The ageing of Western societies is leading to a marked increase in mortality. Death and old age are now intertwined. This situation should be of particular concern to palliative care. But in reality, palliative care remains too inaccessible to the oldest sections of the population. Why this paradox? After reviewing the clinical and organisational reasons that are often given, we invite you to take a more global look, one that is both sociological and ethical.

OBJECTIVE: Aim: To analyze and summarize the implementation of telemedical solutions in geriatrics and gerontology within the Polish healthcare sector, aiming to develop innovative strategies for improving elderly care through telemedical technologies.
METHODS: Materials and Methods: An interdisciplinary pilot project in geriatrics was implemented, focusing on health, organizational, and technological areas. The project involved continuous monitoring of health parameters, remote consultations, and the use of telemedical devices and platforms. Key data collection tools included digital clinimetric outcomes from the FRA-MNA-SARC model, with data transmitted to a telemedical platform.
RESULTS: Results: The pilot project demonstrated significant positive outcomes for senior participants. Continuous monitoring of health parameters allowed for early detection and timely intervention, leading to noticeable improvements in chronic disease management. This proactive approach reduced emergency hospital visits and enhanced overall health stability. The medication adherence support system, with automated reminders, ensured patients took their medications as prescribed, resulting in improved compliance and health outcomes. Telemedical solutions efficiently reduced the need for frequent in-person visits, allowing healthcare providers to monitor progress and adjust therapies in real-time. The project also effectively engaged patients and caregivers, increasing confidence in health management and providing valuable support and real-time information.
CONCLUSIONS: Conclusions: Implementing telemedical solutions in geriatrics within the Polish healthcare sector shows significant potential to improve elderly care. Telemedicine can effectively support chronic disease management, enhance seniors\' quality of life through continuous health monitoring, and provide a practical framework for personalized and efficient healthcare delivery.

BACKGROUND: First language care is critical for older immigrant adults with limited English proficiency, especially in long-term care settings where most residents require staff assistance and experience complex chronic conditions, resulting in multiple communication interactions where language poses a barrier. Although there are a myriad of cultural-language translation apps and devices available, there is a gap in both research and practice on the acceptability and feasibility of these digital resources within the context of long-term care and community settings for older immigrant adults, from a cultural relevance and digital health equity perspective. Our paper outlines a scoping review protocol to examine the state of the literature on the extent to which cultural-language translation apps are used in long-term care settings and community-based elder care. We will also examine the extent to which such apps bridge or further gaps in equitable, accessible and acceptable care for older immigrant adults with limited English language proficiency.
METHODS: This scoping review protocol will employ an adapted five-stage framework outlined by Arksey and O\'Malley guided by enhancements recommended by Levac et al and Colquhoun et al. Using the Joanna Briggs Institute\'s population, concept and context framework, we defined the scope of the scoping review by identifying the target population, concepts for investigation and the context within which the research is situated. We will conduct a search of the literature from 2005 to 2024 using five bibliographic databases from health sciences (Healthstar OVID, MEDLINE OVID and Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO), engineering (Engineering Village Elsevier) and a cross-disciplinary database (Web of Science Clarivate). The research team will adopt a critical, equity-focused approach for the scoping review by integrating Richardson et al\'s framework for Digital Health Equity into our analysis of the findings. This will ensure that health and social equity perspectives are integrated within our methodology and analytical lens. Our analysis will specifically examine selected studies for their engagement with health equity and their ability to address issues such as ageism, ableism and the digital divide within geriatric care.
BACKGROUND: Ethics approval is not required for this scoping review as it involves secondary analysis of published works and no primary data collection involving human subjects. Findings of the review will be shared with community partners and disseminated through publications, conferences and peer-reviewed publications.

