Workforce model interventions for the oral health of older adults in long-term care facilities: An umbrella review.

Interventions to reduce restrictive practices in residential aged care homes: a scoping review.

The antiviral drug prescription landscape has changed as new antivirals for influenza treatment have been approved. Understanding this landscape is important to assess potential under- and mis-utilization and to address gaps in care. This study characterizes patterns in influenza antiviral use in US healthcare settings using a large claims database. We included prescriptions of four antivirals: oseltamivir, baloxavir, peramivir, and zanamivir in US healthcare settings between September 2016 and August 2023, using Komodo Health Database. We estimated the percentage of antiviral prescriptions associated with respiratory disease diagnoses, including influenza, COVID-19, and other respiratory conditions, and the percentage prescribed to patients at high risk of influenza complications. We used multinomial logistic regression to assess the association between patient and prescriber characteristics and the choice of antiviral. Between 865,885 and 3,092,822 influenza antiviral prescriptions were filled annually during the 2016-2017 through 2022-2023 influenza seasons among US insured individuals. Oseltamivir was the most prevalent antiviral type. Baloxavir use remained low, accounting for 1.8%-9.2% of total prescriptions since its 2018 approval. Between 55.6% and 75.4% of prescriptions had an associated influenza diagnosis, with the lowest proportion observed during the 2020-2021 season. Between 2.59% and 5.35% of antivirals were prescribed to high-risk patients. Influenza diagnosis and patient age were associated with prescribing baloxavir rather than oseltamivir. Among US insured individuals, oseltamivir remained the most prescribed antiviral during the 2016-2017 through 2022-2023 seasons, a pattern consistent with its broader FDA-approved indication across age groups and care settings relative to baloxavir, peramivir, and zanamivir.

Co-creating an implementation model for digital health solutions for community aged care: an eHealth fall prevention program

The principle of dignity of risk (DoR) has become a cornerstone of contemporary aged care reform. DoR is ethically framed as an extension of autonomy and person-centred care. While widely considered in policy and professional discourse, DoR is often treated as a self-evident ethical good, with limited critical attention to how it is operationalised within regulated care systems. This paper offers a critical ethical analysis of DoR as enacted in contemporary aged care, arguing that it functions not merely as a moral principle but as a moral technology that redistributes responsibility, liability and ethical burden across residents, nurses, families, organisations and regulatory structures. Drawing on nursing ethics, relational autonomy and regulatory theory, the paper examines how documentation practices, audit cultures and family involvement reconstitute nurses as ethical risk brokers who must legitimise resident choice while remaining accountable for adverse outcomes. Rather than rejecting DoR, the paper reframes it as a form of collective ethical responsibility which requires organisational, regulatory and moral support for nurses beyond individualised accountability. This analysis highlights the need to move from symbolic invocations of autonomy toward ethically sustainable practices that recognise the relational and institutional labour underpinning DoR in everyday nursing practice.

Infections involving enteric bacteria commonly cause hospitalisation and death in long-term residential aged care (LTC) populations. The risk of such infections has been linked with antibiotic-associated depletion of gut anaerobic commensals and the resulting increase in asymptomatic carriage of gut pathobionts. We sought to determine how antibiotic characteristics, particularly activity against anaerobes, influence pathobiont prevalence in LTC residents. Stool samples from 164 LTC residents (median age: 87.9 years, interquartile range: 81.3-93.0 years) underwent metagenomic analysis. Associations between prior antibiotic exposures (categorised according to anaerobe coverage and type) and gut microbiome characteristics were explored using multivariable models. Of the 164 participants, 138 (84.1%) carried at least one enteric pathobiont. Compared to those with no prior antibiotic exposure, treatment with anaerobe covering (EAC) antibiotics was associated with higher rates of pathobiont carriage (β=1.36, P=0.010) and higher overall pathobiont relative abundance (β=3.53, P=0.013). In contrast, exposure to antibiotics with limited anaerobe coverage (LAC) showed no such associations. Investigation of commonly prescribed EAC and LAC antibiotics (amoxicillin-clavulanate and cefalexin, respectively) were consistent with these findings, with higher detection (β=1.60, P=0.007) and relative abundance (β=3.32, P=0.039) of pathobiont species in amoxicillin-clavulanate recipients. Pathobionts with greater representation included both species with inherent resistance (i.e. Enterococcus faecium) and sensitivity (i.e. Klebsiella pneumoniae) to amoxicillin-clavulanate. Antibiotics that deplete commensal anaerobes are associated with pathobiont prevalence in the gut, even where pathobiont species are sensitive to the administered antibiotic. Off-target disruption of commensal anaerobes should be considered when selecting antibiotic treatments, particularly for LTC individuals.

