Background: Depression and delirium are common neuropsychiatric disorders in older adults. Although studies suggest an association between the two conditions, evidence regarding the long-term risk of delirium in older patients with depression in outpatient primary care remains limited. Objective: This study examined the relationship between depression and delirium in individuals aged ≥65 years. Methods: This retrospective cohort study used data from the German IQVIA Disease Analyzer database. It included individuals aged ≥65 years who received their first diagnosis of depression between 2005 and 2023. Using propensity score matching, patients with depression were matched 1:1 with individuals without depression. The primary outcome was incident delirium (ICD-10: F05). Time-dependent Cox regression models were applied for up to ten years of follow-up. Results: After matching, the study population consisted of 203,888 individuals (mean age: 75.8 years; 66% female). The incidence of delirium was higher in patients with depression than in controls (2.0% vs. 1.3%). Depression was associated with an elevated risk of delirium within the first two years after diagnosis (HR 1.42; 95% CI 1.14–1.75) and between six and ten years (HR 1.48; 95% CI 1.05–2.11). No statistically significant association was observed between years 3 and 5. Incident dementia was also associated with delirium (HR 1.52; 95% CI 1.14–2.02). Conclusions: Among older adults receiving outpatient care, depression was associated with a higher rate of subsequently documented delirium. These results complement existing evidence from inpatient settings. Due to the observational nature of the study, causal inferences cannot be made. In a sensitivity analysis excluding individuals with dementia at baseline, the association remained statistically significant across all intervals (HR 1.74, 1.53, and 1.82 for 0–2, 3–5, and 6–10 years, respectively).
Background: Oral bisphosphonates are first-line osteoporosis therapy but can cause mucosal chemical injury when tablets are retained rather than swallowed correctly. This risk is heightened in cognitively impaired older adults with dysphagia or difficulty complying with medication administration guidelines. Case Presentation: A 73-year-old female nursing home resident with advanced vascular dementia presented with 24 h of oral pain, reduced intake, lethargy and new facial swelling. She had received monthly ibandronic acid 150 mg for two years, with documented difficulty swallowing tablets but no formal swallowing assessment. Examination showed ulceration of the left lower lip and anterior tongue with mild vestibular swelling. Clinical investigations excluded haematinic deficiency and osteonecrosis; traumatic, lichenoid, vesiculobullous and neoplastic causes were considered unlikely based on distribution, clinical features and temporal association with the recent dose. Bisphosphonate-associated chemical mucosal injury was diagnosed by hospital dental services. Ibandronic acid was discontinued, topical treatment initiated, and ulcers resolved by three weeks. Denosumab was substituted in view of the patient’s dysphagia and cognitive status. Discussion: This case supports the existing literature identifying inappropriate administration—often linked to dysphagia or physical impairment—as a leading cause of oral bisphosphonate-associated ulceration, typically affecting the tongue and lower lip. Ibandronate-related cases are rarely reported, likely reflecting prescribing frequency rather than lower risk. Current guidelines lack explicit recommendations addressing dysphagia or cognition in prescribing decisions. Conclusions: Presence of dysphagia and cognitive status should be assessed before and during oral bisphosphonate therapy. New oral pain, ulceration or facial swelling should prompt oral examination and medication review, with alternative antiresorptive agents considered when oral administration is impaired.
