Returning home from the hospital is a critical timepoint for medication management among older adults (adults aged 60 years or over) with coronary artery disease. Older adults experience changes in their medication regimens, and a shift from supervised medication management to self-management, leading to a higher risk of medication discrepancies. However, limited studies are available to understand the changes in their perceptions about medication management. This study aims to explore the changes in perceptions about medication management among older adults with coronary artery disease transitioning from hospital to home. A longitudinal qualitative study was conducted with a purposive sample of older adults with coronary artery disease (n = 28) and caregivers (n = 10), during June to September 2024. Older adults participated in interviews before and one month after hospital discharge to home. Semi-structured interviews were conducted regarding the older adults' and caregivers' perceptions of medication management. Data was analysed using thematic and framework analysis. Two themes along with five sub-themes were developed, including: (1) Theme 1. From compliance to engagement in medication management: Sub-theme (1) Feeling compelled to accept to take the medications by disease, Sub-theme (2) Leaving health to the healthcare professionals; (2) Theme 2. Struggling in balancing the benefits and risks of medications: Sub-theme (1) Evolving understanding about the benefits of medications, Sub-theme (2) Predominant concerns about adverse drug events, Sub-theme (3) Indecisiveness in maintaining adherence. The views of older adults and caregivers were consistent across the themes. Changes in perceptions about roles, disease and medications were observed among older adults with coronary artery disease transitioning from hospital to home. Older adults simply followed instructions, but shifted to independent administrators after discharge. They accepted to take medications after discharge, as perceiving consistent threat of coronary artery disease. They had evolving understanding in the benefits and risks of medications and struggled in balancing them. More patient-centered and culturally sensitive interventions are warranted for future research. Providing continuous support in medication management, developing positive perceptions of mild side effects and skills in addressing severe side effects, and involving caregivers are important strategies to optimise medication management.

The proportion of older adults living alone is rapidly increasing in Korea, making this population vulnerable to physical, psychological and social health problems. Functional decline in activities of daily living (ADL) and instrumental activities of daily living (IADL) is particularly pronounced among those living alone. This study applied network analysis to identify the structural relationships and central ADL/IADL items in older adults living alone. We utilised the data from the 2022 Korean Longitudinal Study of Aging. Participants were 1,006 community-dwelling older adults aged ≥ 65 years living alone. ADL (seven items) and IADL (ten items) were coded dichotomously (0 = independent, 1 = required help). Network analysis was performed using IsingFit and qgraph in Rand centrality indices (strength, closeness and betweenness) were estimated. Network stability was evaluated using 1,000 bootstrap case-dropping subsets. Among the participants, 8.55% required help with at least one ADL item, and 20.68% required at least one IADL item. 'Using means of transportation' demonstrated the highest strength centrality, followed by 'going in and out of bathroom, cleaning after urinating or defecating, then getting dressed', 'preparing hot meals' and 'bathing or showering'. The findings of this study highlight central ADL and IADL items within the functional network of older adults living alone. These results provide insights into the interrelationships among functional abilities and may guide future research on strategies to support or prevent functional decline in this population.