Global aging and health care workforce shortages are increasing demand for therapeutic support among older adult and pediatric populations. Care robots, an umbrella term for socially assistive robots, companion and pet platforms, and therapeutic humanoids sharing a social interaction component, have been proposed as embodied digital health adjuncts, but prior syntheses have remained population- or platform-specific, leaving cross-population and cross-platform effects unquantified. This review quantifies the pooled effects of care-robot interventions across 7 prespecified outcome domains, examines robot platform, target population, and intervention-duration moderators, and grades evidence certainty. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020, we searched 5 databases (PubMed, including MEDLINE, Embase, Cochrane CENTRAL, CINAHL, APA PsycINFO) and 2 trial registries (ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform) through April 29, 2026, with no language restriction. Eligible studies were randomized controlled trials of embodied care robots versus standard care, active controls, or waitlist. Random-effects meta-analysis used Hedges g with Hartung-Knapp-Sidik-Jonkman correction; for domains with k≥4, we report 95% CIs and prediction intervals (PIs). Risk of bias used the Cochrane Risk of Bias 2 tool; certainty used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A total of 34 randomized controlled studies (n=2476; 17 countries; 2015-2024) met inclusion criteria; 20 contributed to at least 1 meta-analysis, and 14 entered narrative synthesis. Under Hartung-Knapp-Sidik-Jonkman pooling, only neuropsychiatric symptoms reached significance: Hedges g=0.44 (95% CI 0.03-0.84; 95% PI -0.42 to 1.30; k=6; P=.04). The remaining 6 domains were favorable but nonsignificant: quality of life Hedges g=0.15 (95% CI -0.41 to 0.71; 95% PI -0.86 to 1.16; k=5); depression Hedges g=0.20 (95% CI -0.08 to 0.49; 95% PI -0.36 to 0.76; k=7); agitation Hedges g=0.32 (95% CI -0.07 to 0.71; 95% PI -0.26 to 0.89; k=4); stress and pain Hedges g=0.53 (95% CI -0.48 to 1.53; 95% PI -1.57 to 2.62; k=6); social-communicative skills Hedges g=0.45 (95% CI -0.52 to 1.42; 95% PI -1.66 to 2.56; k=5); and cognitive function Hedges g=0.18 (95% CI -0.62 to 0.98; 95% PI -1.11 to 1.47; k=4). All 7 PIs encompassed the null, indicating no assured effect in new settings. The neuropsychiatric symptom result was fragile: significance was lost in 5 of 6 leave-one-out iterations and on excluding Petersen 2016 (data extraction ambiguity), yielding a Hedges g of 0.40 (P=.10). GRADE certainty was low for neuropsychiatric symptoms and very low for the remaining 6 domains. Across cross-population, cross-platform randomized controlled trial pooling, the evidence does not yet support routine clinical adoption of care robots. Potential benefits are narrow, of low certainty, and contingent on adequately powered multicenter confirmatory trials with PI-informed sample sizes. Care robots are best framed as facilitator-supported adjuncts that augment, rather than substitute for, human-delivered care.