Background: Depression is a major health issue among older adults and is frequently accompanied by chronic physical conditions. Conventional care of depression in older adults is delivered through primary care settings and often fails to address the complex interactions between mental health, physical illness, and social determinants of health in this population. Integrated care models, characterized by coordinated, multidisciplinary, and patient-centered approaches, have emerged as a promising strategy for improving depression outcomes in late life. Objective: This scoping review aimed to characterize integrated care models for managing depression in older adults. The review examined the structure and implementation of these models and evaluated depression-related outcomes. Methods: A systematic literature search was conducted in PubMed and Google Scholar. Studies published in English between 2006 and February 2026 were considered. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs that evaluated integrated care interventions targeting depression in adults aged 65 years or older or mixed adult populations that included older adults. One reviewer conducted the search and initial screening, and four additional reviewers evaluated the eligibility of full-text reports and extracted data using a structured template. Results were synthesized descriptively. Results: Seventeen studies met the inclusion criteria. Integrated care interventions were implemented across primary care clinics, community health centers, and home healthcare programs in several countries. Participants commonly had depression alongside chronic medical conditions, including diabetes, hypertension, heart failure, or chronic obstructive pulmonary disease. Integrated care models varied in staffing, therapeutic components, specialist involvement, delivery intensity, and comparator conditions. Most interventions incorporated multidisciplinary care teams; structured symptom monitoring; care coordination; behavioral or psychological interventions; and, in some studies, chronic disease management, social support, or technology-supported follow-up. Thirteen studies reported a favorable depression-related finding at one or more assessment points; however, benefits were not always sustained, and some studies reported null- or comparator-favoring findings. Conclusions: Integrated care for depression in older adults encompasses heterogeneous models implemented across diverse healthcare contexts. Common themes included multidisciplinary collaboration, coordinated follow-up, structured psychological or behavioral treatment, symptom monitoring, and integration of mental and physical health management. Favorable outcomes were reported in most studies, but findings varied by population, setting, comparator, intervention intensity, and follow-up duration. These findings may inform future program design, although the effectiveness of the integrated care models and the independent contribution of individual components remain uncertain.
Background/Objectives: A crucial issue in Japan, as a rapidly aging society, is supporting the quality of life (QOL) of older adults to ensure they do not require long-term care. This study aims to examine the association between subjective symptoms and psychological stress and QOL decline using a large-scale Japanese national statistics database. Methods: Anonymized data were analyzed from 23,649 adults aged ≥ 65 years, obtained from the Comprehensive Survey of Living Conditions carried out in 2019 in Japan. The degree of association of different factors with QOL decline was analyzed using univariate symptom analysis and adjusted odds ratios (ORs) obtained through binary logistic regression. We also compared the reported frequency and mean number of symptoms in a group with poor QOL and one with good/regular QOL. Results: In the group with poor QOL, significantly more individuals were aged ≥ 75 years, had high levels of psychological stress (Kessler Psychological Distress Scale [K6]), and reported subjective symptoms (p < 0.01). The mean number of symptoms was significantly higher in this group (5.77) than in the good/regular QOL group (3.34, p < 0.01). In the binary logistic regression, the variables with the highest adjusted ORs were the K6 group (4.49), impaired limb movement (2.81), and numbness of the limbs (2.01). Conclusions: These findings indicate that different symptoms, including stress, have varying impacts on QOL in older adults. Addressing symptoms associated with reduced QOL in community-dwelling older adults may help promote continued aging in place.
Purpose: Delirium is a frequent and serious condition in older patients, associated with severe adverse outcomes and lacking proven pharmacological treatments. Non-pharmacological multicomponent strategies are recommended, and specialized delirium care environments (e.g., delirium room, delirium unit, psychogeriatric unit) have been proposed as a potential strategy to improve the management of delirium in hospitalized older adults. Our objective was to provide the first systematic review and pooled analysis on the subject, synthesizing the characteristics of specialized delirium environments in the care of delirium and their association with clinical outcomes. Methods: A systematic search of MEDLINE, Cochrane, and EMBASE identified studies on patients aged 65 years and older with delirium or related acute confusional states admitted to specialized delirium care environments. Study quality was assessed using Cochrane’s risk of bias tools, and exploratory pooled analyses were conducted when at least three studies reported the same outcome. Results: Nine studies, reported across 15 publications and including 2226 patients, met the inclusion criteria. Interventions were heterogeneous in structure and content, but most combined delirium-oriented staff training, enhanced surveillance, environmental adaptation, and multicomponent non-pharmacological care. Comparator groups were also diverse and included standard wards, earlier versions of specialized care models, indirect admission pathways, and non-delirious controls. The narrative synthesis suggested that specialized delirium care environments were most consistently associated with shorter delirium duration, more favorable discharge outcomes, lower physical restraint use, and better functional recovery, while findings for length of stay, falls, psychotropic drug use, and mortality were less consistent. Exploratory pooled analyses suggested a favorable direction of effect for several outcomes, particularly discharge destination and mortality, but pooled estimates were not statistically significant and should not be interpreted as definitive evidence of efficacy. All included studies were judged to be at a high or critical risk of bias. Conclusions: Specialized delirium care environments appear promising for the management of delirium in hospitalized older adults, particularly for outcomes closely related to day-to-day delirium care. However, the current evidence base is limited by substantial heterogeneity in intervention models, comparator groups, and outcome definitions, as well as by a high risk of bias across studies. These findings support further evaluation of specialized delirium care models, but do not yet allow firm conclusions regarding their effectiveness.
