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.
Introduction: The Trauma Medical Home (TMH) randomized clinical trial tested the efficacy of a collaborative care intervention on the biopsychosocial recovery of older injured adults compared to usual care. Study enrollment occurred between 11 October 2017 and 13 October 2021 and study operations were impacted by the COVID-19 pandemic. It is important to measure the potential effects of COVID-19 on research study participants to ensure accurate reporting of results. The purpose of this secondary analysis was to compare depression and anxiety symptoms and health-related quality of life in older adults at TMH study enrollment pre-COVID-19 and during COVID-19. We hypothesized that those enrolled during COVID-19 would have worse symptoms and quality of life. Methods: This study was a secondary analysis of data from a multicenter randomized clinical trial (R01AG052493-01A1) TMH, that examined the ability of a collaborative care model to enhance the recovery of older injured adults compared to usual care. It was hypothesized that the TMH intervention would improve biopsychosocial recovery for injured older adults compared to usual care. The enrollment periods pre-COVID-19 and during COVID-19 were compared. Chi-square tests and Wilcoxon Rank Sum tests, then multivariable linear and logistic regressions were completed with SF-36 component scores and depression (PHQ-9) and anxiety (GAD-7) scores as the dependent variables, respectively. Results: A total of 429 participants were analyzed. There was no significant difference in anxiety and depression symptoms between the pre-COVID-19 and during-COVID-19 enrollment periods. Perceived limitations due to physical health problems were worse for those enrolled during COVID-19 (adjusted β = -9.8, 95% CI -18.3 to -1.4), but other health-related quality of life measures were similar between the two groups. Conclusions: These findings support the conclusion that the negative psychological impacts of the pandemic are likely due to individual factors other than age or COVID-19. These results suggest a high degree of psychological resiliency in older adults under stress. Future research should focus on the potential effects of socioeconomic status, demographic background, and level of physical functioning on psychological outcomes.