The COVID-19 pandemic disrupted healthcare service utilisation, but evidence on its impact on perinatal outcomes is conflicting. We investigated the impact of the pandemic public health measures (eg, lockdowns, reduced healthcare access, altered health-seeking behaviour) on preterm birth (PTB), stillbirth, low birth weight (LBW), small for gestational age, caesarean delivery, breastfeeding initiation (BFI) and neonatal intensive care unit (NICU) admissions. Using linked administrative health databases, we conducted a population-based study of pregnancies before (January 2008-February 2020) or during (March 2020-March 2022) the pandemic; for the latter period, they were categorised by exposure duration. We conducted interrupted time series analyses using season-adjusted generalised linear models, and analyses were stratified by income. Among 222 636 pregnancies (190 694 prepandemic and 31 942 during pandemic), PTB rates increased from 8% prepandemic to 9.1% during the pandemic, with a 19.0% relative increase overall (p<0.01). In stratified analyses, PTB rose by 27.1% in the lower-income group (8.8% to 10.1%, p=0.01) and by 19.7% in the higher income group (7.3% to 8.2%, p=0.02); however, effect modification by income was statistically non-significant. Pregnancies 100% exposed during the first and second year of the pandemic experienced higher rates of PTB by 15.0% (p=0.01) and 11.6% (p<0.01) compared with the prepandemic period, respectively. The pandemic measures were associated with no changes in stillbirth (0.7‰ vs 0.61%; p=0.37) or NICU admission rates (8.3% vs 8.2%; p=0.69). LBW rates increased from 5.5% to 6.3% (13.9% relative increase, p=0.05). Pregnancies spanning the entire first year of the pandemic experienced higher rates of caesarean deliveries (24.6% relative increase, p<0.01). BFI rates decreased from 82.5% to 81.8% (3.9% relative decrease, p=0.01) compared with prepandemic, followed by a slight increase (p=0.02) during the pandemic period. The COVID-19 pandemic measures were associated with increased PTB and caesarean delivery rates, particularly among pregnancies fully exposed to pandemic measures. Over the 2-year pandemic period, stillbirth, NICU admissions and BFI rates were stable.

Background: The COVID-19 pandemic changed the care of older patients in hospitals, whether it was for COVID-19 or another reason for admission. Patients with delirium posed additional challenges to clinicians, particularly because they were in isolation and the family was unable to be present due to the rapidly implemented and strictly enforced infection control measures. Objectives/Aims: To explore nurses' experiences of caring for patients with delirium in an Australian acute care setting, with a focus on how infection prevention and control measures implemented in response to the COVID-19 pandemic impacted clinicians. Design: Descriptive qualitative study. Nurses from two acute aged care wards in a Sydney metropolitan tertiary hospital were invited to participate in semi-structured interviews to explore their overall experience of nursing patients with delirium. Eleven interviews were recorded and transcribed verbatim. Data were analysed qualitatively using human factors principles as an analytical lens. Experiences related to COVID-19 were extracted from the data. Findings: Participants experienced difficulties delivering patient-centred care, as the presence of family was restricted due to the public health orders and infection prevention and control policies imposed in hospitals. Enforcing isolation and excluding the family resulted in care failing to meet nurses' expected standards, with additional challenges in care provision and communication. Conclusion: Nurses described an overwhelming sense of responsibility and moral injuries. The advice to place patients with delirium in isolation was inconsistent with the national delirium clinical care standard. A deeper understanding of the complexity and barriers to managing delirium during a pandemic, where rapid and, at times, conflicting information was available, is needed. These findings will contribute to informing the implementation of controls in the event of future responses, including workforce preparation and support.