Background: Myasthenia gravis is an autoimmune disorder of the neuromuscular junction characterized by fluctuating skeletal muscle weakness. Late-onset MG (onset ≥ 50 and <65 years) and very late-onset MG (VLOMG; onset ≥ 65 years) are increasingly recognized subgroups, and diagnosis in very elderly patients remains challenging because symptoms frequently overlap with age-related conditions and comorbidities. Case Presentation: An 88-year-old man with very late-onset myasthenia gravis (symptom onset at approximately age 85) was urgently referred because of a several-day history of rapidly worsening dysphagia and dysarthria, superimposed on fluctuating diplopia, dysphagia, dysarthria, and fatigable bulbar symptoms that had progressively worsened over the preceding three years. Initial diagnostic evaluation was challenging because of advanced age, previous lacunar infarctions, and multiple comorbidities, including pulmonary thromboembolism, chronic kidney disease, and permanent pacemaker implantation (which precluded brain MRI). Neurological examination and the characteristic fluctuation of symptoms raised suspicion of myasthenia gravis. Serological testing confirmed markedly elevated acetylcholine receptor antibodies, whereas MuSK antibodies were negative. Repetitive nerve stimulation was not performed given the high antibody titer and unambiguous clinical presentation. Thoracic computed tomography excluded thymoma. Treatment with pyridostigmine, azathioprine (maintenance dose kept lower than standard due to chronic kidney disease stage IIIB), and low-dose prednisone (selected due to age and comorbidity profile) resulted in early, patient-reported clinical improvement (approximately 60% in speech and swallowing) over eight weeks of follow-up; a validated severity scale (MG-ADL) showed a score of six (scoring range 0–24). Conclusions: Myasthenia gravis should remain an important differential diagnosis in very elderly patients presenting with fluctuating ocular and bulbar symptoms, even in the presence of multiple comorbidities that may obscure the diagnosis. In this patient, early recognition, antibody testing, and individualised initiation of therapy were followed by meaningful short-term improvement; a single case with eight weeks of follow-up cannot establish that such therapy prevents disease progression or myasthenic crisis, and longer follow-up and additional cases are needed.
Background/Objectives: Sarcopenia is a common public health problem in older adults and is associated with an increased risk of morbidity and mortality, particularly in institutionalized populations. This study aimed to determine the prevalence of sarcopenia in institutionalized older adults, assess the adequacy of protein intake in terms of quantity and quality, and identify factors associated with its presence. Methods: An observational, analytical, cross-sectional study was conducted in three institutional care homes in Loja canton, Ecuador, between 2024 and 2025. A total of 44 older adults aged ≥65 years were included. Sarcopenia was diagnosed according to the EWGSOP2 criteria, and protein intake was assessed using the direct food-weighing method over three days. Descriptive, comparative, and binary logistic regression analyses were performed. Results: The prevalence of confirmed and severe sarcopenia was 61.3%. Severe sarcopenia was more frequent in men, whereas probable sarcopenia was more frequent in women. Participants with sarcopenia presented with lower skeletal muscle mass, skeletal muscle index, and muscle strength. Protein intake was generally insufficient compared with international recommendations, although protein quality was predominantly high or very high. Higher skeletal muscle mass and higher body mass index were independently associated with a lower likelihood of sarcopenia. Conclusions: Sarcopenia in institutionalized older adults appears to be more closely associated with body composition and overall nutritional status than with protein quantity or quality alone. These findings support a comprehensive approach to the prevention and management of sarcopenia that combines adequate nutrition with tailored physical exercise interventions.
