Palliative Care in the Ageing European Population: A Cross-Country Comparison.

With Europe's ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a cohort of SHARE participants aged 65 years or older who had passed away between Wave 6 (2015) and Wave 7 (2017). Information on death circumstances, palliative care utilization, and associated variables were analysed. The study revealed that nearly 13.0% of individuals across these countries died under palliative care, with Slovenia having the lowest rate (0.3%) and France the highest (30.4%). Palliative care utilization in the last 30 days before death was observed in over 24.0% of participants, with the Czech Republic having the lowest rate (5.0%) and Greece the highest (48.8%). A higher risk of using or dying in palliative care was significantly associated with cognitive impairment (low verbal fluency), physical inactivity, and good to excellent self-perceived health. This work highlights the urgent need for enhanced global access to palliative care and advocates for the cross-country comparison of effective practices within Europe, tailored to the unique healthcare needs of older adults.

Complexity of patient care needs in palliative care: a scoping review.

BACKGROUND: Recognizing the need for palliative care (PC) and referral to PC teams improves patients' quality of life. However, in patients with moderate/severe clinical complexity, early recognition of the need for PC may not correspond to referral to specialized PC services. The definition for clinical complexity is still underexplored, as well as the instruments available to assess complexity. This scoping review aims to gather relevant information on the definition of clinical complexity in PC, as well as on the instruments used to objectively assess complexity. METHODS: According to the methodology of a Scoping Review, the keywords: "palliative care", "hospitalization criteria", "complexity criteria", "complexity assessment" and "clinical complexity", were searched in PubMed, Scopus, Cochrane, and b-on databases, during April 2022, for relevant information on the definition and/or approach and/or protocols related to clinical complexity in patients followed in PC, or on the instruments used to assess it, regardless of study design, the language, or year of publication. RESULTS: From the 626 references found, 15 studies were included in the review. According to these studies, complexity may be organized/defined into 3, 4, or 6 domains, generally including the patient, the family, the health system, and the socio-cultural context. Of the 13 instruments mentioned for the objective assessment of complexity, the HexCom, IDC-Pal, and the recent ID-PALL seem to offer the broadest determinations of complexity. CONCLUSIONS: Complexity is a dynamic process, which reflects the reality of patients and families, and patients, families, and health professionals' perceptions, and so it must be systematically adjusted to the stage of the disease. The definition of complexity and the development and use of suitable instruments can help to identify, assess, and improve patients' quality of life, while supporting their family across the grieving process. Yet, this may not always be summarized in a quantitative value by easy-to-use instruments, highlighting the role of PC interdisciplinary teams.

The effect of a physical activity consultation in the management of adolescent excess weight: Results from a non-randomized controlled trial.

The value of physical activity (PA) counselling and its impact on PA behaviour and weight management have been in question. The main aim of this study was to analyse 6 and 12-month effects of a PA consultation (PAC-a structured form of PA counselling) with and without the inclusion of structured exercise, on body mass index (BMI) z-score, body composition and PA levels of adolescents with excess weight (BMI ≥p85), as part of a clinical multicomponent weight management program. Participants were allocated at baseline into a control (CG-standard care, including paediatric and nutrition consultations) and two experimental groups (EGI and EGII). Both EG's were exposed to standard care plus PAC for 12 months. During the first 6 months, EGII additionally participated in two weekly exercise sessions. From 165 participants recruited, 102 completed the intervention (CG n = 28, EGI n = 36 and EGII n = 38). According to generalized estimating equations, at 6 months both EG's improved (p < 0.05) their BMI z-score, waist-height ratio (WHtR), body fat mass, skeletal muscle mass, sedentary time and moderate-vigorous PA (MVPA) compared to CG. Further improvements were observed in BMI z-score between 6 and 12 months in EG's compared to CG. At 6 months, EGII showed a higher (p < 0.05) increase in MVPA compared to EGI, and EGI a higher decrease in WHtR. No other differences were found between EG's. This study suggests that PAC is a time-effective approach to improve BMI z-score, body composition and PA levels in adolescents with excess weight, even without the inclusion of structured exercise.

Effect of a Physical Activity Consultation in the Management of Adolescent Overweight (the PAC-MAnO project): study rationale, design and methods.

BACKGROUND: Adolescent overweight is a major public health concern, as it is associated with several short-run and long-run adverse health outcomes. Inappropriate health behaviours may be at the front of this epidemic. There is widespread need for new strategies that may positively influence dietary and physical activity behaviours. This trial (NCT02941770) was designed to investigate the impact of a physical activity consultation, based on motivational interview technique, on physical activity behaviour and weight status among overweight adolescents followed at a tertiary paediatric care centre. METHODS/DESIGN: This is an ongoing non-randomised controlled clinical trial with a 6-month duration and follow-up at month 12. It is expected to be concluded in December 2018. Adolescents (n=129) aged 12-18 with a body mass index ≥p85 are recruited and allocated into three groups: (1) control group: standard care (paediatric and nutrition consultations, n=43); (2) experimental group I: standard care plus physical activity consultation (n=43); and (3) experimental group II: exposure to two sessions/week of structured physical exercise, in addition to the standard care plus physical activity consultations (n=43). Sample size was calculated according to power analysis. Participants undergo a set of socioeconomic, anthropometric, body composition, clinical and behavioural (dietary and physical activity) assessments. DISCUSSION: Adolescence is a critical period for the acquisition of a healthy lifestyle. The promotion of an active lifestyle may influence adolescents' weight status and further prevent multiple comorbidities. The findings of our study will provide further understanding on the impact of a physical activity consultation on physical activity behaviour and weight reduction/maintenance among overweight adolescents. TRIAL REGISTRATION NUMBER: NCT02941770.