ABSTRACT The global demographic shift towards an aging population has prompted increased interest in the psychosocial and spiritual resources older adults draw upon to navigate later life. This study explores the lived spiritual experiences of Filipino adults aged 50 and older, focusing on how they employ spiritual coping strategies in response to aging-related challenges and how these practices facilitate a shift toward gerotranscendence. By integrating Pargament’s theory of religious coping and Tornstam’s theory of gerotranscendence, the study employs a phenomenological approach to capture how spirituality functions as both a coping mechanism and a developmental transition toward peace, wisdom, and transcendence. Data were collected through semi-structured interviews with 20 Filipino adults aged 50 and older, exploring their experiences with spiritual coping, changing values, and the influence of Filipino cultural values such as pananampalataya (faith) and family-centeredness. Findings highlight that spirituality initially served as a means of coping with stress, providing emotional regulation and meaning-making in the face of health decline and family disruptions. Over time, spiritual practices evolved into a pathway for transcendence, marked by greater acceptance, surrender, and redefined identity. Filipino cultural values, such as the transition from active problem-solving to trust in divine will, framed this shift from coping to gerotranscendence. These findings offer valuable insights for practitioners, underscoring the importance of addressing both the coping and developmental aspects of spirituality in aging care.

Purpose This instrumental case study aims to understand the role of cluster-based coopetition (collaboration with competitors) practices as a performance-enhancing resource-leveraging strategy in a highly regulated sector targeting a vulnerable population. The research setting features a regional cluster within the aged residential care (ARC) sector in New Zealand, namely, where rival organisations’ decision-makers identify and exploit opportunities associated with a vulnerable population. This investigation addresses a problem, since earlier broader-based coopetition research has provided mixed findings in respect of the performance-enhancing nature of this form of resource-leveraging behaviour, as part of owner-managers’ entrepreneurial marketing activities. Design/methodology/approach This investigation is underpinned by an institutional theoretical lens, and findings primarily arise from interviews with decision-makers of 14 smaller-sized ARC facilities in a single regional cluster. In addition, use was made of secondary data like via websites including references to institutional audits. Data collection followed a snowball sampling approach and ended when a point of theoretical saturation was reached. Interviews were recorded and transcribed, then manually coded, plus attempts were used to ensure the trustworthiness of the data was robust. Findings The findings outline certain ‘rules of the game’ for owner-managers in an ARC organisational field where demand outstrips supply. Institutional conditions impact decision-makers’ resource-leveraging practices, namely, to enable them to provide highly regulated care for a vulnerable population given their limited assets. The findings highlight the role of co-existing logics affecting facets of decision-makers’ coopetition activities regarding the provision of ARC. These co-existing logics refer to a need to enhance owner-managers’ respective facility’s performance, alongside that of rivals via coopetition, namely, for mutually beneficial outcomes. Originality/value In contrast to some earlier cluster-based studies in less regulated sectors (and those where demand does not outstrip supply), this investigation offers fresh insights highlighting the importance of co-existing logics that guide under-resourced decision-makers’ performance-enhancing coopetition practices. In addition, new light is shone on potential dark-side implications arising from owner-managers’ resource-leveraging activities in an institutional context involving caring for vulnerable residents within an ageing population.

ABSTRACT Population aging demands precise spatial allocation of eldercare resources, yet systematic misalignments between provision logics and the fixed geography of need remain underexposed. Urban agglomerations concentrate both aging populations and care infrastructure, but their internal spatial (mis)matches across administrative boundaries remain largely unexplored. This study addresses this gap by diagnosing spatial (mis)matches and service pressure across 48 county-level units in China’s Wuhan “1 + 8” City Circle. The Supply–Demand Matching Index and Facility Service Pressure Index were constructed and integrated with Global Moran’s I, Anselin Local Moran’s I, and Getis-Ord Gi* for geostatistical assessment. The findings reveal a systemic decoupling that directly challenges SDG 3 (Good Health and Well-being), specifically universal healthcare access, as resources are spatially misaligned with aging populations. This mismatch exacerbates inequalities (SDG 10), creating territorial burdens in peripheral counties overlooked by conventional density-based planning metrics. By diagnosing these structural vulnerabilities within China’s strategy for Equalization of Basic Public Services, the study reframes spatial justice as a territorial imperative. It argues for integrative planning that re-embeds provision logics within the fixed geography of need to achieve spatial coordination and equilibrium – a critical step toward fostering sustainable and resilient cities (SDG 11).