Background: In line with international aging policies, most people with dementia receive care at home. Community-based respite services aim to relieve, support, or share caregiving responsibilities. More person-centered knowledge based on experiences from this group is needed to increase informed decisions about planning of qualitative respite care. The aim of this study is to describe how people with dementia experience respite care with alternating housing, i.e., living partly at home, partly in residential care, refer to their everyday life and well-being. Methods: A mixed-methods design was used. The qualitative approach focused on variations of dilemmas in interviews with people with dementia who were granted and received respite care (n = 8). Also, a quantitative approach focused on quality of life using behavioral and psychological symptom scores. Results: Everyday life at the respite care accommodation described by people with dementia included morning routines, variation in the environment, activities in the company of roommates, but also a lack of activities. Social belonging was described by people with dementia through living with roommates and through social contact with the healthcare staff. Quality of life and behavioral and psychological ratings varied between individuals and settings, but no consistent pattern was identified. Conclusions: Respite care appears to maintain a high quality of life and a low level of psychological symptoms for most of the people with dementia. Although the sample was small, these results are nevertheless an important contribution to the phenomenon, experiences of respite care by people with dementia, that need further research. Furthermore, these results can give decision-makers guidance for professional care efforts.
Objectives: To examine the association between premorbid personality in people with Alzheimer’s disease and caregiver well-being, while accounting for caregiver personality, sociodemographic characteristics, and behavioural and psychological symptoms of dementia. Methods: This cross-sectional observational study included 56 dyads consisting of people with mild-to-moderate Alzheimer’s disease and their informal caregiver. Caregiver well-being was operationalised using a continuous index derived from a principal component analysis integrating depressive and anxiety symptoms, burden, loneliness, perceived social support, quality of life and happiness. Caregiver personality and the premorbid personality of people with Alzheimer’s disease (assessed retrospectively by an informant) were assessed according to the Big Five model. Behavioural and psychological symptoms of dementia were assessed using the Neuropsychiatric Inventory. Associations were examined using correlation analyses and hierarchical multiple linear regression models. Results: Caregivers had a mean age of 55.2 years (SD = 11.0), and 82.1% were women. Higher premorbid extraversion of people with Alzheimer’s disease was significantly associated with better caregiver well-being (β = 0.123; p < 0.05), and this association remained significant after adjustment for caregiver personality and other covariates. The final model explained 57.3% of the variance in caregiver well-being (R2 = 0.573; p < 0.001). Conclusions: Premorbid extraversion of people with Alzheimer’s disease was independently associated with caregiver well-being. These findings suggest that personality characteristics of both may be relevant for understanding caregiver well-being within a relational perspective of caregiving.
Older adults represent a growing proportion of patients presenting with acute coronary syndromes (ACS), yet they remain a highly heterogeneous population in terms of biological reserve, comorbidity burden, functional status, cognitive performance, and recovery potential. Chronological age alone is an insufficient basis for invasive decision-making, as it may lead to both therapeutic nihilism and disproportionate treatment escalation. Frailty has emerged as a clinically meaningful construct that captures vulnerability to acute stressors and may refine prognostic assessment beyond traditional cardiovascular risk scores. In ACS, frailty is associated with mortality, bleeding, procedural complications, delirium, functional decline, readmission, and loss of independence. However, frailty should not be interpreted as an automatic contraindication to invasive management. Rather, it should inform proportional care by integrating ischemic risk, procedural burden, reversibility potential, patient preferences, and expected quality of recovery. This narrative review examines the role of frailty assessment in older adults with ACS, focusing on its implications for invasive decision-making. We discuss frailty tools, clinical outcomes, therapeutic bias, healthcare inequities, and patient-centered endpoints. Finally, we propose a vulnerability-based framework for cardiovascular care, in which frailty guides individualized therapeutic intensity rather than justifying age-based exclusion from evidence-based treatment.