BACKGROUND: Multicomponent interventions with carers of people with dementia demonstrate positive effects on the health and quality of life for carers and care recipients. The World Health Organization\'s iSupport for Dementia is an evidence-based online psychoeducation programme for carers. However, the programme was mainly implemented as a self-learning tool which might have limited its positive effects on carers and care recipients. Evidence for online multicomponent interventions with carers that incorporates the iSupport programme remains unknown.
OBJECTIVE: This study aimed to partner with health and social care organisations to evaluate the effects of a facilitator-enabled online multicomponent Chinese iSupport programme, which included psychoeducation using the iSupport programme, facilitator-enabled carer support groups and access to care services.
METHODS: A multicentre randomised controlled trial.
METHODS: Participants were family carers in Australia and greater China. We recruited participants to the study from 1st November 2021 to 30th June 2022.
METHODS: The intervention group received the Chinese iSupport programme delivered online. The intervention lasted for 6 months. Our primary outcome was carers\' quality of life. Our secondary outcomes were carers\' self-efficacy, social support, distress reactions to changed behaviours, care recipients\' frequency of changed behaviours, quality of life, unplanned hospital admissions, emergency department presentations and permanent admissions to nursing homes. The outcomes were measured at baseline (T0), 6 months (T1) and 9 months (T2). We applied a multivariate mixed effect linear regression model to capture the group effect, time effect and their interaction.
RESULTS: In total, 266 eligible family carers agreed to participate and were randomly assigned to an intervention group (n = 131) or a usual care group (n = 135). Most carers were women with a mean age of 53 years. The intervention group showed a statistically significant higher score of mental-health-related quality of life (mean difference = 4.1, 95 % CI: 1.5, 6.8, p = 0.002), self-efficacy in controlling upsetting thoughts (mean difference = 7.1, 95 % CI: 2.2, 12.0, p = 0.005) and lower score of distress reactions to changed behaviours (mean difference = -0.1, 95 % CI: -0.3, -0.03, p = 0.012) than the usual care group at T1.
CONCLUSIONS: The facilitator-enabled online multicomponent Chinese iSupport programme demonstrated positive effects for carers on mental health-related quality of life, controlling upsetting thoughts and distress reactions to changed behaviours of people with dementia.
BACKGROUND: This study is registered in the Australia New Zealand Clinical Trials Registry on 12th March 2021 (ACTRN12621000276853).
CONCLUSIONS: The facilitator-enabled online multicomponent Chinese iSupport programme improved family carers\' mental health-related quality of life, control of upsetting thoughts and distress reactions to changed behaviours of people with dementia.

The social service approach for the elderly that emerged in the USSR in the late 1980s and was introduced within the framework of a federal law in 1995 was oriented towards care and service provision. However, various authors have noted that the needs of the elderly and the availability of services often do not coincide, and this gap is growing with the change of generations of the elderly. The modern approach, the founder of which was the Polish demographer E.Rosset, reflected in a number of international documents, prioritizes supporting employment and maintaining independence for the elderly for as long as possible. However, there is still little research clarifying the specific services needed by the elderly themselves. The aim of this article is to demonstrate that the needs and capabilities of the «older generation» are changing noticeably, and the existing approach to the provision of social services, which largely took shape in the 1990s, is outdated. Our research question is: do the digital ecosystems (services) being developed by the Information and Analytical Center of St. Petersburg Government correspond to the needs of the elderly on the one hand, and the provisions enshrined in the Madrid Plan on the other? The study employed qualitative methods: an analysis of a pilot survey of users of the «Active Longevity» service and the opinions of participants in a focus group (age of informants 60-75 years) of elderly individuals conducted on 16.03.2024.
Подход социального обслуживания пожилых, который складывался в СССР с конца 1980-х гг. и в 1995 г. был введен в рамки федерального закона, ориентирован на заботу о пожилых и предоставление им услуг. Однако разные авторы отмечали, что потребности пожилых и возможности получения услуг во многом не совпадают, и этот разрыв увеличивается со сменой поколений пожилых. В современном подходе, родоначальником которого был польский демограф Э.Россет, отраженном в ряде международных документов, приоритетное место отдается поддержке занятости пожилых и сохранению ими независимости как можно дольше. Но до сих пор мало исследований, где уточняется, в каких услугах нуждаются пожилые с их собственной точки зрения. Цель статьи — показать, что потребности и возможности старшего поколения заметно меняются, а существующий подход к предоставлению социальных услуг, сложившийся в основных чертах в 1990-е гг., устарел. Наш исследовательский вопрос: соответствуют ли проектируемые цифровые экосистемы (сервисы, услуги), которые разрабатываются Информационно-аналитическим центром правительства Петербурга, потребностям пожилых, с одной стороны, и положениям, закрепленным в Мадридском плане, с другой. Для исследования использованы качественные методы — анализ пилотного замера мнений пользователей сервиса «Активное долголетие» и мнений участников фокус-группы пожилых (возраст информантов 60–75 лет), проведенный 16.03.2024.