This study investigates the relationships among perceived value, satisfaction, and behavioral intention in home care for older adult patients in the context of doctor-patient disputes and examines the moderating role of trust. This cross-sectional observational study used convenience sampling to recruit 306 older adult patients who had received home care services within the past year. Data were collected via a structured questionnaire comprising 26 items across 7 constructs (functional, emotional, efficiency, and social value; satisfaction; behavioral intention; and trust), each rated on a 5-point Likert scale. The questionnaire demonstrated good reliability and validity. Structural equation modeling was performed using AMOS 24.0 to test path relationships, with model fit evaluated by multiple indices (chi-square to degrees of freedom ratio = 1.289, root mean square error of approximation = 0.031, comparative fit index = 0.983, Tucker-Lewis index = 0.980). Mediation effects were examined using the bootstrap method (5000 resamples), and moderation effects of trust were tested using PROCESS macro (Model 1) in SPSS 26.0. The results showed that social value most strongly predicts satisfaction (β = 0.330, P < .001), followed by emotional (β = 0.236, P < .001) and functional value (β = 0.192, P < .01); efficiency value is nonsignificant (β = 0.080, P > .05). For behavioral intention, emotional value has the strongest direct effect (β = 0.208, P < .01), followed by functional (β = 0.172, P < .01) and efficiency value (β = 0.159, P < .05), social value is nonsignificant (β = 0.114, P > .05). Satisfaction significantly predicted behavioral intention (β = 0.285, P < .001), and partially mediated the relationship between perceived value and behavioral intention. The indirect effect between efficiency value and behavioral intention was not significant (0.027, P > .05), and the 95% CI was 0 (–0.011, 0.115), thus not playing a mediating role. Trust moderates perceived value’s effect on satisfaction, but not for efficiency value (β = –0.043, P > .05). Findings suggest a need for human-centered home care models emphasizing emotional support and social recognition, moving beyond technology-driven approaches. This research supports policymakers in evaluating older adult care services and building trust-based, satisfaction-centered, and value-driven doctor-patient interactions for healthy aging and high-quality elder care.

BackgroundCarers are individuals who provide unpaid care to family members and friends with disabilities, medical conditions, mental illness, or who are frail and aged. The contribution of carers to the Australian health, aged care, disability, and social care systems is significant. However, they face high levels of emotional, social, physical, and financial burdens. The Australian Government has recently introduced policy reforms to improve recognition of carers. However, there is limited evidence on research priorities to facilitate the translation of policies into practice.ObjectiveTo involve Australian stakeholders to a) identify evidence gaps and research needs; and b) set research priorities for carers within the context of ageing, palliative care and end of life.DesignStakeholder consultation study for research priority setting.MethodsAustralian stakeholders with expertise in areas related to carers, aged care, and palliative care were engaged through an online survey, a research roundtable and a focus group to discuss research priorities for carers. The survey qualitative responses, notes from the roundtable, and focus group transcript have been summarised and analysed thematically, using NVivo 14 qualitative software.ResultsTwo main considerations as found from the study are ‘what to research’ and ‘how to research’ to improve recognition and support of carers in Australia. Research priorities identified include recognition and early identification of carers, timely and equitable access to support services, helping carers navigate services, support during the transition of care, post caring, including grief and bereavement support, evaluation of existing services, and carer self-care and wellbeing. Participants commented on the importance of research that engages carers meaningfully, respectfully, and in a timely and flexible manner to ensure maximum impact.ConclusionThis study guides the design of carer-centred research to facilitate the translation of carer policies into practice. It also assists in evaluating the effectiveness, cost-effectiveness and sustainability of existing and new support services.