Background: Gut microbiota plays a key role in the aging process, with age-related microbial shifts contributing to chronic inflammation, metabolic dysfunction, frailty, and cognitive decline. Despite growing interest, an integrated synthesis of how diet and lifestyle modifications influence gut microbiota remains limited. This overview of reviews summarizes the current evidence on how dietary and lifestyle interventions shape microbial composition and affect aging outcomes. Methods: Following the PRISMA guidelines, we searched PubMed and Scopus for English-language reviews (January 2023–October 2025) including human adults aged ≥ 18 years, evaluating dietary or lifestyle interventions, and reporting gut microbiota with healthy-aging outcomes. Quality of the reviews was appraised using the SANRA tool. Results: Mediterranean and plant-based diets, calorie restriction, and microbiota-targeted approaches such as probiotics, prebiotics, symbiotics, and fecal microbiota transplantation were associated with increases in short-chain fatty acid-producing bacteria, including Faecalibacterium, Bifidobacterium, Lactobacillus, and Akkermansia muciniphila, while reducing pro-inflammatory taxa. These changes were linked to improved metabolic and immune function, reduced inflammaging, lower frailty, and greater physical resilience. Cognitive benefits included decreased neuroinflammation and a lower risk of Alzheimer’s and Parkinson’s diseases. Conclusions: Maintaining microbial balance through targeted dietary strategies may support healthier, more resilient aging, offering practical insights for public health and clinical nutrition planning.
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.
Background/Objectives: Physical activity (PA) interventions have the potential to delay or reverse frailty in older people, and previous meta-analyses have shown that PA reduces frailty risk. However, introduction and maintenance of PA during midlife might be more impactful as a public health intervention to reduce frailty at the population level. This study aimed to evaluate the impact of longitudinal PA patterns on future frailty risk and to examine whether it is modified by age of onset before vs. after 60 years. Methods: We conducted a systematic review and meta-analysis of prospective population-based cohort studies evaluating the effect of longitudinal PA trajectories on frailty risk of community-dwelling adults below and above 60 years at baseline. Risk ratios (RRs) from studies eligible for quantitative synthesis were pooled using random-effects meta-analysis. Results: Ten studies involving 111,714 participants from Europe, Asia, and North America were included in the systematic review and six in the meta-analysis. Relative to long-term physical inactivity, persistent PA trajectory was associated with 44% reduced risk of frailty (RR = 0.56, 95% CI:0.42–0.76) with moderate certainty, while inclining trajectories were associated with a 38% reduced risk (RR = 0.62, 95% CI: 0.57–0.68) with low certainty. Results: were similar for populations > 60 and <60 years at baseline. Conclusions: Sustained or increasing PA patterns over time are associated with lower risk of future frailty. These findings warrant further implementation studies to quantify the impact of public health policies promoting physically active lifestyles in midlife on the burden of frailty in aging populations.
Autoimmune oral mucosal diseases, including pemphigus vulgaris, mucous membrane pemphigoid, and oral lichen planus, are important yet frequently underrecognized causes of morbidity in older adults. These conditions often initially present with nonspecific symptoms such as persistent oral pain, erosions, ulcerations, or gingival inflammation, contributing to delays in diagnosis and treatment. Primary care clinicians and geriatricians are uniquely positioned to identify these diseases early and facilitate timely referral for diagnostic confirmation and initiation of therapy. This review provides a practical overview of the clinical presentation, diagnostic evaluation, and initial management of pemphigus vulgaris, mucous membrane pemphigoid, and oral lichen planus and highlights features that should raise suspicion for an autoimmune oral process. In addition to disease-specific therapies, supportive care measures including pain control, oral hygiene counseling, nutritional support, and mental health screening are essential to reducing morbidity and improving quality of life. Special consideration should be given to challenges disproportionately affecting older adults, including frailty, polypharmacy, and social barriers to care. Through timely recognition and a multidisciplinary, patient-centered approach, clinicians can improve outcomes and support the quality of life of this patient population.
Background/Objectives: Return to the pre-hospital residence is a meaningful patient-centered outcome after hospitalization for pneumonia or lower respiratory tract infection (LRTI). We examined factors associated with 30-day non-return, including prespecified baseline characteristics, the initial empirical antimicrobial therapy pattern, and initial treatment failure within 7 days. Methods: This retrospective observational study included 126 consecutive patients aged ≥65 years admitted with pneumonia or LRTI to a community-based general hospital in Japan. Patients who died within 48 h were excluded. Three multivariable logistic regression models were fitted: Model 1 evaluated prespecified baseline characteristics; Models 2 and 3 added the initial empirical antimicrobial therapy pattern and initial treatment failure within 7 days, respectively. Initial treatment failure was treated as a post-baseline marker of an unfavorable early clinical course. Results: The median age was 89.0 years, and 56 patients (44.4%) returned to their pre-hospital residence within 30 days. Higher serum albumin was associated with lower adjusted odds of non-return across all models (OR range, 0.365–0.407 per 1 g/dL increase). Initial treatment failure was associated with higher adjusted odds of non-return (OR, 3.296; 95% CI, 1.095–9.923), whereas the initial empirical antimicrobial therapy pattern showed no statistically significant overall association (global p = 0.859). The principal findings were materially unchanged in sensitivity analyses addressing early deaths and the treatment-failure definition. However, in other supportive analyses, the associations remained directionally consistent but were attenuated and no longer statistically significant in the analysis restricted to 30-day survivors; in addition, the serum albumin association in Model 3 did not retain statistical significance in some leave-one-out analyses. Conclusions: Higher serum albumin at admission was associated with lower odds of 30-day non-return, whereas initial treatment failure was associated with higher odds. Initial treatment failure should be interpreted as a post-baseline marker of an unfavorable early clinical course rather than as an independent baseline predictor. No statistically significant association with the initial empirical antimicrobial therapy pattern was detected. These findings do not establish causality.