The global population of older adults is rapidly growing, presenting significant challenges for health systems, particularly in low- and middle-income countries such as India. Age-based discrimination is an important social determinant of health; however, its relationship with healthcare utilization (HCU) among older adults in India remains underexplored. This study examines whether perceived age-based discrimination is associated with HCU through a sequential pathway involving probable depression and multimorbidity, and whether these associations differ between rural and urban settings. We analysed cross-sectional data from 31,902 community-dwelling adults aged 60 and above from the nationally representative Longitudinal Ageing Study in India (LASI) Wave 1. Perceived age-based discrimination was a binary measure based on attributing unfair treatment to age. Probable depression was assessed using the Composite International Diagnostic Interview-Short Form (CIDI-SF), multimorbidity was defined as the coexistence of two or more self-reported chronic conditions, and HCU was measured as any service use in the past 12 months. Structural equation modelling with weighted least squares means and variance adjusted (WLSMV) estimator was used to examine direct and indirect pathways, with rural-urban differences assessed using a multi-group sequential model. Perceived age-based discrimination was positively associated with probable depression (β = 0.434, p < 0.001), which was associated with multimorbidity (β = 0.207, p < 0.001), which in turn was associated with HCU (β = 0.387, p < 0.001). A small but significant direct effect of discrimination on HCU was observed (β = 0.077, p = 0.005). The total indirect effect was significant (β = 0.035, p < 0.001), indicating a significant sequential indirect pathway via probable depression and multimorbidity. Multi-group analysis showed that the overall indirect effect did not differ significantly between rural and urban groups; however, the association between discrimination and probable depression was stronger in urban areas, whereas the direct association between discrimination and HCU was significant in rural areas but not in urban settings. Perceived age-based discrimination is associated with increased healthcare utilization among older adults in India through both direct and indirect pathways, with the indirect effect operating via probable depression and subsequent multimorbidity. These findings highlight the importance of addressing discrimination and integrating mental health within primary care, while also accounting for rural-urban disparities, to promote equitable healthcare access and improve health outcomes in ageing populations.

Everyday services are increasingly being digitalised, while the proportion of older adults continues to grow. Ensuring that digital services are accessible to this population is essential to prevent digital exclusion and support autonomy. This study aimed to explore older adults' perspectives, experiences, and needs regarding digital services, identify perceived barriers to accessibility, and examine associated ethical and societal concerns. This qualitative descriptive study recruited 48 French community-dwelling older adults in France (28 women, 20 men; mean age = 76.06 years, SD = 9.21; 42 urban, 6 rural). Semi-structured interviews were conducted using an 18-item guide developed from a review of the literature on digital accessibility. The study design and reporting were informed by the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Interviews were audio-recorded, transcribed verbatim, pseudonymised, and analysed using inductive thematic analysis. Coding was performed independently by two researchers, and discrepancies were resolved through discussion. All participants reported using at least one digital technology, primarily for communication, information-seeking, administrative procedures, entertainment, and, more rarely, for professional or obligatory tasks. Participants described both advantages (e.g., convenience, ergonomic interfaces) and difficulties (e.g., lack of support, interface complexity, technical failures), leading to diverse coping strategies such as seeking help, self-learning, delegation, or avoiding digital tools when possible. Feelings toward digitalisation were ambivalent, combining perceived benefits with frustration, concerns about data security, and reflections on the impact of digitalisation on autonomy and human relationships. Participants also identified barriers to accessibility (e.g., lack of digital literacy, financial constraints, poor design, insufficient support) and proposed concrete solutions, emphasising the importance of accessible design, non-digital alternatives, adapted training, and human assistance. Digitalisation offers opportunities for older adults but also raises accessibility, ethical, and societal challenges. While many participants recognised the usefulness of digital services, they also highlighted risks related to autonomy, perceived choice, and reduced human contact. These findings underscore the need for digital services that are inclusive, intuitive, and supported by continuous human assistance to avoid reinforcing existing inequalities.

Older adults with complex needs (CN), commonly defined as the coexistence of multiple chronic conditions and functional limitations, are associated with high levels of medical and long-term care (LTC) utilization. However, evidence on real-world patterns of joint medical and LTC service use among this population in China remains limited. This cross-sectional study utilized data from 177,807 individuals aged ≥ 60 years who underwent LTC insurance assessment in Shanghai between January and May 2023. CN was defined as having three or more chronic conditions with at least one limitation in activities of daily living. Within an integrated care framework, latent class analysis (LCA) was applied to identify patterns of medical and LTC service utilization based on 10 indicators informed by the Andersen Behavioral Model of Health Services Use. Multinomial logistic regression was used to examine the association between CN status and class membership, adjusting for demographic, socioeconomic, and health-related factors. Older adults with CN (n = 42,277) differed significantly from those without CN (n = 135,530) across demographic, socioeconomic, health status, and service utilization. Six latent classes of medical and LTC service utilization were identified: Low Medical & Low Care, Moderate Medical & Low Care, High Medical & All Care, High Medical & Informal Care, High Medical & Formal Care, and High Inpatient & Formal Care. Compared to non-CN individuals, CN individuals had higher probabilities of belonging to high-utilization classes, particularly High Medical & All Care, High Medical & Informal Care, and High Medical & Formal Care classes, with the Low Medical & Low Care Class as the reference. These associations remained significant after adjusting for covariates. Older adults with CN in China showed heterogeneity in patterns of medical and LTC service utilization and were more frequently represented in intensive and multi-sector service use profiles. Early identification of CN individuals and the development of risk-stratified integrated care models may help inform more coordinated and people-centered service delivery approaches.