The article examines the service sector for the elderly as a segment of the silver economy market. The author\'s classification of services provided to the elderly is given according to an expanded set of criteria. During the expert survey, medical and social services that are of primary demand among the elderly were identified. Legal services and transportation services came in second place. The underestimation of the factor of psychological support for both the aging process itself and possible concomitant processes was noted.
В статье исследован сектор услуг для пожилых как сегмент рынка серебряной экономики. Дана авторская классификация услуг, оказываемых пожилым людям, по целому ряду критериев. В ходе экспертного опроса установлены приоритеты и очередность востребованности тех или иных услуг пожилыми. Первую позицию в этом перечне заняли медицинские и социальные услуги. На втором месте оказались услуги правового характера и транспортные. Отмечена недооцененность фактора психологического сопровождения как самого́ процесса старения, так и возможных сопутствующих этому ситуаций.

BACKGROUND: Healthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery.
METHODS: The functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting.
RESULTS: Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care.
CONCLUSIONS: A transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.

OBJECTIVE: To identify evidence reporting on nurse practitioners working in aged care in Australia and to categorise the reported factors found to be barriers or facilitators to operation in terms of establishment, sustainability, and expansion.
BACKGROUND: Nurse practitioners work in a variety of aged care contexts throughout Australia but are underutilised and uncommon. Despite evidence for their effectiveness, it is unclear what barriers or enabling factors contribute to the successful and sustainable implementation of nurse practitioners working in this sector.
METHODS: Based on an a-priori protocol the JBI methodology for scoping reviews was used and the review reported against the PRISMA extension for scoping reviews (PRISMA-ScR). Databases searched included MEDLINE, Embase, Emcare, Web of Science, and Scopus. Peer reviewed and grey literature describing the role of Australian nurse practitioners in aged care were included.
RESULTS: Of 2968 retrieved sources, 18 were included representing studies of a variety of designs from all Australian states and territories. Residential care and in-home care contexts as well as metropolitan, regional, and remote locations were represented. Overall, 123 individual barriers and facilitators were identified across seven inductively derived categories: staff/individual, organisational, system, operational, resource, data, and consumers/clients/residents. In many cases, factors appeared across both positive (facilitators) and negative (barriers) categories.
CONCLUSIONS: Nurse practitioners can improve the quality of care being provided to older people accessing aged care in Australia. When establishing or maintaining nurse practitioner roles in aged care knowledge users should have a comprehensive understanding of the range of factors potentially contributing to or limiting success or sustainability. As implementation is highly contextual, various types of organisational and sectoral factors as well as individual and overarching factors related to the regulation of nurse practitioners practice should be considered.

Geriatrics can enable and monitor a holistic care of older people through a comprehensive geriatric assessment in a structured way. Therefore, it must be integrated much more closely with preventive, rehabilitative and acute care units. Geriatrics are not seen in any aspects as a replacement for general practitioners or in-hospital structures but much more as a supplement to them. With its function-oriented concept, geriatrics can best coordinate the demographically necessary triage between prevention, acute treatment, rehabilitation and palliative care, thus avoiding undertreatment and overtreatment. This can only succeed in collaboration with general practitioners and specialist colleagues. The article categorizes geriatric care structures, such as preventive home visits, acute complex medical treatment, delirium prevention, outpatient and inpatient rehabilitation services based on a case example and makes proposals for structural changes that urgently need to be considered in the current healthcare reform, such as outpatient geriatric centers (AGZ).
UNASSIGNED: Die Geriatrie kann über ein umfassendes geriatrisches Assessment eine ganzheitliche Versorgung älterer Menschen ermöglichen und strukturiert überwachen. Sie müsste damit deutlich mehr in den präventiven, rehabilitativen und akuten Versorgungseinheiten integriert werden. Die Geriatrie sieht sich in keinem Bereich als Ersatz für hausärztliche oder stationäre Strukturen, sondern vielmehr als Ergänzung zu diesen. Sie kann mit ihrem funktionsorientierten Konzept die demografisch notwendige Triage zwischen Prävention, Akuttherapie, Rehabilitation und Palliation koordinieren und damit Unter- und Überversorgung vermeiden. Dies kann nur gemeinsam mit den haus- und fachärztlichen Kolleg:innen gelingen. Der vorliegende Beitrag ordnet geriatrische Versorgungsstrukturen wie präventive Hausbesuche, akutmedizinische Komplexbehandlungen, Delirprävention sowie ambulante und stationäre Rehabilitationsangebote anhand eines Fallbeispiels ein und macht Vorschläge für strukturelle Veränderungen, die in der aktuellen Gesundheitsreform dringend mitgedacht werden sollten, wie etwa ambulante geriatrische Zentren (AGZ).

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