Polypharmacy in older adults is common, rising and inconsistently defined, and it is widely treated as a problem of how many medicines a person takes. This non-systematic narrative review argues that its harm depends more on the appropriateness of the regimen and the pharmacological burden the regimen imposes, with the number of drugs a partly confounded marker rather than the principal cause. Drawing on evidence published mainly since 2020, it traces the shift from counting medicines to weighting them; the prescribing cascade as a patterned and detectable source of inappropriate use; the explicit criteria (Beers, STOPP/START, EURO-FORTA) and implicit measures (the Medication Appropriateness and Drug Burden indices) that give appropriateness operational form; and the evidence that deprescribing is feasible and generally safe, although its benefit is conditional and depends on how it is done. Because these criteria can be applied to medication lists held in routine data, potentially inappropriate prescribing can increasingly be identified beyond the single encounter and at population scale, even as automated tools remain unreliable at judging whether a flagged criterion applies to the individual patient. The review concludes that medication review should prioritise appropriateness and the individual benefit–risk balance rather than the medication count, and that detection can increasingly be scaled even though the clinical decision and the patient’s agreement cannot.
Background/Objectives: Elder abuse remains a significantly underreported public health issue. The study examines how elder abuse is detected through a passive, suspicion-based case-finding pathway in an Italian university hospital emergency department (ED) and what the findings imply for improving systematic screening. Methods: This retrospective study analyzed elder abuse cases accessed at Careggi University Hospital ED (Florence, Italy) from 2017 to 2022. Eligible patients were aged ≥65 years and had suspected or confirmed elder abuse identified through Rosa Code protocol activation, abuse-related ICD-10 codes, and forensic consultation records. Two investigators independently reviewed eligible charts using predefined inclusion criteria and a standardized data-extraction form. Missing or unclear documentation was quantified descriptively, and no imputation was performed. Results: Sixty-seven elder abuse cases were identified during the six-year period, corresponding to a reported detection rate of 0.8% among the records screened for this study (mean: 11.2 cases/year). All eligible cases were captured through Rosa Code activation; ICD-10 and forensic-record searches did not identify additional cases. The majority of victims were women (76.1%), with a mean age of 75.5 years, and 76.1% had documented comorbidities. Physical abuse was the most common form (61.2%), predominantly perpetrated by family members (93.8%) within the victim's home (64.2%). Head and neck injuries were most frequent (43.3%). A notable 50% decline in reported cases occurred during the COVID-19 pandemic. Despite law enforcement notification in 78% of cases, 65.7% of patients were discharged home. Conclusions: The study's detection rate (<1%) falls critically short of international benchmarks (3-5%), underscoring urgent need for systematic screening using validated tools and staff training and multidisciplinary safeguarding pathways in Italian emergency departments.