Person-Centered Care (PCC) has become established as an essential model in geriatric care, promoting the dignity, autonomy, and well-being of residents. However, the COVID-19 pandemic posed an unprecedented challenge to its implementation in nursing homes (NH), affecting both the quality of care and human relationships. This study analyzes the perceptions of residents, relatives, professionals, and directors regarding PCC before, during, and after the pandemic in Catalonia (Spain). A multicenter cross-sectional study was conducted in 30 NH across the 10 healthcare regions of Catalonia. Validated PCC in Gerontology Services model questionnaires were administered to 335 participants, including residents, relatives, professionals, and directors. Each item was retrospectively assessed at three time points: before, during, and after the pandemic. Descriptive, staffing, and pandemic-related variables from the facilities were collected. Statistical analyses included descriptive statistics, nonparametric tests for group comparisons, and bivariate associations assessed using Spearman's rank correlation coefficients. During the COVID-19 pandemic, PCC scores dropped sharply-from 176 pre-pandemic to 136 during the crisis- before partially recovering to 171 post-pandemic, underscoring the substantial impact of the health emergency. Larger NHs and those with more months in "red code" experienced greater losses in PCC scores during the pandemic, while homes with a higher proportion of resident transfers showed smaller decreases. Additionally, NHs with a higher physician-to-resident ratio experienced larger decreases in PCC scores during the pandemic, while NHs that suffered greater losses in PCC scores tended to show greater post-pandemic recovery. This study confirms that PCC is particularly vulnerable during health crises such as the COVID-19 pandemic. The findings highlight the need for flexible organizational structures, adequate resources, and strong ethical guidance to ensure the sustainability of the PCC model and underscore the importance of contingency plans that maintain PCC without compromising residents' safety, dignity, or autonomy. Not applicable.

Previous studies have found that the relationship between changes in BMI and renal function outcomes remains unclear, with both increases and decreases in BMI being associated with a decline in eGFR, especially in the elderly hip fracture population. Therefore, this study aimed to investigate the association between BMI and eGFR upon hospital admission in elderly patients with hip fractures, to better understand the underlying pathophysiological connections and provide a basis for clinical patient management. We conducted a retrospective cross-sectional study involving 1,417 elderly patients with hip fractures, collecting clinical data such as BMI and eGFR at admission. Generalized additive models, smooth curve fitting, and two-piecewise linear regression models were used to explore the linear and non-linear relationships between BMI and eGFR. A total of 1,417 patients with hip fractures were included, with females accounting for 73.04%. The mean age of the patients was 77.57 ± 8.73 years. The mean eGFR was 80.23 ± 21.76 mL/min/1.73m², and the mean BMI was 22.04 ± 3.25kg/m². After adjusting for age, sex, fracture classification, number of comorbidities, smoking, hypertension, coronary heart disease, diabetes mellitus, white blood cell, lymphocyte, neutrophil, hemoglobin, red cell distribution width, albumin and globulin, a significant correlation between BMI and eGFR was still observed (β: -0.72, 95% CI: -1.04 to -0.40). Trend analysis after categorizing BMI into four groups showed that the decrease in eGFR increased progressively with increasing BMI. Non-linear analysis revealed an inflection point at a BMI of 27.5kg/m². To the left of the inflection point, for every 1kg/m² increase in BMI, eGFR decreased by 0.91 mL/min/1.73m², while no correlation was found to the right of the inflection point. There is a non-linear relationship between BMI and eGFR at admission in elderly patients with hip fractures, with a clear inflection point. This suggests that BMI should be considered an indicator for renal function risk assessment when managing these patients, and that targeted renal protective measures should be considered for patients in different BMI ranges.