BackgroundMedication management interventions are designed to reduce medication-related harms in older people with dementia; however, their effect on healthcare utilisation remains unclear.ObjectiveTo summarise the impact of medication management interventions on healthcare utilisation in people with dementia.Data sourcesEmbase, MEDLINE, Web of Science, Cochrane CENTRAL Register of Controlled Trials, CINAHL, PsycINFO.Study selectionInterventional studies assessing the impact of medication management interventions on healthcare utilisation in people with dementia aged ≥65.Data extraction and synthesisEligible randomised controlled trials (RCTs) were meta-analysed with risk ratios (RR), 95% confidence intervals (CIs) using a fixed-effect model. Outcomes from non-randomised studies were summarised through narrative synthesis.Main outcomesHealthcare utilisation, including hospitalisation, emergency department visits, primary care and residential aged care home admissions.ResultsSeven RCTs and five non-randomised studies were eligible for inclusion. Common interventions were physician education (n = 5), physician and patient/carer education (n = 2), physician targeted prescribing reminders (n = 1) and multidisciplinary team-based interventions (n = 5). Among these, physician and patient/carer targeted education resulted in a reduction in all-cause hospitalisation (RR =0.92, 95% CI [0.84–0.99], P = .04) and emergency department visits (RR = 0.92, 95% CI [0.86–0.98], P = .007) while multidisciplinary team-based interventions were effective in reducing drug-related hospital readmission (Hazard Ratio = 0.49, 95% CI [0.27–0.90], P = .02).ConclusionThis review found that physician and patient/carer targeted education showed the most promising effect on all-cause hospitalisation and emergency department visits. Future research should develop tailored educational interventions that address key aspects of medication management to optimise healthcare utilisation in people with dementia.

A cluster randomized controlled trial (GOAL trial) evaluated a comprehensive geriatric assessment for frail older people with chronic kidney disease.

Prior research has highlighted the critical need for targeted training to ensure the aged care workforce are equipped to respond effectively to the diverse and complex needs of Aboriginal and Torres Strait Islander peoples receiving aged care. Therefore, this study aimed to co-design, implement and evaluate a training program to strengthen the capacity of aged care workers to deliver culturally safe and responsive care to Aboriginal and Torres Strait Islander peoples. The training program was developed through a mixed-method approach, undertaken using a community-based research framework where researchers worked in partnership with an Aboriginal community-controlled aged care organisation. This process included a literature review and survey to inform program content, followed by development workshops, an implementation pilot, and evaluation interviews with the aged care workforce across metropolitan, regional, and remote South Australia in 2024. A training program, titled Walking Together in Aged Care, was co-designed and centres the health, wellbeing and cultural needs of Aboriginal and Torres Strait Islander people receiving aged care and is relevant to workforce needs. Evaluation interviews revealed high course acceptability, key learnings, and considerations for scalability and applicability across diverse aged care settings. Walking Together in Aged Care contributes significantly to the broader aim of addressing a lack of appropriate training programs for the aged care workforce delivering care to Aboriginal and Torres Strait Islander peoples.

Purpose This study aims to establish a baseline of indoor environmental quality (IEQ) and perceived indoor environmental conditions in an older ward-style residential aged care facility prior to demolition, providing a benchmark for evaluating a purpose-built replacement in a companion study. In this study, “baseline” refers to minute-resolution distributions of real-world environmental exposure (typical ranges, exceedance proportions and peak frequencies) measured within the existing facility, rather than a single target value. Design/methodology/approach A 14-day monitoring campaign (September–October 2024) was conducted in Perth, Western Australia, across a bedroom, lounge, activity room and corridor. Continuous measures of noise (dB(A)), illuminance (lux) and temperature (°C) were recorded using calibrated loggers (IC-NSRT calibrated acoustic dataloggers; HOBO MX2202 combined light and temperature dataloggers). Results were evaluated against WHO night-noise guidance (recommended night-time limits for sleep protection), AS/NZS 2107:2016, pragmatic circadian-light targets (=1000 lux daytime; =10 lux night) and literature indicating diurnal thermal variation = 2°C. Parallel surveys co-developed with facility stakeholder perceptions (including staff and resident/proxy respondents) of noise, lighting and thermal comfort (staff: 23; residents/proxies: 24). Findings Night-time bedroom sound levels exceeded WHO guidance for most monitored minutes, with intermittent peaks above 55 dB(A). Communal lounges exceeded the 45 dB(A) daytime guideline during most monitored periods. Daytime bedroom illuminance rarely achieved =30 min at =1,000 lux, while night-time exceedances above 10 lux occurred because of corridor spill. Temperatures were generally stable with limited day–night variation (<2°C) in most spaces. Survey responses aligned with measured noise patterns but tended to normalise lighting conditions that fell short of circadian-supportive targets; thermal comfort was rated positively. Practical implications The findings identify actionable priorities for redevelopment and interim operations, including acoustic buffering of bedrooms and corridors, daylight/circadian-supportive lighting provision, night-time spill control and more dynamic thermal zoning or scheduling. Originality/value This study provides a rare pre-replacement baseline integrating continuous IEQ monitoring with stakeholder perceptions in residential aged care, enabling defensible same-site benchmarking against a purpose-built facility.

