms of environmental transformation: an urban setting affected by construction-related change, a semiurban setting affected by agricultural transformation, and a rural setting affected by extractivism. Solastalgia was assessed using the Brief Solastalgia Scale. Psychosocial, health-related, school-related, and contextual variables were measured using validated or locally supported instruments. Bivariate analyses, multiple linear regression, and non-parametric territorial comparisons were conducted. Results: Solastalgia differed significantly across territorial groups, with the semiurban group showing the highest mean ranks for solastalgia, followed by the rural and urban groups. However, territorial comparisons showed heterogeneous psychosocial and health-related patterns rather than a uniform gradient across all outcomes. Older age was independently associated with higher solastalgia scores. In the final regression model, solastalgia was independently associated with resilience, substance use screening, suicide risk, age, physical health status, conflict resolution, concern about climate change, and territorial origin. The model explained 42.9% of the variance in solastalgia scores. Territorial origin contributed a small but statistically significant additional proportion of explained variance. Conclusions: Adolescent solastalgia in Colombia is not reducible to individual psychological vulnerability. It reflects a broader socioecological configuration involving emotional distress, perceived health, psychosocial resources, school-related experiences, concern about climate change, and place-based environmental transformation. These findings support the need for school-based and community-based public health responses that integrate adolescent mental health care with environmental protection, cultural safety, and territorial justice. Full article