Background: In older adults, multimorbidity and polypharmacy complicate medication regimens and often lead to poor adherence. Mobile health (mHealth) has been suggested as a solution to enhance medication adherence in chronic conditions. Despite the increase in smartphone usage among people aged 65 and over, there is still a lack of evidence of mHealth in this age group. Objectives: To evaluate the impact of mHealth interventions on medication adherence in older adults (≥65 years) with chronic diseases, compared with standard care or other interventions. Methods: The review was conducted in accordance with PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews. Randomized controlled trials published from 2000 onwards were considered with no linguistic or geographical restrictions. The databases searched included PubMed, Scopus, Cochrane Library, and CINAHL. Methodological quality was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. Results: 551 records were initially identified, from which 8 randomized controlled trials published between 2014 and 2025 were included. Six of eight studies showed that medication adherence in mHealth groups was significantly higher than in controls. However, one study found benefits only in specific drug classes rather than a general improvement. Conclusions: The results of this review suggest that mHealth has the potential to improve medication adherence among older adults with chronic diseases, especially when interventions go beyond simple reminders and incorporate educational and relational components. Nevertheless, higher quality studies with larger samples and longer follow-up are needed to clarify mHealth's role in the care of this population.
Introduction: Community-based day center programs may support healthy ageing by promoting functional ability, mental well-being, and social participation among older adults, but real-world evidence from Latin America remains limited. Objective: We aimed to examine changes in functional status, mental health, and quality of life among older adults participating in the CEDIAM program in the Maule Region of Chile in 2022 and 2023. Methods: Pre-post observational study using routinely collected data from 15 CEDIAM centers. The 2022 and 2023 datasets were analyzed as independent cohorts. Functional status was assessed with the Barthel Index, the Lawton and Brody scale, and the Timed Up and Go test; mental health with the Mini-Mental State Examination and the 15-item Geriatric Depression Scale; and quality of life with the EuroQol-5D visual analogue scale. Paired comparisons, category-transition analyses, and multivariable logistic regression models of improvement were performed. Results: Baseline samples included 894 participants in 2022 and 897 in 2023. In 2022, all continuous outcomes improved significantly (all p ≤ 0.001). In 2023, the Barthel Index, the Timed Up and Go test, and the Geriatric Depression Scale improved (all p < 0.0001), and the EuroQol-5D visual analogue scale also improved (p < 0.01), whereas the Lawton and Brody scale (p = 0.204) and the Mini-Mental State Examination (p = 0.725) did not. Category-transition analyses showed significant improvements in basic activities of daily living and mobility in both cohorts (both p < 0.001), while significant categorical changes in instrumental activities of daily living, global cognition, depressive symptoms, and self-rated quality of life were observed only in 2022 (all p ≤ 0.01). Rural residence was associated with higher odds of improvement in basic activities of daily living (OR 1.62, 95% CI 1.17-2.25; p = 0.004), whereas age ≥75 years was associated with lower odds of improvement in depressive symptoms (OR 0.56, 95% CI 0.41-0.76; p < 0.001) and self-rated quality of life (OR 0.65, 95% CI 0.45-0.94; p = 0.023). Conclusions: Participation in CEDIAM was associated with favorable changes, particularly in basic functional status and mobility, although responses varied across outcomes and participant subgroups.
Background/Objectives: Telemedicine offers significant potential to improve the quality and accessibility of geriatric care, particularly in resource-constrained settings. However, its effective implementation depends largely on healthcare professionals' acceptance and willingness to use such systems. Drawing on an extended Technology Acceptance Model (TAM), this study examines the determinants of doctors' and nurses' intentions to adopt telemedicine for elderly care in Algeria, with particular emphasis on self-efficacy and institutional support. Methods: This cross-sectional study employed a structured questionnaire administered to 130 healthcare professionals, including physicians and nurses, in Algeria. Hierarchical multiple regression analysis was conducted to test the proposed hypotheses and assess the incremental explanatory power of the extended model. Results: The extended TAM accounted for 48.7% of the variance in intention to use telemedicine. Institutional support (β = 0.432, p < 0.001) and self-efficacy (β = 0.264, p = 0.001) emerged as the strongest predictors. Perceived ease of use (β = 0.178, p = 0.038) and perceived usefulness (β = 0.139, p = 0.021) also had significant positive effects. The inclusion of self-efficacy and institutional support increased the model's explanatory power by 23.5%. Conclusions: The findings highlight the critical role of organizational support mechanisms, digital competencies, and system usability in fostering telemedicine adoption among healthcare professionals. The study provides practical implications for policymakers and healthcare institutions, emphasizing the need for targeted training programs, supportive infrastructure, and institutional policies that enhance confidence and facilitate the integration of telemedicine into clinical workflows.