BackgroundOlder people living in residential aged care homes are at high risk of malnutrition. This study evaluated the implementation and service system outcomes of a multi-component and multi-disciplinary mealtime model that sought to transform the meals and dining experiences in a single aged care home.MethodsMixed methods were used to examine the acceptability and adoption of the model through semi-structured interviews, alongside audits and direct observations of mealtimes. Measures were taken at three time points: baseline (T0), early implementation (T1), and early maintenance (T2), spanning a 10 month period. Normalisation Process Theory was used to examine mechanisms supporting early embedding of the model.ResultsStaff and residents endorsed the acceptability and adoption of the mealtime model, with perceived improvements in aspects of meal quality, meal access, and mealtime experiences. Audit and mealtime observation data demonstrated service-system change with a transition towards more person-centred mealtime care practices and a calmer, more home-like dining environment. Factors mediating implementation and service-system outcomes included a shared vision, project timelines, external accountability, communication, training, role modelling, and leadership. There was evidence that normalisation processes had been activated to help embed the model into routine mealtime care.ConclusionsThe study provides evidence for the acceptability and adoption of the multi-component mealtime model from the perspectives of staff and residents. The findings demonstrate that aspects of meal quality, meal access, and mealtime experiences can be transformed simultaneously, enabled by a systematic and multi-disciplinary approach. Future research is needed to examine the sustainability and cost-effectiveness of the model.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-026-07690-6.

Prostate-specific antigen (PSA)-based prostate cancer (PCa) screening risks overdiagnosis and overtreatment. PCa disproportionately affects Black men, those with a family history (FH) of the disease, and BRCA1/2 gene variant carriers. Risk-adapted approaches are gaining interest but are underexplored. To assess the feasibility of PSA-based Targeted Prostate Health Checks (TPHCs) for men at high PCa risk, compare invitation methods, and assess sociodemographic variations. Prospective feasibility cohort study in four primary care networks (PCNs) in North East London. Men aged 45-69 years from Black ethnic group, or with a positive PCa FH, were identified via primary care records and invited by the PCN to one of two TPHCs: (i) telephone-first (phone consultation followed by hospital-based PSA testing); or (ii) test-first (community-based PSA testing followed by phone consultation). Elevated PSA prompted multiparametric magnetic resonance imaging (mpMRI), and prostate biopsy if malignancy was suspected. Of 2400 invitees, 398 (16.6%) attended. Attendance was higher with the test-first than telephone-first TPHC (22.9% versus 11.2%, P<0.001). Only 51.4% of participants met eligibility criteria owing to inaccurate FH coding, although men who did not meet the eligibility criteria were offered PSA tests. Black men had lower prior PSA testing (55.7% versus 82.5%) and higher deprivation than White men. Elevated PSA occurred in 6.0% of participants (n = 22), with five PCa diagnoses (1.4%). Identification of men at high PCa risk is feasible using age and ethnicity primary care data, but FH coding is unreliable. Test-first invitations improved engagement. Disparities affecting Black men highlight the need for tailored outreach, and better coding of risk factors will facilitate risk-adapted screening.