This study explored the impact of a caregiver educational intervention on improving the quality of life (QoL) of caregivers of community-dwelling activity-limited older adults. This non-randomized, controlled quasi-experimental study with geographically defined groups was conducted in two selected secretariat divisions of the Colombo District in the Western Province of Sri Lanka. The sample of caregivers (N = 72) for the intervention (n = 36) and control (n = 36) groups was selected depending on the highest degree of activity limitations in older adults. The need-based educational intervention delivered to the intervention group consisted of 2-4 sessions (two weeks apart) with live demonstrations. The QoL of both groups was assessed with the Sinhala-validated WHOQOL-BREF questionnaire before and 6 months after the intervention. Data were analyzed by SPSS 20 using Mann-Whitney U and Wilcoxon signed-rank tests to compare mean scores. The mean±SD age of the caregivers was 55.75±12.9 years; the majority were female (80.6%, n = 58), 44.4% (n = 32) were unknown to have a chronic disease, while 26.4% (n = 32) and 27.8% (n = 19) reported having 2 and 3 chronic diseases, respectively. Many caregivers (77.8%, n = 56) perceived their health as satisfactory. Six months after the educational intervention, scores had significantly higher ratings in the overall QoL (61.97±10.33 vs. 51.61±10.99), physical health (68.55±12.39 vs. 54.76±11.32), psychological (69.21±12.04 vs. 54.86±11.89) and social relationships domains (46.06 ±16.72 vs. 34.49 ±17.94) in the intervention group compared to controls (p < 0.01). No significant change was observed in the environmental domain (64.06±12.21 vs. 62.33±11.45; p > 0.05) between the two groups. Pre- vs. post-intervention scores of the overall and the four domains of QoL showed a significant increase in the intervention group (p < 0.001), whereas scores of overall QoL and all three domains except the environmental domain showed a significant decline (P < 0.001) after 6 months when compared to pre-6 months values in the control group. The caregiver educational intervention positively changes the QoL of caregivers of activity-limited older adults. The involvement of healthcare professionals in caregiver education will improve the QoL of caregivers through knowledge enhancement.

The increasing demand for geriatric health services, particularly in rehabilitation, has led to significant delays in the delivery of care across many regions of Germany. In response, Germany has introduced several initiatives, including innovative care models such as the telemedicine integrating multimodal, home-based geriatric aftercare programs GeRas that aimed at improving service efficiency and accessibility in geriatric rehabilitation. While such programs may increase geriatric health services capacity further exploration is needed to assess the scalability of such programs. Thus, the objective of this study was to obtain the perspective of key stakeholders (e.g., health services provider) on the requirements for scaling up of geriatric aftercare programs including a telemedicine component. In a qualitative interview study, 12 key stakeholders were interviewed to obtain their perspectives on the requirement for such geriatric aftercare programs, as well as their scalability, including the integration of telemedicine, taking the GeRas program as an example. The interview data were analysed using Qualitative Content Analysis according to Kuckartz. A total of four main themes emerged from the qualitative content analysis. Theme two, including six subthemes, addressed the requirements for scalability of geriatric aftercare programs. Stakeholders emphasized the need to address financial requirements and establish transparent remuneration models for healthcare providers (1). Personnel requirements (2), and structural needs, including cross-sectional collaboration, were also highlighted (3). Additionally, the development and implementation of educational concepts for both providers and participants were discussed (4). Key requirements for a geriatric aftercare program (5) and the role of telemedicine (6) were also considered. Clear definitions of structural, personnel, and financial requirements, along with interprofessional collaboration, were essential for the scalability and success of geriatric aftercare programs. However, findings show that the scalability of these programs remains complex, yet essential. German Clinical Trials Register (DRKS00029559). Registered 5/10/2022.